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Heather Hedrick Fink, MS, RD, CSSD Owner Nutrition and Wellness Solutions, LLC Indianapolis, Indiana

Alan E. Mikesky, PhD, FACSM Professor Emeritus School of Physical Education and Tourism Management Indiana University-Purdue University Indianapolis Indianapolis, Indiana

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Library of Congress Cataloging-in-Publication Data Names: Fink, Heather Hedrick, author. | Mikesky, Alan E., author. Title: Practical applications in sports nutrition / Heather Hedrick Fink, Alan E. Mikesky. Description: Fifth edition. | Burlington, Massachusetts : Jones & Bartlett Learning, [2018] | Includes bibliographical references and index. Identifiers: LCCN 2016048145 | ISBN 9781284101393 (pbk.) Subjects: | MESH: Sports Nutritional Physiological Phenomena | Sports–physiology | Exercise–physiology | Sports Nutritional Sciences Classification: LCC TX361.A8 | NLM QT 263 | DDC 613.2024796–dc23 LC record available at https://lccn.loc.gov/2016048145

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BRIEF CONTENTS SECTION 1 The Basics of Sports Nutrition . . . . . . . . . . . . . . . . . . . . . . . . . 1 CHAPTER 1 Introduction to Sports Nutrition . . . . . . . . . . . . . . . . . . . . . . . 3 CHAPTER 2 Nutrients: Ingestion to Energy Metabolism . . . . . . . . . . . .23 CHAPTER 3 Carbohydrates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .59 CHAPTER 4 Fats . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .91 CHAPTER 5 Proteins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116 CHAPTER 6 Vitamins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141 CHAPTER 7 Minerals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 178 CHAPTER 8 Water . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 210 CHAPTER 9 Nutritional Ergogenics . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239

SECTION 2 The Practical Application of Sports Nutrition . . . . . . . . 261 CHAPTER 10 Nutrition Consultation with Athletes . . . . . . . . . . . . . . . 263 CHAPTER 11 Weight Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 291 CHAPTER 12 Endurance and Ultra-Endurance Athletes . . . . . . . . . . . 330 CHAPTER 13 Strength/Power Athletes . . . . . . . . . . . . . . . . . . . . . . . . . . . 364 CHAPTER 14 Team Sport Athletes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 392 CHAPTER 15 Special Populations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 420 CHAPTER 16 Jobs in Sports Nutrition . . . . . . . . . . . . . . . . . . . . . . . . . . . 455 APPENDIX A You Are the Nutrition Coach – Answers . . . . . . . . . . . . . . 465 APPENDIX B The Gastrointestinal Tract . . . . . . . . . . . . . . . . . . . . . . . . . 471 APPENDIX C Major Metabolic Pathways . . . . . . . . . . . . . . . . . . . . . . . . . 474 APPENDIX D Calculations and Conversations . . . . . . . . . . . . . . . . . . . . 480 APPENDIX E Growth and Body Mass Index Charts . . . . . . . . . . . . . . . . 483 APPENDIX F Dietary Reference Intakes . . . . . . . . . . . . . . . . . . . . . . . . . 488

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CONTENTS

Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xvi How to Use This Book . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xviii About the Authors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xxiii Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xxiv

SECTION 1 The Basics of Sports Nutrition . . . . . . . . . . . . . . . . . . . . . . . . . 1 CHAPTER 1 Introduction to Sports Nutrition . . . . . . . . . . . . . . . . . . . . . . . 3

What is sports nutrition? 4 Why study sports nutrition? 4 What are the basic nutrients? 4

What are carbohydrates? 5 What are proteins? 5 What are fats? 5 What are vitamins? 5 What are minerals? 5 What is water? 6

How does the body produce energy? 6 What are the dietary reference intakes? 6 What are enriched and fortified foods? 7 What are the basic nutrition guidelines? 7

What are the Dietary Guidelines for Americans? 7 What is the MyPlate food guidance system? 9

How should athletes interpret the information on food labels? 11 Who created the food label regulations? 11 How can the ingredient list be useful to athletes? 11 How can the nutrition facts panel be useful to athletes? 12 How can the percent daily value be useful to athletes? 14 How can nutrient content claims be useful to athletes? 15 How can health claims be useful to athletes? 16

What are the factors to consider when developing an individualized sports nutrition plan for athletes? 17

Why should a sports nutrition plan consider an athlete’s health history? 18 Why should a sports nutrition plan consider a sport’s bioenergetics and logistics? 19 Why should a sports nutrition plan consider an athlete’s total

weekly training and competition time? 19 Why should a sports nutrition plan consider an athlete’s living

arrangements, access to food, and travel schedule? 19 How can sports nutrition knowledge be converted into practical applications? 20 Key Points of Chapter 21 Study Questions 21 References 22

CHAPTER 2 Nutrients: Ingestion to Energy Metabolism . . . . . . . . . . . .23 What happens to nutrients after they are ingested? 24

What are the functions of the various parts of the digestive system? 24

Contents v

How are carbohydrates digested, absorbed, transported, and assimilated in the body? 27

What happens to carbohydrates once they are put into the mouth? 27 How are the simple sugars absorbed into the intestinal wall? 29 What happens to carbohydrates once they make it into the blood? 31 What happens to carbohydrates once they make it to the cells of the body? 31

How are fats digested, absorbed, transported, and assimilated in the body? 31 What happens to fats once they are put into the mouth? 34 What happens to the fats once they are absorbed? 34 What happens to fats once they make it to the cells? 35

How are proteins digested, absorbed, transported, and assimilated in the body? 35 What happens to proteins once they are put into the mouth? 35 How are proteins absorbed into the intestinal wall? 37 What happens to amino acids once they make it to the bloodstream? 38 What happens to amino acids once they make it to the cells of the body? 39

How are minerals, vitamins, and water absorbed and transported in the body? 40 What is energy metabolism, and why is it important? 41 What is energy? 41 What is the human body’s source of chemical energy? 42 How do cells make ATP? 44 What are the three energy systems? 44

What are the characteristics of the phosphagen system? 46 What are the characteristics of the anaerobic and aerobic energy systems? 47

How do the energy systems work together to supply ATP during sport performance? 47

What metabolic pathways are involved with the energy systems? 49 Key Points of Chapter 56 Study Questions 57 References 58

CHAPTER 3 Carbohydrates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .59 What’s the big deal about carbohydrates? 60 What are carbohydrates? 60 How are carbohydrates classified? 61

What are simple sugars? 61 What are complex carbohydrates? 63 Are artificial sweeteners carbohydrates? Are they beneficial or harmful? 65

What functions do carbohydrates serve in the body? 66 How can carbohydrates affect overall health? 67

What role does fiber play in health? 67 What role do simple sugars have in health? 68

How much carbohydrate should be consumed daily? 68 What is the relationship between current body weight and carbohydrate intake? 69 How can carbohydrate needs be determined based

on a percentage of total calories? 69 What impact does the stage of training or competition

schedule have on carbohydrate intake? 70 What are the various sources of dietary carbohydrates? 70

What are the best carbohydrate choices within the grains group? 71 What are the best carbohydrate choices within the fruit and

vegetable groups? 71 What are the best carbohydrate choices within the dairy/alternative group? 71 What are the best carbohydrate choices within the protein foods group? 72

Can foods containing simple sugars or artificial sweeteners be used as a source of carbohydrates? 72

What are the glycemic index and glycemic load, and how can they be used in sports nutrition? 72

What is glycemic load? 73 How does the glycemic index relate to exercise? 74

How are carbohydrates utilized during exercise? 74 How much carbohydrate is stored within the body? 75 Why are carbohydrates an efficient fuel source? 76 Does carbohydrate intake enhance performance? 76 Does carbohydrate intake delay fatigue? 76

What type, how much, and when should carbohydrates be consumed before exercise? 77

What should an athlete eat on the days leading up to an important training session or competition? 78

What should an athlete eat in the hours leading up to an important training session or competition? 78

What type, how much, and when should carbohydrates be consumed during exercise? 81

What types of carbohydrates should be consumed during exercise or sport? 81 How much carbohydrate should be consumed during exercise or sport? 81 When should carbohydrates be consumed during exercise or sport? 83

What type, how much, and when should carbohydrates be consumed after exercise? 83

When should carbohydrates be consumed after exercise or sport? 83 What type of carbohydrates should be consumed after exercise or sport? 84 How much carbohydrate should be consumed after exercise or sport? 85 What are some examples of good meals/snacks for after exercising? 85

Key Points of Chapter 86 Study Questions 87 References 87 Additional Resources 90

CHAPTER 4 Fats . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .91 What’s the big deal about fats? 92 What are fats? 92 How are lipids (fats) classified? 92

What are triglycerides? 92 What is the molecular structure of a triglyceride? 92 What are some of the functions of triglycerides in the body? 93 What are fatty acids? 94 What are phospholipids? 98 What are sterols? 99 Is there such a thing as artificial fats? 100

How much fat is recommended in an athlete’s diet? 101 Can a diet be too low in fat? 102 Can a diet be too high in fat? 102

Which foods contain fat? 103 How much fat is in the grains group? 103 How much fat is in the fruit and vegetable groups? 103 How much fat is in the dairy/alternative group? 103 How much fat is in the protein foods group? 104 How much fat is in the oils? 104

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How can the percentage of calories from fat be calculated for specific foods? 104 What’s the big deal about cholesterol? 106

What is dietary cholesterol, and which foods contain it? 106 How is blood cholesterol classified? 106

How can fats affect daily training and competitive performance? 108 What type, how much, and when should fats be consumed before exercise? 110

Is a single high-fat meal prior to exercise beneficial? 110 Is a short-term pattern of eating high-fat meals beneficial

to exercise performance? 110 Is a long-term pattern of eating high-fat meals beneficial

to exercise performance? 110 What are the recommendations for fat intake prior to exercise? 111

What type, how much, and when should fats be consumed during exercise? 111 What type, how much, and when should fats be consumed after exercise? 112 Key Points of Chapter 113 Study Questions 113 References 114 Additional Resources 115

CHAPTER 5 Proteins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116 Why is protein important to athletes? 117 What are proteins? 117

What is the difference between a “complete” and an “incomplete” protein? 119 What are the main functions of proteins in the body? 121 What is nitrogen balance? 123 How much protein should athletes consume daily? 123

How can protein requirements be calculated based on body weight? 123 How do various dietary and training factors affect protein recommendations? 124 Can too much protein be harmful? 126

Which foods contain protein? 127 Which foods in the grains group contain protein? 127 Which foods in the fruit and vegetable groups contain protein? 127 Which foods in the dairy/alternative group contain protein? 128 Which foods make up the protein foods group? 128 Do foods in the oils and empty calories group contain protein? 128

Are protein supplements beneficial? 129 What is the quantity of protein or amino acids in the

product? Is the supplement necessary? 129 What is the cost of protein supplements? 131 Will protein supplements enhance performance? 131 Are there any risks associated with taking the supplement? 132

Why is protein essential for daily training? 132 What type, how much, and when should protein be consumed before exercise? 133

What type and how much protein should be consumed 4 to 24 hours prior to training or competition? 134

What type and how much protein should be consumed 1 to 4 hours prior to training or competition? 134

What type, how much, and when should protein be consumed during exercise? 134 What type, how much, and when should protein be consumed after exercise? 135

Which type of protein or amino acid source is most beneficial to consume after exercise? 135

Is there a recovery benefit of combining carbohydrates and proteins after exercise? 136

Contents vii

How much protein should be consumed after exercise? 136 When should protein or amino acids be consumed after exercise? 137

Key Points of Chapter 138 Study Questions 138 References 139 Additional Resources 140

CHAPTER 6 Vitamins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141 What’s the big deal about vitamins? 142 What are vitamins? 142 How are the dietary needs for vitamins represented? 142 What are the water-soluble vitamins? 142

Why is thiamin important to athletes? 144 Why is riboflavin important for athletes? 144 Why is niacin important for athletes? 145 Why is vitamin B6 important for athletes? 147 Why is vitamin B12 important for athletes? 149 Why is folate important for athletes? 151 Why is biotin important for athletes? 152 Why is pantothenic acid important for athletes? 154 Why is choline important for athletes? 154 Why is vitamin C important for athletes? 156

What are the fat-soluble vitamins? 157 Why is vitamin A important for athletes? 158 Why are the carotenoids important for athletes? 160 Why is vitamin D important for athletes? 161 Why is vitamin E important for athletes? 164 Why is vitamin K important for athletes? 166

Which vitamins or compounds have antioxidant properties? 166 What are free radicals? 166 What is the relationship between free radicals and exercise? 168 Do athletes need antioxidant supplements? 168

What are phytochemicals? 170 What are phenolic compounds? 170 What are organosulfides? 171 What is lycopene? 171 How can athletes increase phytochemical consumption through whole foods? 172

Key Points of Chapter 174 Study Questions 175 References 175 Additional Resource 177

CHAPTER 7 Minerals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 178 What’s the big deal about minerals? 179 What are minerals? 179 What are the major minerals? 179

Why is calcium important for athletes? 181 Why is phosphorus important to athletes? 183 Why is magnesium important for athletes? 184 Why is sodium important for athletes? 187 Why is chloride important for athletes? 188 Why is potassium important for athletes? 188 Why is sulfur important for athletes? 190

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What are the trace minerals? 191 Why is iron important for athletes? 191 Why is zinc important for athletes? 195 Why is chromium important for athletes? 196 Why is fluoride important for athletes? 197 Why is copper important for athletes? 199 Why is manganese important for athletes? 200 Why is iodine important for athletes? 201 Why is molybdenum important for athletes? 201 Why is selenium important for athletes? 202 Are other trace minerals important for athletes? 203

Key Points of Chapter 206 Study Questions 206 References 207 Additional Resources 209

CHAPTER 8 Water . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 210 What’s the big deal about water? 211

What are the functions of water in the body? 211 What are the sources of water? 212 What are the ways in which we lose body water? 213

What are the consequences of poor water balance? 214 Is it possible to overhydrate the body? 216 How can hydration status be monitored? 216

How much fluid do individuals need on a daily basis? 218 What are the current recommendations for daily fluid intake? 218 Can certain beverages, foods, or medications contribute to fluid losses? 219 What are some practical guidelines for consuming fluids on a daily basis? 220

What is the role of preexercise hydration? 220 How much fluid should be consumed before exercise? 220 What types of fluids should be consumed? 220 What are practical guidelines for consuming fluids before exercise? 222

What is the role of hydration during exercise? 222 What is the magnitude of water and electrolyte losses during exercise? 222 How much fluid should be consumed during exercise? 223 What types of fluids should be consumed during exercise? 225 What are some practical guidelines for consuming fluids during exercise? 230

What is the role of postexercise hydration? 233 How much fluid should be consumed? 233 What types of fluids should be consumed? 233 Are supplements beneficial after exercise? 234 What are some practical guidelines for consuming

fluids after exercise? 235 Key Points of Chapter 236 Study Questions 236 References 237

CHAPTER 9 Nutritional Ergogenics . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239 What is an ergogenic aid? 240 What are dietary supplements? 241

Why do athletes use dietary supplements? 241 What are the regulations governing dietary supplements? 242 Are some supplements better or safer than others? 244

Contents ix

Where can information on nutritional ergogenic aids be found? 246 What tools are available to research information on ergogenic aids? 246 What is doping? 248 What are some of the commonly encountered doping substances? 251

Which nutritional ergogenic aids are commonly used as anabolic agents, prohormones, and hormone releasers? 251

Which nutritional ergogenic aids are commonly used to reduce fat mass? 253 Which nutritional ergogenic aids are commonly used as anticatabolics? 253 Which vitamins and minerals are commonly used as nutritional ergogenic aids? 254

What types of dietary supplements and nutritional ergogenics are commonly used by endurance athletes, strength/power athletes, and team sport athletes? 254

Key Points of Chapter 259 Study Questions 259 References 260

SECTION 2 The Practical Application of Sports Nutrition . . . . . . . . 261 CHAPTER 10 Nutrition Consultation with Athletes . . . . . . . . . . . . . . . 263

Why is nutrition consultation and communication with athletes important? 264 How much do athletes know about sports nutrition? 264 Who provides nutrition assessment and education to athletes? 265 How does the consultation process with athletes begin? 266 What is a diet history? 266

What is a health history questionnaire? 266 Why is an inquiry about supplement use important? 268 What type of food intake information should be obtained from the athlete? 268 How is an exercise/training log used in a nutrition consultation? 271 Which clinical assessments should be conducted in

the initial consultation session? 272 How are food records analyzed? 273

How do you compare dietary intake to nutrition recommendations? 274 What are the steps for the initial consultation with the athlete? 277

How is rapport established with an athlete? 278 How can you determine the reasons for a requested consultation? 278 How is the nutrition assessment conducted? 278 How can an athlete’s readiness for change be assessed? 281 How can appropriate nutrition goals be established? 283 How can appropriate nutrition education be provided to an athlete? 284 How should a consultation be summarized and closed? 285

What are the steps for a follow-up consultation with the athlete? 285 What should walk-in or short sessions with athletes involve? 286 Are there any concerns about the confidentiality of the health, nutrition,

and exercise information provided by the athlete? 287 Key Points of Chapter 289 Study Questions 289 References 290

CHAPTER 11 Weight Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 291 What are the common weight management concerns for athletes? 292 What are the prevalence and significance of overweight and obesity? 292

What are the main health consequences and health risks of overweight and obesity? 293

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What methods are used to determine weight status? 294 What is body mass index? 294 What can measures of body fat distribution tell us? 295

Why is body composition important? 296 What makes up the composition of the body? 296 What are the methods for measuring body composition? 297 How does body composition affect sport performance? 301

What are the components of energy intake and energy expenditure? 302 What influences energy intake? 302 What are the components of energy expenditure? 303

What methods do athletes use to lose weight? 306 How are weight and body composition goals for athletes determined? 306 How are energy needs for weight loss determined? 307 What dietary changes are necessary for athletes to lose weight? 307 How do exercise and physical activity influence weight loss for athletes? 309 How does goal setting help athletes lose weight? 310 What are the summary recommendations for athletes regarding weight loss? 311

What are the weight loss issues for athletes in weight classification sports? 312 What happens when weight loss efforts develop into

disordered eating patterns? 315 What are the different types of eating disorders? 315 What are the main concerns regarding female athletes

and eating disturbances/disorders? 317 What are the main concerns regarding male athletes and

eating disturbances/disorders? 319 What are the best treatment options for eating disorders? 320 How can eating disorders be prevented? 320

How can athletes gain weight healthfully? 322 What kind of resistance training program is best for gaining weight? 322 How can an athlete achieve a positive energy balance? 323 How can an athlete achieve a positive nitrogen balance? 324 Do athletes need dietary supplements to gain weight? 324 What other dietary practices might help an athlete gain weight? 325

Key Points of Chapter 326 Study Questions 327 References 327 Additional Resources 329

CHAPTER 12 Endurance and Ultra-Endurance Athletes . . . . . . . . . . . 330 What is different about endurance athletes? 331 What energy systems are utilized during endurance exercise? 331 Are total energy needs for endurance athletes different from

energy needs of other types of athletes? 331 How are daily energy needs calculated for endurance athletes? 332 How many calories should be consumed during

endurance training or competition? 333 How many calories are required after a training session or competitive event? 334

Are macronutrient needs different for endurance athletes? 334 How important are carbohydrates to endurance athletes? 335

How are daily carbohydrate needs calculated for endurance athletes? 335 How should endurance athletes carbohydrate-load before competition? 336 Should carbohydrates be consumed in the hours or

minutes prior to endurance activities? 337

Contents xi

Should the endurance athlete consume carbohydrates during endurance activities? 338

Is carbohydrate intake important during the recovery period after endurance training or competition? 338

Are protein needs different for endurance athletes? 340 How are daily protein needs calculated for endurance athletes? 340 What is the effect of consuming protein prior to endurance activities? 341 Should proteins be ingested during endurance activities? 342 Is protein needed for recovery from endurance exercise? 343

Should endurance athletes eat more fats to meet their energy needs? 344 How are daily fat needs calculated for endurance athletes? 346 Should fats be eaten while performing endurance activities? 347 Is fat needed for recovery from endurance exercise? 348

Are vitamin/mineral needs different for endurance athletes? 348 Why are the B vitamins important for endurance athletes? 348 Why are vitamins C and E important for endurance athletes? 348 Why is iron important for endurance athletes? 349 Why is calcium important for endurance athletes? 350 Why are sodium and potassium important for endurance athletes? 350

Why are fluids critical to endurance performance? 350 How are daily fluid needs calculated for endurance athletes? 351 How are fluid and electrolyte needs during endurance activities determined? 351

What meal planning/event logistics need to be considered during endurance events? 354

How can a nutrition plan be developed for sports that are not conducive to consuming foods or fluids while exercising? 354

How can a nutrition plan be developed for sports lasting 24 hours or longer? 357 How can a nutrition plan be developed for a multiday

event that will be fully supported? 357 How can a meal plan be developed for a sport such as a long-distance

triathlon that includes a nonconducive eating environment, a length of time spanning several meals, and race course support? 358

Key Points of Chapter 360 Study Questions 361 References 361 Additional Resources 363

CHAPTER 13 Strength/Power Athletes . . . . . . . . . . . . . . . . . . . . . . . . . . . 364 What is different about strength/power athletes? 365 What energy systems are utilized during strength/power exercise? 365 Are the calorie needs of strength/power athletes different

from those of other types of athletes? 366 How are daily calorie needs calculated for strength/power athletes? 366 How are calorie needs calculated during strength/

power training and competition? 371 Are carbohydrate needs different for strength/power athletes? 372

How are daily carbohydrate needs calculated for strength/power athletes? 372 Are carbohydrates needed before and during training and competition? 373 Are carbohydrates needed for recovery from strength/power activities? 375

Are protein needs different for strength/power athletes? 375 How are daily protein needs calculated for strength/power athletes? 376 Do individual amino acids have an ergogenic effect on

muscle growth and development? 377

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Is protein needed before and during training sessions and competitions? 377 Is protein needed for recovery from strength/power activities? 378

Are fat needs different for strength/power athletes? 379 How are daily fat needs calculated for strength/power athletes? 379 Are fats needed before and during training sessions and competitions? 380 Is fat needed for recovery from strength/power activities? 380

Are vitamin and mineral needs different for strength/power athletes? 380 Do strength/power athletes need to supplement with antioxidant vitamins? 380 Should strength/power athletes supplement boron intake? 380 Should strength/power athletes be concerned about calcium intake? 381 Is chromium supplementation important for strength/power athletes? 381 Should strength/power athletes worry about iron? 381 Is magnesium supplementation important for strength/power athletes? 382 Why is zinc important for strength/power athletes? 382 Is multivitamin/mineral supplementation necessary for

strength/power athletes? 382 Are fluid needs different for strength/power athletes? 382

What issues are of concern regarding the fluid intake of strength/power athletes? 382 How are fluid needs during strength/power activities determined? 384 What should athletes drink and when should they drink it? 384 How much fluid should strength/power athletes drink after

training sessions and competitive events? 385 What meal-planning/event logistics need to be considered

during strength/power events? 385 What are high-quality options for snacks between events at meets? 385 What are high-quality options for snacks after competition? 385

Key Points of Chapter 387 Study Questions 388 References 388 Additional Resources 391

CHAPTER 14 Team Sport Athletes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 392 What is different about athletes in team sports? 393 What energy systems are utilized during team sports? 393 How are energy needs different for team sport athletes? 394

How are daily energy needs calculated for team sport athletes? 394 How can energy needs during an event be calculated? 395

Are carbohydrate needs different for team sport athletes? 395 How are daily carbohydrate needs calculated for team sport athletes? 397 What is the effect of carbohydrate consumption prior to team sport activities? 398 Is carbohydrate intake required during team sport activities? 399 Is carbohydrate intake needed for recovery from team sport activities? 400

Are protein needs different for team sport athletes? 400 How are daily protein needs calculated for team sport athletes? 400 Is protein recommended after exercise for recovery? 402

Are fat needs different for team sport athletes? 402 How are daily fat needs calculated for team sport athletes? 402 Is fat recommended after exercise for recovery? 404

Are vitamin and mineral needs different for team sport athletes? 404 How does vitamin intake of team sport athletes compare

to the dietary intake standards? 404 How does mineral intake of team sport athletes compare

to the dietary intake standards? 404

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How does energy consumption affect vitamin and mineral intake? 405 Are vitamin and mineral supplements recommended for team sport athletes? 406

What are the fluid recommendations for team sport athletes? 407 Why are fluids critical to team sport performance? 408 How can dehydration be prevented in team athletes? 408

What meal-planning/event logistics need to be considered during team sport events? 410

Should food be consumed during an event? 410 What should athletes consume between games and at tournaments? 410 Which foods are recommended for athletes while traveling? 412

Key Points of Chapter 416 Study Questions 417 References 417 Additional Resources 419

CHAPTER 15 Special Populations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 420 What is a “special population”? 421 What are the special considerations for athletes with diabetes? 421

What are the main types of diabetes? 422 What are the considerations related to exercise for athletes with diabetes? 423 How can athletes manage their diabetes and excel in sports? 423

What are the special considerations for athletes who are pregnant? 427 How are an athlete’s caloric requirements affected by pregnancy? 427 How are an athlete’s protein requirements affected by pregnancy? 428 How are an athlete’s B vitamin requirements affected by pregnancy? 428 How are an athlete’s vitamin C requirements affected by pregnancy? 429 How are an athlete’s vitamin A requirements affected by pregnancy? 429 How are an athlete’s magnesium requirements affected by pregnancy? 430 How are an athlete’s iron requirements affected by pregnancy? 430

What are the special considerations for child and teen athletes? 431 How does nutrition affect growth and maturation in the child

or teen athlete? 431 Are fluid needs for young athletes different from those of adult athletes? 434 Do young athletes require higher vitamin and mineral intake? 434

What are the special considerations for college athletes? 435 Are college athletes’ energy needs higher than their precollege needs? 435 What are practical tips for the implementation of a college athlete’s meal plan? 436 How does alcohol consumption affect college athletes’ nutrition? 437

What are the special considerations for masters athletes? 440 How do the nutrient needs of masters athletes change? 441 How does the presence of chronic disease affect nutrient

needs of masters athletes? 443 What are the special considerations for vegetarian athletes? 443

What are the various types of vegetarianism? 444 Which vegetarian foods are rich in protein? 446 Which vegetarian foods are rich in iron? 448 Which vegetarian foods are rich in zinc? 449 Which vegetarian foods are rich in calcium and vitamin D? 449 Which vegetarian foods are rich in vitamin B12? 449

Key Points of Chapter 451 Study Questions 452 References 452 Additional Resources 454

xiv Contents

CHAPTER 16 Jobs in Sports Nutrition . . . . . . . . . . . . . . . . . . . . . . . . . . . 455 Why should you consider becoming a registered dietitian? 456 What are the steps to becoming a registered dietitian? 456

What are the curriculum requirements for an undergraduate degree in dietetics? 456

Do individuals need a graduate degree to be a sports dietitian? 457 What do the dietetic internships entail, and how does the

experience relate to becoming a dietitian? 457 How is the board exam taken, and what topic areas are covered? 458

Is continuing education required once the RD credential is obtained? 458

What is the Board Certified as a Specialist in Sports Dietetics credential? 459

Is licensure necessary for registered dietitians? 459 What if you are not an RD and don’t have a license—can

you still give nutrition advice to athletes? 459 How can students and professionals obtain practical

experience in the field of sports nutrition? 460 What are the potential job markets in sports nutrition? 461 Key Points of Chapter 464 Study Questions 464 References 464

APPENDIX A You Are the Nutrition Coach – Answers . . . . . . . . . . . . . . 465

APPENDIX B The Gastrointestinal Tract . . . . . . . . . . . . . . . . . . . . . . . . . 471

APPENDIX C Major Metabolic Pathways . . . . . . . . . . . . . . . . . . . . . . . . . 474

APPENDIX D Calculations and Conversations . . . . . . . . . . . . . . . . . . . . 480

APPENDIX E Growth and Body Mass Index Charts . . . . . . . . . . . . . . . . 483

APPENDIX F Dietary Reference Intakes . . . . . . . . . . . . . . . . . . . . . . . . . 488

GLOSSARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 492

INDEX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 503

Contents xv

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PREFACE Sports nutrition is an exciting field that combines the sciences of nutrition and exercise physiology. The gener- ally accepted notion that proper nutrition can positively impact athletic performance has created the need for exercise and nutrition professionals to acquire knowledge that goes beyond the basics of general nutrition.

In addition, emerging career opportunities in sports nutrition require that academic programs preparing reg- istered dietitians expand the application of nutrition beyond the clinical population. Strength coaches and personal trainers also need to go beyond the nutrition basics to help their athletes achieve optimal performance. The growing research base supporting the importance of sports nutrition and the inherent interest of athletes seek- ing a nutritional edge have created an increased demand for sports nutrition courses in dietetic and exercise sci- ence programs.

In order to obtain a job in the sports nutrition field, readers need to understand current nutrition guidelines, be aware of the results of emerging research, and be able to practically apply sports nutrition knowledge to ath- letes of all ages, sports, and abilities. This text has been developed to meet these needs, providing readers with an opportunity to learn the most up-to-date informa- tion related to diet and athletic performance while also addressing consultation skills and giving readers the tools they need to educate others properly. The focus on research, current guidelines, and practical application of information makes this sports nutrition textbook unique among other texts currently on the market.

Undergraduate and graduate students as well as pro- fessionals from several different backgrounds will ben- efit from this textbook. Students in dietetics, exercise science, and athletic training programs will enhance their education with an understanding of the relation- ship among essential nutrients, energy metabolism, and optimal sports performance. Dietetics students seek- ing the registered dietitian (RD) credential will appreci- ate the thorough explanations and many helpful tips on how to guide an athlete through nutrition consultations. Exercise science and athletic training students will learn how to educate athletes regarding public domain sports nutrition guidelines as well as how to work together as a team with a registered dietitian and physician. Current professionals in the field of sports nutrition will bene- fit from adding this text to their reference library due to the straightforward and complete presentation of current sports nutrition recommendations and examples of prac- tical applications for athletes participating in endurance, strength/power, and team sports.

Organization and Enhancements The most exciting change included in this fifth edition of Practical Applications in Sports Nutrition is its new, full-color layout. There is no question that color adds a new dimen- sion to the text’s readability, and it serves to even better highlight the various features of the text.

As in previous editions, Chapters 1 through 9 pro- vide an introduction to sports nutrition, including the definition of sports nutrition and an explanation of gen- eral nutrition concepts; a review of digestion and energy metabolism; a thorough explanation of macronutrients, micronutrients, and water and their relation to athletic performance; and, finally, an overview of nutritional ergo- genics. Enhancements within Chapters 1–9 in this fifth edition include:

• Updated/revised figures and tables throughout • The introduction and discussion of new labeling

requirements and how to use them • Updated sport nutrition recommendations based

on the 2016 position statement from the American College of Sports Medicine (ACSM), the Academy of Nutrition and Dietetics (AND), and the Dietitians of Canada (DC)

• The inclusion of the new 2016 World Anti-Doping Association Prohibited Substances List

• Several new Fortifying Your Nutrition Knowledge features (e.g., Mobile Apps: Technology in Weight Management). Several of this textbook’s unique features appear in

the second half of the text, within the practical applica- tion section. Chapter 10 focuses on how to educate, com- municate with, and empower athletes to make behavior changes through nutrition consultations. Chapter 11 cov- ers enhancing athletic performance through nutrition while also focusing on weight management, including weight loss, weight gain, and eating disorders. Changes to Chapter 11 include updated statistics and graphs on obesity, as well as condensed sections covering body com- position measurement and weight loss.

In Chapters 12–14, sports are divided into three cat- egories: endurance, strength/power, and team, each cov- ered separately. Each chapter reviews the most current research as it relates to the energy systems and spe- cific nutrition needs of athletes, which as noted earlier, reflect the new sports nutrition recommendations of ACSM, AND, and DC for these various categories of sports. Chapters 12–14 serve as examples of one of the main objectives of this book: To empower individuals to excel in the sports nutrition field by teaching sports nutrition

guidelines and showing how to apply the concepts to ath- letes in various sports. These chapters demonstrate how to give advice that is practical and easy to follow.

Due to the increasing occurrence of athletes with special medical or nutritional considerations—including those who are pregnant, vegetarian, masters athletes, or have chronic diseases—Chapter 15 targets the unique nutrition requirements of these special populations. The text concludes with a chapter dedicated to helping read- ers discover and understand the pathway to becoming a sports dietitian through education and experience. Enhancements to Chapters 15 and 16 include updated tables, references, resources, and websites.

The Pedagogy Throughout the text the primary, secondary, and tertiary section headings are phrased as questions. We formatted the section headings as questions to help readers focus

their attention and to foster interest in the topic before they begin to read. In other words, they are “directed” to read about topics with the specific purpose of obtaining an answer to a question. This is an effective way of read- ing and borrows from the work of Francis Robinson, who developed the widely used “preview-question-read-recite- review” (PQ3R) reading technique. The goal is to prevent “hollow reading,” in which a person reads the words on the pages but without a specific understanding or per- spective of why he or she is reading.

Our mission is for readers to become engrossed in their reading with the hope that they will be inspired to learn more about the relatively new and growing field of sports nutrition. After all, regardless of where a reader’s academic and career paths may lead, knowledge of good nutrition is universally applicable to one’s personal health and well-being, to enjoyment of recreational and sports activities, and, in the case of dietitians and fitness profes- sionals, to career success.

Preface xvii

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HOW TO USE THIS BOOK ©

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Key Questions addressed 1. What’s the big deal about vitamins?

2. What are vitamins?

3. How are the dietary needs for vitamins represented?

4. What are the water-soluble vitamins?

5. What are the fat-soluble vitamins?

6. Which vitamins or compounds have antioxidant properties?

7. What are phytochemicals?

You are the nutrition Coach Roger is a starting guard on his college basketball team. He is a leader on his team, stays after prac- tice to work on his shots, and is busy with academic and community life on campus. Because of his hectic schedule, he has little time for meal planning, grocery shopping, and food preparation. Din- ner is usually consumed at the athletics training table during the week, and the rest of his meals are consumed either at home or at local restaurants. A 3-day food record kept by Roger recently was analyzed using a nutrition software program. the analysis revealed overall energy intake was not meeting his estimated needs, and vitamins A, c, and folate were consistently low throughout the 3-day period. the rest of the vitamins and minerals met the minimum RDA or Ai requirements.

Questions • What questions should you ask Roger about his typical daily diet?

• What recommendations do you have for Roger to improve his dietary intake of vitamins and his energy intake?

• How can you help Roger meet these recommendations?

Vitamins

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Key Questions Addressed sections open each chapter and introduce students to key material, piquing their interest in covered topics and encouraging purposeful reading.

You Are the Nutrition Coach case studies at the beginning of the chapter provide context to chap- ter material. Students are urged to carefully con- sider the case study prior to reading the chapter and reconsider it after completing their reading.

What role does fiber play in health? Fiber is a complex carbohydrate that the body cannot digest or absorb. Most fibers are made up of long chains of sugar units and thus are classified as polysaccharides. However, unlike starch, fiber polysaccharides cannot be broken down by human digestive enzymes into small enough units for the body to absorb. Thus, fiber, with the exception of some resistant starches, does not contribute energy to the body as do other digestible carbohydrates. Even though it is a minimal energy source, fiber promotes good health in many ways.8

When we eat plant foods, the indigestible fiber portion adds bulk to the intestinal contents. It does so by attract- ing water into the intestines, some of which is absorbed by the fiber itself, causing it to expand. The greater the bulk of the intestinal contents, the greater the peristaltic actions of the smooth muscles in the intestinal walls and the faster the passage of foods through the digestive sys- tem. The water drawn in by the fiber also helps soften the stools for easy passage out of the system. If fiber intake is low, there is less water and less intestinal bulk, which results in stools that are small and hard, and that pass more slowly through the length of the intestines. Con- stipation and hemorrhoids can occur more readily when stools are hard and when fiber intake is low. Constipation produces an uncomfortable full feeling, often with gas, and is particularly uncomfortable during exercise.

Active individuals who eat adequate fiber and con- sume adequate fluids will have fewer problems with constipation than those who do not exercise. Physical exercise not only strengthens the muscles used during exercise, but also tends to produce a healthier GI tract that moves food and fluids efficiently and quickly through the system. This is just another example of the importance of combining exercise with good nutrition.

Choosing foods rich in fiber may help reduce the risk of some types of cancers.8 The link between fiber and colon cancer has received much attention. Controversy exists in the research as to whether fiber has a positive or a neutral effect on the risk for colon cancer. Some studies support a positive correlation between high fiber intakes and colon cancer risk reduction,9,10 whereas others do not support this finding.11–13 The theory behind fiber’s poten- tial ability to decrease colon cancer risk is that the higher bulk of insoluble fibers may “dilute” toxins in the intesti- nal tract plus speed the passage of toxins out of the body. This decreased transit time may reduce the amount of contact between potential cancer-causing agents and the intestinal mucosal cells. More research, especially studies that control for type of fiber and food intake, needs to be conducted to determine whether there is a direct corre- lation between high fiber intake and a lowered incidence of colon cancer. Regardless of future findings, eating a diet rich in complex carbohydrates, including fruits, veg- etables, whole grains, and legumes, provides a healthful diet and can aid in the prevention of many other disease conditions (see FIGURE 3.6 ).

deficit in needed car- bohydrates. Finally, carbohydrates are the primary energy source for the ner- vous system. Nerve cells do not store carbohydrates like muscle cells do; their

source for carbohydrates is the bloodstream. When blood glucose levels fall, nerve cell function suffers, which can have a dramatic effect on exercise and sport performance.

Gaining the Performance Edge

Cutting carbohydrates from an ath- lete’s diet leads to “performance sui- cide.” Carbohydrates are the “master fuel” for all sports.

Fortifying Your Nutrition Knowledge

What Does “Low Carb” Mean? The FDA regulation for nutrient content claims allows manufac- turers to highlight and make health-related claims on their food labels regarding certain nutrients or dietary substances in their products. However, the FDA permits only specified nutrients or substances to have these nutrient content claims. The FDA has not established a set of values for descriptors identifying carbo- hydrates. Food manufacturers can put quantitative statements on labels such as “6 grams of carbohydrates” as long as they are factual. However, they cannot make a statement such as “only 6 grams of carbohydrates” because that implies the food is a car- bohydrate-reduced or low-carbohydrate food. If the label “char- acterizes” the level of a nutrient, then it is considered a nutrient content claim. Therefore, a claim of “low carbohydrate” cannot be used on food labels because it characterizes the amount of carbohydrates in that food.

Although there are no official definitions of low carbohydrate, the FDA is gathering evidence and will potentially develop a statement outlining carbohydrate food-labeling guidelines. Guidelines are likely to be similar to those established for such terms as “low fat,” “reduced fat,” or “reduced sugar.” These will list the number of grams of carbohydrates to be considered “low” and probably will include definitions of reduced carbo- hydrates as well.

How can carbohydrates affect overall health? It is widely recognized that a diet moderate to high in car- bohydrates is important for optimal daily training, high energy levels, and overall good health. Carbohydrate-rich foods contain not only energy for working muscles, but also nutrients required for proper body func- tioning, such as fiber, vitamins and min- erals, and various phytochemicals.

phytochemicals A large class of bio- logically active plant chemicals that have been found to play a role in the maintenance of human health.

Chapter 3 Carbohydrates 67

Fortifying Your Nutrition Knowl- edge boxes expand on timely topics with the intent of providing infor- mation that is beyond the basics of the sports nutri- tion topic being discussed.

Gaining the Per- formance Edge boxes provide insightful tips on how to apply sports nutri- tion knowledge when working with athletes.

Key Terms are bolded within the text and defined in a sidebar to help students quickly identify and understand new terms.

How to Use this Book xix

Food for Thought callouts refer students to web- based workbook activities to further their under- standing or engagement in nutritional topics.

Training Tables help students translate sports nutrition knowledge into actual meal planning ideas, recipes, or food selections.

In regard to athletic performance, there is no evi- dence that the ingestion of excess sulfur is ergogenic.

What are the complications of sulfur deficiency? Deficiencies of sulfur are rare, unless a protein defi- ciency is also present, which would include a deficiency in methionine and cysteine. Under normal conditions, it appears that adequate sulfur spares cysteine from the synthesis of PAPS, allowing cysteine to instead be used for protein synthesis and growth. When sulfur is present in suboptimal levels, cysteine is required for the production of PAPS, thus sacrificing protein synthesis.

What are the symptoms of sulfur toxicity? There have been reports of individuals suffering from osmotic diarrhea after consuming large quantities of sulfur.29 An association has also been suggested between high sulfur intakes and the risk of ulcerative colitis. Unfortunately, at this time there is insufficient evidence to formulate recommendations for sulfur intake, includ- ing the establishment of an upper limit.29

Which foods are rich in sulfur? Sulfur is found in a variety of foods, with the highest con- centrations found in some fruits, soy flour, certain breads, and sausages. Juices, beers, wines, and ciders also contain a significant quantity of sulfur. Drinking water is another com- mon source of sulfur; however, quantities can vary dramati- cally based on the region of the country and the water source.

What is a suggestion for a sulfur-rich meal or snack? Because no RDA/AI level has been set for sulfur, a “sulfur-rich” meal cannot be rec- ommended. Athletes should include sul- fur-containing foods on a daily basis in addition to consum- ing adequate levels of protein.

Do athletes need sulfur supplements? Because an insuf- ficient amount of information is avail- able to even draw conclusions on an RDA, EAR, AI, or UL for sulfur, recom- mending sulfur sup- plements does not appear to be war- ranted at this time.

What is a suggestion for a potassium-rich meal or snack? Snack: Summertime Salad (see TRAINING TABLE 7.3 )

Total potassium content = 457 milligrams

Do athletes need potassium supplements? Potassium supplements are not needed and can cause harm in large doses. For athletes, the emphasis should be placed on food sources of potassium because adequate potassium intake is easily attainable through a balanced diet. Large doses of supplemental potassium, at levels of 18,000 milligrams or higher, can disrupt muscle contraction and nerve transmission, ultimately leading to a heart attack.

Why is sulfur important for athletes? Sulfur is unique because it is considered an essential nutrient, but it does not have an established RDA, EAR, AI, or UL.29 Regardless of the lack of hard numbers, sulfur or sulfate is a nutrient that athletes should consume on a daily basis for proper bodily functioning.

What is the RDA/AI for sulfur? There is no RDA, EAR, or AI for sulfur because of the fact that it can be obtained from food and water, as well as be derived from specific amino acids in the body.29

What are the functions of sulfur for health and performance? Sulfur is a component of hundreds of compounds in the body. The body synthesizes the majority of these com- pounds using the sulfur consumed in the diet and from sulfur produced in the body from degradation of the amino acids methionine and cysteine. The most notable sulfur- containing compound in the body is 3-phosphoadenosine- 5-phosphosulfate (PAPS). Sulfate derived from methionine and cysteine found in dietary proteins and the cysteine component of glutathione provide sulfate for use in PAPS synthesis.29 PAPS, in turn, is then used in the biosynthesis of other essential body compounds.29 Sulfur has also been associated with the growth and development of tissues.

Gaining the Performance Edge

The major minerals include calcium, phosphorus, magnesium, sodium, chloride, potassium, and sulfur. Each of these minerals plays a spe- cific and important role in overall health and athletic performance. Athletes should strive to consume these nutrients from whole foods first, and rely on supplements only when individually indicated.

Food for Thought 7.1

Importance of Mineral Intake for Athletes: Major Minerals

Review the recommendations, food sources, and significance of major minerals for athletes.

Training Table 7.3: Summertime Salad This salad tastes best during the summer months when tomatoes are in season.

1 small tomato, diced

¼ whole cucumber, diced

¼ cup red onion, diced

2 tbsp light Italian dressing

Mix together the vegetables and dressing.

Chill before serving.

Serving size: 1½ cups (recipe makes one serving)

Calories: 95 kcals

Protein: 2 grams

Carbohydrate: 12 grams

Fat: 5 grams

190 SECTION 1 The Basics of Sports Nutrition

xx How to Use this Book

The Box Score concludes each chapter with Key Points and numerous Study Questions, which con- tinue to engage students in thoughtful review of important chapter material.

The Box Score Key Points of Chapter

n To become a registered dietitian (RD), individuals must meet specific requirements in undergraduate college courses and obtain a minimum of a bach- elor’s degree at an accredited college or university.

n Registered dietitians have to obtain a minimum of 1200 hours of supervised experience after obtaining a bachelor’s degree before they can take the registra- tion exam for dietitians.

n In some states, registered dietitians must be licensed, in addition to being registered. Laws in states that require licensure are developed to pro- tect the public from harm that could potentially be done by individuals who say they are “nutritionists.” These individuals typically have not had the same education, training, or supervision as registered and licensed dietitians.

n Non-nutrition-credentialed professionals should check licensure laws in their state to be sure they

are not providing nutrition services outside of the law. Much public domain information is available for all professionals to educate athletes in order to help them with performance nutrition.

n The Board Certified as a Specialist in Sports Dietet- ics (CSSD) credential is a certification offered by the Commission on Dietetic Registration of the Acad- emy of Nutrition and Dietetics. Individuals with this credential are recognized as knowledgeable and experienced in working with athletes and nutrition for performance enhancement.

n Obtaining the RD credential is the first step to becoming a sports dietitian. Additional work and volunteer experience in the sports nutrition arena, as well as possible graduate studies in the exer- cise science field, will prepare dietitians for a job in sports nutrition.

Study Questions

1. What, if any, are the differences between a sports nutritionist and a dietitian?

2. In what job settings can registered dietitians be found? 3. What are the three required steps that must be com-

pleted in order to become a registered dietitian? 4. What academic coursework should students be pre-

pared to take when pursuing a BS degree in dietetics? 5. Discuss the various ways in which a registered dieti-

tian may obtain continuing education credits. 6. Discuss some of the various ways that students inter-

ested in sports nutrition can get field experience.

7. What are some of the daily roles and responsibilities of a registered dietitian involved in sports nutrition?

8. What nutrition information can an individual who is not a licensed or registered dietitian provide to athletes? What are the legal and ethical issues sur- rounding noncredentialed nutrition assessment and therapy?

9. Explain the qualification requirements for the CSSD credential. Why is this credential important in the sports nutrition field?

References

1. Academy of Nutrition and Dietetics, Accreditation Counsel for Education in Nutrition and Dietetics. Accreditation Standards for Didactic Programs in Nutrition and Dietetics. Available at: http://www. eatrightacend.org/ACEND/. Accessed April 25, 2016.

2. Academy of Nutrition and Dietetics, Commission on Dietetic Registration. Sports Dietetics Application Information. Available at: www.cdrnet.org/certifica- tions/board-certification-as-a-specialist-in-sports- dietetics. Accessed April 25, 2016.

3. Commission on Dietetic Registration. State Licen- sure. Available at: http://cdrnet.org/state-licensure. Accessed April 25, 2016.

4. Driskell JA, Wolinsky I. Nutritional Assessment of Ath- letes. Boca Raton, FL: CRC Press; 2002.

5. Rogers D. Dietetics trends as reflected in various pri- mary research projects, 1995–2011. J Acad Nutr Diet. 2012;112(suppl 1):64S–74S.

464 SECTION 2 The Practical Application of Sports Nutrition

How to Use this Book xxi

Integrated Teaching and Learning Package A robust set of instructor’s resources are available to qualified instructors. They include the following:

n LMS-ready Test Bank, featuring more than 1,000 questions

n Slides in PowerPoint format, including more than 400 slides

n Instructor’s Manual, containing Objectives, Out- lines, and Discussion Questions for each chapter

n Image Bank, including more than 200 illustrations and photographs featured in the text

n Workbook Exercises, tied to specific sections in each chapter

xxii How to Use this Book

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Heather Hedrick Fink, MS, RD, CSSD Heather Hedrick Fink, owner of Nutrition and Wellness Solutions, LLC, is a Registered Dietitian and Board Certi- fied as a Specialist in Sport Dietetics. She completed her undergraduate degree in dietetics as well as her master of science degree in kinesiology at the University of Illi- nois, Urbana-Champaign. Heather is also certified by the American College of Sports Medicine as a Certified Exer- cise Physiologist. Heather has been providing nutrition, fitness, and wellness programming to individuals, corpo- rations, and athletic teams for close to 20 years.

Heather’s interests and extensive experience are in the areas of wellness, disease prevention, weight man- agement, exercise programming, vegetarian nutrition, and sports nutrition, ranging from the recreational to the ultra-endurance athlete. Her sports nutrition prac- tice includes acting as the sports dietitian for the Indi- ana University–Purdue University Indianapolis athletic department, as well as working with club teams, individ- ual athletes, trainers, and coaches to optimize their nutri- tion and hydration strategies. She has appeared on local NBC, CBS, and cable television shows and news broad- casts to educate central Indiana residents on the ben- efits of a healthy lifestyle. Heather is also the author of the Absolute Beginner’s Guide to Half Marathon Training. She has been interviewed and quoted in Women’s Day, Ladies Home Journal, and Newsweek magazines. Heather is also an accomplished triathlete, duathlete, and marathon runner who has qualified for and competed in the Hawaii Iron- man and Boston Marathon.

Alan E. Mikesky, PhD, FACSM Alan E. Mikesky retired in 2016 and is professor emer- itus at the School of Physical Education and Tourism Management at Indiana University–Purdue University Indianapolis (IUPUI), and former Director of the Human Performance and Biomechanics Laboratory. While at IUPUI, he held adjunct appointments with the School of Medicine, Department of Anatomy, and served as research associate at the National Institute for Fitness and Sport in Indianapolis. Dr. Mikesky received his undergraduate degree in biology from Texas A&M University and his mas- ter of science degree in physical education with a spe- cialization in exercise physiology from the University of Michigan. He received his doctorate in anatomy/cell biol- ogy from the University of Texas Southwestern Medical Center at Dallas, where he studied the adaptations of skeletal muscle to heavy resistance exercise. He is a Fel- low of the American College of Sports Medicine (ACSM) and was fitness editor for ACSM’s quarterly newsletter, Fit Society Page. He has served as a member of the editorial board for the National Strength and Conditioning Asso- ciation’s Journal of Strength and Conditioning Research and Strength and Conditioning Journal. He is also coauthor of the sixth edition of Physical Fitness: A Way of Life, a textbook published by Cooper Publishing Group. His past research focused on the functional improvements and physiologi- cal adaptations to various forms of resistance exercise. He has investigated the impact of strength training on gait, balance, incidence of falls, joint proprioception, func- tional ability, and chronic diseases such as osteoarthritis. In retirement, he will continue to consult and collaborate with former colleagues on research projects and pursue his interests in “entomophagia,” which involves the rais- ing and use of insects as food for human consumption.

ABOUT THE AUTHORS

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ACKNOWLEDGMENTS We would like to thank Jones & Bartlett Learning’s Nutri- tion team for making this fifth edition a reality. Thanks to Sean Fabery and Taylor Maurice on the editorial team for their support, encouragement, and direction for the development of this fifth edition. Thank you to Tina Chen, Molly Hogue, and Brooke Haley on the production team for their tireless efforts in the production of the text, as well as to Merideth Tumasz and Shannon Sheehan for their work on obtaining permissions and developing the art program. Thanks to Andrea DeFronzo and the entire Jones & Bartlett marketing and sales teams. Their dedica- tion to our book has helped us surpass our goals.

We are grateful to the reviewers who obviously spent a large part of their valuable time reviewing the previous edition of our text:

John Acquaviva, PhD Wingate University

Damon Amato, MS, LAT, CSCS Lasell College

Craig Biwer, MS, CSCS, ACSM-HFS University of Wisconsin Oshkosh

Peter F. Bodary, PhD University of Michigan

Lorrie Brilla, PhD, FACSM, FACN, CNS Western Washington University

Karina Christopher, MS, RD, LD Eastern Kentucky University

Karen Gibson, DCN, RD, CD, CSSD Viterbo University

Timothy Harvey, MS, ATC Mercyhurst University

Tawni Holmes, PhD, RD University of Central Oklahoma

Janeen R. Hull, MS Portland Community College

Kathleen M. Laquale, PhD, ATC, LAT, LDN Bridgewater State University

Simin Levinson, MS, RD, CSSD Arizona State University

Michael Mangum, PhD Columbus State University

Kevin Pietro, MS, RD, LD University of New Hampshire

Connie Tompkins, PhD University of Vermont

Green T. Waggener, PhD University of West Florida

Beth A. Young, MA, RD, CSSD, CD University of Southern Indiana

Their thoughtful, constructive comments provided the feedback necessary to enhance our book with accu- rate and timely sports nutrition updates.

Finally, we would be remiss not to acknowledge the patience, understanding, and support of our spouses and families. The countless hours spent on this project took away from precious family time and could not have been done without help “picking up the slack” in the other areas of our lives. Without their support, keeping this project on schedule would have never been possible.

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The Basics of Sports Nutrition This section provides an introduction to sports nutrition, including a review of general nutrition concepts; an overview of digestion and energy metabolism; a thorough explanation of macronutrients, micronutrients, and water and their relation to athletic performance; and, finally, a discussion of nutritional ergogenics.

Chapter 1 Introduction to Sports Nutrition

Chapter 2 Nutrients: Ingestion to Energy Metabolism

Chapter 3 Carbohydrates

Chapter 4 Fats

Chapter 5 Proteins

Chapter 6 Vitamins

Chapter 7 Minerals

Chapter 8 Water

Chapter 9 Nutritional Ergogenics

SECTION 1

Key Questions Addressed 1. What is sports nutrition?

2. Why study sports nutrition?

3. What are the basic nutrients?

4. How does the body produce energy?

5. What are the Dietary Reference Intakes?

6. What are enriched and fortified foods?

7. What are the basic nutrition guidelines?

8. How should athletes interpret the information on food labels?

9. What are the factors to consider when developing an individualized sports nutrition plan for athletes?

10. How can sports nutrition knowledge be converted into practical applications?

You Are the Nutrition Coach Jennifer is a 42-year-old tennis player. She states that recently her energy levels have dropped and that she has had a hard time recovering from long tennis matches. She also complains of being “hungry all the time.“ The constant hunger has been frustrating because she is trying to maintain her current weight by attempting to control her total daily intake. She has been “eating well“ since finding out 2 years ago that she has high cholesterol. She received counseling from a dietitian at the time of her diagnosis and subsequently made major changes in her diet, such as switching to nonfat foods and eliminating dairy. Her goals are to increase her energy levels, decrease recovery time, and create a meal plan that will also be healthy for her husband and three sons.

Question • What should Jennifer’s top priority be—her high cholesterol, struggle to maintain her weight,

constant hunger, low energy levels, or long recovery time?

Introduction to Sports Nutrition

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CHAPTER 1

What is sports nutrition? Sports nutrition is a specialization within the field of nutrition that partners closely with the study of the

human body and exercise science. Sports nutrition can be defined as the application of nutri-

tion knowledge to a practical daily eating plan focused on providing the fuel for physical activity, facilitating the repair and rebuilding process following hard physical work, and optimizing athletic performance in competi- tive events, while also promoting overall health and well- ness. The area of sports nutrition is often thought to be reserved only for “athletes,” which insinuates the inclu- sion of only those individuals who are performing at the elite level. In this text, the term athlete refers to any indi- vidual who is regularly active, ranging from the fitness enthusiast to the competitive amateur or professional. Differences may exist in specific nutrient needs along this designated spectrum of athletes, creating the excit- ing challenge of individualizing sports nutrition plans.

To fully understand and subsequently apply sports nutrition concepts, professionals instructing athletes on

proper eating strat- egies first need to have a command of general nutrition as well as exercise science. The sec- ond step is to gain the knowledge of how nutrition and exercise science are intertwined, under-

standing that physical training and dietary habits are reliant on each other to produce optimal performance. The final step can be considered one of the most critical— the practical application of sports nutrition knowledge to individual athletes participating in a sport or physical activity.

Sports nutrition professionals must be able to teach athletes by putting “book” knowledge into practice with actual food selection and meal planning, while keeping in mind the challenges presented by busy schedules of exercise, competitions, work, school, and other commit- ments. It is this third step that many professionals lack after graduating from an undergraduate or graduate pro- gram in sports nutrition, dietetics, exercise science, or athletic training. Our focus is to review sports nutrition concepts while also translating the information into spe- cific meal plans, recipes, and case study scenarios. Stu- dents are encouraged to seek additional opportunities outside the classroom to work with recreational and elite athletes to gain more experience in applying sports nutri- tion concepts before searching for a job in the “real world.”

Why study sports nutrition? Sports nutrition has emerged as a recognized specialty area within the field of nutrition. Athletes challenge their bodies on a regular basis through physical training and competitions. To keep up with the physical demands of their activity or sport, athletes need to fuel their bodies adequately on a daily basis. This fueling process requires a specialized approach; therefore, athletes who want to make dietary changes should seek out professionals who are experts in sports nutrition and experienced in devel- oping individualized plans.

Sports nutrition research is provid- ing new and exciting information on a reg- ular basis. It is critical that sports nutri- tion professionals stay current so they can be evidence- based practitioners. Gone are the days of suggesting dietary practices based on anecdotal observa- tions or experiences. Becoming an evi- dence-based practi- tioner requires use of nutrition guidelines and dietary practices that have been doc- umented as being effective through peer-reviewed research. Professionals who have studied sports nutrition, have experience in the field, and continue to stay abreast of the latest nutrition research can prescribe individualized dietary plans that meet basic nutritional needs, enhance performance, and speed recovery in athletes of all sports. Becoming an evi- dence-based sports nutrition practitioner can lead to an exciting and fulfilling career.

What are the basic nutrients? Foods and beverages are composed of six nutrients that are vital to the human body for producing energy, con- tributing to the growth and development of tissues, regulating body processes, and preventing deficiency and degenerative diseases. The six nutrients are carbo- hydrates, proteins, fats, vitamins, minerals, and water and are classified as essential nutrients. The body requires these nutrients to function properly;

Gaining the Performance Edge

The field of sports nutrition requires a command of general nutrition and exercise science, an understanding of their interrelationship, and the knowledge of how to practically apply sports nutrition concepts.

sports nutrition A specialty area of study and practice within the field of nutrition.

Gaining the Performance Edge

The field of sports nutrition is grow- ing, increasing the demand for qual- ified sports nutrition professionals. To be considered an “expert“ in sports nutrition, a professional must obtain the appropriate education and certification background as well as hands-on experience work- ing with athletes.

evidence-based practitioner An individual whose professional prac- tice is based upon information, guidelines, or interventions that have been shown through research to be safe and effective.

essential A nutrition descriptor referring to nutrients that must be obtained from the diet.

4 SECTION 1 The Basics of Sports Nutrition

however, the body is unable to endogenously manufac- ture them in the quantities needed daily, and therefore these nutrients must be obtained from the diet. Carbohy-

drates, proteins, and fats are classified as macronutrients because they have a caloric value and the body needs a large quantity of them on a daily basis. The micronutrients include vitamins and minerals; the prefix micro is used because the body’s daily requirements

for these nutrients are small. Water fits into its own class, and requirements for it vary greatly among individuals. These nutrients will be discussed briefly in this section.

What are carbohydrates? Carbohydrates are compounds constructed of carbon, hydrogen, and oxygen molecules. Carbohydrates are con- verted into glucose in the body, providing the main source of fuel (4 calories per gram of carbohydrate) for all physi- cal activity. Carbohydrates are found in a wide variety of foods, including grains, fruits, and vegetables, as well as in the milk/alternative (soy, rice, nut, and other nondairy products) group.

What are proteins? Amino acids are the building blocks of proteins, which are constructed of carbon, hydrogen, oxygen, and nitro-

gen molecules . Amino acids can be made within the body (nonessential) or obtained from

dietary sources. Proteins are involved in the development, growth, and repair of muscle and other bodily tissues and are therefore critical for recovery from intense physical training. Proteins ensure that the body stays healthy and continues working efficiently by aiding in many bodily processes. Protein can also be used for energy, provid- ing 4 calories per gram; however, it is not used efficiently and therefore is not a source of energy preferred by the body. Proteins are found in a variety of foods, including grains and vegetables, but are mainly concentrated in the milk/alternative as well as meat and beans/alternative (soy products, nuts, seeds, beans, and other nonanimal products) groups.

What are fats? Fats, like the other macronutrients, are compounds made up of carbon, hydrogen, and oxygen molecules. Fats are also known as lipids, and they come from both plant and

animal sources in our diet. Triglycerides are the most common type of fat. Other fats include cholesterol and phospholipids. With 9 calories per gram, fats are a con- centrated source of energy. Fat is primarily used as a fuel at rest and during low-to moderate-intensity exer- cise. Fats are also involved in providing structure to cell membranes, aiding in the production of hormones, form- ing the insulation that wraps nerve cells, and facilitating the absorption of fat-soluble vitamins. Fats are concen- trated in butter, margarines, salad dressings, and oils, but they are also found in meats, dairy products, nuts, seeds, olives, avocados, and some grain products.

What are vitamins? Vitamins are a large class of nutrients that contain carbon and hydrogen, as well as possibly oxygen, nitrogen, and other elements. There are two main requirements for a substance to be classified as a vitamin. First, the substance must be consumed exogenously because the body cannot produce it or cannot produce it in sufficient quantities to meet its needs. Second, the substance must be essential to at least one vital chemical reaction or process in the human body. Vitamins do not directly provide energy to the body; however, some vitamins aid in the extraction of energy from mac- ronutrients. Vita- mins are involved in a wide variety of bodily functions and processes that help to keep the body healthy and disease free. Vitamins are classified as either water-soluble (B vita- mins and vitamin C) or fat-soluble (vita- mins A, D, E, and K), depending on their method of absorp- tion, transport, and storage in the body. Vitamins are found in nearly all foods, including fruits, vegetables, grains, meat and beans/alternative, milk/alter- native, and some fats.

What are minerals? Minerals are also a large group of nutrients. They are com- posed of a variety of elements; however, they lack car- bon. Minerals have a role in the structural development of tissues as well as the regulation of bodily processes. Physical activity places demands on muscles and bones, increases the need for oxygen-carrying compounds in the blood, and increases the loss of sweat and electro- lytes from the body, all of which hinge on the adequate

macronutrients These include carbohydrates, proteins, and fats and are classified as such because they have caloric value and the body has a large daily need for them.

micronutrients Vitamins and min- erals are classified as micronutrients because the body’s daily require- ments for these nutrients are small.

nonessential A nutrient descrip- tor referring to nutrients that can be made within the body.

Gaining the Performance Edge

Each of the six nutrients has a role in the health and proper function- ing of the human body. Physical activity places extra demands on the body, increasing the impor- tance of the nutrients' presence in the diet. Many of the nutrients are so critical to optimal athletic perfor- mance that the total daily require- ments are increased to meet the demands placed on the body. The six basic nutrients each have dis- tinct, but also intertwining, roles, making it critical to consume ade- quate amounts of each nutrient on a daily basis.

Chapter 1 Introduction to Sports Nutrition 5

intake and replacement of dietary minerals. Minerals are categorized into major minerals (calcium, sodium, potas- sium, chloride, phosphorus, magnesium, and sulfur) and trace minerals (iron, zinc, copper, selenium, iodine, fluo- ride, molybdenum, and manganese) based on the total quantity required by the body on a daily basis. Similar to vitamins, minerals are found in a wide variety of foods, but mainly are concentrated in the meat and beans/alter- native and milk/alternative groups.

What is water? Forming a category of its own, water deserves to be high- lighted because of its vital roles within the body. The human body can survive for a much greater length of time without any of the macro- or micro-nutrients than with- out water. The body is 55–60% water, representing a nearly ubiquitous presence in bodily tissues and fluids. In athlet- ics, water is important for temperature regulation, lubri- cation of joints, and the transport of nutrients to active tissues. In addition to plain water, water can be obtained from juices, milk, coffee, tea, and other beverages, as well as watery foods such as fruits, vegetables, and soups.

How does the body produce energy? The body derives its energy from foods ingested daily. Car- bohydrates, fats, and proteins are known as the energy

nutrients because they serve as the body’s source for energy. These energy nutrients are quite literally chemicals

that have energy trapped within the bonds between the atoms of which they are made. The energy trapped within these nutrients is released when metabolic pathways within the cells break down the foods into their constit- uent parts, carbon dioxide and water. Some of the energy released is conserved or captured and used to make

another high-energy chemical called ade- nosine triphosphate (ATP). The rest of the energy is lost as heat. ATP is the body’s

direct source of energy for cellular work. Without a con- stant source of ATP, muscles would not be able to gener- ate force, and thus athletes would not be able to move or perform any physical activity.

What are the dietary reference intakes? Several different terms are used to describe the recommendations for macronutrients and micronutrients. The Recommended Dietary Allowances (RDAs) were

developed in 1941 by the U.S. National Academy of Sci- ences. The RDAs were the primary values health pro- fessionals used to assess and plan diets for individu- als and groups and to make judgments about excessive intakes. The RDAs still exist for many nutrients; how- ever, a newer way to quantify nutrient needs and excesses for healthy individ- uals has been devel- oped and termed the Dietary Refer- ence Intakes (DRIs). The DRIs expand on the RDAs and take into consider- ation other dietary quantities such as Estimated Average Requirement (EAR), Adequate Intake (AI), and Tolerable Upper Intake Level (UL). DRIs are con- t i n u a l l y b e i n g r ev i ew e d , a n d reports on various groups of nutrients are published as scientific data are gathered. This com- prehensive effort to develop all compo- nents of the DRIs is

under the auspices of the Standing Committee on the Scientific Evaluation of Dietary Refer- ence Intakes of the Food and Nutrition Board, the Institute of Medicine, and the National Academy of Sciences of the United States, along

energy nutrients Carbohydrates, proteins, and fats serve as the body's source of energy and are considered the energy nutrients.

adenosine triphosphate (ATP) The molecule that serves as the body's direct source of energy for cellular work.

Recommended Dietary Allow- ance (RDA) The average daily dietary intake level that is sufficient to meet the nutrient requirements of the overwhelming majority (i.e., 98%) of a healthy population.

Dietary Reference Intakes (DRIs) A newer way to quantify nutrient needs and excesses for healthy individuals. The DRI expands on the older Recommended Dietary Allowance (RDA) and takes into con- sideration other dietary quantities such as Estimated Average Require- ment (EAR), Adequate Intake (AI), and Tolerable Upper Intake Level (UL).

Estimated Average Require- ment (EAR) The estimated daily intake level of a vitamin or mineral needed to meet the requirements, as defined by a specified indicator of adequacy, of half of the healthy individuals within a given life stage or gender group.

Adequate Intake (AI) A refer- ence intake for nutrients that is used instead of the Recommended Dietary Allowance. When insuffi- cient scientific evidence is available to calculate an Estimated Average Requirement (EAR), then an AI is used. Similar to the EAR and the Recommended Dietary Allowance (RDA), the AI values are based on intake data of healthy individuals.

Tolerable Upper Intake Level (UL) The highest level of daily nutri- ent intake that poses no adverse health effects for almost all individ- uals in the general population.

Gaining the Performance Edge

The DRIs encompass the EAR, RDA, AI, and UL for each macronutri- ent, vitamin, and mineral based on recent research and epidemiologi- cal data of healthy populations. As more information and data are dis- covered, these recommendations will be updated and revised.

6 SECTION 1 The Basics of Sports Nutrition

The first successful fortification program was the addi- tion of iodine to salt in the 1920s to prevent goiter and other iodine deficiency conditions. In general, fortifica- tion is not required by the FDA, with the exception of folic acid in grains and vitamin D in milk. Other fortification programs are designed to enhance the quality of a prod- uct, such as the addition of vitamin A to milk and other dairy foods, as well as lysine to specific corn products to enhance protein quality. The food industry has the free- dom to add any vitamin or mineral to a product. However, the FDA does require companies to show that a dietary insufficiency exists and therefore requires fortification in otherwise standardized products. Some products contain vitamins or minerals not naturally found in the food or beverage, such as added vitamin D and vitamin B12 in soy

milk. Other products boost existing vita- min or mineral con- tent, such as extra vitamin C added to orange juice. Sport supplements, such as bars and shakes, are highly fortified

with a variety of vitamins and minerals. Athletes should check labels to ensure that their total daily consumption of any vitamin or mineral is not in excess of upper dietary limits. For more information about enrichment and forti- fication, visit the FDA’s website at www.fda.gov.

What are the basic nutrition guidelines? The keys to healthful eating are to consume a diet that provides adequate nutrients to maintain health, includes a variety of foods, is balanced, and is consumed in mod- eration. Government agencies have developed several tools that provide general healthful eating guidelines that include balance, variety, and moderation to help the American population maintain or improve health. The Dietary Guidelines for Americans and the MyPlate2 food guidance system are two such tools that convert scien- tific evidence into practical applications that Americans can use to eat more healthfully. These general guidelines are applicable to sedentary and athletic individuals alike.

What are the Dietary Guidelines for Americans? The Dietary Guidelines for Americans, developed jointly by the U.S. Department of Health and Human Services (HHS) and the U.S. Department of Agriculture (USDA), are revised and published every 5 years. The first Dietary Guidelines were published in 1980. The most recent ver- sion of the Dietary Guidelines for Americans was pub- lished in 2015.3 The guidelines provide science-based advice for people age 2 years and older on dietary and physical activity habits that can promote health and reduce the risk for chronic illnesses and conditions such

with Health Canada.1 The definitions of the various DRIs are reviewed in TABLE 1.1 .

What are enriched and fortified foods? When grains are milled, the germ and bran are removed. Because the germ and bran contain a majority of the vita- mins and minerals in whole grains, the resulting refined product is less nutritious. Refined grain products include white flours, bread, pasta, rice, crackers, and cereals. To prevent deficiency diseases, the Food and Drug Admin- istration (FDA) mandated in 1943 that the nutrients lost during the milling process of wheat, rice, and corn be replaced. The nutrients identified and thus added to refined grain products include thiamin, riboflavin, niacin,

and iron. The addi- tion of vitamins and minerals to refined products is termed enrichment.

Fortification is the addition of a vitamin or mineral to a food or beverage in which it was not originally present.

enrichment The addition of vita- mins and minerals to refined/pro- cessed products to increase their nutritional value.

fortification The process of add- ing vitamins or minerals to foods or beverages that did not originally contain them.

Gaining the Performance Edge

Enrichment and fortification of foods and beverages are intended to help individuals meet their daily nutrient needs.

Table 1.1 Review of the Nutrient Intake Descriptors

Descriptor Definition Dietary Reference

Intake (DRI) Umbrella term for all nutrient classifications,

including RDA, EAR, AI, and UL.

Recommended Dietary Allowance (RDA)

Average daily dietary intake level that is sufficient to meet the nutrient requirements of nearly an entire (i.e., 98%) healthy population. The established RDAs can vary based on life stage, including age; gender; and, if appropriate, pregnancy and lactation.

Estimated Average Requirement (EAR)

Daily intake level of a vitamin or mineral estimated to meet the requirements, as defined by a specified indicator of adequacy in half of the healthy individuals within a life stage or gender group.

Adequate Intake (AI) Intake recommendation when insufficient scientific evidence is available to calculate an EAR/RDA. AI values are based on intake data of healthy individuals. However, the results of studies regarding the nutrient in question are not conclusive enough or more study is required before an EAR/RDA can be established.

Tolerable Upper Intake Level (UL)

The highest level of daily nutrient intake that poses no adverse health effects for almost all individuals in the general population. At intakes above the UL, the risk of adverse effects increases.

Chapter 1 Introduction to Sports Nutrition 7

as cardiovascular disease, diabetes, and hypertension. A healthful diet that is not excessive in calories, follows the nutrition recommendations contained in the guide- lines, and is combined with physical activity should enhance the health of most individuals.

The primary purpose of the Dietary Guidelines is to provide the public with information about nutrients and food components that are known to be beneficial for health and to provide recommendations that can be implemented into an eating and exercise plan. The 2015– 2020 Dietary Guidelines cover five interrelated themes. These themes and the key recommendations from the 2015–2020 Dietary Guidelines report are as follows (http://health.gov/dietaryguidelines/2015/guidelines/ executive-summary/):3

Themes 1. Follow a healthy eating pattern across the lifespan.

All food and beverage choices matter. Choose a healthy eating pattern at an appropriate calorie level to help achieve and maintain a healthy body weight, support nutrient adequacy, and reduce the risk of chronic disease.

2. Focus on variety, nutrient density, and amount. To meet nutrient needs within calorie limits, choose a variety of nutrient-dense foods across and within all food groups in recommended amounts.

3. Limit calories from added sugars and saturated fats and reduce sodium intake. Consume an eating pat- tern low in added sugars, saturated fats, and sodium. Cut back on foods and beverages higher in these com- ponents to amounts that fit within healthy eating patterns.

4. Shift to healthier food and beverage choices. Choose nutrient-dense foods and beverages across and within all food groups in place of less healthy choices. Con- sider cultural and personal preferences to make these shifts easier to accomplish and maintain.

5. Support healthy eating patterns for all. Everyone has a role in helping to create and support healthy eating patterns in multiple settings nationwide, from home to school to work to communities.

Key Recommendations Consume a healthy eating pattern that accounts for

all foods and beverages within an appropriate calorie level.

The Dietary Guidelines’ Key Recommendations for healthy eating patterns should be applied in their entirety, given the interconnected relationship that each dietary component can have with others.

A healthy eating pattern includes: • A variety of vegetables from all of the subgroups—

dark green, red and orange, legumes (beans and peas), starchy, and other

• Fruits, especially whole fruits • Grains, at least half of which are whole grains • Fat-free or low-fat dairy, including milk, yogurt,

cheese, and/or fortified soy beverages

Figure 1.1 Exercising regularly, combined with a diet that does not exceed calorie needs, helps manage weight.

• A variety of protein foods, including seafood, lean meats and poultry, eggs, legumes (beans and peas), and nuts, seeds, and soy products

• Oils A healthy eating pattern limits:

• Saturated fats and trans fats, added sugars, and sodium Key Recommendations that are quantitative are pro-

vided for several components of the diet that should be limited. These components are of particular public health concern in the United States, and the specified limits can help individuals achieve healthy eating patterns within calorie limits:

• Consumption of added sugars to less that 10% of calo- ries per day

• Consumption of saturated fats to less than 10% of calories per day

• Consumption of sodium to less than 2,300 mg per day • If alcohol is consumed, it should be consumed in

moderation—up to one drink per day for women and up to two drinks per day for men—and only by adults of legal drinking age.

Meet the Physical Activity Guidelines for Americans. Americans of all ages—children, adolescents, adults,

and older adults—should meet the Physical Activity Guide- lines for Americans to help promote health and reduce the risk of chronic disease. Americans should aim to achieve and maintain a healthy body weight (see FIGURE 1.1 ). The

8 SECTION 1 The Basics of Sports Nutrition

relationship between diet and physical activity contrib- utes to calorie balance and managing body weight.

Although the Dietary Guidelines listed here were developed with the American population’s health in mind, athletes can benefit from implementing the guide- lines in their daily nutrition planning. By selecting a vari- ety of nutrient-dense foods, as dictated in the guidelines, athletes can meet their energy, macronutrient, and micro- nutrient needs for a high level of sport performance. The MyPlate food guidance system can be used to further plan an athlete’s daily food intake by practically applying the information in the Dietary Guidelines.

What is the MyPlate food guidance system? The USDA released the MyPlate food guidance system in 2011 (www.ChooseMyPlate.gov). The USDA’s Center for Nutrition Policy and Promotion, established in 1994, developed the MyPlate system to improve the nutri- tion and well-being of Americans. The MyPlate system (see FIGURE 1.2 ) is a revision of the MyPyramid that was released in 2005. The new icon was developed for two main purposes: (1) to improve the effectiveness in moti- vating consumers to make healthier food choices and (2) to incorporate the latest nutrition science information into the new system. MyPlate and the Dietary Guidelines for Americans complement each other and can provide basic guidelines and practical applications for healthful eating to improve health and well-being.

The MyPlate website encourages individuals to find their healthy eating style and build it throughout their lifetime. The website reminds individuals that every

Figure 1.2 Anatomy of MyPlate.

food and beverage consumed matters. The right mix of foods and nutrients can help athletes be healthier now and in the future. Long-term health can be accom- plished by:

• Focusing on variety, amount, and nutritional value of foods

• Choosing foods and beverages with less saturated fat, sodium, and added sugars

• Starting with small changes to build healthier eat- ing styles

• Supporting healthy eating for everyone Graphically, the MyPlate food guidance system is

a useful and intuitive way for athletes to eat well and improve their health. The MyPlate icon provides a visual representation of a balanced, nutritious meal. The icon is a plate split into four sections, each representing a different type of food (protein, whole grains, fruits, and vegetables). The sections vary in size depending on the recommended portion of each food an athlete should eat. A circle shape next to the plate represents dairy prod- ucts, especially milk. Each of the food groups are further described in print and electronic format to help consum- ers make positive nutrition changes. The concepts and main messages in each food category are described briefly in the following paragraphs.

The key message in the grain group of MyPlate is that at least half of the total grains consumed should be from whole grain sources. The goal is to eat three or more ounce-equivalents of whole-grain products each day. Indi- viduals who require more calories will need to consume more than this amount daily. Examples of whole grains include brown rice, bulgur, oatmeal, and whole wheat breads, crackers, and pastas. Consumers can check the food label for the words “whole grain” and the ingredient panel for the word “whole” or “whole grain” before the grain ingredient.

In the fruit group, MyPlate encourages not only con- suming the recommended amount of fruit each day, but also consuming a wide variety of fruits. Fruits consumed fresh, canned, frozen, dried, or as 100% juice all count toward the fruit recommendation. However, MyPlate rec- ommends focusing on whole fruits versus fruit juices. This recommendation is made because fruit juices tend to be more calorie dense and contain little fiber compared to whole fruits.

Similar to the fruit category, emphasis is placed not only on consuming enough vegetables daily, but also on choosing different vegetables throughout the week to obtain a greater variety of the nutrients provided from vegetables. The vegetables are listed in five subgroups based on nutrient content: dark green, orange, starchy, dry beans and peas, and other vegetables. The main con- sumer message with vegetables and fruits is to “make half of your plate vegetables and fruits.”

The protein foods group includes items made from meat, poultry, fish, dry beans or peas, eggs, nuts, and seeds. The key concept for this group is to make choices Courtesy of USDA.

Chapter 1 Introduction to Sports Nutrition 9

that are low fat or lean when selecting meat and poultry. The dry beans and peas, including soy products, are part of this group as well as the vegetable group. Dry beans and peas are naturally low in fat and nutrient dense. Nuts, seeds, and some fatty fishes contain higher fat content, but these fats are from healthy oils and should be chosen frequently as a substitute for meat or poultry.

The dairy group of MyPlate contains liquid milk prod- ucts, yogurt, cheeses, and many foods made from milk. The key concept for the dairy category is to consume three cups of fat-free or low-fat (1%) milk or an equiv- alent amount of yogurt or cheese per day. Foods made from milk that retain calcium after processing (such as cheese and yogurt) are part of this food group, but foods made from milk that do not contain appreciable calcium (such as cream cheese and butter) are not included in this group. Individuals who do not or cannot consume milk and milk products should consume dairy alterna- tive products (soy, nut, or grain-based milk, yogurt, and cheese) and other calcium-rich foods daily.

A variety of different foods are part of the oils and empty calories categories of MyPlate. Please note that these categories are not food groups. Although Ameri- cans are encouraged to minimize sources of empty calo- ries, some essential nutrients are provided by oils. The key concept in the oils category is to choose mainly monoun- saturated and polyunsaturated fats contained in foods such as fish, nuts, seeds, and vegetable oils. Oils used in liquid form, such as canola, corn, olive, and sunflower, are considered unsaturated and are commonly used in cooking. Other foods that are composed primarily of oils include items such as mayonnaise, salad dressing, and soft margarine. Consumers should review the Nutrition Facts panel of these foods to ensure that no trans fats are present. Foods and beverages containing solid fats and added sugars are considered empty calories because they provide extra calories with few to no nutrients. Although small amounts of these foods can be included daily, most Americans are consuming far more than is healthy and therefore should focus on limiting their intake. Examples of empty calories include butter, shortening, desserts, and sodas.

Physical activity is not depicted in the MyPlate icon but is encouraged as part of a healthy lifestyle. The key message is to become less sedentary and to engage in regular physical activity. Physical activity includes move- ment that uses energy. Adults should engage in at least 2 hours and 30 min- utes of aerobic phys- ical activity at a moderate level each week or 1 hour and 15 minutes of aerobic physical activity at a vigorous level each week. For example, moderate or vigorous

Food for Thought 1.1

ChooseMyPlate Diet Assessment

In this exercise, you will learn how to use the online SuperTracker dietary assessment tool as you analyze your personal diet.

Figure 1.3 The SuperTracker tool allows individuals to get informa- tion that is specific to their needs for energy, nutrient composition, and physical activity level.

activities include walking briskly, hiking, gardening/yard work, golf (walking and carrying clubs), weight training, bicycling, swimming, and aerobics. Physical activities that are not intense enough to meet the recommendations might include walking at a casual pace or doing light household chores.

To personalize a plan, individuals can go to www. ChooseMyPlate.gov2 and use the SuperTracker tool to get information that is specific to their needs for energy, nutri- ent composition, and physical activity level. FIGURE 1.3 shows the food group recommendations, examples of foods that count for each food group, and nutrition tips for an individual requiring a 2000 calorie diet. This indi- vidualization is helpful because not all individuals at the same age and gender have the same physical activity level and energy needs.

Courtesy of USDA.

10 SECTION 1 The Basics of Sports Nutrition

sports nutrition, and how to apply the label information to individual scenarios. A full report and explanation of the food label and associated regulations can be found at www.fda.gov.

Who created the food label regulations? The Food and Drug Administration (FDA) is the govern- ing body responsible for ensuring the safety of foods sold in the United States; this includes overseeing the proper labeling of foods. In 1990, Con- gress passed the Nutrition Label- ing and Education Act (NLEA) based on the demand for consistent con- sumer informa- tion and labeling of all foods. The passage (1990) and implementation (1994) of the NLEA resulted in a series of changes on food packages. A nutrition label is now required on most food packages, with a few exceptions, such as small, individual food packages (modified label required) and meat products (governed by the USDA, therefore no labeling is required). The nutrition label- ing of food products must follow specific FDA guidelines and include the following: (1) a statement of identity; (2) the net contents; (3) the name and address of the manu- facturer, packer, or distributor; (4) an ingredient list; and (5) a Nutrition Facts panel. The statement of identity is prominently displayed on the front of the food label and gives the commonly used name or a descriptive title to the food contained within the package. Also on the front of the food label along the bottom edge, the net contents can be found. The net contents give the quantity of food within the package and are expressed in units of weight, volume, or numeric count. The name and address of the producer or distributor of the product is usually in the small print found beneath the list of ingredi- ents. Contact information is important in case the ath- lete has further questions about the product or needs to report problems. The food label may also include FDA- approved nutrient content claims or health claims that highlight certain characteristics or potential benefits of the food. Finally, the list of ingredients and Nutrition Facts panel must be shown on the label. Each is discussed in the following sections.

The MyPlate website provides a wealth of informa- tion for consumers to apply healthful eating and exer- cise patterns into their daily lifestyle. Athletes can use the website tools to learn their personalized nutrient needs. Many athletes who train extensively daily will need a significantly higher number of calories than the average person. These additional calories should be con- sumed in nutrient-dense foods from the MyPlate food groups. In summary, MyPlate provides detailed guide- lines for improving overall health, as well as athletic performance, with adequate daily nutrition and physi- cal activity.

How should athletes interpret the information on food labels? The nutrition guidelines presented in this text are a com- bination of the current research in sports nutrition and the practical application of that knowledge. A large part of the practical portion is athletes’ awareness of how the foods they eat contribute to their total daily needs. The food label (see FIGURE 1.4 ) provides athletes with credible and reliable nutrition information about various food and beverage products, ultimately empowering them to make wise food choices on a daily basis. However, some athletes find the food label confusing and difficult to interpret. This section will provide a brief overview of the food label, the components that pertain directly to

Figure 1.4 Information on food labels. Federal regulations determine what can and cannot appear on food labels.

Food and Drug Administration (FDA) The governing body respon- sible for ensuring the safety of foods sold in the United States. This includes oversight of the proper labeling of foods.

nutrient content claims Nutri- tion-related claims on food labels that highlight certain characteris- tics of the food.

health claim A description placed on a food label that describes potential health benefits of a food or nutrient.

Nutrition information

List of ingredients

Information about the

manufacturer

Chapter 1 Introduction to Sports Nutrition 11

How can the ingredient list be useful to athletes? An ingredients list is required on all foods that contain more than one ingredient. The ingredients must be listed in descending order of predominance in the product. The order of predominance is determined by weight, with the ingredient that weighs the most listed first and the one that weighs the least listed last. Athletes can use this nutrition tool to evaluate the nutrition quality of a prod- uct as well as to ensure that they avoid any food/additive to which they may be allergic or intolerant.

The nutrition quality of a product can be evaluated by the presence of a specific ingredient as well as the order of listed ingredients. For example, many athletes are instructed to increase their daily intake of fiber. Know- ing that whole-grain products will contain more fiber than refined flour products, athletes can use the ingre- dients label to choose breads, muffins, bagels, and pastas that contain “whole wheat flour” versus “enriched white flour.” Another common example pertains to choosing a healthy cereal. Many cereals contain a large quantity of added refined sugars. By studying the order of ingre- dients on the label and choosing a brand that does not have “sugar,” “sucrose,” “corn syrup,” or other types of sugar in the first two or three ingredients, athletes can feel confident that they have chosen a lower-sugar, and potentially healthier, cereal.

How can the nutrition facts panel be useful to athletes? The Nutrition Facts panel informs consumers about the specific nutrient content of foods in quantifiable terms. Manufacturers must use the Nutrition Facts panel within the specified FDA guidelines and must provide accurate information about the nutrient content of the food. In May of 2016, the FDA updated labeling require- ments; however, manufacturers will not have to be in full compliance with the new guidelines until July 2018. As a result, consumers will see both the current/original Nutrition Facts panel and the new version of the Nutri- tion Facts panel as manufacturers begin phasing in the required changes to their food labels. An example and description of the current/original Nutrition Facts panel are presented in FIGURE 1.5 . Foods that are not required to carry a Nutrition Facts panel include delicatessen- style foods; fresh bakery products; foods that provide no significant nutrition, such as instant coffee and most spices; and multiunit packages. Smaller packages may require a modified Nutrition Facts panel, as shown in

FIGURE 1.6 . Starting just below the Nutrition Facts heading on

each food label, the following required components are all applicable to athletes:

• Serving size and servings per container: Athletes need to understand what counts as one serving. Often,

Figure 1.5 The Nutrition Facts panel.

Pr od

uc t-

sp ec

i� c

In fo

rm at

io n

Co ns

is te

nt In

fo rm

at io

List of Nutrients

Serving Size: The serving size is a standardized reference amount, but check twice to see if this is the amount you usually eat. The numbers that you will be looking at are based on this quantity.

% Daily Values: These percentages are based on the values given below in the footnote for a 2000-calorie diet. Thus, if your caloric intake is different, you will need to adjust these values appropriately.

Daily Values Footnote: Daily Values are shown for two caloric intake levels to emphasize the importance of evaluating your own diet in order to apply the information on the label.

Caloric Conversion Information: Handy reference values help you check the math on your own calculations!

Title

Calories Per Serving: Having the number of calories and the number of calories from fat next to each other makes it easy to see if a food is high in fat.

Vitamin A 0% • Vitamin C 0% Calcium • Iron 0% 4% * Percent Daily Values are based on a 2,000

calorie diet. our daily values may be higher or lower depending on your calorie needs:

Calories per gram: Fat 9 • Carbohydrate 4 • Protein 4

2,500 80g 25g 300mg 2,400mg 375g 30g

2,000 65g 20g 300mg 2,400mg 300g 25g

Calories: Less Than Less Than Less Than Less Than

Total Fat Sat Fat Cholester Sodium Total Carbohydrate Dietary Fiber

Dietary Fiber 2g 8% Sugars 2g

Protein 4g

2% 1%

Total Fat1g Saturated Fat 0g Trans Fat 0g

Cholesterol 0mg Sodium160mg Total Carbohydrate 15g

0% 7%

% Daily Value*

Amount Per Serving

Calories 90 Calories from fat 10

Serving Size: 1 slice (34g/1.2 oz) Servings Per Container: 20

Nutrition Facts

12 SECTION 1 The Basics of Sports Nutrition

panel represents the total quantity of fiber present in a product but does not distinguish between soluble and insoluble fibers. The “sugar” category is a com- bination of naturally occurring and refined sugars. Because there is no distinction between naturally occurring and added refined sugars on the current nutrition facts panel, an athlete should review the ingredients list for the presence of fruits and fruit juices (naturally occurring sugars often accompanied by many other nutrients) or any refined sugar prod- uct (providing calories and carbohydrates but devoid of other nutritional value). There is no Percent Daily Value (%DV, discussed in the following section) for sugars because there are no RDA values or Daily Ref- erence Values (DRVs) established specific to sugars. It should be noted that this has been changed on the newly revised Nutrition Facts panel that now must show “added sugars” and their %DV.

• Protein: The total quantity of protein, another indis- pensable nutrient for athletes, is provided on the Nutrition Facts panel.

• Vitamins and minerals: On the current Nutrition Facts panel only two vitamins (vitamins A and C) and two minerals (calcium and iron) are required on the food label. On the newly revised Nutrition Facts panel vitamin D and potassium are also required to be listed. Of course, all vitamins and minerals are important for athletes; however, these four nutrients are generally consumed in suboptimal quantities in the United States and therefore deserve special attention.

• Daily Values footnote and calorie conversion: The con- cept of Daily Values will be discussed in the follow- ing section. The calorie conversion information is a handy reference for athletes so that they can perform their own calculations based on individual needs and goals. As noted earlier, the FDA has revised its guidelines for

the Nutrition Facts panel and manufacturers will have to comply with the new labeling requirements by July 2018. FIGURE 1.7 shows a side-by-side comparison of the cur- rent and revised Nutrition Facts panels. While the basic look of the label remains similar, there are several fea- ture changes that better highlight important consumer information. These feature changes include increases in the font size of “Calories”, “Servings Per Container”, and the “Serving Size”. Also the “Calories” and “Serving Size” have been bolded for further emphasis and easy location on the label. Finally, the footnote at the bottom of each Nutrition Facts panel has been revised to better explain what percent daily value means.

The revised labeling also includes some informa- tional changes. Food manufacturer’s will not only have to continue to list the percent Daily Values for certain nutri- ents, they will also need to report the actual amounts of those nutrients in grams. In regard to vitamins and

Figure 1.6 Nutrition Facts panel on small packages. Food products that have small packages can use an abbreviated version of the Nutrition Facts panel.

athletes consider one package to be “one serv- ing,” when in fact there could be multiple servings included in a container, as stated on the Nutrition Facts panel. Because the nutrition information is pre- sented for one serving, athletes will need to multiply the nutrition information listed on the Nutrition Facts panel by the number of servings consumed to obtain an accurate estimate of total nutrient intake.

• Calories and calories from fat: Reviewing the calo- rie content of foods eaten throughout the day will enable athletes to ensure adequate total energy con- sumption. To obtain the percentage of calories from fat, the “calories from fat” can be divided by the total “calories” and then multiplied by 100. On the newly revised Nutrition Facts panel, “calories from fat” has been removed, thus it needs to be calculated. To do so, locate “total fat” on the panel and multiply the total fat in grams by 9. Athletes should aim for a diet that includes no more than 30–35% of total calories from fat, indicating it is low to moderate in fat. Calcu- lating the percentage for each food chosen through- out the day can help athletes make healthy choices.

• Total fat, saturated fat, and trans fat: Fat is important in an athlete’s diet; however, it should be consumed in moderation. Athletes can compare different brands or types of food to find low- or moderate-fat options. Saturated and trans fats are detrimental to heart health; therefore, athletes should attempt to mini- mize their intake of these fats.

• Cholesterol: Cholesterol is not a required nutrient in the diet. Cholesterol is made in the body and there- fore does not need to be consumed daily.

• Sodium: Classified as an electrolyte, sodium is an essential nutrient for athletes because it is lost in sweat. Sodium has also been linked to high blood pressure. Athletes should consume enough to meet their needs but avoid excessive intake.

• Total carbohydrates, dietary fiber, and sugars: Carbohy- drates are the master fuel for all athletics and should compose a majority of an athlete’s diet. Dietary fiber plays a role in weight management and disease pre- vention and aids in the maintenance of blood sugar levels that deliver a consistent dose of energy to the body. The “dietary fiber” section on the Nutrition Facts

Chapter 1 Introduction to Sports Nutrition 13

minerals that must be listed on the label, Vitamin D and potassium have been added, while Vitamins A and C have been dropped from required listing to optional list- ing. Calcium and iron will continue to be required on the list of nutrients. The amount of “added sugar” will need to appear on the label along with its percent daily value. While the “Total Fat”, “Saturated Fat” and “Trans Fat” con- tent will continue to be required information on the label, the “Calories from Fat” has been removed due to the fact that the calories from fat is not as important as the type of fat consumed.

Finally, serving sizes have been adjusted based on packaging size and what people are likely to eat in regard to amount consumed in one sitting, rather than what they are supposed to eat (i.e., a suggested serv- ing size). In addition, products that are packaged with

more than one serving but that could be consumed in one sitting will be required to add a second column to indicate the amount of calories and contents per pack- age (see FIGURE 1.8 )

For the purposes of this book, the newly revised label- ing guidelines will be used and referred to in subsequent chapters.

How can the percent daily value be useful to athletes? The Percent Daily Value (%DV) is listed on the food label for a variety of macronutrients, vitamins, and miner- als. The %DV can be used to determine how a particular product meets an athlete’s needs as well as to compare the nutrient content of two different products. For exam- ple, the DV for cholesterol is less than 300 milligrams.

Figure 1.7 Side-by-side comparison of the current Nutrition Facts Label (left) to the newly revised label (right).

Nutrition Facts Serving Size 2/3 cup (55g) Servings Per Container About 8

Amount Per Serving Calories 230

Total Fat 8g Saturated Fat 1g Trans Fat 0g Cholesterol 0mg Sodium 160mg Total Carbohydrate 37g Dietary Fiber 4g Sugars 1g Protein 3g

Vitamin A Vitamin C Calcium Iron * Percent Daily Values are based on a 2,000 calorie diet. Your daily values may be higher or lower depending on your calorie needs:

Calories: Total Fat Sat Fat Cholesterol Sodium Total Carbohydrate Dietary Fiber

Less Than Less Than Less Than Less Than

65g 20g 300mg 2,400mg 300g 25g

80g 25g 300mg 2,400mg 375g 30g

2,000 2,500

10% 8%

20% 45%

% Daily Value*

12% 5%

0% 7%

12% 16%

Calories from Fat 40

Nutrition Facts 8 servings per container Serving size

Amount per serving

2/3 cup (55g)

Calories 230 % Daily Value*

Total Fat 8g Saturated Fat 1g Trans Fat 0g

Cholesterol 0mg Sodium 160mg Total Carbohydrate 37g

Dietary Fiber 4g Total Sugars 12g

Protein 3g Includes 10g Added Sugars

10% 5%

14%

7% 13%

20%

* The % Daily Value (DV) tells you how much a nutrient in a serving of food contributes to a daily diet. 2,000 calories a day is used for general nutrition advice.

Vitamin D 2mcg Calcium 260mg Iron 8mg Potassium 235mg

10%

20% 45%

Reproduced from FDA. Changes to the Nutrition Facts Label. Retireved from: http://www.fda.gov/Food/GuidanceRegulation/GuidanceDocumentsRegulato- ryInformation/LabelingNutrition/ucm385663.htm

14 SECTION 1 The Basics of Sports Nutrition

The %DV represents what percentage of the daily total is provided in one serving of a product. If the product provides 100 milligrams of cholesterol, the %DV will be 33%, because 100 is one-third of 300. The overall concept is that athletes can tally up the percentages of all foods consumed throughout the day and aim for a grand total of 100%, indicating that all needs have been met. How- ever, the caveat is that the %DV is based on the needs of an individual following a 2000-calorie diet. Many athletes require substantially more than 2000 calories daily, and therefore obtaining 100% of all nutrients may not necessarily be adequate. The Daily Values footnote, listed on most current Nutrition Facts panels, presents additional information for those following a 2500-calo- rie diet; however, even the 2500-calorie goals may not be enough for most athletes. In general, athletes may find it easier to know their individual daily needs and evaluate a product based on their own goals versus the %DV goals. TABLES 1.2 and 1.3 summarize the reference

Figure 1.8 An example of the newly revised Nutrition Facts label on a packaged food product that contains more than one serving, and is packaged in such a way that the entire contents could be eaten in one sitting.

amounts used to develop the %DV for macronutrients and micronutrients.

Whether or not the %DV can be useful for an athlete’s individual needs, it can be used to compare the nutrient density of various products. As an example, athletes who need to consume more iron can look at the %DV of sev- eral brands of cereal and know that the brand with the highest %DV for iron contains the greatest total quantity of iron, therefore making that brand the best choice. The benefit of this type of comparison is that athletes are not required to memorize how much iron they need in a day; they merely need to look for the product with the highest percentage (highest %DV). See FIGURE 1.9 for an example of this type of comparison.

How can nutrient content claims be useful to athletes? In addition to the Nutrition Facts section, the NLEA of 1990 included guidelines for food manufacturers to place nutrition-related claims on food labels. These claims highlight certain characteristics of the food and are called nutrient content claims. Foods can be labeled with claims such as “low fat,” “reduced sugar,” or “high in fiber” only if they meet certain criteria. The definitions of the approved nutrient content claims are presented in Fortifying Your Nutrition Knowledge. These nutrition descriptor statements allow athletes to quickly identify the products that meet their individual needs or dietary goals. For example, if an athlete has high cholesterol lev- els, a product labeled “cholesterol free” would be easily identifiable.

Currently, there are no approved regulations on nutrition descriptors or content claims regarding total carbohydrates. Because of the growing trend of consum- ers choosing low-carbohydrate foods in hopes of losing weight, food manufacturers are placing terms such as “low carb” and “net carbs” on food labels. The FDA is cur- rently gathering evidence and developing a statement

Table 1.2 Daily Values on Food Labels

Food component 2000 kcal intake Fat 65 g

Saturated fat 20 g

Protein 50 g

Cholesterol 300 mg

Carbohydrates 300 g

Fiber 25 g

Sodium 2400 mg

Data from U.S. Food and Drug Administration. Available at: http://www.fda. gov/Food/GuidanceRegulation/GuidanceDocumentsRegulatoryInformation/ LabelingNutrition/ucm064928.htm.

Nutrition Facts 2 servings per container Serving size 1 cup (255g)

Calories 110 220 % DV* % DV*

Total Fat Saturated Fat Trans Fat

Cholesterol Sodium Total Carb.

Dietary Fiber Total Sugars

Protein Includes Added Sugars

6% 10%

21%

10%

13%

Per serving Per

container

13% 20%

10%

43%

21%

25%

16%

Vitamin D Calcium Iron Potassium

* The % Daily Value (DV) tells you how much a nutrient in a serving of food contributes to a daily diet. 2,000 calories a day is used for general nutirtion advice.

25% 15%

50% 30% 12%

10% 20%

10g5g

4g2g

0g 0g

30mg

480mg

70g

12g 14g

15mg

240mg

35g

6g 7g

18g9g

5mcg

200mg

1mg

470mg

10mcg

400mg

2mg

940mg

Reproduced from FDA. Changes to the Nutrition Facts Label. Retireved from: http://www.fda.gov/Food/GuidanceRegulation/GuidanceDocu- mentsRegulatoryInformation/LabelingNutrition/ucm385663.htm

Chapter 1 Introduction to Sports Nutrition 15

claims that have been well supported in the scientific lit- erature. To date, the following health claims have been approved (www.fda.gov): 1. Calcium and osteoporosis: Adequate calcium may

reduce the risk of osteoporosis. 2. Sodium and hypertension (high blood pressure): Low-

sodium diets may help lower blood pressure. 3. Dietary fat and cancer: Low-fat diets decrease the risk

for some types of cancer. 4. Dietary saturated fat and cholesterol and the risk of coro-

nary heart disease: Diets low in saturated fat and cho- lesterol decrease the risk for heart disease.

5. Fiber-containing grain products, fruits, and vegetables and cancer: Diets low in fat and rich in high-fiber foods may reduce the risk of certain cancers.

6. Fruits, vegetables, and grain products that contain fiber, particularly solu- ble fiber, and the risk of coronary heart disease : Diets low in fat and rich in sol- uble fiber may reduce the risk of heart disease.

7. Fruits and vegetables and cancer: Diets low in fat and rich in fruits and vegetables may reduce the risk of certain cancers.

8. Folate and neural tube defects: Adequate folate status before and early in pregnancy may reduce the risk of neural tube defects (a birth defect).

9. Dietary noncariogenic carbohydrate sweeteners and den- tal caries (cavities): Foods sweetened with sugar alco- hols, D-tagatose, and sucralose do not promote tooth decay.

10. Soluble fiber from certain foods and risk of coronary heart disease: Diets low in fat and rich in these types of fiber can help reduce the risk of heart disease.

11. Soy protein and risk of coronary heart disease: Foods rich in soy protein as part of a low-fat diet may help reduce the risk of heart disease.

12. Plant sterol/stanol esters and risk of coronary heart dis- ease: Diets low in saturated fat and cholesterol that also contain several daily servings of plant stanols/ sterols may reduce the risk of heart disease.

13. Whole-grain foods and risk of heart disease and certain can- cers: Diets high in whole-grain foods and other plant foods and low in total fat, saturated fat, and cholesterol may help reduce the risk of heart disease and certain cancers.

14. Potassium and the risk of high blood pressure and stroke: Diets that contain good sources of potassium may reduce the risk of high blood pressure and stroke.

15. Fluoridated water and reduced risk of dental caries: Drinking fluoridated water may reduce the risk of dental caries or tooth decay.

outlining carbohydrate food-labeling guidelines. Guide- lines are likely to be similar to those established for such terms as “low fat” or “reduced sugar.” In the meantime, athletes should recognize that carbohydrates are the master fuel for athletics, and therefore products tout- ing a lower carbohydrate content may not be an ideal choice.

How can health claims be useful to athletes? Health claims describe the potential health benefits of a food or nutrient. The FDA strictly regulates allow- able health claims on food labels and allows only health

Food for Thought 1.2

Reading Food Labels

In this exercise, you will locate vari- ous pieces of key information on the food label and use it to inter- pret the nutritional value of a food.

Table 1.3 Daily Values for Athletes Older Than 4 Years

Food component Daily value Protein 50 g

Vitamin A 5000 IUa

Vitamin D 400 IU

Vitamin E 30 IU

Vitamin K 80 μgb

Vitamin C 60 mg

Foltae 400 μg

Thiamin 1.5 mg

Riboflavin 1.7 mg

Niacin 20 mg

Vitamin B6 2 mg

Vitamin B12 6 μg

Biotin 300 μg

Pantothenic acid 10 mg

Calcium 1000 mg

Phosphorus 1000 mg

Iodine 150 μg

Iron 18 mg

Magnesium 400 mg

Copper 2 mg

Zinc 15 mg

Chloride 3400 mg

Manganese 2 mg

Selenium 70 μg

Chromium 120 μg

Molybdenum 75 μg

aIU = international units bμg = micrograms Note: Some DVs are based on old DRI values and thus may not reflect current recommendations. Data from U.S. Food and Drug Administration. Available at: http://www.fda. gov/Food/GuidanceRegulation/GuidanceDocumentsRegulatoryInformation/ LabelingNutrition/ucm064928.htm.

16 SECTION 1 The Basics of Sports Nutrition

16. Saturated fat, cho- lesterol, and trans fat, and reduced risk of heart dis- ease : Replac- ing saturated fat with simi- lar amounts of unsaturated fats may reduce the risk of heart dis- ease. To achieve this benefit , total daily calo- ries should not increase. New hea l th

claims can be approved at any time based on scientific evidence, and, there- fore, this list may expand in the future.

What are the factors to consider when developing an individualized sports nutrition plan for athletes? As mentioned earlier, one of the exciting aspects of the field of sports nutrition is individualizing eating plans for athletes. Each athlete is different—there is no “one-size- fits-all” type of meal plan, training diet, or competition hydration schedule. Certainly the basic sports nutri- tion concepts and guidelines can be applied universally; however, each athlete will require a unique approach by tweaking those guidelines to fit individual needs. For example, all athletes should consume a combination of carbohydrates and protein after exercise to initiate the repair and rebuilding process. However, one athlete may enjoy a turkey sandwich with a banana, whereas another athlete may crave an omelet, toast, and orange juice. Both of these meals meet the carbohydrate–protein combina- tion requirement but also take into consideration per- sonal taste preferences. This individualized approach is much more challenging and requires a greater breadth of knowledge than “cookie-cutter” plans. Sports nutrition

Figure 1.9 Comparing iron content of two cereals. These labels are from two different breakfast cereals: (left) cornflakes and (right) wheat bran. Comparing the iron content of both cereals is easy using the Percent Daily Values of each.

Gaining the Performance Edge

The food label can be very help- ful to athletes choosing to follow a more healthful diet. Athletes should review all the information on the Nutrition Facts panel as well as the ingredients list to aid in making informed food and bev- erage choices. Nutrient content claims and health claims identify products that might be appealing to individual athletes based on their nutrition goals and needs; however, these statements should not take the place of review- ing the Nutrition Facts panel and ingredients list.

Nutrition Facts 18 servings per container Serving size

Amount per serving

1 cup (28g)

Calories 100 Cereal

with ½ cup Skim Milk

% Daily Value*

Total Fat 0g Saturated Fat 0g Trans Fat 0g

Cholesterol 0mg Sodium 300mg Total Carbohydrate 24g

Dietary Fiber 1g Total Sugars 23g

Protein 3g Includes 10g Added Sugars

0% 0%

13% 8%

20%

* The % Daily Value (DV) tells you how much a nutrient in a serving of food contributes to a daily diet. 2,000 calories a day is used for general nutrition advice.

Vitamin D 2mcg Calcium 0mg Iron 9mg Potassium 25mg

10%

25%

0% 45%

140

15% 10%

25%

15% 45%

Nutrition Facts 15 servings per container Serving size

Amount per serving

1 cup (30g)

Calories 60 % Daily Value*

Total Fat 1g Saturated Fat 0g Trans Fat 0g

Cholesterol 0mg Sodium 125mg Total Carbohydrate 24g

Dietary Fiber 13g Total Sugars 11g

Protein 4g Includes 0g Added Sugars

2% 0%

52%

5% 8%

* The % Daily Value (DV) tells you how much a nutrient in a serving of food contributes to a daily diet. 2,000 calories a day is used for general nutrition advice.

Vitamin D 2mcg Calcium 78mg Iron 5mg Potassium 230mg

6% 25%

100

52%

8% 10%

10%

12%

20% 25%

Cereal with ½ cup Skim Milk

Chapter 1 Introduction to Sports Nutrition 17

professionals with this philosophy will succeed because of the recognition that their plans are based on solid research and current guidelines while also being practi- cal, easy to implement, and specific to an athlete’s sport and lifestyle.

Several factors must be considered when calculating nutrient needs and developing a meal plan for an athlete, including the individual’s health history, the bioenergetics of the athlete’s sport, total weekly training and competi- tion time, living arrangements, access to food, and travel schedules.

Why should a sports nutrition plan consider an athlete’s health history? First and foremost, an athlete must be healthy to train and compete to his or her potential. Proper nutrition plays a vital role in preventing deficiency and degenerative dis- eases, while also aiding in the treatment of existing medi- cal conditions. An athlete’s health history must be the “team captain” in the sports nutrition game plan, with sport-specific planning, training/competition schedules, living arrangements, and personal preferences rounding out the starting lineup.

Fortifying Your Nutrition Knowledge

Approved Nutrient Content Claims Free: Food contains no amount (or trivial or “physiologically inconsequential“ amounts). May be used with one or more of the following: fat, saturated fat, cholesterol, sodium, sugar, and calorie. Synonyms include without, no, and zero.

Fat-free: Less than 0.5 g of fat per serving. Saturated fat-free: Less than 0.5 g of saturated fat and less than 0.5 g trans fat per serving. Cholesterol-free: Less than 2 mg of cholesterol per serving. Sodium-free: Less than 5 mg of sodium per serving. Sugar-free: Less than 0.5 g of sugar per serving. Calorie-free: Fewer than 5 calories per serving.

Low: Food can be eaten frequently without exceeding dietary guidelines for one or more of these components: fat, saturated fat, cholesterol, sodium, and calories. Synonyms include little, few, and low source of.

Low fat: 3 g or less per serving. Low saturated fat: 1 g or less of saturated fat; no more than 15% of calories from saturated fat. Low cholesterol: 20 mg or less per serving. Low sodium: 140 mg or less per serving. Very low sodium: 35 mg or less per serving. Low calorie: 40 calories or less per serving.

High, Rich in, Excellent source of: Food contains 20% or more of the Daily Value for a particular nutrient in a serving. Good source, Contains, Provides: Food contains 10–19% of the Daily Value for a particular nutrient in one serving. Lean and Extra lean: The fat content of meal and main dish products, seafood, and game meat products.

Lean: Less than 10 g fat, 4.5 g or less saturated fat, and less than 95 mg of cholesterol per serving and per 100 g. Extra lean: Less than 5 g fat, less than 2 g saturated fat, and less than 95 mg of cholesterol per serving and per 100 g.

Reduced, Less: Nutritionally altered product containing at least 25% less of a nutrient or of calories than the regular or reference product. (Note: A “reduced” claim can't be used if the reference product already meets the requirement for “low.”) Light: This descriptor can have two meanings:

1. A nutritionally altered product contains one-third fewer calories or half the fat of the reference food. If the refer- ence food derives 50% or more of its calories from fat, the reduction must be 50% of the fat.

2. The sodium content of a low-calorie, low-fat food has been reduced by 50%. Also, light in sodium may be used on a food in which the sodium content has been reduced by at least 50%.

Note: “Light” can still be used to describe such properties as texture and color as long as the label clearly explains its mean- ing (e.g., light brown sugar or light and fluffy). More, Fortified, Enriched, Added, Extra, Plus: A serving of food, whether altered or not, contains a nutrient that is at least 10% of the Daily Value more than the reference food. May only be used for vitamins, minerals, protein, dietary fiber, and potassium. Healthy: A healthy food must be low in fat and saturated fat and contain limited amounts of cholesterol (≤95 mg) and sodium (≤480 mg for individual foods and ≤600 mg for meal- type products). In addition, a single-item food must provide at least 10% or more of one of the following: vitamins A or C, iron, calcium, protein, or fiber. A meal-type product, such as a frozen entrée or dinner, must provide 10% of two or more of these vita- mins or minerals, or protein, or fiber, in addition to meeting the other criteria. Additional regulations allow the term healthy to be applied to raw, canned, or frozen fruits and vegetables and enriched grains even if the 10% nutrient content rule is not met. However, frozen or canned fruits or vegetables cannot contain ingredients that would change the nutrient profile. Fresh: Food is raw, has never been frozen or heated, and con- tains no preservatives. Fresh frozen, frozen fresh, and freshly fro- zen can be used for foods that are quickly frozen while still fresh. Blanched foods also can be called fresh. Percent fat free: Food must be a low-fat or a fat-free product. In addition, the claim must reflect accurately the amount of nonfat ingredients in 100 g of food. Implied claims: Implied claims suggest that a nutrient is absent or present in a certain amount or suggests a food may be use- ful in maintaining healthy dietary practices. These claims are prohibited when they wrongfully imply that a food contains or does not contain a meaningful level of a nutrient. For example, a product cannot claim to be made with an ingredient known to be a source of fiber (such as “made with oat bran”) unless the product contains enough of that ingredient (in this case, oat bran) to meet the definition for “good source” of fiber. As another example, a claim that a product contains “no tropical

18 SECTION 1 The Basics of Sports Nutrition

time each day to training and competition. Obviously, the athletes who are more active will have greater energy and nutrient needs. However, it is not always as simple as tell- ing highly active athletes to “eat more.” Many athletes struggle to meet their daily needs because of the time constraints of meal planning and preparation, as well as short periods of time between workouts, work, school, and other life commitments. Sports nutrition profession- als need to be creative in helping athletes to determine how to consume adequate amounts of energy and nutri- ents while making meal planning easy, convenient, and quick.

A sports nutrition plan also includes the develop- ment of a fueling and hydration schedule for train- ing and competition. The timing of meals and snacks must be strategi- cally scheduled to provide enough time for food to digest before train- ing sessions and to prevent too much time from elapsing after training. Fluid requirements vary considerably among athletes. Therefore, the construction of a hydration schedule is individualized for the athlete and spe- cific to the sport. The energy and nutrients consumed before, during, and after exercise are part of an overall daily sports nutrition plan that can literally make or break an athlete’s performance. The more time an athlete spends training each week, the more strategic planning needs to occur to create an appropriate, individualized regimen (see FIGURE 1.10 ).

Why should a sports nutrition plan consider an athlete’s living arrangements, access to food, and travel schedule? A perfectly calculated nutrition plan is worthless if the athlete cannot execute the plan because of a lack of con- trol over the foods available to him or her on a daily basis. For example, a college athlete who lives in a dorm is at the mercy of what is served in the university cafeterias. Therefore, the cafeteria menus should be built into the sports nutrition plan for this athlete. Sports nutrition professionals must fully understand each athlete’s living arrangements and access to food before developing an individualized program.

For example, an athlete with diabetes must care- fully balance his or her intake of carbohydrates with daily doses of insulin to prevent hyper- or hypoglyce- mia. Whereas most athletes would not think twice about drinking a large glass of juice in the morning before a workout, a diabetic athlete consuming only juice (a car- bohydrate source without a protein source to stabilize the digestion of food and blood sugar levels) may experi- ence blood sugar swings that can potentially affect per- formance. In addition to performance in a single workout, long-term poor blood sugar management can lead to a plethora of associated medical conditions later in life. An athlete’s health history must be considered first and then, subsequently, recommendations can intertwine with sport-specific suggestions.

Why should a sports nutrition plan consider a sport’s bioenergetics and logistics? Energy metabolism is the foundation of sports nutrition. Consideration of the cellular machinery and metabolic pathways responsible for making the energy needed to participate in a specific sport is critical for the develop- ment of an individualized eating plan. For example, the calorie, macronutrient, and micronutrient needs of a foot- ball player (intermittent exertion over the course of sev- eral hours) will be different from the needs of a rower (continuous effort for typically less than 10–20 minutes). Even within one sport, such as running, different events (100-meter sprint versus a marathon) will highlight vari- ous energy systems (short, intense effort versus sustained moderate effort). In addition to the bioenergetics of a sport, nutrition plans for athletes must also consider the logistics of training sessions and competitions. Some sports are very conducive to drinking and eating during activity (biking), whereas other sports make fluid and energy consumption difficult (open water swimming). Sports nutrition profes- sionals must devise plans that are specific to the energy systems utilized during training and competition as well as realistic to the nature of an athlete’s sport.

Why should a sports nutrition plan consider an athlete’s total weekly training and competition time? Athletes can range from the weekend warrior to the full- time professional. Each athlete will dedicate a period of

oils” is allowed, but only on foods that are “low” in saturated fat, because consumers have come to equate tropical oils with high levels of saturated fat.

Source: Reproduced from Food and Drug Administration. Food Label- ing and Nutrition: Nutrient Content Claims Definitions and Approved Claims. Available at: http://www.fda.gov/Food/GuidanceRegula- tion/GuidanceDocumentsRegulatoryInformation/LabelingNutrition/ ucm2006828.htm.

Gaining the Performance Edge

Individualization in nutrition plan- ning for athletes is essential for success as a sports nutrition profes- sional. Standardized plans will con- tribute to the great success of some athletes, while leaving others on the sidelines. Incorporating factors such as an athlete's health history, the bioenergetics and logistics of the sport, weekly training/competition time, living arrangements, access to food/beverages, and travel sched- ules into an individualized nutri- tion program will ultimately lead to the athlete's success and peak performance.

Chapter 1 Introduction to Sports Nutrition 19

How can sports nutrition knowledge be converted into practical applications? One of the biggest challenges facing all health promotion professionals is helping people make permanent behav- ior changes. When working with individuals, possessing “book” knowledge is only one part of the equation; pro- fessionals must know how to assess a person’s readiness for change, engage in active listening, and then provide the appropriate information or guidance. This process is particularly applicable to counseling athletes on dietary changes to improve performance. Not only should meal plans be based on individual needs, but the construction of the plans also must take into consideration the ath- lete’s preparedness for change. One tool that that can be used to counsel athletes is the Transtheoretical Model,4 which assesses a person’s readiness for change.

The skill of active listening can be a powerful tool for helping athletes initiate change. Athletes want to know that a sports nutrition professional cares about them, their performance, and their capabilities for change. Sports nutrition professionals should refrain from developing a “dictatorship” where athletes simply sit quietly and listen to

the dietary changes they “need” to make to improve their per- formance and/or health. Instead, ath- letes should be active participants in their meal planning and goal setting. Food selections should be based on an athlete’s likes and dislikes ver- sus which foods are “best” for them—if an athlete does not enjoy the foods in

the established meal plan, adherence will be poor. Goals should be realistic and manageable to plant the seeds for success and accomplishment that will motivate athletes to continue working on healthy eating behaviors. Listen to athletes—know their goals, questions, and concerns—and then build an individu- alized plan that is mutually acceptable and productive.

Access to food can also be a factor before, during, or after competitions. Many athletes are required to eat with the team at their training table before a game, thereby limiting their food choices to what is provided for the team. Recreational athletes who are participat- ing in weekend events, such as running or walking road races, often must rely on the products supplied on the course for hydration and fueling. Developing an appropri- ate race day plan for these athletes involves investigating the foods and beverages available on the course and then planning for the athletes to practice with these specific items throughout training to prevent any surprises on race day. Consuming the optimal blend of nutrients after exercise is also of great importance. Each athlete will vary in his or her ability to pack a postexercise snack or deci- pher the most appropriate food/beverage option from a buffet of available items.

Proper nutrition while traveling is a challenge for everyone—athletes and nonathletes alike. Travel forces individuals to change their routine, sometimes wreaking havoc on an athlete’s good intentions and typical nutri- tion habits. Athletes must be educated on how to make healthy choices and appropriate substitutions while on the road. Creative planning, packing nonperishable foods for the trip, and learning to be flexible will help athletes remain optimally fueled while traveling.

Figure 1.10 Athletes may travel to events and stay at the competition venue for several hours or all day. Athletes need to plan ahead to fuel and hydrate adequately throughout the event day.

Gaining the Performance Edge

Knowing the current sports nutri- tion research, established dietary guidelines, and performance- enhancing recommendations is not enough; sports nutrition pro- fessionals must be skilled in help- ing athletes convert the sports nutrition knowledge into practical, daily guidelines for food and bever- age intake.

Food for Thought 1.3

You Are the Nutrition Coach

Practically apply the concepts from this chapter to several case studies.

20 SECTION 1 The Basics of Sports Nutrition

The Box Score Key Points of Chapter

■ Sports nutrition can be defined as the conversion of nutrition knowledge into a practical daily eating plan focused on providing the fuel for physical activ- ity, facilitating the repair and rebuilding process fol- lowing hard physical work, and optimizing athletic performance in competitive events, while also pro- moting overall health and wellness.

■ In this text, the term athlete refers to any individual who is regularly active, ranging from the fitness enthusiast to the competitive amateur or professional.

■ Sports nutrition professionals must have a com- mand of general nutrition and exercise science, understand how nutrition and physical training are intertwined, and practice the practical application of sports nutrition knowledge.

■ The area of sports nutrition is a growing field, with many opportunities for a rewarding and exciting career.

■ Foods and beverages are composed of six nutri- ents that are vital to the human body for producing energy, contributing to the growth and development of tissues, regulating body processes, and preventing deficiency and degenerative diseases. The six nutri- ents are carbohydrates, proteins, fats, vitamins, min- erals, and water.

■ The body derives its energy from carbohydrates, fats, and proteins, which are collectively known as the energy nutrients. Their breakdown within the cells of the body provides the energy to make ATP, which is the body's direct source of energy for not only sport performance, but also all biological work.

■ The Dietary Reference Intakes were developed to expand on the Recommended Dietary Allowance values and to set new recommendations for nutri- ents that did not have an RDA. The DRIs identify the reference amount of a specific nutrient needed for individuals to prevent deficiency conditions in generally healthy individuals. The DRIs include the RDA, EAR, AI, and UL for each vitamin, mineral, and macronutrient.

■ Processing of foods often destroys or removes vita- mins. Enrichment is a process by which vitamins are restored to foods after processing. Fortification is another way to improve the nutrient value of foods. It involves adding vitamins or minerals to foods in which the vitamins or minerals were not originally present.

■ The 2015–2020 Dietary Guidelines for Americans emphasize the fact that nutrition choices and physi- cal activity interact to improve health and prevent chronic conditions. The guidelines focus on making smart choices from all food groups, balancing food intake with physical activity to maintain weight, and choosing nutrient-dense foods.

■ MyPlate, along with the 2015–2020 Dietary Guide- lines for Americans, encourages individuals to make better food choices. The MyPlate icon pro- vides a visual representation of a balanced, nutri- tious meal.

■ The food label allows athletes to obtain credible and reliable nutrition information about various food and beverage products, ultimately empowering them to make wise food choices on a daily basis.

■ Developing an individualized sports nutrition plan for athletes involves considering the individual’s health history, the bioenergetics and logistics of the athlete’s sport, total weekly training and competi- tion time, living arrangements, access to food, and travel schedules.

■ When working with athletes, possessing “book” knowledge is only one part of the equation; profes- sionals must know how to assess a person’s readi- ness for change, engage in active listening, and then provide the appropriate information or guidance.

■ Sports nutrition professionals should listen closely to the goals, questions, and concerns of athletes and then build an individualized nutrition plan that is mutually acceptable and productive. Athletes should be active participants in their meal planning and goal setting.

Study Questions

1. What is sports nutrition? Is it applicable only to com- petitive athletes? Defend your answer.

2. What are the six nutrient categories? Which nutrients are termed the “energy nutrients”?

3. What is the difference between Dietary Reference Intake (DRI) and Recommended Dietary Allowance (RDA)? What do EAR, AI, and UL stand for?

4. What do the terms enriched and fortified mean? How are they different?

5. What information can be learned about a food from its food label?

6. What is the MyPlate food guidance system? In what ways does it apply to sports nutrition?

7. When developing an individualized nutrition plan for an athlete, what factors must be taken into consideration?

Chapter 1 Introduction to Sports Nutrition 21

References

1. Institute of Medicine Food and Nutrition Board. Dietary Reference Intakes: A Risk Assessment Model for Establishing Upper Intake Levels for Nutrients. Washing- ton, DC: National Academies Press; 1998.

2. U.S. Department of Agriculture. ChooseMyPlate. gov. Available at: http://www.choosemyplate.gov. Accessed May 2, 2016.

3. U.S. Department of Health and Human Services, U.S. Department of Agriculture. Dietary Guidelines for Americans 2015–2020 (8th ed.). Available at: http:// health.gov/dietaryguidelines/2015/guidelines/. Accessed May 2, 2016.

4. Prochaska JO, Velicer WF. The transtheoretical model of health behavior change. Am J Health Promotion. 1997;12(1):38–48.

whistle © credit goes here; apple © credit goes here; carrot © credit goes here

22 SECTION 1 The Basics of Sports Nutrition

Key Questions Addressed 1. What happens to nutrients after they are ingested?

2. How are carbohydrates digested, absorbed, transported, and assimilated in the body?

3. How are fats digested, absorbed, transported, and assimilated in the body?

4. How are proteins digested, absorbed, transported, and assimilated in the body?

5. How are minerals, vitamins, and water absorbed and transported in the body?

6. What is energy metabolism, and why is it important?

7. What is energy?

8. What is the human body’s source of chemical energy?

9. How do cells make ATP?

10. What are the three energy systems?

11. How do the energy systems work together to supply ATP during athletic performance?

12. What metabolic pathways are involved with the energy systems?

You Are the Nutrition Coach Kay is an aspiring 800-meter track athlete who has read various nutrition books with the hope of finding the ideal diet for her sport. From her reading, she has learned that fats yield more calories per gram than carbohydrates. In addition, she knows that dietary proteins are needed to help her muscles recover from training and additionally can be used for energy. She is now convinced that one of the popular high-fat, high-protein, low-carbohydrate diets is her best choice. Her coach dis- agrees with her decision. She recommends that Kay speak with a sports nutrition professional before changing her current diet, in which the majority of calories come from carbohydrates.

Questions • Bioenergetically speaking, is Kay on the right track with her thinking?

• What energy system does an athlete running the 800-meter event rely on for energy?

• Is a diet of energy-dense fats really better for Kay’s event?

• How would you explain to Kay why she should or should not follow this new diet?

Nutrients: Ingestion to Energy Metabolism

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What happens to nutrients after they are ingested? When nutrients are ingested they have not technically entered the body. The digestive tract is merely an inter- nalized conduit that connects the mouth to the anus (see

FIGURE 2.1 ). Substances in the digestive tract are techni- cally still outside of the body until they are absorbed across the membrane linings of this system. Once absorbed across the membranes of the digestive tract, the nutrients have officially entered the body and can be transported via blood and lymph throughout the body. Because most foods are too large to be absorbed, they first must be broken down into smaller pieces via digestion.

Digestion is the process of breaking down ingested food through mechanical and enzymatic activity so that it can be absorbed into the body. The remainder of this

section will discuss the various parts of the gastrointestinal system and their function in nutrient d i g e s t i o n a n d absorption.

digestion The process of break- ing down ingested foods into their basic units in preparation for absorption by the cells of the gastrointestinal tract.

Figure 2.1 Anatomy of the digestive system.

Figure 2.2 Functional organization of the digestive system. Although digestion begins in the mouth, most digestion occurs in the stomach and small intestine. Absorption occurs pri- marily in the small intestine.

What are the functions of the various parts of the digestive system? The anatomical organization and functions of the various parts of the digestive tract are shown in FIGURE 2.2 . The digestive system extends from the mouth to the anus and is more than 25 feet long in most individuals. The mouth, or oral cavity, is the entry point for ingested nutrients. The main digestive process that occurs in the mouth is mastication, more commonly known as “chewing.” The mechanical process of mastication breaks foods into pieces, thereby increasing the exposed surface area of the

food and facilitating enzymatic action. Three pairs of salivary glands , namely the parotid, submandibular, and sublingual glands, secrete saliva into the oral cavity (see FIGURE 2.3 ). The saliva

not only moistens the food particles,

salivary glands Glands of the mouth that produce and secrete saliva.

oral cavity Another name for the mouth, which makes up the first segment of the gastrointestinal tract.

mastication The process of chewing.

Anus

Rectum

Large intestine

Small intestine

Gallbladder

Liver

Pancreas

Stomach

Esophagus

Salivary glandsMouth

Anatomical organization

Mouth

Esophagus

Digestion and absorption

Absorption and elimination

Elimination

These organs produce and secrete substances that aid in digestion.

Stomach

Small intestine

Large intestine

Rectum

Liver

Gallbladder

Bile duct

Pancreas Small intestine

Functional organization

Ingestion and digestion

24 SECTION 1 The Basics of Sports Nutrition

The small intes- tine makes up the majority of the length of the GI tract and is approximately 20 feet long. It is divided into three segments: the duo-

denum, the jejunum, and the ileum (see FIGURE 2.4 ). As the partially digested food exits the stomach, it enters the duodenum, which is a short segment of the small intestine. Although approximately only a foot in length, the duodenum is where the food from the stomach is barraged with more digestive enzymes from the gallblad- der and pancreas. Much of the digestion of foodstuffs is completed in the duodenum, making the food ready for absorption.

In addition to the small intestine being long, the walls inside it are convoluted and lined with villi, which are

small tube-shaped projections (see

FIGURE 2.5 ). Each vil- lus has blood and lymphatic supply so

that absorbed nutrients can gain easy access into the cir- culatory systems of the body. The combination of the small intestine’s length and the convoluted villi-lined interior results in a large surface area with which to absorb foodstuff. In fact, most of the absorption of nutri- ents occurs in the remaining segments of the small intes- tine: the jejunum and ileum.

From the small intestine, the remainder of the undi- gested, partially digested, and unabsorbed contents pass into the large intestine. The large intestine includes the colon (ascending, transverse, and descending), the

rectum, and the anal canal, which exits the body at the anus (see FIGURE 2.6 ). Pas- sage of the intesti- nal contents along the GI tract slows in the large intestine, normally taking 18 to 24 hours to pass through. The intesti-

nal contents are subjected to bacteria that not only con- tinue digesting some of the undigested and unabsorbed foodstuffs, but also produce intestinal gas and certain vitamins. Some of the vitamins produced by these bac- teria are absorbed along with excess water as the remaining contents pass through the colon. Water absorption in the colon helps to solidify the remaining excrement, which by the time it reaches the rectum is 60% solid matter and 40% water. The rectum is basically

villi Small rod-shaped projections that cover the walls of the small intestine.

large intestine The terminal por- tion of the gastrointestinal tract, which receives undigested, partially digested, and unabsorbed contents from the small intestine. It is in the large intestine that the formation of feces occurs. The large intestine consists of the colon, rectum, and anal canal.

but also contains enzymes that initiate the enzymatic breakdown of carbohydrates and fats.

The bolus of food is then swallowed and passes into the esophagus, which is a tube leading from the back of the oral cavity to the stomach. Food passes so quickly through the esophagus that relatively little digestion

occurs there. Once in the stomach, the food is subjected to stomach acids and other enzymes that further the digestive process. The stom- ach has a muscular wall that churns the food, mixing it with stomach acids and enzymes. This diges- tive process contin- ues for roughly an hour before food begins to exit the stomach. Although some absorption of nutrients does occur

in the stomach, the overwhelming majority occurs in the next portion of the gastrointestinal tract (GI tract), the small intestine.

esophagus The segment of the digestive system that connects the oral cavity to the stomach.

stomach The distensible, pouch- like portion of the gastrointestinal system that receives foods from the esophagus. It has muscular walls that mechanically churn food and assist in the digestive process. Ingested foods pass from the stom- ach into the duodenum.

small intestine The portion of the gastrointestinal system where the bulk of digestion and absorp- tion occurs. The small intestine is divided into three segments: duo- denum, jejunum, and ileum.

Figure 2.3 The salivary glands. The three pairs of salivary glands supply saliva, which moistens and lubricates food. Saliva also contains salivary enzymes that begin the digestion of starch.

gastrointestinal tract (GI tract) The regions of the digestive system that include the stomach, small intestine, and large intestine.

Sublingual gland

Parotid gland

Submandibular gland

Chapter 2 Nutrients: Ingestion to Energy Metabolism 25

Figure 2.4 The small intestine. Secretions from the pancreas, liver, and gallbladder assist in digestion. All along the intestinal walls, nutrients are absorbed into blood and lymph. Undigested materials are passed on to the large intestine.

Most digestion happens here.

Pancreas secretes bicarbonate (a base) and enzymes that digest fats, carbohydrates, and proteins.

Secretions from liver, pancreas and gallbladder enter small intestine.

The liver secretes bile which aids in the digestion of fats.

Bile from gallbladder emulsifies fats.

Duodenum 25–30 cm (10–12 in.)

Absorbs digested nutrients.

Point where small intestine ends and large intestine begins.

Jejunum ~213 cm (~7 ft)

Ileum ~365 cm (~12 ft)

26 SECTION 1 The Basics of Sports Nutrition

How are carbohydrates digested, absorbed, transported, and assimilated in the body? Many different types of carbohydrates are found in foods. The commonality regarding the different types of carbohydrates is that they are all composed of simple sugars known as monosaccharides. Carbohydrates are classified based on the number of simple sugars making up their structure. For example, disaccharides are made up of two linked simple sugars. Oligosaccharides are carbohydrates composed of 3 to 10 linked sugars, and polysaccharides are complex carbohydrates made of 11

or more linked sim- ple sugars. The m o n o s a c c h a r i d e most important to the human body is glucose. To obtain g l u c o s e f r o m ingested foods, the carbohydrates must undergo digestion. The digestive pro- cess breaks down the carbohydrates into their constitu- ent sugars so that t h ey c a n b e absorbed, trans- ported, and used by the cells of the body.

What happens to carbohydrates once they are put into the mouth? The digestive process begins with the mechanical actions of mastication and the activity of an enzyme found in the saliva secreted by the salivary glands. Saliva contains the enzyme amylase, which begins the breakdown of starchy

foods to individual glucose molecules. Starch is the only type of carbohydrate and, besides fats, the only nutrient in which enzymatic breakdown begins in the mouth. Although digestion starts in the mouth, very little

of the starch is completely broken down to glucose by the time the food is swallowed and enters the esophagus. In the short transit time through the esophagus to the stom- ach, amylase continues its breakdown of starch.

disaccharide A simple carbohy- drate that consists of two linked sugar molecules.

oligosaccharide A complex car- bohydrate made up of 3 to 10 linked simple sugars.

amylase A digestive enzyme that breaks down carbohydrates into simple sugars.

starch The major plant storage form of carbohydrates. Starch is composed of long chains of linked glucose molecules.

the storage site for the excrement until elimination, or def- ecation, occurs. The

following sections will provide a more detailed explana- tion of how and where each nutrient is digested and absorbed.

Figure 2.6 The large intestine. In the large intestine, bacteria break down dietary fiber and other undigested carbohydrates, releasing acids and gas. The large intestine absorbs water and minerals and forms feces for excretion.

Figure 2.5 The absorptive surface of the small intestine. To maximize the absorptive surface area, the small intestine is folded and lined with villi. You have a surface area the size of a tennis court packed into your gut.

polysaccharide A complex car- bohydrate composed of 11 or more linked simple sugars. Starches and glycogen are examples of polysaccharides.

defecation The physical process of excreting feces from the rectum.

monosaccharide A single sugar molecule. Monosaccharides are the building blocks for more com- plex carbohydrates.

Capillary Epithelial cell

Lacteal

Artery Vein Lymphatic vessel

Colon

Cecum

Anal canal

Rectum

Absorbs water, sodium, chloride, potassium, and vitamin K.

Bacteria digest small amounts of fiber.

Chapter 2 Nutrients: Ingestion to Energy Metabolism 27

The small intestine is where the majority of digestion and absorption of carbohydrates and other nutrients occurs. In the duodenum, the bolus of food is exposed to digestive enzymes from the pancreas, gallbladder, and cells of the small intestine (see Figure 2.4). The pancreas secretes pancreatic amylase. This enzyme continues the digestion of starch, breaking it down into the disaccharide

maltose. The muco- sal cells and micro- villi of the intestinal tract contain their own enzymes called

Once in the stomach, the food is subjected to hydro- chloric acid, which denatures the salivary amylase, thus halting enzymatic digestion of starches in the stomach. However, the mechanical breakdown of food continues through the churning and powerful contractions of the smooth muscle in the stomach walls. The smooth mus- cle actions help to mix the stomach acid into the food bolus. This process, which prepares the food bolus for movement into the small intestine, usually takes 1 to 4 hours. No absorption of carbohydrates or other nutrients, except for alcohol, occurs in the stomach (see FIGURE 2.7 ); these nutrients therefore pass on with the other gastric contents into the small intestine.

Figure 2.7 Absorption of nutrients.

pancreatic amylase An enzyme secreted by the pancreas into the duodenum that assists in the diges- tion of starches.

Stomach

Alcohol

Fat, fat-soluble vitamins, cholesterol

Water, vitamin K

Carbohydrates, water, water-soluble vitamins amino acids

Water, amino acids, sodium, chloride potassium, vit B12

Water, minerals, carbohydrates

lacteals

Left subclavian and left internal jugular veins

Liver

Duodenum

Jejunum

Ileum

Colon

Portal vein

28 SECTION 1 The Basics of Sports Nutrition

through permeable cell membranes driven only by dif- ferences in concentration gradient. Passive diffusion is a non-energy-requiring mechanism of absorption, and mol- ecules always move from high concentration to low con- centration. The bigger the difference in concentration, the greater the movement of molecules across the membrane. Molecules can enter cells by passively diffusing through the cell membrane or by passing through protein chan- nels in the cell membrane (see Figure 2.8a). Because cell membranes are composed of fatty substances, fats and fat-soluble molecules, such as oxygen, carbon dioxide, and alcohol, can pass directly through membranes dur- ing passive diffusion. Conversely, water passively diffuses across membranes using the protein channels in the cell membranes. Unlike water, the water-soluble nutrients, such as carbohydrates, amino acids, minerals, and some vitamins, are not absorbed via passive diffusion and must rely on other forms of transport, such as facilitated diffu- sion or active transport.

Facilitated diffusion, similar to passive diffusion, does not require energy, and molecules move from areas of high concentration to low concentration; however, mol- ecules must be carried across the membrane by protein

carriers (see Figure 2.8b). The monosac- charide fructose is absorbed via facili- tated diffusion, but because its passage through membranes is dependent solely

on concentration gradients, its absorption is slower than that of other monosaccharides, such as glucose and galac- tose, which are absorbed by active transport.

Active transport is an energy-requiring form of absorption that requires transporter proteins, but, unlike facilitated diffusion, the direction of the transport is not dictated by concentration gradients (see Figure 2.8c). In other words, during active transport, molecules can be

moved against con- centration gradients (i.e., from low to high concentrations). The monosaccharides glucose and galac- tose are absorbed across the intestinal

lining via active transport. The name of the transporter protein found in the intestines is SGLUT1. For SGLUT1 to transport these simple sugars through the intestinal cell membrane, it must first bind to a sodium ion. Conversely, if no sugars are available, the bound sodium is not trans- ported into the cell either. In other words, SGLUT1 must bind both a sodium ion and sugar for transport into the cell to occur. This is the reason why physiology books refer to this specific active transport process as a glucose– sodium symport.

facilitated diffusion A means of cellular absorption in which pro- tein carrier molecules are required to move substances across mem- branes driven only by differences in concentration gradient.

active transport An energy- requiring means of cellular absorp- tion in which substances are carried across membranes by protein mole- cules. Active transport is not depen- dent on concentration gradients.

the brush border disaccharidases. These enzymes go to work on the food as it enters the small intestine and break

down disaccharides into monosaccha- rides, which are then ready for absorption. There are a variety of disaccharidases that function to digest specific carbohy- drates. For example, maltase splits the disaccharide malt- ose into two single glucose molecules. S u c ra s e s p l i t s sucrose into glucose and fructose. Lactase splits lactose into glucose and galac- tose. After enzymatic

digestion of the carbohydrates, the resulting simple sug- ars are absorbed through the intestinal wall in the jeju- num and upper ileum (see Figure 2.7) and enter the bloodstream.

When individuals have an insufficient supply of the enzyme lactase in their intestinal tract, they are not able to break down the milk sugar lactose. As a result, lactose goes undigested and is passed on to the large intestine, where it is exposed to bacteria. The bacteria ferment lac- tose in the colon, producing gas and bloating. Consuming dairy products that have added lactase or taking prod- ucts like Lactaid before consumption of dairy foods can decrease or eliminate these symptoms.

Any unabsorbed and/or undigested polysaccharides, such as fiber, that make it through the small intestine enter into the large intestine, where some bacterial diges- tion and gas formation can occur. However, no absorption of carbohydrates occurs in the large intestine, and thus any remaining carbohydrates pass through the system and are eliminated as feces. Figure 2.7 provides a graphic summary of nutrient absorption, showing that the major- ity of carbohydrates are absorbed in the jejunum.

How are the simple sugars absorbed into the intestinal wall? There are four ways that nutrients can be absorbed into the intestines: passive diffusion, facilitated diffusion, active transport, and endocytosis (see FIGURE 2.8 ). The

following is a brief overview of how these absorptive pro- cesses are used for carbohydrates.

Passive diffusion involves the move- ment of molecules

brush border disacchari- dases Digestive enzymes pro- duced by cells of the intestinal wall that break disaccharides into simple sugars.

lactase A digestive enzyme that breaks lactose into the simple sug- ars galactose and glucose.

maltase A digestive enzyme that breaks down maltose into two glu- cose molecules.

sucrase A digestive enzyme that breaks down sucrose into glucose and fructose molecules.

passive diffusion A means of cellular absorption in which the movement of molecules through permeable cell membranes is driven only by differences in con- centration gradient.

Chapter 2 Nutrients: Ingestion to Energy Metabolism 29

Figure 2.8 Mechanisms for nutrient absorption. (A) Passive diffusion. Using passive diffusion, some substances easily move in and out of cells, either through protein channels or directly through the cell membrane. (B) Facilitated diffusion. Some substances need a little assistance to enter and exit cells. The transmembrane protein helps out by changing shape. (C) Active transport. Some substances need a lot of assistance to enter cells. Similar to swimming upstream, energy is needed for the substance to penetrate against an unfavorable concentration gradient. (D) Endocytosis. Cells can use their cell membranes to engulf a particle and bring it inside the cell. The engulfing portion of the membrane separates from the cell wall and encases the particle in a vesicle.

(B) FACILITATED DIFFUSION

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High

Low

Transmembrane protein carrier changes shape to facilitate entry and exit of some nutrients (e.g., fructose).

ATP

Minerals, some sugars, and most amino acids move against a concentration gradient with an input of energy.

Co nc

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Low

High

(D) ENDOCYTOSIS

Outside of cell Inside of cell

The cell membrane surrounds small molecules and engulfs them.

Tube-shaped transmembrane protein channel

Cell membrane

(A) PASSIVE DIFFUSION

Water and water soluble substances (e.g., urea, glycerol) and small lipids move with a concentration gradient.

Co nc

en tra

tio n

High

Low

30 SECTION 1 The Basics of Sports Nutrition

What happens to carbohydrates once they make it to the cells of the body? Once glucose is transported to various bodily tissues, such as skeletal muscle, it must gain access to the inside of tis- sue cells in order to be used for energy or to be stored. Unlike intestinal absorption, in which glucose is actively transported via SGLUT1, glucose in the blood is taken into the cells by specialized transporter proteins via facilitated diffusion. These specialized membrane proteins are called glucose transporters (GLUT) and are present in all cells in the body. Some of these glucose transporters are stimu- lated by the hormone insulin, which, in turn, increases

the rate of cellular glucose uptake.

Several differ- ent types of glu- cose transporters are present in vari-

ous tissues throughout the body. In regard to muscle, the transporters are called GLUT1 and GLUT4. At rest or when blood levels of the hormone insulin are low, most glucose enters muscle cells via the GLUT1 transporter. However, when glucose and insulin levels in the blood are high (e.g., after a meal) or when muscle is active (e.g., during exercise), the GLUT4 transporter protein is stimu- lated and becomes the major transporter of glucose into the muscle cells. Once the glucose has gained entrance into a cell, it has several fates, depending on the type of cell it enters. In a liver cell, for example, glucose can be stored as glycogen, converted to a fatty acid and released into the bloodstream, or it can remain a glucose mole- cule and flow from the liver to other cells throughout the body via the bloodstream. When a glucose molecule in the blood reaches muscle cells, adipose tissues, or other types of cells, it can be taken up from the blood and either stored, used for energy, or converted to fat (see FIGURE 2.9 ). If it is stored, the glucose molecule can be linked to other glucose molecules, forming the complex carbohydrate known as glycogen. Glucose can remain stored as glyco- gen in the cell until it is needed for energy, at which point it is cleaved from the glycogen chain and metabolized.

How are fats digested, absorbed, transported, and assimilated in the body? Although fats are made up of carbon, hydrogen, and oxy- gen atoms similar to carbohydrates, they have very dif- ferent chemical structures and physical properties. Fats are molecules that belong to a group of compounds

known as lipids, which are organic compounds that are insoluble in water and feel greasy to the touch. Sources of dietary lipids are

glucose transporters (GLUT) Spe- cialized membrane carrier proteins that are responsible for the active transport of glucose into cells.

Endocytosis is a means of cellular uptake that involves the cell membrane encircling molecules and

internalizing them (see Figure 2.8d). Although the process of endocytosis does occur in cells lining the GI tract, it is not a

process that accounts for carbohydrate uptake. Of the four mechanisms, facilitated diffusion and

active transport explain carbohydrate absorption by the cells lining the small intestine.

What happens to carbohydrates once they make it into the blood? Once the simple sugar molecules cross the intestinal cell membranes and enter the blood, they are transported to the liver via the hepatic portal system. This system is a net- work of blood vessels that collects the absorbed nutrients from the small and large intestines and delivers them to the liver (see Figure 2.7). No special carrier proteins are required when the sugars reach the bloodstream because they are soluble in water (i.e., blood plasma). Once the bloodborne simple sugars reach the cells of the liver, those that are not in the form of glucose (e.g., fructose, galactose) are con-

verted to glucose. The glucose can then be stored as glyco- gen in the liver cells or released into the bloodstream.

Rising blood glucose levels after ingestion of carbo- hydrates stimulates the release of insulin, which is a hor-

mone secreted by specialized cells within the pancreas known as beta cells. The release of insu- lin into the blood- s t re a m c a u s e s glucose transporter proteins (see next section) within the cell membranes of muscles and other tissues to begin the uptake of glucose, thereby preventing blood glucose levels from rising too high. Diabetes results when the beta cells

do not produce enough insulin to lower blood glucose lev- els, or the beta cells produce insulin to which the body’s tissues do not respond normally. The end result is abnor- mally high blood glucose levels, sometimes in excess of two to four times the normal level.

endocytosis A means of cellular absorption in which substances are encircled by the cell membrane and internalized into the cell.

insulin A hormone secreted by specialized cells within the pancreas that lowers blood glucose levels after snacking or meals.

beta cells Specialized cells within the pancreas that secrete the hor- mone insulin.

glycogen The storage form of car- bohydrates in animal cells. Glyco- gen consists of intricately branched chains of linked glucose molecules.

diabetes A medical disease that is characterized by high blood glucose levels. Diabetes results when either the beta cells of the pancreas do not produce enough insulin or the body's tissues do not respond normally to insulin when it is produced.

lipids A class of organic compounds that is insoluble in water and greasy to the touch. Lipids are commonly referred to as fats and exist in the body primarily as triglycerides.

Chapter 2 Nutrients: Ingestion to Energy Metabolism 31

butter, margarines, salad dressings, and oils. Lipids are also found in meats, dairy products, nuts, seeds, olives, avocados, and some grain products. Most dietary lipids exist in the form of triglycerides; therefore, the following discussion will focus on the digestion, absorption, trans-

port, and assimila- tion of triglycerides (see FIGURE 2.10 ).

Fatty acids are basically carbon

atoms that are linked in a chainlike fashion (see FIGURE 2.11 ). These chains of carbon can be of varying lengths, and thus fatty acids can be classified as short (4 or fewer carbons),

medium (6 to 10 car- bons), or long (12 or more carbons). Dur- ing triglyceride diges- tion, one fatty acid

triglyceride A lipid that is com- posed of a glycerol molecule with three attached fatty acids.

Figure 2.9 Flowchart of glucose and other simple sugars immediately after a meal.

may be removed, leaving a diglyceride, or two fatty acids may be removed, leaving a monoglyceride. The fatty acids cleaved off the glycerol back- bone become what are known as free fatty acids.

Fat digestion, absorption, and transport are more

elaborate than that of other macronutrients because of fat’s insolubility in water. For example, the majority of enzymes involved in digestion are water soluble, which under normal circumstances would prohibit them from effectively acting on fats. However, the body’s digestive system subjects fats

diglyceride A lipid that is com- posed of a glycerol molecule with two attached fatty acids.

monoglyceride A lipid composed of a glycerol molecule with one attached fatty acid.

free fatty acid Compounds com- posed of long hydrogen-carbon chains that have a carboxyl group on one end and a methyl group at the other. Free fatty acids can be formed when a fatty acid is cleaved from a triglyceride molecule.

Glucose (galactose, fructose)

Glucose

Glucose CO2 + H2O + Energy

Glucose

Fatty acids

α-Glycerol- phosphate

Fatty acids

Triglycerides

Glycogen

GI tract Liver

Adipose tissues

Almost all tissues

Muscle

Glucose

Glycogen

32 SECTION 1 The Basics of Sports Nutrition

to substances known as emulsifiers, which work around the insolubility issue and allow enzymes to do

Figure 2.10 Forming a triglyceride. Concentration reactions attach three fatty acids to a glycerol backbone to form a triglyceride. These reactions release water.

Figure 2.11 Fatty acids vary in length and can be classified as short, medium, or long. The longer the fatty acid, the more solid it is at room temperature.

their job. Emulsifiers are substances that break lipids into very small globules that stay suspended in the watery con- tents of the GI tract and increase the exposed surface area of fats to the actions of digestive enzymes. Without being emulsified, the fats would tend to stick together in large

emulsifier A substance that breaks lipids into very small globules so that they are more manageable in watery fluids.

H C C

C C OH

H O

H C C

C C C CC

C C C

C C

C C OH

H C C

C C C CC

C C C OH

H O

M or

e liq

ui d

M or

e so

lid

H2O H2O H2O

CH OH

CH O

HC H

COH

Glycerol

3 Fatty acids 1 Triglyceride and 3 molecules of water

Chapter 2 Nutrients: Ingestion to Energy Metabolism 33

clumps, making it difficult for enzymes to do their jobs. As noted earlier, the following discussion focuses on the digestion of triglycerides.

What happens to fats once they are put into the mouth? Mastication breaks up fat into smaller pieces, and lingual lipase in saliva initiates the enzymatic digestive process.

However, because food is in the mouth for a relatively short period of time before being swallowed,

very little fat is actually digested in the mouth. When food is swallowed, the lingual lipase is passed

into the stomach, where it continues to break down the fats, at least until it is denatured by stomach acid. Gastric lipase is secreted by the chief cells in the stomach lining and continues the enzymatic digestive process in the

stomach. The gastric lipase breaks the tri- g lycer ides into diglycerides, which aid in the digestive

process by serving as emulsifiers. Churning and muscular contractions of the muscles in the stomach wall also assist in breaking apart large pieces of food and, in com- bination with emulsifiers, help keep the fats dispersed and in suspension. After 2 to 4 hours in the stomach, approximately one-third of the dietary triglycerides have been broken down into diglycerides and free fatty acids.1

As the food contents reach the small intestine, the duodenal cells release hormones that stimulate the release of enzymes that further assist in lipid digestion. For example, cholecystokinin (CCK) is released and trav- els via the blood to the pancreas and gallbladder. CCK stimulates the pancreas to produce large quantities of digestive enzymes that are delivered to the duodenum via the bile duct. CCK also stimulates the gallbladder to

contract, forcing bile and pancreat ic enzymes down the bile duct and into the duodenum (see Figure 2.2). Bile is important in the fat digestion process because it contains bile salts and leci- thin (a type of lipid), which keep the fats emulsified so that

the water-soluble digestive enzymes can continue to do their job. Secretin, released from duodenal cells, stimu- lates the pancreas to release bicarbonate, which neutral- izes the acidity of the intestinal contents. Neutralizing the acids prevents denaturation of protein enzymes,

lingual lipase An enzyme for fat digestion that is secreted by cells located at the base of the tongue.

gastric lipase A fat-digesting enzyme secreted by cells of the stomach.

cholecystokinin (CCK) A hor- mone produced by cells of the small intestine that stimulates the release of bile salts and pancreatic enzymes.

secretin A hormone released from the duodenum that stimulates the release of bicarbonate from the pancreas.

such as pancreatic lipase and other digestive enzymes, allowing the enzy- matic breakdown of foods to progress. The pancreat ic lipase is released in large amounts and finishes the diges- tive process of fats, thereby breaking the remaining triglycer-

ides into glycerol, monoglycerides, and free fatty acids of various lengths. Short- and medium-chain fatty acids, which are water soluble, are absorbed into the intestinal lining via passive diffusion. The monoglycerides and long-chain fatty acids, which are water insoluble, are encircled by bile salts, forming microscopic bubbles known as micelles. The micelles transport the long- chain fatty acids and monoglycerides to the cells lining the intestinal walls, at which time they are released from the micelles and passively diffused into the interior of the intestinal cells. FIGURE 2.12 provides a graphic sum- mary of triglyceride digestion.

Fat digestion and absorption are for the most part completed by the time the food contents reach the large intestine. Minimal amounts of fat are found in the large intestine or passed in fecal matter. However, some dis-

ease conditions can cause fat malabsorp- tion, resulting in ste- atorrhea, or fatty stools. Radiation

therapy for cancer, digestive surgeries requiring a large portion of the small intestine to be removed, Crohn’s dis- ease, and cystic fibrosis all can cause fat malabsorption.

What happens to the fats once they are absorbed? Once absorbed, the water-soluble glycerol and short- and medium-chain fatty acids pass through the intestinal cells and diffuse into capillaries, thus entering directly into the bloodstream (see FIGURE 2.13 ). The monoglycerides and long-chain fatty acids that are absorbed are reassembled into triglycerides within the intestinal cells. The resynthe-

sized triglycerides are then combined with protein carriers to form lipoproteins. These lipoproteins with their fatty cargo then pass through the intestinal cells. Once they leave the intestinal cells, they

pancreatic lipase A digestive enzyme secreted by the pancreas into the duodenum that breaks down triglycerides.

micelles Tiny bubbles made up of monoglycerides and long-chain fatty acids that are wrapped in bile salts. Micelles help transport digested fats to the intestinal wall for absorption.

steatorrhea An abnormal condi- tion in which large amounts of fat are found in the feces.

lipoproteins Substances that transport lipids in the lymph and blood. These substances consist of a central core of triglycerides sur- rounded by a shell composed of proteins, phospholipids, and choles- terol. Various types of lipoproteins exist in the body and differ based on size, composition, and density.

34 SECTION 1 The Basics of Sports Nutrition

Figure 2.12 Triglyceride digestion. Most triglyceride digestion takes place in the small intestine.

are called chylomi- crons. Chylomicrons do not enter directly into the bloodstream, but instead enter into the lymphatic system (see Figure 2.13). The lymphatic system then delivers

the chylomicrons to the large veins of the neck via the thoracic duct. The fats then empty into the blood and are distributed throughout the body.

What happens to fats once they make it to the cells? Fats have many functions within the body. However, bio- energetically, depending on the physical state of the body, the type of cell, and the need for energy, once fats reach the cells they can be either used for energy or stored for later use. For example, if energy demands are low and the bloodborne chylomicrons and their fatty payloads enter capillaries within adipose tissue or the liver, the chylomi- crons can be acted upon by an enzyme located on the cap- illary wall called lipoprotein lipase (LPL). LPL breaks the triglycerides inside the chylomicrons into free fatty acids

and glycerol. The free fatty acids immedi- ately diffuse into the fat or liver cells, where they are recombined with a

lipoprotein lipase (LPL) A spe- cialized enzyme that breaks down triglycerides into glycerol and free fatty acids.

new glycerol from inside the cells and once again re- formed into triglycerides. These newly formed triglycerides are stored until needed for energy. However, if the muscles are active and need energy, free fatty acids and chylomi- crons in blood flowing through the capillaries of muscles can be used for energy. LPL in the capillaries of muscles acts upon the triglycerides in the chylomicrons, similar to the LPL in adipose tissues. The free fatty acids in the blood, in addition to those released from the chylomicrons, are transported across the muscle cell membrane and into the interior of the cell where they are used for energy.

How are proteins digested, absorbed, transported, and assimilated in the body? Of the three macronutrients, proteins are the least used by the body as a source of chemical energy; however, they play the biggest role in providing structure to the body. Proteins also form the enzymes critical to the thousands of chemical reactions required to sustain life.

Proteins are made up of basic building blocks called amino acids. The proteins important to the human body are composed of 20 different amino acids. To make the proteins required, dietary proteins must supply the nec- essary amino acids. The following sections discuss how dietary proteins are digested and utilized by the body.

What happens to proteins once they are put into the mouth? Once again, mastication initiates the digestive pro- cess; however, unlike carbohydrates and fats, which are

chylomicron A droplet made of resynthesized triglycerides wrapped in lipoproteins that is produced by the intestinal cells. Chylomicrons are passed from the intestinal cells where they then enter into the lym- phatic system.

Fats become tiny droplets.

30% of triglycerides become diglycerides and fatty acids.

Triglycerides and diglycerides become glycerol, monoglycerides, and free fatty acids.

Mouth

Where Source of digestive enzymes

Digestive enzyme

Digestive products

Salivary glands

Pancreas

Stomach

Small intestine

Lingual lipase

Gastric lipase

Pancreatic lipase

Stomach

Chapter 2 Nutrients: Ingestion to Energy Metabolism 35

Figure 2.13 Summary of lipid absorption.

subjected to digestive enzymes present in the saliva, pro- teins do not undergo enzymatic digestion in the mouth. The majority of protein digestion occurs in the stomach and upper portion of the small intestine. Hydrochloric acid (HCl) secreted by the stomach lining denatures pro- teins. Denaturation is the process by which the three- dimensional shape of the protein begins to unravel (see FIGURE 2.14 ). This makes the chemical bonds between

the amino acids more accessible to diges- tive enzymes. The acidic environ- ment, along with the churning of the food

contents via the muscular contraction of the stomach, allows for greater mixing with the HCl, thereby allowing

denaturation A process by which proteins lose their three-dimen- sional shape and as a consequence their enzymatic activity.

Bile salts

Emulsification

Micelles

Glycerol, short- and medium-chain fatty acids are absorbed from small intestine into blood

Enzymes and bile salts emulsify the fat droplets to form micelles

Fat droplet

Monoglycerides

Long-chain fatty acid

Cholesterol

Chylo- micron

Lipo- protein

D iff

us io

n D

iff us

io n

Phospholipids

Reformed triglycerides

Glycerol Short-chain fatty acids

Medium-chain fatty acids

Bile salts are recycled

Blood capillaryLymphatic vessel

Intestinal cells package cholesterol, triglycerides, and phospholipids into lipoproteins that are secreted into the lymph

Cholesterol

Enzymes

Long-chain fatty acids Phospholipids

Monoglycerides

Micelles deliver their fatty cargo to the intestinal cells

36 SECTION 1 The Basics of Sports Nutrition

for a more thorough denaturation of the proteins. In addi- tion to the HCl, the enzyme pepsin begins breaking the proteins made up of longer chains of amino acids into shorter amino acid chains. The enzyme pepsin in the stomach is responsible for approximately 10–20% of pro- tein digestion.2 However, at this stage in the digestive process proteins are mostly broken down into smaller protein chains rather than single amino acids.

The majority of digestion of protein takes place in the small intestine, where additional protein-digestive enzymes called proteases break down the protein chains into even smaller units. Both the pancreas and small intestine make and release proteases. Cells lining the

small intestine also secrete peptidases, which continue to break the short pro- tein chains into lengths of three or fewer amino acids. The resulting sin- gle amino acids and protein chains of two or three amino acids are absorbed by either facilitated diffusion or active

transport. Most of the absorption takes place in the cells that line the duodenum and jejunum.

Figure 2.14 Denaturation. Exposing a protein to heat, acids, oxida- tion, and mechanical agitation can destabilize it, causing it to unfold and lose its functional shape.

proteases A class of protein- digesting enzymes that break the chemical bonds holding amino acids together.

peptidases A group of protein- digesting enzymes that are released from cells of the small intestine. Pep- tidases work on breaking the chem- ical bonds of short-chain proteins (i.e., three or fewer amino acids), thereby yielding single amino acids.

The final stage of protein digestion occurs inside the intestinal cells after absorption. Once inside the intestinal cells, other peptidases break the remain- ing chemical bonds in the protein chains to produce individual amino acids. Some of the absorbed amino acids are used by the intestinal cells themselves. The majority of amino acids are transported out of the intestinal cells via facilitated diffusion and enter into the portal system of blood vessels that go directly to the liver. Amino acids are then either used by the liver or released into the general cir- culation FIGURE 2.15 provides a graphic summary of protein digestion.

Digestion and absorption of protein are quite efficient in the stomach and small intestine, and, as a result, very little protein makes it to the large intestine. Protein that does end up in the large intes- tine is excreted in the feces. Some medical condi- tions may cause protein digestion and absorption problems, and it is important for the sports nutrition professional to be aware of these conditions in order to adapt the dietary plan, particularly when dealing with athletes. For example, celiac disease is a diges- tive disorder that involves the inability to digest cer- tain plant proteins. Athletes with celiac disease are not able to digest the protein in wheat, rye, oats, and other grains. Because these grains are excel- lent sources of carbohydrates that athletes need for energy, the sports nutrition professional must work closely with the athlete to find alternative plant protein/energy sources that will not exacerbate the symptoms and/or progression of the disease.

How are proteins absorbed into the intestinal wall? Amino acid absorption occurs through facilitated diffusion and active transport (see Figures 2.8b and 2.8c). The majority of amino acids require active transport to gain access into the intestinal cells. The active transport process for amino acids is the same as described for glucose earlier in the chap- ter, although amino acids and glucose use different transport proteins. Similar amino acids share the same active transport systems and carrier proteins. For example, the branched chain amino acids—leu- cine, isoleucine, and valine—all depend on the same carrier protein for absorption. Proteins consumed in the daily diet usually contain a variety of amino acids needed by the body. Because a variety of amino acids are being moved into cells through a variety of different carrier proteins, competition for the same membrane transporter is minimized, and the amino acids tend to be taken into the cell in proportions representative of the food’s composition.

Taking supplements containing large amounts of a single amino acid can affect the absorption of other amino acids if they share the same transport carrier.

Heat (or other conditions)

Chapter 2 Nutrients: Ingestion to Energy Metabolism 37

primarily skeletal muscle and the liver (see FIGURE 2.16 ). The blood and its circu- lating amino acids make up the central

part of the body’s amino acid pool. Amino acid concentra- tions in the blood are in equilibrium with the amino acids in the other compartments making up the amino acid pool. However, relatively few amino acids are circulating in the blood compared to the quantity found in muscle and the liver. If amino acid levels fall in one compartment, amino acids from the other compartments are mobilized to correct the imbalance. This sharing of amino acids

For example, athletes trying to increase muscle mass may take supplements containing high doses of a specific amino acid or combination of amino acids. This may actu- ally work against them because it could create competition for transport carriers that would result in the overabsorp- tion of one amino acid at the expense of another.

What happens to amino acids once they make it to the bloodstream? The amino acids that enter the bloodstream after diges- tion of ingested proteins become part of the body’s amino acid pool, which consists not only of bloodborne amino acids, but also the amino acids found in other tissues,

amino acid pool The collection of amino acids found in body fluids and tissues that is available for pro- tein synthesis.

Figure 2.15 The breakdown of protein in the body. Digestion breaks down protein into amino acids that can be absorbed.

In the small intestine, proteases continue to break the polypeptide chains into smaller peptides. Different enzymes called peptidases continue attacking the peptide bonds to yield tripeptides and dipeptides as well as single amino acids.

In the stomach, proteins are unfolded into long polypeptide chains of amino acids by the action of hydrochloric acid. The enzyme pepsin begins the digestion of polypeptides into shorter chains called peptides.

These short peptides and amino acids can be absorbed by intestinal cells. Inside the cell, the peptides are completely broken down into amino acids by intestinal peptidases. The individual amino acids are absorbed into the capillaries of the villi and transported to the liver via the portal vein.

Amino acids are transported to the liver via the portal vein. The liver can use amino acids to manufacture a variety of important substances. Those amino acids not used by the liver travel in the bloodstream to other tissues throughout the body.

Lymph

Villi

Capillary network

Amino acid

38 SECTION 1 The Basics of Sports Nutrition

when carbohydrate stores of energy are low and demands for energy are high. Alternatively, when amino acid levels are in excess they can be converted to fat and stored for later energy use by the body (see Figure 2.16).

The sharing of amino acids between compartments is dynamic and ongoing. Proteins in the body are con- stantly turning over, requiring amino acids from the pool on a continual basis. However, this sharing of amino acids between compartments is a short-term fix for providing necessary amino acids. Daily dietary protein intake is essential to maintaining the body’s amino acid pool. If protein intake is not adequate, pro- teins from muscle and other tissues will be cannibal- ized to provide the necessary amino acids, negatively affecting an athlete’s training abilities and competitive performance.

What happens to amino acids once they make it to the cells of the body? The amino acids circulating in the blood enter the cells of the body by facilitated diffusion. Once inside the cells, the amino acids become the building blocks for specific proteins. The specific protein constructed inside the cell is determined by current needs and/or the influences of outside factors such as hormones. For example, the hor- mone testosterone causes muscle cells to increase pro- duction of contractile proteins, thus causing the muscle to become bigger and stronger.

The actual instructions for making the specific proteins needed by the cell lie in the strands of DNA (deoxyribo- nucleic acid) found in the nucleus (see FIGURE 2.17 ). Seg-

ments of DNA that call for specific pro- teins are called genes. When a cell needs a particular protein, the specific gene with the instructions for that protein is copied in a process known as transcription. Tran- scription results in the formation of mes- senger ribonucleic acid (mRNA), which is a genetic set of instructions on how to make the protein. Upon leaving the cell nucleus, messenger RNA delivers the instructions to the ribosomes, which are the cellular organ- elles located in the cell cytoplasm that

between compartments can help ensure that needed amino acids are available when deficits arise.

Amino acids in the pool can be used for a vari- ety of functions depending on the body’s needs. They

are primarily used to synthesize new structural proteins, enzymes, hormones, or other nitrogen- containing com- pounds. They can be metabolized for energy, particularly

Figure 2.16 Amino acid pool turnover. Cells draw upon their amino acid pools to synthesize new proteins. These small pools turn over quickly and must be replenished by amino acids from dietary protein and degradation of body protein. Dietary protein supplies about one-third, and the break- down of body protein supplies about two-thirds of the roughly 300 grams of body protein synthesized daily. When dietary protein is inadequate, increased degrada- tion of body protein replenishes the amino acid pool. This can lead to the breakdown of essential body tissue.

deoxyribonucleic acid (DNA) The molecular compound that makes up the genetic material found within the nuclei of cells.

transcription The process of copy- ing genetic information from a spe- cific DNA sequence through the formation of messenger RNA.

messenger ribonucleic acid (mRNA) A type of nucleic acid that carries the genetic instructions for protein synthesis from the cell nucleus to the ribosomes located in the cell cytoplasm.

gene A specific sequence of DNA found within cell nuclei that con- tains information on how to make enzymes or other proteins.

ribosomes Cellular organelles that are responsible for protein synthesis.

Liver

Amino acid pool in cells Amino acid pool in cells Protein synthesis

Synthesis of non-protein molecules

Amino groups

Carbon skeletons

Urea

Urea excretion

Kidney

Amino acids from cell breakdown

Body proteins

Dietary protein

Protein degradation

Fates of Carbon Skeletons The remaining carbon skeletons can be used to make fatty acids or glucose, or broken down completely to yield energy.

Urea The liver removes amino groups from excess amino acids and converts the amino groups to urea for excretion by the kidneys.

Chapter 2 Nutrients: Ingestion to Energy Metabolism 39

Gaining the Performance Edge

Maintaining adequate protein intake for athletes is essential for the continual replenishment of the amino acid pool.

build the protein. In a process known as translation, the ribosomes read the mRNA segment and begin attaching

amino acids together in the sequence called for by the instructions. The amino acids needed by the ribosomes are delivered to the “pro- tein construction site” by transfer ribo- nucleic acid (tRNA). This process of tRNA delivering the needed amino acids to the

ribosomes continues until the protein has been constructed.

If an amino acid is required but not present at the time of protein construction, the protein-building process is stopped. If the required amino acid is a nonessential amino acid, the cell makes the amino acid and tRNA delivers it, continuing the building process. However, if the amino acid needed is an essential amino acid, the building process can- not continue, and the protein requested is not completed. This is why an athletic diet should include high-quality complete or complementary proteins so that all of the

translation The process in which proteins are produced by ribo- somes as they read the genetic instructions found on messenger RNA.

transfer ribonucleic acid (tRNA) A type of ribonucleic acid that is responsible for delivering specific amino acids to the ribo- some during production of protein.

Figure 2.17 Protein synthesis. Ribosomes are our protein-synthesis factories. First mRNA carries manufacturing instructions from DNA in the cell nucleus to the ribosomes. Then tRNA collects and delivers amino acids in the correct sequence.

essential amino acids are available when needed. One miss- ing essential amino acid can stop the construction of a protein. When this happens, the partially constructed protein is degraded, and its amino acids are used elsewhere or metabo- lized for energy.

How are minerals, vitamins, and water absorbed and transported in the body? Minerals, vitamins, and water (unlike carbohydrates, proteins, and fats) do not need to be broken down into smaller units via digestion to be absorbed into the body. As foodstuffs are being digested, the vitamins and miner- als within the foods are released into the intestinal con- tents. The majority of minerals released during digestion are absorbed in the duodenum and jejunum of the small intestine. The exceptions are sodium, potassium, and chloride, which are absorbed in the large intestine.

Vitamins are categorized as being either water solu- ble or fat soluble. The water-soluble vitamins (i.e., B-com- plex vitamins and vitamin C) dissolve in the watery mix of food in the GI tract and are absorbed along with the water. The majority of water and all of the water-soluble vitamins (see Figure 2.7) are absorbed in the small intes- tine. The water-soluble vitamins easily gain access to the blood and move freely throughout the body within the fluids both inside and outside of cells.

The fat-soluble vitamins (i.e., vitamins A, D, E, and K), when released from the digesting foods, dissolve in the fatty portions of the GI contents. As a result, they are transported along with the digested fats in micelles to the intestinal wall where they are absorbed via passive diffusion. Similar to the water-soluble vitamins, the majority of fat-soluble vitamins are absorbed in the small intestine (see Figure 2.7). A small amount of vitamin K is produced by bacteria in the large intestine and is then also absorbed. Once inside the intestinal cells, the fat-soluble vitamins are packaged into the chylomicrons and then, along with other fats, trans- ported via the lymph into the bloodstream. From there they are delivered throughout the body. Some are delivered and used by cells; others are stored along with fat in adipocytes. The fact that fat-sol- uble vitamins are stored in the body is one reason why tak- ing high dosages of fat-soluble vitamins is not recommended.

DNA

Nucleus

mRNA

Polypeptide

Ribosome

Nuclear pore

Cytoplasm

tRNA

mRNA leaves the nucleus and attaches to a protein ribosome

Gene

tRNAs bring specific amino acids to the ribosome, where the amino acids are bound to a protein chain

A specific length of DNA serves as a pattern to make mRNA

40 SECTION 1 The Basics of Sports Nutrition

Food for Thought 2.1

Digestion

This exercise tests your compre- hension of the digestive process.

Gaining the Performance Edge

An athlete's diet must include high- quality complete protein sources or complementary protein foods so that the diet provides all of the essential amino acids. Failure to do so will result in inadequate pro- tein synthesis, ultimately affect- ing training, recovery, and sport performance.

What is energy metabolism, and why is it important? Energy metabolism is a foundational component of sports nutrition. Knowledge of the cellular machinery and met- abolic pathways responsible for deriving energy from the macronutrients once they reach the cells is critical to the sports nutrition professional. Without knowledge of the three energy systems and how they work together to supply energy during specific activities, the sports nutrition professional is severely disadvantaged in regard to creating an individualized dietary plan. Knowledge of energy metabolism also enables the sports nutrition pro- fessional to objectively assess the potential effective- ness of dietary supplementation. Finally, comprehending energy metabolism enables sports nutrition profession- als to educate their athletes about the energy needs of their sport, thus helping to dispel many of the miscon- ceptions that abound in sports nutrition. The remainder of this chapter will define energy, identify which nutrients supply energy, and discuss how cells derive energy during rest and exercise.

What is energy? Energy is an entity that is better explained or defined than shown because it has no shape, no describable fea- tures, and no physical mass. Energy is what enables cells, muscles, and other tissues of the body to perform work, or, in layperson’s terms, to get things done. The cellu- lar and bodily functions that keep humans alive require energy. Similar to an automobile that relies on the chemi- cal energy of gasoline to run the motor, the cells of the body require chemical energy derived from the foods we eat to power their many different functions. In the case of sport performance, the muscle cells must derive enough energy from nutrients to fuel muscle contrac- tion. In short, an understanding of energy, where it comes

from, and how the body uses and stores it is tantamount to understanding metabolism.

Metabolism is the sum total of the energy required by the body to perform all of its functions and thus is made up of both anabolic and catabolic processes ( FIGURE 2.18 ). Anabolic processes involve the building of more complex structures

or chemical molecules and require energy to occur; for

metabolism The sum total of all the energy required to power cel- lular processes and activities.

anabolic process A metabolic function that involves the build- ing of more complex structures or chemical molecules and is associ- ated with the storage of energy.

catabolic process A metabolic function that involves the break- down of structures or molecules and is associated with energy being released.

example, when cells of the body use amino acids to make highly complex proteins or use simple sugars to make glycogen for storage within the cells (see lower half of Figure 2.18). Conversely, catabolic processes involve the

Figure 2.18 Metabolism. Catabolic processes result in biodegradation and energy release, and anabolic processes utilize energy to drive biosynthesis. Metabolism consists of both cata- bolic and anabolic processes.

Proteins (amino acids)

Carbohydrates (sugars)

Energy

Glycogen

Body protein Lipids

Fats (fatty acids)

Molecular building blocks (Amino Acids, Glucose, Fatty Acids)

BIOSYNTHESIS

BIODEGREDATION

Energy

Catabolic

Anabolic

Chapter 2 Nutrients: Ingestion to Energy Metabolism 41

energy for animal life originates from plants. Specifically, the plants use radiant energy from the sun to build high- energy bonds between atoms of carbon, hydrogen, nitro- gen, and oxygen. In doing so, plants form molecules of carbohydrates, proteins, and fats, which serve as energy nutrients for the plants themselves, any animals that eat plants, and on up the food chain. Because animals digest the consumed carbohydrates, fats, and proteins and can convert them into their own forms of each (see Figure

2.18), we can get energy nutrients, also known as mac- ronutrients, from both plant and ani- mal sources. When plant and animal foods are eaten, the digestive system breaks the nutrients into their constitu- ent parts so that they can be absorbed and transported to

the cells. The cells can then use the bloodborne nutrients as building blocks for biosynthesis, store them for later use, or metabolize them for energy production.

What is the human body’s source of chemical energy? Based on the previous section, it could be concluded that the chemical energy in carbohydrates, fats, and proteins is the direct source of energy for cellular function. However,

this is not the case. The direct source of energy for all bio- logical processes comes from a high- energy molecule known as adenosine triphosphate (ATP). In short, the chemi-

cal energy from mac- ronutrients is used to make another high-energy chemi- cal known as ATP. The energy stored in the chemical bonds of ATP is released when

the bonds are broken and can be used by the cells to per- form biological work, as shown in FIGURE 2.19 .

ATP is an adenosine molecule with a chain of three phosphate groups attached to it in series (see FIGURE 2.20 ). The energy used by the body is stored in the molecular bonds between the second and third phosphate groups,

breakdown of structures or molecules and are associated with energy being released; for example, when proteins, carbohydrates, and fats making up the foods we eat are broken down and used to provide energy. The absolute minimal amount of energy required to keep humans alive is called basal metabolic rate (BMR). A slightly higher amount of energy is required for resting metabolic rate (RMR). BMR and RMR are expressed in kilocalories (kcals), which are the commonly used units of measurement for

energy. A kilocalo- rie is the amount of heat energy required to raise the tem- perature of 1 liter of water 1 degree centigrade, specifi- cally from 14.5°C to 15.5°C. BMR and RMR measurements are obtained in dif- ferent ways. BMR is measured under very stringent con- ditions and requires subjects to spend the night in a sleep lab. The subjects must be well rested, ther- mally neutral (i.e., neither hot nor cold), and in a transitional state of waking (i.e.,

not asleep but not fully alert) at the time of the actual BMR measurement. RMR measures are much easier to obtain. Subjects must fast for 12 hours but can drive to the laboratory, where they relax for 20 to 30 minutes in a supine/reclined position before their RMR is measured. BMR and RMR are used by sports nutrition profession- als to determine an athlete’s 24-hour energy expenditure. This total daily energy expenditure can be used both to establish the dietary caloric intake necessary to achieve energy balance and when counselling athletes in weight management.

Energy exists in six basic forms: chemical, nuclear, electrical, mechanical, thermal, and radiant. However, the form of energy that humans and animals directly rely upon for survival is chemical energy. Chemical

energy is energy that is stored within bonds between atoms of molecules. When the bonds b e t we e n t h e s e atoms are broken, energy is released and can be used to

perform work. On earth, the primary source of chemical

chemical energy Energy that is released as the bonds holding chemicals together are broken. In the human body the foods ingested provide chemical energy to make ATP, which is the ultimate source of chemical energy in the body.

adenosine triphosphate (ATP) A chemical compound that contains three phosphate groups attached to an adenosine molecule. ATP is the direct source of energy for all biological processes.

basal metabolic rate (BMR) The minimum amount of energy required to sustain life at the wak- ing state. BMR is usually measured in the laboratory under very rigor- ous conditions.

resting metabolic rate (RMR) The minimum amount of energy required to meet the energy demands of the body while at rest. RMR is typically measured instead of BMR because it is only slightly higher than BMR and is determined under less rigorous conditions.

kilocalories (kcals) The unit of measure for energy. It is the amount of heat energy required to raise the temperature of 1 liter of water 1 degree centigrade.

42 SECTION 1 The Basics of Sports Nutrition

Gaining the Performance Edge

Macronutrients are needed in large quantities compared to other nutri- ents and act as sources of chemical energy in the body and as building blocks for biosynthetic processes. The macronutrients are more spe- cifically known as carbohydrates, fats, and proteins.

Gaining the Performance Edge

ATP is the body's direct source of chemical energy for powering muscle contractions and other bodily functions.

as well as between the first and second groups. When the bonds between the second and third or first and second phosphate groups are broken, energy is released. Some of the released energy is used to perform work, and the remainder is lost as heat energy, which cannot be used by the body. When the bond to the third phos- phate group is broken, the resultant products formed are an adenosine diphosphate (ADP) and an unattached

inorganic phosphate group (Pi) (see Figure 2.20). ADP still has some energy poten- tial for use by the body. If the last phosphate group is cleaved from the ADP, the result is the formation of adenosine mono- phosphate (AMP)

and another Pi (see Figure 2.20). Although ATP is the direct source of energy for cel-

lular functioning, it is stored in very small quantities in the cells. For example, in muscle cells, ATP stores are so small they can be depleted in as little as 3 seconds of muscle activity. Despite the fact that ATP is stored in very limited amounts, it is important to note that cells never completely deplete their ATP stores. FIGURE 2.21 shows ATP levels during an intense sprint lasting 14 seconds. Note that at the point of exhaustion, roughly 30% of the muscle’s ATP still remains. Obviously, athletes perform activities that last longer than 3 seconds every day, so the body must have ways of replenishing ATP once it is used. In fact, every cell, particularly muscle cells, can replenish any ATP that is used to keep the ATP fuel tank somewhat full. If ATP levels fall too low because the

adenosine diphosphate (ADP) A chemical compound that contains two phosphate groups attached to an adenosine molecule. ADP, when phosphorylated, becomes ATP.

Figure 2.19 The ADP–ATP cycle. When extracting energy from nutri- ents, the formation of ATP from ADP + Pi captures energy. Breaking a phosphate bond in ATP to form ADP + Pi releases energy for biosynthesis and work.

Figure 2.20 ATP, ADP, AMP, and high-energy phosphate bonds. Your body can readily use the energy in high-energy phos- phate bonds. During metabolic reactions, phosphate bonds form or break to capture or release energy.

Figure 2.21 Effect of intense activity on ATP levels in muscle. Even when an activity results in exhaustion, ATP levels are not totally depleted.

adenosine monophosphate (AMP) A chemical compound that contains a single phosphate group attached to an adenosine molecule.

M u

sc le

C el

l L ev

Full

ATP

Empty

Start Exhaustion

12 sec. all out sprint

Energy

Formation of ATP requires energy from the metabolic breakdown of energy nutrients

Energy

ADP + Pi

Muscle activity Nerve transmission Biosynthesis All other energy-requiring processes

Breakdown of ATP releases energy to power:

ATP

Pi Pi Pi

ATP: Adenosine Triphosphate

2 high-energy bonds

Inorganic phosphate group

Pi Pi

ADP: Adenosine Diphosphate

1 high-energy bond

Adenosine

AMP: Adenosine Monophosphate

No high-energy phosphate bonds

AMP is inter- convertible with both ADP and ATP.

ATP and ADP are interconvertible.

Chapter 2 Nutrients: Ingestion to Energy Metabolism 43

possesses a nucleus that contains the genetic information needed for making the enzymes and cellular structures required for ATP production.

To further ex plain ATP formation, a basic under- standing of bioenergetics is necessary. Bioenergetics is

the study of how energy is captured, transferred, and/or utilized within bio-

logical systems. Because this book deals with sports, the specific biologic system we will discuss in this chapter is muscle. To rebuild ATP, unattached phosphates must be reattached to AMP or ADP to re-form ATP. The process of resynthesizing ATP requires energy in and of itself, and this is where the energy trapped in the bonds of foods (i.e., macronutrients) comes into play. Using the analogy of a real-life factory, each of the muscle cells in the human body possesses what can be called a metabolic factory.

These metabolic fac- tories are responsible for manufacturing the cells’ ultimate energy source, ATP (see FIGURE 2.23 ).

Continuing with the metabolic factory analogy, inside the factory is an ATP pool (i.e., the cell’s inventory of read-

ily available energy). Whenever a cell needs quick energy, it does not need to wait

for the metabolic factory to produce ATP because ATP is already there ready to be used. However, the inventory of ATP is very small and must be maintained above a certain critical level, because if the cell runs out of ATP, it can no longer function and dies. Fortunately, cells have three dif- ferent energy systems (see Figure 2.23), each capable of providing ATP and preventing depletion of the ATP pool. The following section discusses each energy system in greater detail.

What are the three energy systems? The three energy systems that func- tion within the metabolic factories of muscle cells to prevent ATP deple- tion are the phos- phagen system ,

ATP pool The muscle cell’s inven- tory of readily available ATP.

activity is so intense that the muscle cells cannot make ATP fast enough, protective mechanisms kick in that in turn cause fatigue. Fatigue is a noted decrease in perfor- mance level, which slows down or even stops the activity

and thus protects the cell’s ATP levels. Poor nutrition can directly affect ATP production and thus decrease sport per-

formance. As a result, there must be a way for cells to make or replenish ATP once it has been used.

How do cells make ATP? To metabolize the energy nutrients, and in the process make ATP, the cells must possess the right metabolic equipment. Although there are many different types of cells that make up the body, they all have similarities. FIGURE 2.22 provides the names and functions of many

of the parts of typi- cal cells. For exam- ple, all cells have a cell membrane that encloses the con- tents of the cell, known as the cyto- plasm. The Figure 2.22 cell membrane serves as a barrier that regulates or prevents the influx

of substances into or out of the cytoplasm. The watery component of the cytoplasm that fills much of the inte- rior of the cell is known as the cytosol. Dissolved in the cytosol are enzymes, which are proteins responsible for

accelerating each step in the meta- bo l ic pathways responsible for gen- erating ATP. In addi- tion, within the cytoplasm there are cellular structures known as organ- elles that perform specific functions. The organelle of most importance in regard to the pro- duction of ATP is the mitochondrion. The

mitochondrion is sometimes more descriptively called the “aerobic powerhouse of the cell” because many of the metabolic pathways responsible for the aerobic pro- duction of ATP are found inside. Finally, each cell

fatigue A physical condition marked by the point in time at which the work output or perfor- mance cannot be maintained.

cytosol The watery or fluid part of the cytoplasm.

organelles Specialized structures found inside cells that perform specific functions. For example, the mitochondria are organelles responsible for the aerobic produc- tion of energy for the cell.

metabolic factory The cellular enzymes, organelles, and metabolic pathways responsible for the pro- duction of energy within the cells.

mitochondrion A specialized cel- lular organelle responsible for the aerobic production of ATP within the cell.

cell membrane The membrane that makes up the outer boundary of a cell and separates the internal contents of the cell from the exter- nal substances.

cytoplasm The interior of the cell. It includes the fluid and organelles that are enclosed within the cell membrane.

bioenergetics The study of energy transfer within a biological system.

phosphagen system The energy system composed of the high- energy phosphates ATP and creatine phosphate. It is also known as the immediate energy system. Of the three energy systems, it is capable of producing ATP at the fastest rate.

44 SECTION 1 The Basics of Sports Nutrition

Gaining the Performance Edge

Poor nutrition can directly affect ATP production and thus decrease sport performance.

the anaerobic sys- tem, and the aerobic system (see Figure 2.23). These three energy systems have different properties when it comes to

how much (i.e., their capacity to make ATP) and how quickly (i.e., their rate of ATP production) they can produce ATP (see TABLE 2.1 ).

Figure 2.22 Component parts of a typical cell.

aerobic system The energy sys- tem that relies upon the presence of oxygen to make ATP. Of the three energy systems, it is the slowest at producing ATP but has an almost unending capacity to make ATP.

anaerobic system (anaerobic glycolysis) The energy system that has the capability to generate ATP in the absence of oxygen. The anaero- bic system results in the formation of ATP and lactate.

Cell membrane

Carbohydrate chain

Protein

Ribosome

Nucleus

Lysosome

Smooth endoplasmic reticulum

Rough endoplasmic reticulum

Intermembrane space

Mitochondrion

Golgi apparatus

Cytosol

Outer membrane

Inner membrane

Mitochondrial matrix

Endoplasmic reticulum (ER) • An extensive membrane system extending from the nuclear membrane. • Rough ER: The outer membrane surface contains ribosomes. • Smooth ER: Devoid of ribosomes, the site of lipid synthesis. Golgi apparatus • A system of stacked membrane-encased discs. • The site of extensive modification, sorting, and packaging of compounds for transport. Lysosome • Vesicle containing enzymes that digest intracellular materials and recycle the components. Mitochondrion • Contains two highly specialized membranes, an outer membrane and a highly folded inner membrane. Membranes are separated by narrow intermembrane space. Inner membrane encloses space called mitochondrial matrix. • Often called the power plant of the cell. Site where most of the energy from carbohydrate, protein, and fat is captured in ATP (adenosine triphosphate). • About 2,000 mitochondria in a cell. Ribosome • Site of protein synthesis.

Organelles

Cell Membrane • A double-layered sheet, made up of lipid and protein, that encases the cell. • Controls the passage of substances in and out of the cell. • Contains receptors for hormones and other regulatory compounds.

Nucleus • Contains genetic information in the DNA of chromosomes. • Site of RNA synthesis—RNA needed for protein synthesis. • Enclosed in a double-layered membrane.

Cytoplasm • Enclosed in the cell membrane and separated from the nucleus by the nuclear membrane. • Filled with particles and organelles that are dispersed in a clear semiliquid fluid called cytosol. Cytosol • The semifluid inside the cell membrane. • Site of glycolysis and fatty acid synthesis.

Mitochondrion

Free Ribosomes

Chapter 2 Nutrients: Ingestion to Energy Metabolism 45

metabolic pathways to start producing energy. Because these pathways are lengthy, there would be a lag period before the increased production of ATP would be available. The phosphagen system serves as an energy buffer that fills the immediate need for ATP until the other two energy systems with higher capacities for generating ATP

can ramp up their production of ATP. The high-energy phosphates that make up the phos- phagen energy sys- tem are the cell’s stores of ATP (i.e., the ATP pool) and another high-energy

molecule, called creatine phosphate (CP) or, alternatively, phosphocreatine.

CP is a high-energy phosphate that in a one-step metabolic reaction can give its phosphate group to ADP to rebuild another ATP (see FIGURE 2.24 ). This metabolic

What are the characteristics of the phosphagen system? The phosphagen system is the simplest of the three energy systems and consists of the ATP pool itself and several other high-energy phosphates already present inside the cells that can provide energy almost as quickly as ATP. The phosphagen system is also known as the immediate energy system because it is capable of provid-

ing energy instanta- neously. For example, when athletes burst from the starting blocks in a race, there must be an immedi- ate source of energy available to enable them to go from no movement to maxi-

mum speed in fractions of a second. If ATP was not readily available at the start of the race, then the athlete’s mus- cles would have to wait for the anaerobic and aerobic

immediate energy system The energy system composed of the high-energy phosphates ATP and creatine phosphate; as a result it is also known as the phosphagen sys- tem. Of the three energy systems, it is capable of producing ATP at the fastest rate.

Table 2.1

Comparison of Characteristics of the Three Energy Systems

Energy system Energy system complexity Maximal rate of ATP production

Capacity to make ATP Lag time to increased ATP production

Phosphagen Low; one-step process Very fast Very limited None; instantaneous

Anaerobic Moderate; 12-step process Fast; runs a close second Limited Seconds

Aerobic Very high; many processes and steps

Very slow; distant third Unlimited Minutes

creatine phosphate (CP) A high- energy phosphate stored inside muscle cells.

phosphocreatine A high-energy phosphate stored inside muscle cells. It is also known as creatine phosphate.

Figure 2.23 Metabolic factory analogy of energy metabolism.

BLOOD Macronutrients

INPUT

Lactate CO2 H2O H+

MUSCLE CELL

OUTPUT

Anaerobic Energy System

ATP Pool

Phosphagen Energy System

ATP

Aerobic Energy System

Macronutrients Proteins

Fats Carbs

Macronutrient stores

Lactate

CO2 H2O H+

46 SECTION 1 The Basics of Sports Nutrition

Figure 2.24 The ATP–CP energy system. To maintain relatively con- stant ATP levels during the first few seconds of a high- intensity activity, creatine phosphate releases energy and its phosphate (Pi) to regenerate ATP from ADP.

Figure 2.25 The three energy systems work together to meet the energy demands of any level of physical activity. Width of arrow along with gray shading denote degree and source of energy contribution.

reaction is accelerated by the enzyme creatine kinase.3 The ATP pool and the one-step creatine kinase reaction that

comprise the phos- phagen energy sys- tem give it the highest rate of pro- duction of ATP of the three energy systems and enable it to pro-

vide instantaneous energy to the cells. Its high rate of ATP production makes the phosphagen energy system the one most relied upon when energy is needed quickly during very fast, powerful muscle contractions (see FIGURE 2.25 ).

Although the phosphagen system can supply ATP at very high rates, it has a limited capacity to generate ATP. Specifically, the phosphagen system would only be able to provide energy for 5 to 15 seconds, depending on the intensity of the activity.4 As a result, it needs assistance from the other energy systems.

What are the characteristics of the anaerobic and aerobic energy systems? As mentioned earlier, unlike the phosphagen system, which is basically an inventory of readily available high- energy phosphates within cells, the anaerobic and aero- bic energy systems must generate ATP via more complex cellular processing (see Table 2.1). As a result, there is a slight lapse in time before the aerobic and anaerobic sys- tems can ramp up and begin contributing ATP when an activity begins or changes in intensity. Compared to the phosphagen system, the anaerobic energy system is not quite as fast at producing ATP, but it has a slightly higher capacity to make more ATP. In contrast, the aerobic energy system has an unlimited capacity to make ATP and far exceeds the phosphagen and anaerobic systems in this characteristic. However, because it is a complex system, its rate of ATP production is much slower than the other two. In short, each energy system has different charac- teristics that help to satisfy our body’s energy needs no matter what the activity.

creatine kinase The enzyme that catalyzes the reaction transferring phosphate from creatine phos- phate to adenosine diphosphate to make ATP.

How do the energy systems work together to supply ATP during sport performance? During sports, the energy requirement of muscle is related to the intensity and duration of the activity. In other words, slow movements do not require ATP to be supplied as rapidly as more powerful, fast movements do.

Creatine phosphate Creatine

Energy

ATPADP

ATP pool

Aerobic Energy System

Anaerobic Energy System

Phosphagen System

Powerful Short Burst Activity (e.g., shot put, jump, pitch)

ATP pool

Aerobic Energy System

Anaerobic Energy System

Phosphagen System

Short Sprint or Activity (10 seconds of intense, all-out activity)

ATP pool

Aerobic Energy System

Anaerobic Energy System

Phosphagen System

Long Sprint or Activity (1 to 3 minutes of all-out activity)

Aerobic Energy System

Anaerobic Energy System

Phosphagen System

Long Duration, Non-Steady-State Activity (4 to 6 minutes, all-out activity)

ATP pool

Aerobic Energy System

Anaerobic Energy System

Phosphagen System

Long Duration, Steady-State Aerobic Activity (30 minutes of continuous activity)

ATP pool

Chapter 2 Nutrients: Ingestion to Energy Metabolism 47

and anaerobic systems would have to help fill the slight energy deficit. However, the energetic demand placed on the phosphagen and anaerobic systems would be rela- tively low, and the runner could maintain this increased pace for approximately a mile or two before fatigue sets in. However, if the marathoner decided to sprint as fast as possible, then the all-out sprint would require ATP to be supplied at rates well above the aerobic system’s ability to supply it. In this scenario the muscles would have to rely much more heavily on the other two energy systems, and exhaustion would set in much more quickly. If the marathoner timed the final sprint just right, sprint speed could be maintained for approximately 200 meters before the muscles’ ATP stores fell to critically low levels. Recall that when ATP levels get low exhaustion sets in (see Fig- ure 2.21). Sprinting places a huge demand on the phos- phagen and anaerobic energy systems, and, as a result, regular sprint training causes muscles to adapt. The mus- cles increase their stores of ATP and CP. In addition, the muscle cells make more enzymes such as creatine kinase and others associated with anaerobic metabolism. The end result is a sprint athlete who can maintain his or her maximum running speed for fractions of a second longer than the competition and thus perhaps win the race. Creatine monohydrate is a dietary supplement that

increases the levels of CP in the muscle, and thus is a popular item with sprint and power athletes.5 Cre- atine monohydrate bolsters the immedi-

ate energy system’s ability to supply ATP, thus delaying fatigue in high-intensity activities.6,7

Athletes with energy needs somewhere between those of the sprinter and those of the marathoner rely on the three energy systems working together. The reli- ance on each of the systems depends on the nature of the sport. In other words, there exists an energy con- tinuum (see FIGURE 2.26 ). The energy required for various

sports activities falls at different points along this energy continuum. For example, an athlete who runs the mile moves at

speeds somewhere between those of the sprinter and those of the marathoner (see Figure 2.25d). The inten- sity of the miler’s run is higher than that which can be provided by the aerobic system but not so intense that it puts a huge demand on the phosphagen system. In this case the anaerobic system plays a larger role in working with the aerobic system to provide the needed ATP. The bottom line is that any activity relies on the optimal blending of energy production by the three energy systems (see Figure 2.26).

energy continuum A continuum of activity levels spanning from low- est to maximum, with all points in between requiring slightly increas- ing rates of energy production.

As discussed earlier, the existing ATP pool in muscle cells is very small. Therefore, it is imperative that the three energy systems work together to maintain ATP levels. Remember, muscle cells never run out of ATP. Thus, if an activity is so intense and burns ATP so quickly that the three energy systems cannot supply ATP fast enough to prevent ATP depletion, fatigue ensues (Figure 2.21). Fatigue causes a decrease in the level of activity, result- ing in a lower energy demand, thereby giving the energy systems a chance to begin replenishing the level of ATP.

To prevent fatigue and maintain ATP levels above the threshold for fatigue, the energy systems must work together, taking advantage of their unique characteristics to meet the metabolic demands for ATP. Of the three energy systems, the muscle cells rely predominantly on the aero- bic system because of its unending ability to make ATP. If the energy requirements of an activity are low enough for the aerobic energy system to meet the energy demands, exercise can be continued for a long duration. This results in a condition called steady state exercise, where the

energy demands are being met primarily by the aerobic system (see Figure 2.25e). The more highly trained the aerobic energy system, the faster a

person can move while remaining in a steady state. Endurance athletes train every day to challenge and

improve the aerobic systems of their muscle cells. Their muscles respond to the daily demands by increasing the cellular organelles where aerobic production of ATP occurs: the mitochondria. As mentioned earlier, increas- ing the number and size of mitochondria enables the cell to greatly increase the speed with which it makes ATP. Because ATP can be supplied much more rapidly, the speed of the activity can be performed more quickly while the athlete remains in a steady state. This is why highly trained marathoners can run 26.2 miles at speeds that untrained persons could not run for even 1 mile without fatiguing.

When the energy needs of the muscle cannot be met by the aerobic system, the other two systems are needed to supplement the deficiency in ATP. If the activ- ity is just slightly above the ability of the aerobic sys- tem to supply ATP, then the amount supplemented by the other two systems is low, and the activity can be continued for quite a while before fatigue sets in (see Figure 2.25d). As the intensity of the activity increases, the ability to produce energy through the aerobic path- ways decreases, and therefore the reliance on the other two systems increases, causing fatigue to ensue more quickly. For example, if a marathoner decided to increase her running speed to something faster than her normal race pace, the demand for ATP production would go up. If the increase in speed was slightly above the aerobic system’s ability to supply ATP, then the phosphagen

creatine monohydrate A dietary supplement that can help improve an athlete's anaerobic strength and power by increasing levels of cre- atine phosphate in muscles.

steady state exercise Any level or intensity of physical activity in which the energy demand for ATP is met by the aerobic production of ATP.

48 SECTION 1 The Basics of Sports Nutrition

What metabolic pathways are involved with the energy systems? The phosphagen system does not involve any metabolic pathways because its function is based on already exist- ing stores of high-energy phosphates. The cellular pro- cessing required to make ATP anaerobically or aerobically occurs via metabolic pathways. Metabolic pathways can

be anabolic path- ways, which require energy and result in the formation of more complex mol- ecules, or catabolic pathways, which release energy and result in the break- down of molecules (see FIGURE 2.27 ). The anaerobic and aero- bic metabolic path- ways are catabolic. In short, anaerobic and aerobic meta- bolic pathways are

sequential steps in which foods (i.e., carbohydrates, fats, and proteins) are broken down (see TABLES 2.2 and 2.3 ). In other words, these metabolic pathways are assembly lines in reverse (i.e., disassembly lines). Instead of build- ing something in a stepwise systematic fashion, meta- bolic pathways slowly break apart food molecules in an

Figure 2.26 ATP contribution of the three energy systems to maximally sustained activities of very short, high-intensity exercise, such as the shot put (i.e., left margin of graph), to low- intensity maximally sustained exercise lasting longer than 3 minutes, such as running a marathon (i.e., right margin). Note: The longer the duration of ”maximally sustained activity,” the lower the exercise intensity. Area 1 spans from fractions of a second to 30 seconds, area 2 spans from 30 seconds to 1.5 minutes, area 3 spans from 1.5 minutes to 3 minutes, and area 4 is for time longer than 3 minutes.

Figure 2.27 Catabolism and anabolism. Catabolic reactions break down molecules and release energy and other products. Anabolic reactions consume energy as they assemble complex molecules.

metabolic pathways Sequentially organized metabolic reactions that are catalyzed by enzymes and result in the formation or breakdown of chemicals within the body.

anabolic pathway A metabolic pathway that requires energy and results in the formation of more complex molecules.

catabolic pathway A metabolic pathway that degrades complex compounds into simpler ones and in the process gives off energy.

Very High 0

100

High Moderate Low

P er

ce n

t A T

P S

u p

p lie

Exercise Intensity

2 3 41

Phosphagen system

Anaerobic system

Aerobic system

Reproduced with permission of McGraw-Hill Education LLC from Bow- ers RW, Fox EL. Sports Physiology, 3rd ed. Dubuque, IA: William C Brown Publishers; 1992, p. 34.

Amino acid catabolism also produces urea.

Energy

Energy Energy Energy Energy

+ + +

Energy Energy

Glycogen

Glucose

Glucose Glucose

Glycerol

Amino acids

Amino acid Amino acid

Triglyceride

Catabolic Reactions

Aanbolic Reactions

Triglyceride

Protein

Fatty acids

CO2 and H2O

Chapter 2 Nutrients: Ingestion to Energy Metabolism 49

Unlike the phosphagen system, which at its longest is one step, the anaerobic system involves a metabolic path- way (i.e., glycolysis) of 12 steps. Because it is lengthier and more complex than the phosphagen system, it is a little slower to adapt to changes in activity level. However, it is much faster to adapt than the aerobic energy system, which is the slowest of the three systems. The anaerobic energy system is a major contributor to intense (i.e., maxi- mal effort) activities that last from 1 to 3 minutes (see Figure 2.25c). During these activities, oxygen availability is limited because of the intense muscle contractions that close off blood vessels and limit delivery of oxygen, at least in large enough quantities to completely meet the energy demands of the activity.

Although the anaerobic system’s rate of production of ATP is fairly high, its capacity for making ATP is limited (see Table 2.1). During intense exercise, hydrogen ions are released and accumulate in the muscle cells due to the rapid breakdown of ATP. The buildup of hydrogen ions and the acidic condition it causes interferes with the activ- ity of key glycolytic enzymes and mechanisms of muscle contraction thus causing fatigue. To experience the fatigue caused by hydrogen ion build-up, one only needs to run around an outdoor track as fast as possible. The burning feeling experienced in the muscles is caused by the acidic condition that results from hydrogen ion build-up.

Compared to the other energy systems, the aero- bic system is the slowest at producing ATP, but it has an unlimited ability to make ATP. The aerobic system pro- vides the fuel for resting metabolic needs. It also is the energy system most relied upon for longer duration, con- tinuous activities that can be performed for minutes to hours. The aerobic energy system is also the longest and most complex of the three energy systems (see Table 2.1). It involves five different metabolic pathways (see Table 2.2). The metabolic pathways involved depend on the chemical structure of the food molecule being broken down (see Table 2.3 and FIGURE 2.29 ). The end products of the aerobic energy system are ATP, carbon dioxide, and water. It should be noted that carbon dioxide and water are the very same molecules used by plants to make car- bohydrates, along with fats and proteins. In short, plants use carbon dioxide from the air, water from the soil, and light energy from the sun to make the energy nutrients. During aerobic metabolism our cells break the foods back down to their constituent parts of carbon dioxide and water, thus releasing the chemical energy in the foods (see Figure 2.28) and using it to make ATP. The carbon dioxide and water released from the body can then be reused by plants to make more energy nutrients, thus completing the ongoing energy cycle.

What pathways are associated with the aerobic breakdown of carbohydrates? The first metabolic pathway carbohydrates must pass through is the glycolytic pathway (see Figure 2.28). When suf- ficient oxygen is present, pyruvate, which is the end product of glycolysis, is converted to acetyl coenzyme A (acetyl CoA)

organized stepwise order. This helps the cells to cap- ture as much energy as possible from foods to make ATP. Although there is some commonality in the metabolic pathways required to break down carbohydrates, fats, and proteins, there are a couple pathways that are unique depending on the energy nutrient being processed and/or the availability of oxygen.

The anaerobic energy system (see FIGURE 2.28 ), involves one metabolic pathway called anaerobic glycolysis. The only macronutrient that can be broken down via glycol- ysis is carbohydrates. Glycolysis is unique in that it can

be part of both the anaerobic and aero- bic energy systems. When adequate amounts of oxygen are not available and energy is needed, the

end product of glycolysis (i.e., pyruvate) is converted to lactate (see Figure 2.28). This last step or reaction enables glycolysis to continue producing ATP without the need for oxygen, which is why it is called the anaerobic energy system. Anaerobic means without oxygen. Alternatively,

if oxygen is present, then pyruvate is not converted to lactate. Instead, it is metabo- lized in other meta-

bolic pathways that are associated with the aerobic energy systems discussed in the following section.

glycolysis A metabolic pathway that is responsible for the break- down of glucose. It is unique in that it can function with or without the presence of oxygen.

anaerobic A term used to describe a condition in which oxygen is not present.

Table 2.2

Metabolic Pathways Associated with the Three Energy Systems

Phosphagen Anaerobic Aerobic Metabolic pathways

None Glycolysis Beta-oxidation

Glycolysis

Deamination

Citric acid cycle

Electron transport chain

Table 2.3

Energy Nutrients and the Sequence of the Aerobic Metabolic Pathways That Metabolize Them for Energy

Carbohydrates Fats Proteins Glycolysis 1

Beta-oxidation 1

Deamination 1

Citric acid cycle 2 2 2

Electron transport chain 3 3 3

50 SECTION 1 The Basics of Sports Nutrition

(see FIGURE 2.30 ) rather than converted to lactate as during anaerobic metabo- lism. The acetyl CoA then enters into the citric acid cycle (see FIGURE 2.31 ), which is a series of reactions that occur inside of the mitochondria of the cell. The pri-

mary purpose of the citric acid cycle is to strip hydrogens

Figure 2.28 Anaerobic glycolysis.

citric acid cycle One of the major metabolic pathways of the aerobic energy system. It is also known as the Krebs cycle or the tricarboxylic acid cycle. Its main role is to strip hydrogens from compounds pass- ing through it.

pyruvate The end product of glycolysis.

from the molecules as they pass through. The stripped hydro- gens are picked up by special carrier mol- ecules known as nic- otinamide adenine dinucleotide (NAD) and flavin adenine dinucleotide (FAD). NAD and FAD com- bine with the stripped hydrogens to form

nicotinamide adenine dinucle- otide (NAD) One of two electron carriers that is responsible for shut- tling hydrogens from one metabolic step or pathway to another.

flavin adenine dinucleotide (FAD) One of two electron carri- ers that is responsible for shuttling hydrogens from one metabolic step or pathway to another.

NAD+

NADH + H+

NAD+

NAD+ NAD+

NADHH+ +

ADPADP

Pyruvate LactateLactate

Pyruvate

ADP

O ne

w ay

O ne

w ay

ATP

ATP ATP

ATP

Glucose (C6)

O ne

w ay

O ne

w ay

Chapter 2 Nutrients: Ingestion to Energy Metabolism 51

NADH and FADH, respectively. The attached hydrogens are transported to the final aerobic pathway, the electron trans- port chain (ETC) (see FIGURE 2.32 ).

Figure 2.30 Pyruvate to acetyl CoA. When oxygen is readily available, each pyruvate formed from glucose yields one acetyl CoA and one NADH.

electron transport chain (ETC) The final metabolic pathway of the aerobic energy system. It is responsible for transferring hydrogens from one chemical to another and in the process making ATP and water.

Figure 2.29 Aerobic metabolism of the macronutrients.

The hydrogen transfer molecules associated with the electron transport chain are located on the inner mem- brane of the mitochondria. The transfer of hydrogens down the ETC begins once the hydrogen carriers NADH and FADH release their hydrogens to the ETC (see Figure 2.32). The resulting NAD and FAD are available to cycle back to the citric acid cycle to pick up more hydrogens. The hydrogens dumped into the ETC are transferred from one transfer molecule to another. In the process of hydrogen transfer, energy is given off and captured in the form of ATP. The final acceptor molecule for the hydrogens being passed down the ETC is oxygen, which results in the formation of water (see Figure 2.32). The ETC is the metabolic pathway that generates the most ATP during aerobic metabolism. The problem is that the ETC is the final pathway in aerobic metabolism, and as a result, it takes time for ATP formation to increase in response to exercise or activity.

The citric acid cycle and the electron transport chain are aerobic pathways that are common to all three energy nutrients. As already noted, both of these metabolic path- ways are found in the mitochondria of the cells. For this reason, mitochondria are called “aerobic powerhouses” of the cells. Endurance-type training challenges these meta- bolic pathways to produce energy more rapidly. The cells adapt to endurance training by increasing the size and number of mitochondria, allowing for greater production of ATP aerobically.8 This is one of the reasons why endur- ance athletes can perform at higher intensities for a lon- ger duration than untrained persons.

What pathways are associated with the aerobic breakdown of fats and proteins? Fats and proteins cannot be metabolized via glycolysis and therefore must pass through other pathways before entering into the citric acid cycle and ETC (see Figure 2.29).

When oxygen is readily available and energy is needed, pyruvate is

converted to acetyl CoA.

When limited oxygen is available, pyruvate is

shunted to form lactate.

To electron transport chain

Electron transport chain

Lactate

Citric acid cycle

Glucose

e– Acetyl CoA

Pyruvate

H+ +

Coenzyme A

Pyruvate Lactate

Acetyl CoA

On e

w ay

CoA CO2

e–e–

NADH

NAD+

Beta oxidation

ATP

e–

FATS CARBOHYDRATES PROTEINS

Fatty acids Glucose

Glycolysis

Amino acids

Deamination

Pyruvate

Acetyl CoA

Citric acid cycle

Electron transport chain

e–

52 SECTION 1 The Basics of Sports Nutrition

Figure 2.31 The citric acid cycle. This circular pathway conserves carbons as it accepts one acetyl CoA and yields two CO2, three NADH, one FADH2, and one guanosine triphosphate (GTP), a high-energy compound that can be readily converted to ATP.

Fats must first be metabolized via beta-oxidation, which is a cyclical pathway that is found within the confines of

the mitochondria. Each pass of a fatty acid through beta- oxidation cleaves off two carbon frag- ments from the end of the fatty acids.

Each pass also results in the formation of an NADH and an FADH. The two carbon fragments are converted to ace- tyl CoA, which then enters the citric acid cycle and ulti- mately the ETC. The NADH and FADH transfer their hydrogens to the ETC for use in ATP production.

Proteins contain nitrogen components in their molecular structure. These nitrogen-containing compo- nents cannot be used by the body and thus must first be cleaved from the protein before it can be metabolized for energy. The process in which the nitrogen group is cleaved from proteins is called deamination (see FIGURE 2.33 ).

Once the nitrogen is r e m o v e d , t h e remaining carbon molecule can pass through the citric acid cycle and then

beta-oxidation The first meta- bolic pathway of fat metabolism, which cleaves off two carbon mol- ecules each time a fatty acid chain cycles through it.

deamination The metabolic path- way that is responsible for removing the nitrogen or amine group from the carbon structure of amino acids.

the ETC to produce ATP (see Figure 2.29). However, it should be noted that proteins are not normally a major source of energy (they provide less than 10% of energy for exercise) unless energy expenditure is high and/or car- bohydrate intake is low.9

When diets are low in carbohydrates or when an ath- lete is involved in training that depletes carbohydrate stores, the body must get its carbohydrates from some- where else. It does so by converting proteins in the body to carbohydrates in a process known as gluconeogenesis

(see FIGURE 2.34 ). Dur- ing gluconeogenesis, proteins are broken down into amino acids, transported to the liver, and con- verted to the car- bohydrate glucose, which can then be used for energy by the body tissues. Unfortunately for the athlete, most of the proteins used in

gluconeogenesis come from muscle.10 This is one reason why carbohydrate intake is so important to the athlete.

gluconeogenesis The formation of glucose from noncarbohydrate sources such as proteins.

Electron transport chain

Citric acid cycle

e–

e– e–

GTP

To electron transport chain

CoA Acetyl CoA

Citrate (citric acid)

Citric acid cycle

Oxaloacetate

ADP ATP

GDP + Pi

Pi +

CO2

To electron transport chain

CO2

+ H+ e–e–

NADH

NAD+

FAD

e–e– FADH2

e–e–

NADH

NAD+

+ H+

e–e–

NADH

CoA

Chapter 2 Nutrients: Ingestion to Energy Metabolism 53

Gaining the Performance Edge

Carbohydrates spare muscle pro- tein by decreasing the body's reli- ance on gluconeogenesis to make its own carbohydrates.

If carbohydrate intake is adequate to meet energy demands and carbohydrate stores are replenished after training, then pro- teins do not need to be converted to carbohydrates, and muscle protein is spared. The relation- ship between carbo- hydrate intake and protein breakdown for energy is a criti- cal concept to under- stand. Put in other words, adequate carbohydrates in the diet spare muscle protein.

Figure 2.33 Deamination. A deamination reaction strips the amino group from an amino acid.

Figure 2.32 Electron transport chain. This pathway produces most of the ATP available from glucose, as well as fats and amino acids. Mitochondrial NADH delivers pairs of high-energy electrons to the beginning of the chain. Each of these NADH molecules ultimately produces 2.5 ATP. The pairs of high-energy electrons from FADH2 enter this pathway farther along, so one FADH2 produces 1.5 ATP.

The liver converts the amino group to ammonia and then to urea.

The structure of the remaining carbon skeleton determines where it can enter the energy-producing pathways.

H N CC OH

CC OHO

Inner mitochondrial membrane

Outer mitochondrial membrane

ADP + Pi +

Oxygen accepts the energy-depleted electrons and reacts with hydrogen to form water.

H2O ATP

ATP synthase

Mitochondrial matrix

O2⁄ 1

Cytosol

Electron transport chain

e–e–

NADH

NAD+ FAD

H+ e–e–

FADH2

e–e– e–e–

Outer mitochondrial membrane

Inner mitochondrial membrane

Mitochondrial matrix

54 SECTION 1 The Basics of Sports Nutrition

Food for Thought 2.2

Understanding Bioenergetics

In this exercise, your knowledge of how the energy systems work together to supply ATP during activity will be challenged.

Food for Thought 2.3

You Are the Nutrition Coach

Apply the concepts from this chapter to several case studies.

Figure 2.34 Gluconeogenesis. Liver and kidney cells make glucose from pyruvate by way of oxaloacetate. Gluconeogenesis is not the reverse of glycolysis. Although these pathways share many reactions, albeit in the reverse direction, gluconeogenesis must detour around the irreversible steps in glycolysis.

Some amino acidsPyruvate

Acetyl CoA

Oxaloacetate

ATP

NADH + H+

GTP

Some amino acids

Some amino acids Some amino acids

Citric acid cycle

CoA

GDP

Glycerol

Glucose

ADP

NAD+

ADP

Lactate

Chapter 2 Nutrients: Ingestion to Energy Metabolism 55

The Box Score Key Points of Chapter

n The digestive system is basically a long, internal- ized tube that passes through the body. Foods enter via the mouth and exit from the anus. Substances in the digestive system have not entered the body until they are absorbed across the intestinal wall.

n The anatomy of the digestive system includes the mouth, esophagus, stomach, small intestine, and large intestine. Associated structures, including the salivary glands, pancreas, liver, and gallblad- der, secrete enzymes and bile salts that help in the digestive process.

n Digestion of carbohydrates begins in the mouth as a result of the mechanical process of mastication and the enzymatic actions of salivary amylase. How- ever, the majority of digestion occurs in the small intestine, where the foodstuffs are subjected to the actions of various pancreatic and intestinal enzymes.

n During digestion, carbohydrates are broken down into their component parts, monosaccharides (i.e., simple sugars).

n Absorption of monosaccharides occurs in the small intestine via facilitated diffusion or active transport, depending on the type of sugar.

n Once the bloodborne simple sugars reach the cells of the liver, those that are not in the form of glucose (e.g., fructose) are converted to glucose. The glucose can then be stored as glycogen in the liver cells or released back into the bloodstream to be used for energy or stored by other cells of the body.

n Digestion of dietary fats begins in the mouth via mastication and the enzymatic actions of salivary lipase. The digestive process continues in the stom- ach through muscle actions of the stomach wall and the enzymatic actions of gastric lipase. However, the majority of fat digestion occurs in the small intes- tine, where various lipases act on the dietary fats (i.e., triglycerides), breaking them into free fatty acids and monoglycerides.

n Absorption of fats also occurs in the small intes- tine. The short- and medium-chain fatty acids are absorbed via passive diffusion and enter directly into the bloodstream. Long-chain fatty acids and monoglycerides are wrapped by bile salts to form micelles and carried to the intestinal wall, where the fats are released from the micelles and absorbed via passive diffusion. The absorbed fats from the micelles are resynthesized into triglycerides and packaged into chylomicrons. The chylomicrons are released from the cells and enter into the circulatory system via the lymph.

n Lipoprotein lipase, which is located on capil- lary walls and inside adipocytes, is the enzyme

responsible for the entrance and exit of fats from the adipocytes.

n Fatty acids in the blood are transported into muscle cells via facilitated diffusion, whereas triglycerides in bloodborne chylomicrons are acted upon by lipo- protein lipase in the capillaries found in muscle. Lipoprotein lipase breaks down the triglycerides into fatty acids, which are then transported across the muscle cell membrane. Once inside the muscle cells, the fats can be stored or used for energy.

n During digestion, dietary proteins are broken into their basic building blocks, known as amino acids.

n Digestion of proteins begins in the mouth via mas- tication and continues in the stomach where they are denatured by hydrochloric acid. Once they leave the stomach, protease enzymes in the small intes- tine continue to break the proteins into single amino acids or small chains of two or three amino acids.

n The small digested protein remnants are absorbed via facilitated diffusion or active transport in the small intestine. Once inside the intestinal cells, any exist- ing chains of amino acids are broken up into single amino acids and then released into the bloodstream.

n When ingested amino acids make it into the blood- stream, they become part of the body’s amino acid pool. The amino acid pool also includes amino acids found in other tissues, primarily skeletal muscle and the liver. The blood, with its circulating levels of amino acids, makes up the central part of the amino acid pool, which remains in equilibrium with the other compartments. This helps to maintain the blood’s levels of amino acids, thereby serving as a constant and readily available source of amino acids for the body.

n Amino acid absorption from the bloodstream into the cells of the body tissues occurs through facili- tated diffusion. Once inside, the amino acids can be used to make needed proteins through the pro- cesses of transcription and translation. Genes in the nucleus are transcribed to form mRNA. The mRNA leaves the nucleus and is translated by ribosomes, which attach the amino acids together to form the specific protein required.

n Minerals, vitamins, and water do not need to be broken down into smaller units via digestion to be absorbed into the body.

n Digestion of food releases minerals and vitamins, thereby making them available for absorption. Most vitamins and minerals are absorbed in the small intestine. The exceptions are sodium, potassium, chloride, and some vitamin K, which are all absorbed in the large intestine.

56 SECTION 1 The Basics of Sports Nutrition

n Without knowledge of the three energy systems and how they work together to supply energy during specific sports activities, the sports nutrition profes- sional is severely disadvantaged with regard to cre- ating an individualized dietary plan.

n Energy is an entity that is better explained or defined than shown because it has no shape, no describable features, and no physical mass. Energy enables ath- letes to perform physical work and is measured in kilocalories (kcals). All cellular and bodily functions require energy. The sum total of all the energy (i.e., total daily calories) required by the body to power cel- lular processes and activities is known as metabolism.

n Energy exists in six basic forms: chemical, nuclear, electrical, mechanical, thermal, and radiant. How- ever, the form of energy that humans and animals directly rely upon for survival is chemical energy.

n The macronutrients—carbohydrates, fats, and pro- teins—are also known as the energy nutrients. The energy trapped in the bonds of macronutrients is used to make a high-energy compound known as adenosine triphosphate (ATP). ATP is the body’s direct source of energy for all biological work. The role of the cellular metabolic factory is to release the chemical energy stored in the macronutrients and use it to make ATP.

n Energy metabolism or bioenergetics is the study of how energy is captured, transferred, and/or utilized within biological systems. The three energy systems responsible for production of ATP are the phosphagen, anaerobic, and aerobic systems. Each of these systems has unique characteristics, but they work together to supply the specific ATP needs of the athlete.

n The three energy systems are constantly working together to maintain the small ATP pools that exist in cells. Anywhere along the energy continuum,

from rest to maximal physical movements, the three energy systems work together to maintain the ATP levels. ATP levels are never depleted in cells; if the energy systems cannot keep up with energy demand, fatigue occurs. The decrease in perfor- mance caused by fatigue lowers energy demand and enables the energy systems to prevent ATP deple- tion.

n To metabolize the energy nutrients and in the pro- cess make ATP, the cells must possess enzymes that sequentially break down the energy nutrients and in the process capture energy in the form of ATP. The enzymes for the phosphagen and anaerobic systems lie within the cytoplasm of the cell. The majority of enzymes and molecular compounds important to the aerobic system are found within specialized organelles known as mitochondria. As a result, mito- chondria are sometimes referred to as the “aerobic powerhouses” of cells.

n Carbohydrates can be metabolized for energy both aerobically and anaerobically. In fact, carbohydrates are the only macronutrient that can be metabolized for energy via the anaerobic system. Fats and pro- teins can be metabolized only via the aerobic sys- tem. This is just one reason why carbohydrates are so important to athletes.

n The aerobic energy system is composed of five met- abolic pathways, three of which are unique to each energy nutrient. Carbohydrates are metabolized via glycolysis, then the citric acid cycle, followed by the electron transport chain. Fats must go through beta- oxidation, then the citric acid cycle, and finally the electron transport chain. Proteins, which are not usually a major energy source, are first deaminated and then metabolized via the citric acid cycle and the electron transport chain.

Study Questions

1. What are the various anatomical components of the digestive system?

2. What are some of the similarities in the digestive processing of carbohydrates, fats, and proteins? How does digestion differ among them?

3. What are the four processes of cellular absorption? 4. Digestion breaks the macronutrients into their con-

stituent parts so that they can be absorbed. What are the constituent parts of each macronutrient?

5. What is the difference between a micelle and a chylomicron?

6. What are the possible fates of the sugars, fats, and amino acids released into the bloodstream during the digestion of foods?

7. How do cells make proteins? Where are the instruc- tions for protein synthesis found, and what processes are involved in making proteins?

8. What is energy? What are the various forms of energy? Which form is most important to human physiology?

9. What are the macronutrients? What role do they play with regard to supplying the body with energy?

10. What are the three energy systems? What are their characteristics with regard to rate of production and capacity to make energy?

11. What cellular organelle is called the “aerobic power- house” of the cell? Explain why.

12. An elite marathoner is at mile 17 in the race and bio- energetically in steady state. What energy systems are contributing to the athlete’s energy needs? Which energy system is the major contributor?

13. What energy system is the major contributor of ATP during a discus throw?

Chapter 2 Nutrients: Ingestion to Energy Metabolism 57

14. An athlete is running an 800-meter race in a track meet. What energy systems are contributing to the athlete’s energy needs? Which energy system is the major contributor of ATP?

15. What metabolic pathways are required to aero- bically metabolize fats? Can fats be metabolized anaerobically?

16. Which energy system is also called the “immediate energy system”? What high-energy compounds make up this system?

17. Which compounds are known as hydrogen carriers and play a big role in transferring hydrogen ions to the electron transport chain?

References

1. Jones PJH. Lipids, sterols, and their metabolites. In: Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Philadelphia, PA: Lippincott Williams and Wilkins; 1999:67–94.

2. Guyton A. Textbook of Medical Physiology. 9th ed. Phila- delphia, PA: WB Saunders; 1996.

3. Brooks GA, Fahey TD, Baldwin KM. Exercise Physiology: Human Bioenergetics and Its Applications. 4th ed. Boston, MA: McGraw-Hill; 2005:31–42.

4. McArdle WD, Katch FI, Katch VL. Exercise Physiology: Nutrition, Energy, and Human Performance. 7th ed. Philadel- phia, PA: Lippincott Williams and Wilkins; 2001:134–161.

5. Harris RC, Soderlund K, Hultman E. Elevation of creatine in resting and exercised muscle of nor- mal subjects by creatine supplementation. Clin Sci. 1992;83(3):367–374.

6. Earnest CP, Beckham S, Whyte BO, Almada AL. Effect of acute creatine ingestion on anaerobic performance. Med Sci Sports Exerc. 1998;30(suppl):141.

7. Casey A, Constantin-Teodosiu D, Howell S, Hultman E, Greenhaff PL. Creatine ingestion favorably affects performance and muscle metabolism during maxi- mal exercise in humans. Am J Physiol. 1996;271(1 Pt 1):E31–E37.

8. Bizeau ME, Willis WT, Hazel JR. Differential responses to endurance training in subsarcolemmal and intermyo-fibrillar mitochrondria. J Appl. Physiol. 1988;85(4):1279–1284.

9. White TP, Brooks GA. [U-14C] glucose, alanine, and leucine oxidation in rats at rest and two intensities of running. Am J Physiol. 1981;240:E155–E165.

10. Paul GL, Gautsch TA, Layman DK. Amino acid and protein metabolism during exercise and recovery. In: Wolinsky I, ed. Nutrition in Exercise and Sport. Boca Raton, FL: CRC Press; 1998.

58 SECTION 1 The Basics of Sports Nutrition

Key Questions Addressed 1. What’s the big deal about carbohydrates?

2. What are carbohydrates?

3. How are carbohydrates classified?

4. What functions do carbohydrates serve in the body?

5. How can carbohydrates affect overall health?

6. How much carbohydrate should be consumed daily?

7. What are the various sources of dietary carbohydrates?

8. What are the glycemic index and glycemic load, and how can they be used in sports nutrition?

9. How are carbohydrates utilized during exercise?

10. What type, how much, and when should carbohydrates be consumed before exercise?

11. What type, how much, and when should carbohydrates be consumed during exercise?

12. What type, how much, and when should carbohydrates be consumed after exercise?

You Are the Nutrition Coach Meggan is a 15-year-old soccer player. She is very athletic, plays midfielder, and is noted for her speed and endurance. She has been trying to lose a few pounds to achieve a more comfortable playing weight, and therefore has decreased her carbohydrate intake from 65% of her total daily caloric intake to 40%. Lately she has been feeling fatigued in the middle of her 2- to 3-hour practices and weekend games, which is affecting her performance. Meggan’s coach has suggested that she bring a water bottle filled with a sports drink to their next practice. However, Meggan dislikes the taste of sports drinks and decides to find an alternative. She enjoys juices of any kind; therefore, the following Saturday she fills her water bottle with orange juice and drinks diligently throughout practice. Half- way through practice, instead of feeling tired, she is feeling nauseous and has intestinal cramping.

Questions • What are the possible causes of Meggan’s earlier-than-usual fatigue?

• What dietary suggestions might you give to Meggan to get her back to peak sport performance?

Carbohydrates

ut te

rst oc

k / fr

ac ta

l-a n

er o I

m ag

es /G

et ty

Im ag

CHAPTER 3

What’s the big deal about carbohydrates? Extensive research on the importance of carbohydrates in the diet has been conducted since the 1970s. There is little doubt that this macronutrient is critical to a healthy diet and crucial for optimal athletic performance. The popularity of distance sports such as triathlons, mara- thons, and distance cycling has sparked even more inter- est in carbohydrates within the scientific community and dietary supplement industry. The challenge for athletes is to consume the best sources and establish ideal practices for carbohydrate intake to improve sport performance. Athletes and active individuals are becoming increas- ingly exposed to both facts and misconceptions regarding the role of carbohydrates; thus, sports nutrition profes- sionals need to have a clear understanding of carbohy- drates and their dietary and performance-related roles. Most individuals know that dietary carbohydrates are an energy source for the body, but they do not understand how important a role carbohydrates actually play, par- ticularly for sports and exercise activities. Furthermore, many athletes do not have an appreciation for the fact that adequate intake of carbohydrates is also crucial for recovery from exercise and maintenance of carbohydrate stores in the body. Finally, many people do not understand the impact of the various types of carbohydrate foods and the timing of their intake in regard to exercise and sport performance. The purpose of this chapter is to clarify the understanding of this “master fuel.”

What are carbohydrates? Carbohydrates are a class of organic molecules con- sisting of a carbon (C) backbone with attached oxygen (O) and hydrogen (H) atoms. Carbo means “carbon” and hydrate means “water,” or H2O, thus giving a hint as to how these molecules are formed.1 The simplest of carbohydrates in terms of molecular structure, the sim- ple sugars, exist in arrangements of one or two molecules.

The arrangement and number of carbon molecules dictate the type of simple sugar. The chemical formula for these simple sugars is CnH2nOn, where n equals a num- ber from three to seven. For example, the most impor- tant simple sugar for the human body is glucose. It has six carbons in its chemical structure, and thus its for- mula is C6H12O6. In addition to glucose, there are liter- ally hundreds of other simple sugars that exist in nature. However, glucose and a few other simple sugars are the most important to the human body because they can be digested, absorbed, and utilized for energy.

Glucose and most of the other types of carbohydrates that exist in nature are synthesized by plants in a process known as photosynthesis (see FIGURE 3.1 ). The energy required to construct a carbohydrate comes from the sun.

simple sugars Another name for simple carbohydrates. These are sugars that exist as single sugar mol- ecules (i.e., monosaccharides) or two linked simple sugar molecules (i.e., disaccharides).

Figure 3.1 Photosynthesis. Plants release oxygen as they use water, carbon dioxide, and energy from the sun to make carbohydrate (glucose) molecules.

Water molecules

Energy, 6 carbon dioxide molecules and 6 water molecules

6 CO2 + 6 H2O + energy C6 H12 O6 + 6 O2

1 glucose molecule (carbohydrate)

6 oxygen molecules

60 SECTION 1 The Basics of Sports Nutrition

TABLE 3.1 . The sim- ple carbohydrates are made up of only one or two sugar molecules linked together, whereas complex carbohydrates are composed of longer and more complex chains of sugars.

What are simple sugars? Simple sugars are a classification of carbohydrates that includes monosaccharides and disaccharides. A mono- saccharide is nothing more than a single molecule of sugar. Many different types of monosaccharides exist in nature; however, the three simple sugars that serve as nutrients to humans are glucose, fructose, and galactose.

Glucose is the most abundant simple carbohydrate found in nature (see

FIGURE 3.3 ). It rarely exists as a monosac- charide in food but is joined with other sug- ars to form disaccha- rides and other complex carbohy- drates. In the body, glucose supplies energy to cells. The blood glucose level in the body is closely regulated to ensure that adequate energy is available to vital cells and organs at all times. The brain uses glucose exclu- sively except in times of starvation, when glucose is scarce. Galactose (see Figure 3.3) is rarely found alone in nature or in foods. It is most commonly linked with glucose, forming the disaccharide lactose, or milk sugar.

Fructose (see Figure 3.3) has the sweetest taste of the monosaccharides. It occurs naturally in fruits and some veg- etables and provides the sweet taste. Honey is approximately half fructose and half glucose. A common sweetener containing fructose is high fructose corn syrup, which is added to sweeten many soft drinks, candies, jellies, and desserts.

Disaccharides, also considered to be simple carbohy- drates, are made of two simple sugars (di means “two”) that are linked (see FIGURE 3.4 ). Examples of disaccharides

glucose One of the most com- monly occurring simple sugars in nature. It is the carbohydrate that humans rely upon for cellular energy.

fructose A simple sugar known for its sweet taste that is commonly found in fruits.

The sun’s light energy is captured by plants and used to combine carbon dioxide (CO2) from the air and water (H2O) from the soil to create simple sugars. The simple sugars are linked together to make complex carbohy-

drates, such as starch and glycogen. Starch (found in plant cells) and glycogen (found in animal cells) are complex car- bohydrates that are stored inside cells and used for energy when needed. Starch and glycogen are nothing more than glucose molecules linked together in chains of various lengths and configurations (see FIGURE 3.2 ).

How are carbohydrates classified? There are several types of carbohydrates that can be clas- sified in different ways. The most common way to classify carbohydrates is using the terms simple and complex. The different simple and complex carbohydrates are listed in

photosynthesis An energy- requiring process in which plants capture light energy from the sun and use the energy to combine carbon dioxide and water to form carbohydrates.

Figure 3.2 Structure of starch and glycogen. Plants contain two main types of starch: amylose and amylopectin. Animals store glucose as glycogen.

simple carbohydrate A form of carbohydrate that exists as a mono- saccharide or disaccharide.

galactose A simple sugar found in milk.

complex carbohydrate A carbo- hydrate composed of three or more linked simple sugar molecules.

Starch (amylose)

Starch (amylopectin)

Glycogen

Table 3.1 Carbohydrate Classifications and Common Examples

Simple carbohydrates Complex carbohydrates Monosaccharides Disaccharides Oligosaccharides Polysaccharides

Glucose Sucrose Maltodextrin Fiber

Fructose Lactose High fructose corn syrup

Starch

Galactose Maltose Corn syrup

Chapter 3 Carbohydrates 61

and one molecule of galactose. Lactose gives milk and other dairy products their sweet taste. Some individu- als are intolerant to lactose. As a result, milk and other dairy products cause gastric upset because these people lack or have reduced levels of the enzyme necessary to digest and absorb the lactose sugars. Another disaccha- ride, maltose, is com- posed of two glucose

Figure 3.3 Structure of glucose, fructose, and galactose. Glucose and galactose are six-sided structures; fructose is a five-sided structure.

are sucrose (fructose + glucose), lactose (glucose + galactose), and maltose (glucose + glucose).

Sucrose is commonly referred to as table sugar and is composed of one glucose and one fructose molecule. Sucrose is manufactured using extraction processes from sugar beets and sugar cane to produce granulated sugar and powdered sugar. When a food label lists sugar as the first ingredient, the term refers to sucrose. Sucrose

and other common nutritive sweeteners that can be found on food labels are listed in TABLE 3.2 . Lactose is commonly known as milk sugar and is composed of one molecule of glucose

Figure 3.4 Structure of disaccharides. The three monosaccharides pair up in different combinations to form the three disaccharides.

sucrose A commonly consumed disaccharide also known as table sugar. It is composed of linked glu- cose and fructose molecules.

lactose The disaccharide found in milk that is composed of the simple sugars glucose and galactose.

maltose A disaccharide made up of two linked molecules of glucose.

CH2OH

C O

H C

H H

HOCH2

O CH2OH

OH C

CH2OH

C O

H C

H H

H Glucose (basic unit of polysaccharides)

Galactose (found as part of lactose in milk)

Fructose (found in fruits, vegetables, and honey)

Note that the only difference is the location of the H and OH on this carbon.

All three mono- saccharides have 6 carbons, 12 hydrogens, and 6 oxygens.

Common table sugar Purified from beets or sugar cane A glucose-fructose disaccharide

Milk sugar Found in the milk of most mammals A glucose-galactose disaccharide

Malt sugar A breakdown product of starches A glucose-glucose disaccharide

Sucrose

Lactose

Maltose

DISACCHARIDES

Table 3.2 Common Nutritive Sweeteners in Foods

Sucrose Corn Syrup

Corn sweetener Dextrin

High fructose corn syrup Concentrated fruit juice

Molasses Maple syrup

Malt Cane sugar

Honey Maltose

Dextrose Fructose

Sugar Confectioner’s sugar

Brown sugar Turbinado sugar

62 SECTION 1 The Basics of Sports Nutrition

Starches are polysaccharides and serve as a major source of carbohydrates in our diet. Food sources rich in starch include grains, legumes, potatoes, and yams (see FIGURE 3.5 ). Starches give foods some of their sticky or moist properties. Glycogen, also called animal starch, is the storage form of carbohydrate in animals.2 Glyco- gen is not found in plants. It is composed of long, highly branched chains of glucose molecules (see Figure 3.2). Stored glycogen in humans can be rapidly broken down into single glucose molecules for use by cells for energy.

Dietary fiber, yet another complex car- bohydrate, is found in plant cell walls and inside plant cells. All plant foods contain some fiber of varying types. Most fiber is indigestible by the body, and therefore provides no

caloric or carbohydrate value when consumed. There are two types of fiber, which are classified based on their

molecules. It seldom occurs naturally in foods, but forms whenever long molecules of starch are broken down. In the human body, digestive enzymes begin to break starch down into maltose in the mouth. Although a sugar, malt- ose is very bland tasting.

What are complex carbohydrates? The complex carbohydrates found in foods are starches and fiber (see TABLE 3.3 ). Glycogen is the storage form of carbohydrates in the body and is considered a com- plex carbohydrate because of its similarity in structure to starch (see Figure 3.2). Complex carbohydrates are composed of many sugar molecules linked in often very long and complicated carbon chains. Carbohydrates that are composed of short chains of 3 to 10 linked sugars are known as oligosaccharides. Examples of oligosac- charides are the maltodextrins, corn syrup, and high fructose corn syrup. Polysaccharides are complex carbo- hydrates composed of even longer chains of 11 or more sugars. Polysaccharides can be straight chains of linked sugars or can be highly branched (see Figure 3.2). The molecular structure of a polysaccharide determines how soluble it is in water, how easy it is to digest, and how it behaves when heated.

Figure 3.5 Food sources of starch. A variety of grain products, pota- toes, and legumes are good sources of starch.

Fortifying Your Nutrition Knowledge

Experience the Digestion of a Starch to a Sugar Chew a saltine cracker until it tastes sweet. The digestive enzymes in saliva break down the long chains of sugar mole- cules to produce glucose and maltose, thus making the cracker eventually taste sweet.

Gaining the Performance Edge

Glycogen is the storage form of carbohydrates in muscle cells. It is a readily available source of energy for muscle and is critical for fuel- ing performance in endurance, strength/power, and team sports.

Table 3.3 High-Carbohydrate Foods

High in complex carbohydrates

High in simple carbohydrates

• Bagels Naturally Present

• Cereals • Fruits

• Corn • 100% Fruit juices

• Crackers • Plain nonfat yogurt

• Legumes • Skim milk

• Peas Added

• Popcorn • Angel food cake

• Potatoes • Candy

• Rice Cakes • Cookies

• Squash • Frosting

• Tortillas • Gelatin

• High-sugar breakfast cereals

• Jams

• Jellies

• Sherbet

• Soft drinks

• Sweetened yogurt

• Syrups

Chapter 3 Carbohydrates 63

solubility in water: soluble and insoluble. Soluble fibers are found primarily in oats, barley, legumes (dried beans, peas, lentils), and some fruits and vegetables. Insoluble f iber sources are primarily

whole grain products, nuts, seeds, and some vegetables. Consuming foods that contain both soluble and insoluble

fiber can help pre- vent high cholesterol and diverticular dis- ease, regulate blood glucose levels, and help prevent and/or treat constipation. A high-fiber diet also

produces an increased satiety level that may aid in weight loss over time by reducing hunger, and thus ultimately decreasing caloric intake. Current recommendations for fiber intake are 25 grams and 21 grams per day for women aged 19–50 and older than 50, respectively, and 38 grams and 30 grams per day for men aged 19–50 and older than 50, respectively.3 These recommendations are based on the fiber intake required to reduce the risk of cardiovascular disease. Unfortunately, the average American consumes only 10–20 grams of fiber per day.4 TABLE 3.4 lists the fiber content of common foods.

The Food and Nutrition Board, part of a panel con- vened to evaluate the Dietary Reference Intakes on fiber, proposed new definitions for dietary fiber, func- tional fiber, and total fiber.3 These updated definitions evolved from a need to have consistent nutrition label-

ing regarding fiber because of the cre- ation of new prod- ucts that behave like fiber but do not meet the former tra- ditional definition of fiber. Many of these new food prod- ucts have potential health benefits, yet they do not meet the previous U.S. definitions for fiber based on analytical methods.3 The new definitions for fiber include:

insoluble fiber A type of non- digestible plant carbohydrate that does not dissolve in water. Insolu- ble fiber sources are primarily whole grain products, nuts, seeds, and some vegetables.

• Dietary fiber: Consists of nondigestible carbohydrates and lignins that are intrinsic and intact in plants; examples include cellulose, hemicellulose, pectin, gums, beta-glucans, fibers found in oat and wheat bran, plant carbohydrates, and lignins.

• Functional fiber: Consists of isolated, nondigestible car- bohydrates that have beneficial physiological effects in humans; examples include, pectin, gums, animal carbohydrates (chitin and chitosan), and commer- cially produced carbohydrates such as resistant starch, polyols, inulin, and undigested dextrins.

• Total fiber: The sum of dietary and functional fiber. These definitions are not likely to alter the recom-

mended intake levels, but will more clearly define the sources of fiber and the specific potential for health bene- fits when consumed. Fiber remains intact in the gut and is exposed to the nor- mal bacteria present in the large intes- tine. Bacteria aid the digestive pro- cess, and as bacterial metabolism occurs, it produces gas as a by-product. Fiber, when consumed in excess, can cause bloating and flatulence that can be

Gaining the Performance Edge

Limiting high-fiber foods starting several hours to 1 day prior to com- petition can help avoid feelings of heaviness, bloating, and/or intesti- nal discomfort.

dietary fiber A complex carbohy- drate obtained from plant sources that is not digestible by humans. Although dietary fiber provides no energy for cellular activity, it does help maintain a healthy digestive sys- tem, lower blood cholesterol levels, and regulate blood glucose levels.

functional fiber Isolated, non- digestible carbohydrates that have beneficial physiological effects in humans.

total fiber The sum of dietary and functional fiber.

soluble fiber A type of indigest- ible plant carbohydrate that dis- solves in water. Soluble fiber has been shown to help lower blood cholesterol levels in some individu- als. Sources of soluble fiber are oats, barley, legumes, and some fruits and vegetables.

Table 3.4 Fiber Content of Common Foods

Food Amount Fiber (g) Apple 1 medium 4.4

Pear 1 medium 4.0

Banana 1 medium 2.0

Broccoli ½ cup 2.6

Corn ½ cup 3.0

Carrots 2 medium 3.4

Green beans ½ cup 2.7

Beans (black, pinto, etc.) ½ cup 9.7

Whole wheat bread 1 slice 3.01

Oatmeal 1 cup cooked 4.0

Bran flakes 1 cup 5.0

Popcorn 1 cup 1.0

1Fiber content of bread and other baked goods varies greatly depending on the brand. Data from U.S. Department of Agriculture, Agricultural Research Service, 2012. USDA National Nutrient Database for Standard Reference, Release 25. Nutrient Data Laboratory home page. Available at: http://www.ars.usda.gov/ba/bhnrc/ndl.

64 SECTION 1 The Basics of Sports Nutrition

uncomfortable to athletes during training and competi- tion. In addition, undigested fiber increases stool mass and volume and attracts water into the large intestine. The added weight, feeling of heaviness, and possible complications with diarrhea or constipation are depen- dent upon water intake and can contribute to uncom- fortable workouts and competitions for athletes. Some athletes choose to limit high-fiber foods in their diet for several hours or up to 1 day prior to heavy training or competitions to avoid potential intestinal discomfort. However, because of fiber’s health-promoting effects, high-fiber foods should not be completely avoided, and athletes should make an effort to include carbohydrates containing fiber on a regular basis.

Are artificial sweeteners carbohydrates? Are they beneficial or harmful? As their name indicates, artificial sweeteners provide sweetness to foods but not at the expense of calories. Artificial sweeteners can actually be hundreds of times sweeter than sucrose (see TABLE 3.5 ). Some artificial sweet- eners are derived from carbohydrates, modified with alterations to their molecular structure, making them less digestible and thereby yielding fewer calories when eaten. Other artificial sweeteners, such as aspartame, are not carbohydrates at all and may be derived from amino acids. Because they contain few or no calories, their value

in producing better-tasting low-calorie foods and pro- viding sweetness without calories is quite beneficial to those on restricted diets or trying to lose weight. Indi- viduals with diabetes or insulin sensitivity can also enjoy sweetened foods without consuming excess sugars and calories.

Artificial sweeteners are regulated in the United States by the FDA. Some are on the Generally Recognized as Safe (GRAS) list regulated by the FDA, and others are con- sidered food additives. Food additives must be approved for use in food products by the FDA before entering the food supply. The FDA approves and regu- lates the safety limit of food additives and sets acceptable daily intakes (ADIs). The ADI is the estimated amount per kilogram of body weight that a person can consume every day over a life- time without risk.4 The ADI is conser- vative and is set at an amount approx- imately 100 times

Generally Recog nized as Safe (GRAS) Substances that have not been conclusively proven to be safe but are generally accepted by experts as being safe for human consumption and therefore can be added to foods by manufacturers.

acceptable daily intake (ADI) The FDA-established safety limit for food additives and artificial sweeteners. The ADI is set at approx- imately 100 times below the level required for toxic or adverse effects.

Table 3.5 Sugars and Artificial Sweeteners

Name Sweetness (relative to sucrose)

ADI (mg/kg/day) Trade name Appropriate for cooking/baking

Sucrose 1.0 Yes

Maltose 0.4 Not commonly used

Fructose 1.73 Yes

D-Tagatose 0.75–0.92 Not specified Yes

Sorbitol 0.0–0.7 Not specified Not commonly used

Erythritol 0.6–0.8 Not specified Yes

Xylitol 0.9 Not specified Not commonly used

Mannitol 0.5–0.7 Not specified Not commonly used

Acesulfame K 200 15 mg/kg Sunett; Sweet One Yes

Aspartame 160–220 50 mg/kg Nutrasweet; Equal; Sugar Twin No

Saccharin 200–700 5 mg/kg Sweet’N Low; Sweet Twin; Necta Sweet Yes

Sucralose 600 5 mg/kg Splenda Yes

Cyclamate 30 11 mg/kg Yes

Stevia (Reb A) 200–300 12 mg/kg Truvia; Purevia; Sweetleaf Yes

Neotame 8000 18 mg/kg Yes

Data from American Dietetic Association. Position of the American Dietetic Association: Use of nutritive and nonnutritive sweetners. J Am Diet Assoc. 2004;104;255–275; Bray GA, Nielsen SJ, Popkin BM. Consumption of high-fructose corn syrup in beverages may play a role in the epidemic of obesity. Am J Clin Nutr. 2004;79;537–543.

Chapter 3 Carbohydrates 65

less than the minimum level at which observed adverse effects occurred in animal studies. Artificial sweeteners such as aspartame, saccharin, acesulfame K, and sucra- lose have all obtained FDA approval for use in food prod- ucts. However, some researchers and practitioners remain concerned about the safety of sugar substitutes. Because of the inconsistent results from research studies on the long-term safety of artificial sweetener consumption, intake should be kept to a minimum.

Saccharin was the first of the commercially produced artificial sweeteners; it hit the market in the early 1960s. The safety of saccharin became an issue when it was determined that laboratory rats consuming saccharin had a higher incidence of bladder cancer than rats that did not consume saccharin. In 1991, the FDA withdrew its proposed ban on saccharin and now considers it to be a safe food additive for use in foods and beverages, cos- metics, gums, and candies. Aspartame and acesulfame K are two other common artificial sweeteners that have been approved for use as tabletop sweeteners and use in heat-stable foods such as diet sodas, puddings, gelatins, candies, and gum.

Sucralose and tagatose are relatively new additions to the list of artificial sweeteners. Sucralose is a chemi- cally altered form of sucrose that is manipulated by sub- stituting the sucrose hydroxyl group with chlorine. This produces an intense sweetness—about 600 times sweeter than sucrose.5 Tagatose attained GRAS status in 2002 and is a low-calorie, full-bulk natural sugar that is 92% as sweet as sucrose.6 It contains a caloric value of 1.5 kcal/g because only about 15–20% of the product is absorbed in the small intestine. Tagatose provides sensory and tex- tural qualities similar to sugar in many foods, adding to its versatility in the development of new food products with lower calories without a reduction in palatability.

Sugar alcohols, also known as polyols, are dissimilar to regular sugars and sugar substitutes because they are digested and absorbed differently. They are found naturally in plants such as berries and other fruits and some vege-

tables, but they also are produced for commercial use. Sugar alcohols such as xylitol, sorbitol, and mannitol are nutritive sweeteners (contain some calo- ries) and often are added to sweeten products such as

mints, candy, and gum. They are not as easily digested or absorbed by the body and therefore contain fewer calories (one-half to one-third fewer) than sugar. The incomplete absorption does not allow for direct metabolism that would provide the usual 4 calories per gram of carbohydrate.7 Depending on the type or brand, sugar alcohols generally contain 1.5–3.0 calories per gram. Because sugar alcohols

do contain calories, they can have some effect on glucose levels, and if eaten in large amounts can increase blood glucose levels.

All sugar alcohols are regulated by the GRAS list or as food additives. Sugar alcohols must be listed on food labels if a nutrient claim is made, such as “sugar-free” or “reduced sugar.” Sugar alcohols are listed on the ingre- dient list and on the nutrition facts section of the label. Excessive intake of sugar alcohols can have a laxative effect and may cause diar- rhea.7 Food products that contain sugar alcohols can put a warning on the label stating, “excess con- sumption of this product may have a laxative effect.” Ath- letes trying to reduce caloric or carbohydrate intake may consume foods that contain sugar alcohols as artificial sweeteners. However, because of the laxative effect, athletes may need to reduce the amount and type of artificial sweeteners consumed prior to exercise.

There are benefits to using all of the varieties of arti- ficial sweeteners in foods. They provide a sweet taste and several have bulking properties, while contributing fewer calories than sugars. They do not promote tooth decay, and consumption of gum and mints sweetened with sugar substitutes instead of sugars can be benefi- cial to dental health. Consumers need to be aware, how- ever, that foods containing sugar substitutes and those promoted as “low carbohydrate” are not necessarily low calorie. This misconception may lead to overconsumption of foods with sugar substitutes and therefore an increased overall calorie intake.

What functions do carbohydrates serve in the body? Carbohydrates serve several important roles in the body, many of which are critical to optimal sport performance. Carbohydrates are the most important source of energy for the body. Although fat stores supply a large quantity of energy, carbohydrates must be present to metabolize fats at the rapid rates needed to support the caloric demands of exercise and sport competition. Furthermore, the higher the intensity of the activity, the greater the reli- ance of the body on carbohydrates. In fact, carbohydrates are the only macronutrient that can provide energy for anaerobic activities such as sprinting. Adequate carbo- hydrate intake also helps spare muscle tissue. If an ath- lete’s carbohydrate intake is low, his or her body will turn to the breakdown of muscle protein to make up for the

polyols A class of food sweeten- ers that are found naturally in some plants but are not easily digested and thus yield fewer calories. Poly- ols, also known as sugar alcohols, include xylitol, erythritol, sorbitol, and mannitol and often are added to sweeten products such as mints, candy, and gum.

Gaining the Performance Edge

Artificial sweeteners can be used by athletes wishing to control body weight; however, because of the laxative effect of some sweeten- ers, athletes may need to reduce the amount and type of artificial sweeteners consumed prior to competition.

66 SECTION 1 The Basics of Sports Nutrition

deficit in needed car- bohydrates. Finally, carbohydrates are the primary energy source for the ner- vous system. Nerve cells do not store carbohydrates like muscle cells do; their

source for carbohydrates is the bloodstream. When blood glucose levels fall, nerve cell function suffers, which can have a dramatic effect on exercise and sport performance.

Gaining the Performance Edge

Cutting carbohydrates from an ath- lete’s diet leads to “performance sui- cide.” Carbohydrates are the “master fuel” for all sports.

Fortifying Your Nutrition Knowledge

phytochemicals A large class of bio- logically active plant chemicals that have been found to play a role in the maintenance of human health.

Chapter 3 Carbohydrates 67

and produce cavities. Choosing low-sugar foods and rins- ing the mouth after eating sugary or sticky foods can help reduce the risk of dental caries.

Recently, sugar, specifically in the form of high fruc- tose corn syrup (HFCS), has been purported to be one of the reasons for the rise in obesity and related disease rates in the United States.14,15 Much of the research has focused on the correlation between increased consumption of sodas and other sugar-sweetened beverages containing HFCS and weight gain.16–18 However, not all studies have shown a direct link, especially in humans.19 A proposed metabolic theory explaining the mechanism by which fructose causes weight gain is through the suppression of insulin and leptin production.14,20 More research is needed to elucidate a cause and effect relationship as well as to develop associated intake recommendations.

From a practical standpoint, weight gain may be associated with the consumption of high-sugar foods as a result of the typi- cal high calorie value of these items. How- ever, it may not be simply the sugar that makes the foods high-calorie. Many sweet foods contain significant amounts of fat as well. All carbohydrates, sim- ple sugars or complex, contain 4 calories per gram. Fats contain 9 calories per gram. Foods such as cookies, cakes, ice cream, and many chocolate candies contain both sim- ple sugars and fat. The fat often contributes as many (or more) calories to these products as sugars do.

Sugar and foods made with significant amounts of sugar are often low in total nutrients, lack fiber, and are calorie dense. Choosing these foods regularly makes it dif- ficult to meet individual needs for vitamins, minerals, and other nutrients because they can take the place of nutri- ent-dense foods. This, combined with a higher incidence of dental caries, the caloric density of high-sugar foods contributing to weight problems, and the low amount of fiber found in individuals consuming a high-sugar diet, suggests that reducing refined sugar intake in foods and beverages is the best option for better health.

How much carbohydrate should be consumed daily? The quantity of carbohydrate needed on a daily basis varies among athletes based on several factors, includ- ing current body weight, total energy needs, the specific metabolic demands of their sport, and their stage of train- ing or competition schedule. The primary role of carbohy- drates is to provide energy to cells, particularly the brain, which is the only carbohydrate-dependent organ in the

Figure 3.6 Food sources of fiber. Whole grains, legumes and seeds are good sources of fiber.

Soluble fiber appears to play a significant role in reducing the risk of heart disease.8 Several studies have shown that diets high in soluble fiber decrease blood cho- lesterol levels. Soluble fiber may help reduce serum cho- lesterol levels by binding bile acids in the GI tract, thus preventing their reabsorption. This is significant because bile acids are made from cholesterol in the liver and are secreted into the intestinal tract to aid with fat absorp- tion. In addition, short-chain fatty acids, produced from bacterial fermentation of fiber in the large intestine, may inhibit cholesterol synthesis.

Foods rich in complex carbohydrates may indi- rectly help with weight loss or maintenance of a healthy weight.8 Fruits, vegetables, whole grains, and starchy legumes are usually low in total fat and calories. A diet that contains adequate portions of these lower calorie foods may replace higher calorie foods, thus producing a caloric deficit. Because of their bulk, these foods provide a feeling of fullness that lasts longer when compared with less complex carbohydrate foods. High-fiber foods take longer to digest and absorb; thus the full feeling lasts lon- ger, and individuals may eat less often.

What role do simple sugars have in health? In contrast to the benefits of high complex carbohydrate and fiber intake, simple carbohydrates—specifically refined sugars—may have some negative health conse- quences. Highly sugared foods and those that are sticky and stay in the mouth longer may produce more den- tal caries (cavities). Sugar, sugared soda, and fruit drinks (especially when sipped slowly throughout the day); crackers; and chewy candies that get caught in teeth have a greater likelihood of producing cavities than do less- sticky sweet foods. Bacteria in the mouth react with sugar and produce acids. These acids erode the tooth enamel

Food for Thought 3.1

Daily Carbohydrates and Fiber for Athletes

In this exercise, you will analyze a 1-day meal plan and discuss the health benefits of appropriate car- bohydrate intake.

68 SECTION 1 The Basics of Sports Nutrition

body. The RDA for carbohydrates recommends at least 130 grams per day for adults and children, based on the aver- age minimum amount of glucose utilized by the brain.21 The Acceptable Macronutrient Distribution Range (AMDR) for carbohydrates for males and females age 9 and older is 45–65% of daily calories.21

What is the relationship between current body weight and carbohydrate intake? Carbohydrate needs can be determined based on current body weight. Three to 12 grams of carbohydrate per kilo- gram of body weight is a general recommendation for cal- culating daily carbohydrate needs for athletes.22 Clearly, individual carbohydrate needs can vary greatly. Using the general recommendation of 3–12 g/kg, an athlete who weighs 60 kg would require 180–720 grams of car- bohydrates per day. The large range in recommendations allows for changes in exercise intensity, environmental conditions, and personal preferences, as well as type and quantity of daily physical activity. TABLE 3.6 provides sug- gested daily carbohydrate intake recommendations for a variety of activity levels.

How can carbohydrate needs be determined based on a percentage of total calories? The recommended range of 45–65% of calories coming from carbohydrates is quite large. The level of carbohy- drate in this range can be chosen for each individual based on medical conditions, training regimen, and per- sonal food preferences. This range provides enough car- bohydrates for the general population to maintain energy levels. For athletes, the middle-higher end of this percent- age range is usually recommended. As training volume increases, or for endurance athletes preparing and taper- ing for competition, the percentage of calories from car- bohydrates can increase beyond the recommended range to as high as 70–75%. For recreational athletes or individ- uals with certain medical conditions, such as diabetes,

carbohydrate intake at the middle to low end of the range is typically appropriate.

The following provides an example of how to calcu- late carbohydrate needs based on a percentage of total calories:

Assume a recreational athlete requires 2500 calories daily and 55% of total calories from carbohydrates: 1. Calculate the number of total calories contributed by carbo-

hydrates based on the goal percentage: 2500 × 0.55 (55% of calories from carbohydrates) = 1375 calories from carbohydrates.

2. Convert calories from carbohydrates to grams of carbo- hydrates daily: 1375 calories ÷ 4 calories/gram = 344 grams of carbohydrates daily (see TRAINING TABLE 3.1 ). It is important to calculate and compare the grams of

carbohydrates based on both current body weight and the percentage of calories coming from carbohydrates. It can be misleading to follow only one formula or the other. For example, a 70-kg distance runner (exercising 2 hours per day) who consumes 4000 calories per day, of which 50% are carbohydrate calories, will consume approximately 500 grams of carbohydrates. At 70 kg, 500 grams is approx- imately 7 grams of carbohydrates per kilogram of body weight. If the quantity of carbohydrates was evaluated solely on the percentage of total calories contributed by carbohydrates, it might be perceived as falling on the low end of the recommendations. However, 7 grams of carbo- hydrate per kilogram of body weight falls well within the 6–10 g/kg recommendation for high-volume training, and therefore both guidelines are met.

Another important consideration is to calculate the percentage of calories contributed by carbohydrates and compare it to daily protein and fat needs. In cases such

Table 3.6 Daily Carbohydrate Intake Recommendations

Type of training Training duration (hours/day)

Daily carbohydrate intake range (g/kg)

Low intensity or skill-based activities

< 1.0 3–5

Moderate training ~1.0 5–7

High volume training

1.0–3.0 6–10

Extreme commitment

> 4.0–5.0 8–12

Training Table 3.1: Sample Meal Plan Providing 340–350 Grams of Carbohydrate

Food/Beverage Grams of Carbohydrate

Breakfast

1½ cups of raisin bran cereal 62

1 cup skim milk 12

1 cup sliced strawberries 11

Lunch

Grilled cheese sandwich 28

2 cups of vegetable soup 24

10 saltine crackers 20

Pear 26

Dinner

1½ cups of spaghetti with marinara sauce 70

+ 3 oz ground turkey 0

1 cup mixed vegetables 15

2 cups skim milk 24

1 cup frozen yogurt with 1/3 cup mixed berries 54

Total Carbohydrate Intake 346 grams

Chapter 3 Carbohydrates 69

as weight loss, total calories may be restricted slightly, and therefore carbohydrate estimates based on current body weight may launch the percentage from carbohy- drates into the 75–85% range. This high percentage makes it challenging, if not impossible, to include adequate lev- els of proteins and fats in the daily meal plan without exceeding total calorie needs. It is important to always balance carbohydrate, protein, and fat needs relative to total calorie estimates to ensure that athletes are properly fueled while meeting their goals of weight loss, mainte- nance, or gain.

A daily carbohydrate intake of 8-12 g/kg has been suggested as optimal for some athletes, especially dur- ing long-duration and high-intensity training sessions and competitive events.22 Athletes competing in the Race Across America, a nonstop cycling race from coast to coast, may consume this level of carbohydrate intake, which may translate to as much as 65–75% of their calo- ries from carbohydrates during the event (see Fortifying Your Nutrition Knowledge on the Race Across America).

What impact does the stage of training or competition schedule have on carbohydrate intake? For most athletes, carbohydrate needs will increase slightly as training volume increases or when approaching a competition. In general, during the off-season or recov- ery periods total calorie needs may be lower, and therefore total carbohydrate needs will also decline. As preseason conditioning begins and training volume and intensity are on the rise, carbohydrate needs will increase. Dur- ing the competitive season, carbohydrate needs remain high in preparation for hard workouts or events. Later in this chapter, the concept of carbohydrate loading, or supercompensation, which involves increasing the intake

Fortifying Your Nutrition Knowledge

Heather’s Experience as the Dietitian for Team 70+ in the Race Across America The Race Across America is a nonstop cycling event from the West Coast to the East Coast of the United States. I had the pleasure of planning and executing the nutrition plan for the 70+ Team—a four-man team of athletes over the age of 70—in August of 1996.

We met as a team in April of that year to begin planning. Dur- ing this meeting, I gathered background information on each individual—their food likes and dislikes, the type of beverages and food usually consumed during cycling, estimates of their sweat rates, food allergies and intolerances, medications, and much more. Between April and August, I calculated the daily energy, carbohydrate, protein, and fat needs for all four riders. The estimates were based on the system of two riders perform- ing an 8-hour shift: riding 1 hour, and resting for 1 hour in the van following the riders. The average distance and time ridden

in 1 day, based on an estimate of the riders pedaling at 15 mph, was 60–90 miles, or 4 to 6 hours a day. The average total cal- orie needs for the riders was approximately 5000–5500 calo- ries a day, with at least 65% of the total calories coming from carbohydrate.

I devised a daily regimen that included several meals, many snacks, and lots of fluid. Meals were eaten during a rider’s 8-hour shift off, in which the riders would be delivered to the roaming motor home following the team. In the motor home, the riders would eat a solid meal, get a massage, and sleep. Snacks were consumed during the rider’s rest hour in the van during his 8-hour shift. Fluids were consumed throughout the day, with a focus on sports drinks while cycling. The meals con- sisted of high-carbohydrate, moderate-protein foods includ- ing items such as spinach lasagna, turkey chili, and yogurt and cheese stuffed potatoes. As the week progressed, the riders’ tastes changed, requiring slight modifications to the menu items. The most requested food combination was baked pota- toes with raisins, salt, and milk. I would have never guessed that this combination would be so appealing!

The men ate a wide variety of foods throughout the week, supplying a perfect balance of carbohydrate, protein, fat, and fluids. Through daily food records, weigh-ins before and after shifts, and monitoring urine color and quantity, I ensured that the men stayed energized and hydrated. The 70+ Team com- pleted the race in 9 days, 2 hours, and 27 minutes. This achieve- ment granted them the recognition of the first team of men 70 years and older to ever successfully finish the Race Across America.

of carbohydrates in the days leading up to a competition, is discussed.

Some athletes, such as body builders, maintain a moderate amount of carbohy- drate intake during training but decrease carbohydrate intake in the days and weeks leading up to a com- petition, to create a more lean or “cut” look.

What are the various sources of dietary carbohydrates? Carbohydrates are found within each food group of the MyPlate food guidance system. The richest sources of carbohydrates are found in the grains, fruits, and vege- tables. Most dairy/alternative products, as well as beans, legumes, and nuts from the protein foods group, provide

Gaining the Performance Edge

Carbohydrate needs are determined based on a variety of factors, includ- ing total body weight, percentage of total calories, stage of training, and individual health conditions. Con- sider all of these factors when advis- ing athletes on an appropriate level of daily carbohydrate intake.

70 SECTION 1 The Basics of Sports Nutrition

• Soluble and insoluble fiber. • Vitamin C, potassium, and beta carotene. • A variety of antioxidants and phytochemicals. • Fewer calories than other carbohydrate sources, for

those attempting to lose weight. Fruits and vegetables can be consumed in many forms

(see TRAINING TABLE 3.3 ). There are benefits and drawbacks to each form: fresh, frozen, canned, dried, and juices. TABLE 3.8 outlines the reasons to choose or not to choose each form for a variety of different situations and preferences.

What are the best carbohydrate choices within the dairy/alternative group? Dairy/alternative foods and beverages provide a convenient mix of carbohydrates and proteins (see TRAINING TABLE 3.4 ). Most choices from this group are good sources of calcium. Milk is unique because it is an excellent source of calcium as well as vitamin D. Calcium and vitamin D are essential nutrients, especially to athletes participating in weight- bearing sports, providing strength and structure to bones. Dairy foods are produced from a variety of sources, most

moderate amounts of carbohydrates. Sweets, desserts, and sodas—part of the empty calories allowed in the MyPlate system—provide carbohydrates mainly in the form of simple sugars. Even though carbohydrates are found universally within each food group, it is impera- tive that athletes choose the most nutrient-dense options within each category for optimal performance and health.

What are the best carbohydrate choices within the grains group? Most of the foods found in the grains section of MyPlate are excellent sources of complex carbohydrates, fiber, and B vitamins (see TRAINING TABLE 3.2 ). The key is to choose whole-grain products that are more nutrient dense and sustain energy longer than refined carbohydrates. TABLE 3.7 lists a variety of healthy whole-grain options to choose most often, as well as refined starches to be incor- porated sparingly.

What are the best carbohydrate choices within the fruit and vegetable groups? In addition to carbohydrates, fruits and vegetables are ideal for athletes because they contain:

Table 3.7 The Goodness of Whole Grains

Whole grains to choose often

Refined grains to choose sparingly

Whole wheat bread White bread

Whole-grain cereals High-sugar cereals

Brown rice White rice

Whole wheat pasta White pasta

Barley Crackers

Bulgur wheat Croissants

Oatmeal

Quinoa

Spelt berries

Wheat pita bread

Wheat berries

Whole-grain tortillas

Whole wheat couscous

Training Table 3.4: Incorporating Carbohydrate-Rich Dairy/Alternatives into Meals/Snacks

• Top yogurt with oatmeal, nuts, or dried fruit for a midday snack or light breakfast.

• Layer fresh fruit, yogurt, and granola in a tall glass for a yogurt parfait.

• Use milk to make hot cereals, tomato soup, or hot chocolate.

• Thinly slice or shred cheese for salads, chili, and sandwiches.

Training Table 3.2: Incorporating Carbohydrate-Rich Whole Grains into Meals/Snacks

• Cook a mixture of old-fashioned oatmeal and bulgur wheat with skim or soy milk and top with dried fruit and nuts.

• Toast whole wheat, spelt, or millet bread and top with peanut butter.

• Stir-fry lean meats or tofu with vegetables and serve over brown rice, whole wheat couscous, or wheat berries.

• Make a complete meal with a dish of whole wheat pasta, garbanzo beans, and roasted/steamed vegetables mixed lightly with olive oil and Italian seasonings.

Training Table 3.3: Incorporating Carbohydrate-Rich Fruits and Vegetables into Meals/Snacks

• Keep fresh fruit on hand for quick snacks and complements to breakfast, lunch, or dinner.

• Freeze slightly overripe fruits to blend into smoothies (see Soccer Smoothie recipe) made with other ingredients such as milk, yogurt, peanut butter, or juices.

• Add sautéed vegetables to spaghetti sauce or canned soups.

• Purchase precut vegetables for snacks, stir-fry, salads, or stews.

Soccer Smoothie

1 frozen banana*

8 oz skim or soy milk

1 scoop chocolate-flavored protein powder

1–2 tbsp peanut butter

Place all ingredients in a blender and mix until smooth.

* Peel overripe banana, place in a plastic bag, and freeze overnight beforehand.

Serving Size: 2 cups (Recipe makes one serving)

Calories: 373 kcals

Protein: 32 grams

Carbohydrates: 44 grams

Fat: 10 grams

Chapter 3 Carbohydrates 71

commonly from the milk of cows. Soy and other grain- derived milk, yogurt, and cheese products are an excellent alternative for those choosing to avoid animal products or for individuals who struggle with lactose intolerance. The soy/grain products tend to be low in saturated fat, have no cholesterol, and provide a good source of carbohydrates and proteins. However, the plant sources of dairy alterna- tive products are typically not naturally high in calcium and vitamin D; therefore, look at the Nutrition Facts panel on each dairy alternative product to ensure that it has been fortified with these nutrients.

What are the best carbohydrate choices within the protein foods group? Beans, lentils, nuts, seeds, and soy products are included in the protein foods group and are excellent sources of carbohydrates (see TRAINING TABLE 3.5 ). These foods are also a good source of protein, iron, zinc, and fiber. Beef, chicken, fish, eggs, and other ani- mal meats do not con- tain carbohydrates.

Can foods containing simple sugars or artificial sweeteners be used as a source of carbohydrates? Some sugary or sweet foods can serve as sources of car- bohydrates (see TRAINING TABLE 3.6 ). Candies, desserts, jel- lies, and regular sodas contain carbohydrates in the form of simple sugars but are otherwise void of nutrient value. These foods complement other foods to make meals and snacks more flavorful and enjoyable. Sweets and sodas do not need to be permanently excluded from the diet but should be used sparingly. Diet sodas, desserts, and snacks replace sugar with artificial sweeteners, thus pro- viding minimal or no carbohydrates. Diet foods can be incorporated into a healthy diet, but should also be used sparingly to make room for carbohydrate-rich and nutri- ent-dense foods.

What are the glycemic index and glycemic load, and how can they be used in sports nutrition? There has been much interest in both the lay and scientific literature about the glycemic index of foods. In the quest for the optimal diet for sport performance, investigators have been searching for information about the different types of carbohydrate foods and the timing of these foods that may be beneficial to athletes. It has been suggested

Gaining the Performance Edge

Athletes should be educated on the benefits and drawbacks of different forms of fruits and vegetables. How- ever, the bottom line is to encour- age athletes to eat more fruits and vegetables, in any form they find convenient!

Table 3.8 Pros and Cons of Various Forms of Fruits and Vegetables

Form Benefits Drawbacks When to Include in the Meal Plan Fresh Can be enjoyed raw or cooked. Retains

nutrients if eaten soon after purchasing. Very flavorful.

Spoils within 7 to 14 days of purchase. Produce shipped from other countries may lose some nutritional value between being harvested and served at the table.

Any time! Raw fruits and vegetables are perfect for snacking. Fruits and vegetables should compose about one- third to one-half of each meal.

Frozen Frozen soon after harvesting, thus retaining most nutrients. Can be stored in the freezer for 3 to 6 months for convenience and availability year-round.

May not be sustainable for dishes calling for fresh fruits/vegetables or in salads.

Fruits can be used in smoothies or thawed and eaten with yogurt or cereals. Vegetables make quick meals by thawing and heating thoroughly on the stove or in the microwave. Perfect for soups, stews, lasagna, and casseroles.

Canned Canned soon after harvesting, thus retaining most nutrients. Can be stored for 6 to 12 months for convenience and availability year-round. Do not have to be refrigerated.

Fruits may be canned with added sugars. Look for fruits canned in their own juice. Vegetables are typically canned with sodium or other preservatives. Rinse canned vegetables before serving.

Canned fruits are perfect to keep in a desk drawer or in the car for a quick, easy snack, any time. Canned vegetables can be used for any dish calling for cooked vegetables, or added to sauces, soups, or stews for a vegetable boost.

Dried Do not require refrigeration. Can be stored for 6 to 12 months or more. Concentrated source of calories.

May not be appropriate for all recipes. High in calories for a small amount of food compared to fresh fruits and vegetables; therefore, may not be the best form for individuals attempting to lose weight.

Add to nuts for a trail mix snack. Keep on hand for a fruit source when fresh fruits are not available. Great for traveling.

Juices Quick and easy source of fruits and vegetables. Concentrated source of vitamins and minerals compared to whole fruits and vegetables.

Contains significantly more calories per serving than fresh fruits and vegetables. Minimal to no fiber is found in juices.

Ideal for after exercise, providing a dose of fluids, carbohydrates, potassium, vitamin C, and other nutrients. For some, a small amount of juice before exercise settles well and supplies fluid and carbohydrates to sustain effort during exercise.

72 SECTION 1 The Basics of Sports Nutrition

that the glycemic index and the glycemic load can provide guidance to athletes to help them make appropriate car- bohydrate choices. While sports nutri- tion professionals should understand these concepts, it is important to realize that “in the majority of studies examined, neither glycemic index not glycemic load affected endur- ance performance nor metabolic rep- sonses when condi- tions were matched for carbohydrate and energy.”22

The glycemic index (GI) indicates how much a certain food raises blood glucose levels when consumed in isola- tion. The index is cal- culated by measuring the incremental area under the blood glu- cose curve following ingestion of a test food that provides 50 grams of carbohy- drates, compared with the area under the curve following an equal carbo- hydrate intake from a reference food.23 Glucose and white bread are most often used as the food standard, given a GI value of 100, to which all other foods are compared. Accordingly, a GI of 70 indicates that consuming 50 grams of the food in question provides an increase of blood glu- cose 70% as great as that for ingesting 50 grams of pure glucose.24 GI testing occurs after an overnight fast. The GI ranking of specific foods is based on the measurement of the blood glucose response 2 hours after the sample food is ingested.

Unfortunately, the GI of individual carbohydrate foods cannot be determined based simply on their clas- sification as a mono-, di-, or polysaccharide. Similarly, it is too simplistic to instruct people to eat more complex car- bohydrates than simple carbohydrates to help keep gly- cemic response low. Fiber, protein, and fat content, along with other factors, can affect the GI of carbohydrate foods (see TABLE 3.9 ). The GI of foods appears to be much more complex than initially thought and is not an easy way to categorize food. As a result, its use in daily dietary practice is of little practical value.

What is glycemic load? The concept of glycemic load was introduced in 1997 to determine whether the overall glycemic effect of a diet, not just the carbohy- drate content, is related to disease risk.25 Researchers defined dietary gly- cemic load as the product of the GI of food and the amount of carbohydrates in a serving. Therefore, an indi- vidual food that has an established GI and a known amount of carbohydrates in the serving size tested can also have a glycemic load number. By summing the gly- cemic load of individual foods consumed throughout one day, the overall glycemic load of the whole diet can be calculated.26 Thus, glycemic load looks at the impact of carbohydrate consumption, taking the GI into consideration.

Glycemic Load = (GI × carbohydrate content per serving)/100

glycemic index (GI) An index for classifying carbohydrate foods based on how quickly they are digested and absorbed into the bloodstream. The more quickly blood glucose rises after ingestion, the higher the glycemic index.

glycemic load A way of assessing the overall glycemic effect of a diet based on both the glycemic index and the number of carbohydrates provided per serving for each food ingested.

Gaining the Performance Edge

Dietary carbohydrates can be obtained from a variety of foods throughout the MyPlate food guid- ance system. Each food group provides a unique blend of carbohy- drates and other nutrients. Athletes should focus on the most nutrient- dense carbohydrate sources, includ- ing whole grains, fruits, vegetables, low-fat dairy/alternatives, beans/ legumes, and nuts.

Training Table 3.5: Incorporating Carbohydrate-Rich Protein Foods into Meals/Snacks

• Use extra-firm tofu for spaghetti sauce or casseroles.

• Keep canned beans on hand to toss into salads or pasta dishes.

• Make hummus (see Handball Hummus recipe) from garbanzo, cannellini, or black beans for a quick sandwich spread or dip for vegetables.

• Spread peanut butter on whole grain bread, bagels, or crackers.

Handball Hummus

1 15-oz can of garbanzo beans, drained; reserve liquid

1–2 tbsp liquid from the can of garbanzo beans

1–2 tbsp tahini (sesame seed paste)

1–2 tbsp lemon juice

1 tsp ground cumin

½ tsp ground coriander

¼ tsp ground black pepper

Place all ingredients in a food processor. Blend until smooth. Serve with pita bread, raw vegetables, or as a sandwich spread.

Serving Size: ¼ cup (Recipe makes eight servings)

Calories: 110 kcals

Protein: 5 grams

Carbohydrates: 16 grams

Fat: 3 grams

Training Table 3.6: Incorporating Moderate Amounts of Carbohydrate-Rich Sweets into Meals/Snacks

• Use 1–2 teaspoons of jelly on toasted whole grain bread or muffins.

• Enjoy 1–2 small cookies with milk as a bedtime snack.

• Bake oatmeal cookies with a few chocolate chips.

• Savor a bite-sized candy bar instead of a full-size bar after a meal.

Chapter 3 Carbohydrates 73

of the glycemic index have suggested that athletes should consume low-GI foods before exercise, and high-GI foods during and after exercise.27–29

While using the GI of foods to help athletes improve sport performance may have some merit, there are also some limitations. Most GI studies have been conducted using human subjects who are not exercise trained. The responses to GI in trained versus untrained individuals could be very different. In general, trained individuals have more muscle mass and are more insulin sensi- tive than are untrained individuals. In addition, not all research reports a direct correlation between the GI of foods consumed before, during, and after exercise and enhanced athletic performance.30

Not all foods have been tested and ranked in the GI system. Many factors affect the GI and can ultimately influence the glucose and subsequent insulin response in the bloodstream. In practical terms, a variety of low-, moderate-, and high-GI foods contain a variety of nutri- ents, soluble and insoluble fiber, and phytochemicals that are beneficial to the body. Educating athletes about these health benefits, while incorporating recommendations on carbohydrate intake for sport performance, will help ath- letes stay healthy and perform optimally.

How are carbohydrates utilized during exercise? Whether an athlete is engaging in long-duration endur- ance activities, intermittent exercise, or short-duration, high-intensity power sports, carbohydrates are needed to supply fuel to the muscles and brain. In regard to oxygen consumption, carbohydrates produce energy in a more efficient manner than fats or proteins. Athletes who eat lower levels of carbohydrates find that workouts become harder to complete, mental focus is more difficult, energy levels drop, and muscles feel fatigued.

The body prefers to use carbohydrates as fuel during exercise. Depending on the intensity of the exercise, car- bohydrates may be broken down for energy via aerobic or anaerobic means. At low to moderate exercise levels, carbohydrates are primarily aerobically metabolized for energy. Each glucose molecule passes through glycoly- sis, where it is broken down to pyruvate. From there, the pyruvate is converted to acetyl coenzyme A (CoA) and enters into the citric acid cycle. The citric acid cycle strips hydrogens off the carbon structure of the acetyl CoA, leav- ing the carbon atoms to bind with oxygen to form CO2. The hydrogens are carried to the electron transport chain, where they are used to create energy in the form ATP. In the process of transferring hydrogens, water is formed (see FIGURE 3.7 ).

At rest and during low exercise intensities (< 20% of aerobic power), fatty acids play a major role in energy pro- duction along with carbohydrates. However, when

However, there are many influences that affect indi- vidual responses to the glycemic load, including factors that could slow carbohydrate absorption, the total glyce- mic load of a meal or several meals throughout the day, and the differences in single serving sizes that people typically consume that may be very different from the portions tested to establish a GI for individual foods. The glycemic load data should be used cautiously to account for these variances.

How does the glycemic index relate to exercise? Discussions about the GI have led researchers to test whether the GI of foods is helpful to active individuals. Because carbohydrates are a primary fuel for athletes, especially during high-intensity or long-duration exercise, it has been suggested that manipulating the diet using GI information may improve sport performance. The goal of using the GI is to optimize carbohydrate availability before, during, and after exercise. In general, supporters

Table 3.9 Factors Affecting the Glycemic Index of Foods

Factor Explanation Type of carbohydrate The glycemic index of individual carbohydrate

foods cannot be determined based simply on their classification as simple (i.e., mono- or disaccharides) or complex (i.e., polysaccharides) because some complex carbohydrates have higher glycemic indexes than simple ones.

Fiber content Typically, high fiber content lowers the glycemic index of a food.

Fiber type Soluble fiber tends to lower the glycemic index of a food more than insoluble fiber.

Protein content The higher the protein content of a carbohydrate food or meal, the lower the glycemic index.

Fat content The higher the fat content of a carbohydrate food or meal, the lower the glycemic index.

Form of the food (i.e., liquid versus solid)

Liquid sources of carbohydrates tend to have higher glycemic indexes than solid foods of similar carbohydrate makeup.

Timing of the meal The time since the last meal can affect the glycemic index of carbohydrate foods.

Food combinations Combining a high-carbohydrate food with other foods greatly alters the glycemic index of the food compared to if it were eaten alone. Typically, mixing carbohydrate sources with foods containing proteins and fats lowers the glycemic index. Consuming different carbohydrate foods at the same time also can affect the glycemic index compared to if the carbohydrate food had been eaten by itself.

Amount of carbohydrate consumed

The glycemic index of a carbohydrate source can be altered by the quantity of carbohydrate ingested (i.e., glycemic load).

74 SECTION 1 The Basics of Sports Nutrition

exercise intensities increase to a moderate level (40-60% of aerobic power), carbohydrates become the major source of energy. The reason for this switch is because oxygen delivery, and thus availability, becomes limited during intense aerobic exercise and the body shifts to the meta- bolic fuel (i.e., carbohydrates) that will deliver the most energy for the amount of oxygen available. The point at which carbohydrates take over as the primary energy source is called the crossover point.31 As depicted in FIGURE 3.8 , activities to the left of the crossover point rely primarily on fats for energy. Endurance training causes adap- tations in the body that cause the cross- over point to move to the right. In other words, trained endurance athletes can exercise or perform at higher intensities and rely more on fats than carbohydrates for energy than untrained indi- viduals. This is important because the body’s

crossover point The point on an increasing continuum of exercise intensity where fats and carbohy- drates each contribute 50% of the needed energy and beyond which carbohydrates become the pre- dominant energy source.

Figure 3.7 Carbohydrate metabolic pathways. The citric acid cycle strips hydrogen from the carbon structure of the acetyl CoA, leaving the carbon atoms to bind with oxygen to form CO2. The hydrogen is then carried to the electron transport chain, where it is used to create energy in the form of ATP.

Source: Adapted from Brooks GA, Mercier J. Balance of carbohydrate and lipid utilization during exercise: the “crossover” concept. J Appl Physiol. 1994;76(6):2253–2261.

Figure 3.8 Carbohydrate and fat utilization at varying intensities of exercise. The point at which carbohydrates take over as the primary energy source is called the crossover point. Endurance training can shift the crossover point to the right.

carbohydrate stores are limited, and when the muscles deplete their glycogen stores, they fatigue. Because endur- ance training increases the body’s ability to use fats for energy, it helps to spare glycogen and thus delays fatigue, which improves endurance performance.

During the most intense activities, such as an all-out sprint, carbohydrates are the only macronutrient that can be metabolized fast enough to provide energy. The energy comes from the anaerobic breakdown of glucose to lactic acid (see Figure 3.7). This metabolic pathway is capable of producing energy very rapidly and thus can supply the energy needed in activities that require rapid production of ATP. Because most sports require bursts of intense activity that draw energy from anaerobic metab- olism, restricting carbohydrates from an athlete’s diet is tantamount to performance suicide.

How much carbohydrate is stored within the body? As previously discussed, carbohydrates are stored in the body as glycogen. Unfortunately, compared to fats, the other major source of energy in the body, very little gly- cogen is stored. The body may be able to store a total of only 400–600 grams of carbohydrates in the liver and muscle.32 This amounts to about 1600–2400 kcal (4 kcal per gram of carbohydrate) depending on body size, time of day, and dietary intake. Although 1600–2400 kcals sounds like a lot, it should be noted that only about 400– 500 kcals are actually directly available to be used for maintaining blood glucose levels. The remaining 1200– 1900 calories from glycogen are found in the muscle cells, which are very stingy about sharing their glycogen.

ATP

e–

CARBOHYDRATES

Glucose

G ly

co ly

si s

Pyruvate Lactic acid

Citric acid cycle

Electron transport chain

Acetyl CoA

e–

E ne

rg y

co nt

rib ut

io n

(% )

Aerobic power (%)

0 0

100

20 40 60 80 100

Carbohydrates

Fats

Training

Chapter 3 Carbohydrates 75

In other words, muscle cells are not capable of releasing stored glucose directly into the bloodstream. Unlike in liver cells, which can release glucose back into the blood to help to maintain glucose levels between meals, once glucose is taken into the muscle cell, it cannot be directly released back into the bloodstream. Therefore, once the liver is depleted of glycogen, blood glucose levels begin to decrease. Conversely, fat cells, known as adipocytes, store an estimated 90,000 kcals of energy and are capable of sharing their stored energy with the rest of the body. Because carbohy- drates are such an important fuel for the exercising mus- cle and so little is stored in the body, individuals need to be aware of ways to improve both circulating and storage forms of carbohydrates for success during training and competition.

Why are carbohydrates an efficient fuel source? Carbohydrates are a good source of rapid energy for sev- eral reasons. One reason is that carbohydrates are actu- ally stored in the muscle cells themselves. This means they are readily available to provide energy at the very outset of exercise, unlike most fats, which are stored at remote sites in the body and must be delivered via the bloodstream.

Another reason carbohydrates are such an efficient fuel is that they can provide energy for a short period of time without the need for oxygen. To get energy for exercise or sports from fats, our cells must have oxygen. Without adequate amounts of oxygen being delivered to the muscles, fats and, to a lesser extent, proteins cannot produce enough energy to support intense exercise. For- tunately, not only are carbohydrates readily available for energy, but also muscle cells can break down carbohy- drates for energy without oxygen being present. This is known as anaerobic metabolism.

Finally, when carbohydrates are broken down in the presence of adequate oxygen, because of the chemical makeup of carbohydrates compared to fats, less oxygen is needed. A person’s aerobic exercise rate is limited by how fast oxygen can be delivered to muscle cells, so it is better to rely on carbohydrates because less oxygen is needed.

Does carbohydrate intake enhance performance? There is no question about the importance of carbohy- drates in sport performance. In fact, athletes who prac- tice a diet that restricts carbohydrates for a long period of time are severely hindering their preparation for and performance in their sport. A review of the earlier sec- tion on the role of carbohydrates gives hints to this fact. Regardless of the sport or its energy requirements, a pos- itive mental attitude and energetic approach to train- ing are required on an ongoing basis if improved sport

adipocyte A single fat cell.

Figure 3.9 Diet composition, muscle glycogen levels, and time to fatigue. The muscle glycogen stores serve as readily avail- able energy sources for muscle during activity. Exercise and/or diet can greatly affect glycogen levels. Data from Astrand PO. Diet and athletic performance. Federation Proc. 1967;26:1772–1777.

performance is the goal. Depleted muscle glycogen levels and low blood glucose levels lead to loss of mental focus, feelings of weakness, and thus ineffective training.

Does carbohydrate intake delay fatigue? The answer to this question is a resounding yes, if the fatigue is the type experienced by many endurance ath- letes. As noted earlier in this chapter (see the section “What functions do carbohydrates serve in the body?”), carbohydrates, namely glucose, are an important source of energy during exercise. Because carbohydrates are an important energy source, the body stores them as gly- cogen in the liver and muscles. Liver glycogen is impor- tant for maintaining blood glucose levels between meals and during exercise, thereby providing a relatively con- stant supply of energy to muscles and other tissues. The muscle glycogen stores serve as readily available energy sources for muscle during activity. Exercise and/ or diet can greatly affect glycogen levels (see FIGURE 3.9 ). A diet high in carbohydrates can lead to increased gly- cogen stores in both the liver and the muscle, whereas one that is low in carbohydrates can decrease glycogen levels. Depletion of glycogen stores at either of these locations can negatively affect performance. Figure 3.9 clearly indicates that the carbohydrate composition of a diet affects initial muscle glycogen levels and that high glycogen levels can significantly increase the amount of time until exhaustion in an exercising athlete. In fact, this is the main reason why endurance athletes engage in carbohydrate loading in the days leading up to an event. It is not that extra glycogen in the muscle cells makes endurance athletes faster; it just enables them

W or

k T

im e

(m in

ut es

)

Initial muscle glycogen level (g/100 g muscle)

120

180

240

300

1 2 3 4 5

Diets: Low carbohydrate Moderate carbohydrate High carbohydrate

76 SECTION 1 The Basics of Sports Nutrition

to maintain their race pace for a longer period of time, which translates into faster race times.

Ingestion of carbohydrates during activity is also critical for delaying fatigue in endurance sports.33 Over time, the liver’s glycogen stores begin to decrease because of the increased demand for glucose. As the liv- er’s glycogen stores near depletion, its ability to maintain blood glucose levels decreases and work output dimin- ishes. If exercise persists after liver glycogen is depleted, muscles will continue to use available blood glucose for energy. Eventually, blood glucose levels will fall below normal levels, causing hypoglycemia (low blood sugar). Signs and symptoms of low blood glucose include hun- ger, dizziness, shakiness, headache, and irritability. If carbohydrate intake remains insufficient and glucose levels continue to drop, unconsciousness, coma, and death can result.

As shown in FIGURE 3.10 , after about 90 minutes of exercise, which corresponds to the amount of time it takes to severely diminish liver glycogen stores, blood lev- els of glucose begin to fall below resting levels (i.e., time = 0 minutes). However, when a glucose polymer drink was ingested at minute 135, blood glucose increased to lev- els comparable to those earlier in the exercise session.

Figure 3.10 Carbohydrate sports drinks and performance. Blood glucose levels begin to fall below resting levels after 90 minutes. Subjects who consumed carbohydrate drinks (135 minutes) had dramatically increased blood glucose levels, whereas levels continued to decrease in subjects fed a placebo. Data from Coggan AR, Coyle EF. Metabolism and performance following carbohydrate ingestion late in exercise. Med Sci Sports and Exerc. 1989;21(1):59–65.

Helping the body to maintain blood glucose levels through carbohydrate ingestion during exercise can, in turn, translate into sustained effort and thus enhanced per- formance.33 Figure 3.10 clearly demonstrates the impor- tance of consuming carbohydrates during activity and its impact on blood glucose.

Power sports are those that require very short bursts of intense activity. The most extreme examples of power sports are shot put, discus, Olympic weightlift- ing, and the 100-meter sprint. In power sports, reliance on stored glycogen for energy is very low, and thus gly- cogen depletion in regard to performance is not neces- sarily of concern. However, a strong argument can be made for the impact carbohydrates have on the prepa- ration (i.e., the intense training required) for the sport competition. Diets low in carbohydrates combined with frequent intense training can, over time, diminish mus- cle and liver glycogen levels and lower blood glucose levels. Low blood glucose decreases overall energy level, motivation to train, and the mental focus needed for high-intensity training. In addition, decreased muscle glycogen levels can lead to feelings of chronic fatigue and thus decreased training intensity levels. The end result is suboptimal sport preparation, and thus poor competition performance.

What type, how much, and when should carbohydrates be consumed before exercise? To perform optimally, adequate amounts of carbo- hydrates need to be supplied to the body prior to exercise. The source, quantity, and timing of the carbo- hydrates ingested can lead either to a high-energy, high- performance exercise session or to a feeling of staleness and fatigue. Proper nutrition before exercise focuses on the quantity and type of food consumed in the days leading up to a work- out or event. Also of importance is the timing between eat- ing and exercise. The key to optimal nutri- tion before, as well as during and after, exercise is individu- alization. Each per- son has likes and dislikes, tolerances and in-tolerances. There is not one “best” pregame meal, sports beverage, or postexercise snack. However, by following a few guide- lines and lots of experimentation, athletes can deter- mine the nutrition plan that best fits their sport and lifestyle.

Gaining the Performance Edge

Listen and learn about athletes’ food/beverage likes and dislikes. Encourage them to experiment with a variety of carbohydrate-rich meals, snacks, and sports bever- ages during training to determine the best option for optimal perfor- mance on race day.

Exercise Time (min)

B lo

od G

lu co

se L

ev el

5.5

High

Time to fatigue

5.5

2.5

3.0

3.5

4.0

* *

4.5

5.05.0

4.5

4.0

3.5

3.0

2.5

0 30 60 90 120 150 180 210

Chapter 3 Carbohydrates 77

What should an athlete eat on the days leading up to an important training session or competition? It is widely recognized that exercise performance will be enhanced when preceded by several days of a high-carbo- hydrate diet. It is critical to consume adequate amounts of carbohydrates in the days, as well as the hours, lead- ing up to an exercise session or competition to maximize energy levels and performance.

As mentioned previously, research has shown that by increasing glycogen stores prior to exercise, athletes can increase the time to fatigue and enhance performance during prolonged, strenuous exercise (see Figure 3.9). The term carbohydrate loading has traditionally referred to the process of muscle glycogen supersaturation and has been shown to increase glycogen levels above normal, thus allowing ath- letes to perform lon- ger before fatiguing. For example, the gly- cogen content of skeletal muscle in an untrained indi- vidual, consuming a balanced diet, is typically around 80 mmol/kg of muscle wet weight. An adaptation of regular exercise training is the ability for muscles to store more glycogen. Therefore, trained individuals generally have muscle glycogen levels of ~125 mmol/kg. However, during tapering and carbohydrate loading, when exercise is decreased so that less glycogen is used on a daily basis and carbohydrate intake is simultaneously increased, gly- cogen stores can be boosted to levels of 175–200 mmol/kg of muscle wet weight.34

The concept of carbohydrate loading was first inves- tigated by Bergstrom and colleagues in the late 1960s.35 Although he found his 6-day regime to be effective at packing the muscle cells with up to two times their nor- mal glycogen concentration, the two exhaustive exercise bouts and the first 3 days of low carbohydrate inges- tion were found to be physically and mentally taxing to the athletes. Since then several modified versions of the original (i.e., classical 6-day protocol) have been developed with the intent of making it easier on the athlete and thereby avoiding the unwanted side effects (e.g., muscle soreness, fatigue, poor mental attitude). See TABLE 3.10 for details on a few of the modified car- bohydrate-loading regimes. The most current carbohy- drate-loading guidelines recommend 10-12 grams of carbohydrate per kilogram of body weight in the 36-48 hours prior to workouts or events lasting longer than 90 minutes.22

Much of what is known about carbohydrate loading has been derived from studies involving male subjects. It is interesting to note that studies involving carbohy- drate loading in females have yielded equivocal results. It

appears that for effective carbohydrate loading to occur in females, close attention must be paid to the total energy intake, level of carbohydrate intake, and phase of the menstrual cycle.36 Female athletes who increased their normal total energy intake by 34%, and at the same time maintained a carbohydrate intake of 75% of total calo- ries, demonstrated muscle glycogen increases compara- ble to males.37 It has also been reported that carbohydrate loading is more effective during the luteal phase rather than the follicular phase of the menstrual cycle. The dif- ference in the glycogen loading within the cells seems to be related to the differences in hormonal levels that exist between the menstrual phases.38 In fact, it has been reported that women taking oral contraceptives may have an advantage when it comes to carbohydrate loading due to the muting of hormonal differences between the men- strual phases.36,39

An athlete must take into consideration that temporary water weight gain may occur with carbohydrate loading. Muscles store 3 grams of water for every 1 gram of carbohydrate. Some individuals find that the extra water weight contributes to a bloated feeling and a sense of stiffness, which may negatively affect performance. Instead, “loading” the muscles with carbohydrates can be viewed as a daily component of training. If an athlete consumes 55–70% of total calories from carbohydrates daily, muscles may be consistently “topped off,” therefore not requiring an alteration to normal eating immediately prior to an event.

What should an athlete eat in the hours leading up to an important training session or competition? The 24 hours leading up to an important training session or competition are a critical time for carbohydrate-rich meals. By understanding the importance to performance and the general guidelines for intake, athletes can perfect their ideal pre-exercise meal/snack routine.

Four to 24 hours before exercise, training, or competition Four to 24 hours before exercise, foods high in carbo- hydrates should compose a majority of each meal and snack, providing approximately 60–70% of total calories. Eating high-carbohydrate foods during this time frame will help to “top off” glycogen stores in the muscles and liver, allowing athletes to start an exercise session with a full tank of “energy fuel.”

In addition to carbohydrates, proteins and fats play a role in preexercise meals 4 to 24 hours before activity. By incorporating protein- and fat-containing foods, the ath- lete ensures balance and moderation. Proteins and fats also contribute to the feeling of satiety, preventing the athlete from overeating.

carbohydrate loading A high- carbohydrate dietary plan com- monly used by endurance athletes that is designed to engorge muscle cells with glycogen.

78 SECTION 1 The Basics of Sports Nutrition

Especially when competing, athletes should con- sume meals and snacks consisting of familiar foods in the 24 hours prior to the event. There should be no trial-and- error at this time; meals and snacks should be planned weeks in advance after experimentation to find the opti- mal blend and type of solid foods and liquids. Eating or drinking unfamiliar foods in the 24 hours before an event can lead to unwanted gastrointestinal distress, such as indigestion, upset stomach, diarrhea, and cramping. Any of these symptoms will certainly compromise an athlete’s ability to perform to his or her potential.

Zero to 4 hours before exercise At this point, carbohydrate stores are at their peak prior to exercise, and the focus shifts to foods and bever- ages that will digest easily and prevent the athlete from

feeling hungry at the beginning of a training session or competition (see TRAINING TABLE 3.7 ). Athletes should strive to consume 1–4 grams of carbohydrate per kilogram of body weight in the 1 to 4 hours prior to exercise.22,40-43 Specific recommendations within these ranges will be based on individual tolerance. Athletes should be encour- aged to experiment with varying quantities of carbohy- drate and timing of intake during training to devise a plan for game day.

In the 1 to 4 hours prior to exercise, athletes should consider including the following foods:

• Complex carbohydrates: Carbohydrates consumed at this time will be used to elevate blood glucose lev- els for the start of an exercise session. Choose foods that are easy to digest and relatively low to moder- ate in fiber.

Table 3.10 Methods of Carbohydrate (CHO) Loading

CHO loading regimen

Requires exhaustive exercise or glycogen depletion

Exercise protocol Diet details Reference

Classic 6-day Yes Day 1 involves an exhaustive bout of exercise; days 2 and 3 involve moderate submaximal exercise; day 4 involves another exhaustive exercise bout; no exercise on days 5 and 6.

First 3 days low-CHO diet (~15% total calories); next 3 days high-CHO diet (~70% total calories)

Bergstrom et al.a

6-day No First 3 days involve intense submaximal exercise of decreasing duration. Day 1 involves 90 minutes exercise days 2 and 3 require 40 min of exercise. Next 2 days only 20 minutes of submaximal exercise. Last day no exercise.

First 3 days mixed diet (~50% CHO); next 3 days high CHO (~70% of total calories)

Sherman et al.b

Classic 3-day Yes Exhaustive bout of exercise followed by 3 days of no exercise.

3 days of high CHO intake (~70% total calories)

Ahlborg et al.c

Modified 3-day No No exercise for 3 days. 3 days of high CHO (10 g of CHO/kg of body weight per day)

Burke et al.d

1-day No No exercise for 1 day. 1 day of high CHO (10 g of CHO/kg of body weight per day)

Burke et al.e, Bussau et al.f

aBergstrom J, Hermansen L, Hultman E, Saltin B. Diet, muscle glycogen, and physical performance. Acta Physiol Scand. 1967;71:140–150. bSherman WM, Costill DL, Fink WJ, Miller JM. Effect of exercise–diet manipulation on muscle glycogen and its subsequent utilization during performance. Int J Sports Med. 1981;2(2):114–118. cAhlborg B, Bergstrom J, Brohult J, Ekelund LG, Maschio G. Human muscle glycogen content and capacity for prolonged exercise after different diets. Forsvarsmedicin. 1967;3:85–99. dBurke LM, Hawley JA, Schabort EJ, Gibson ASC, Mujika I, Noakes TD. Carbohydrate loading failed to improve 100-km cycling performance in a placebo-controlled trial. J Appl Physiol. 2000;88:1284–1290. eBurke LM, Angus DJ, Cox GR, Cummings NK, Febbraio MA, Gawthorn K, Hawley JA, Minehan M, Martin DT, Hargreaves M. Effect of fat adaptation and carbohydrate restoration on metabolism and performance during prolonged cycling. J Appl Physiol. 2000;89(6):2413–2421. fBussau VA, Fairchild TJ, Rao A, Steele P, Fournier PA. Carbohydrate loading in human muscle: an improved 1 day protocol. Eur J Appl Physiol. 2002;87:290–295.

Chapter 3 Carbohydrates 79

• Carbohydrate-rich protein sources: Protein will help to maintain blood glucose levels by delaying the diges- tion and absorption of carbohydrates after the meal. Foods that contain both carbohydrates and protein include dairy products, dairy-alternative products, soy products, and legumes. Legumes should be con- sumed in small amounts because they are packed with fiber, which can cause gastrointestinal discom- fort in some athletes.

• Fluids: Approximately 2 cups of fluid should be con- sumed 2 hours prior to exercise. In addition, aim for 1 cup of fluid 1 hour prior and 7 ounces of fluid 30 minutes prior to exercise. Water, milk, and juice are the best choices in the 2 to 4 hours before exercise. Water provides fluid and is absorbed quickly. Milk and juices provide fluid, carbohydrates, and a variety of vitamins and minerals. In general, sports drinks are not the best choice 2 to 4 hours before exercise, but are ideal during training. Compared to milk and juice, sports drinks have a lower concentration of carbo- hydrates, vitamins, and minerals. One exception to this rule may be for endurance athletes preparing for a long-duration training or exercise session. Sports drinks will provide fluid and a small amount of car- bohydrates before training or competition, generally without gastrointestinal distress. Some individuals find that consuming concentrated fluids such as milk or juices within an hour of exercise causes nausea and cramping. Each athlete is different; trial and error will uncover tolerances and preferences. In the last 2 hours prior to exercise, light meals,

small snacks, and beverages containing carbohydrates are ideal. Small quantities of carbohydrates help to keep blood glucose levels elevated, while minimizing the risk for gastrointestinal upset. Some research has suggested that eating carbohydrates during the 30 minutes immedi- ately prior to exercise can be detrimental to performance.

The theory is that ingested carbohy- drates will elevate insulin levels, caus- ing a reduction of blood glucose within 15 minutes of the initiation of exer- cise.44 However, most studies have failed to demonstrate a reduction in exer- cise performance during endurance activities resulting from preexercise carbohydrate con- sumption, especially if carbohydrate con- sumption is con-

tinued during exercise.45 The bottom line is that each athlete responds differently to the ingestion of carbo- hydrates immediately prior to exercise, and, therefore, individual preferences and tolerances must be built into an athlete’s nutrition recommendations.

Some individuals are concerned about eating prior to exercise and are hesitant about consuming any type of food or beverage. In some cases, the athlete has never consumed food or liquid prior to exercise, especially morning exercise, and is doubtful or leery about testing the procedure. These athletes should be encouraged to try a small snack or beverage such as a glass of juice or milk, a piece of fruit, or a slice of toast. The athlete may not consume a full, well-balanced meal, but something is better than nothing. If an athlete becomes nervous or anxious before an event, an upset stomach or intes- tinal distress will often result. Suggest that the athlete eat small amounts at a time of the foods he or she has found agreeable during training. Bites of a bagel, sips of juice, or sports beverages can be used in this situation to provide some fuel without further upsetting the gastro- intestinal tract.

Besides the energy that can be provided by carbohy- drates ingested prior to exercise, it has also been reported that the presence of carbohy- drates in the mouth activates regions of the brain that can improve exercise per- formance.46 Merely rinsing the mouth for about 10 sec- onds with a 6% car- bohydrate solution appears to stimulate

Gaining the Performance Edge

Remember that each athlete is dif- ferent. Some people may feel most comfortable eating their preexer- cise meal 3 to 4 hours prior to train- ing and find that waiting longer to eat leads to stomach and intesti- nal cramping. Others may find that they get too hungry if too much time passes between their last meal/snack and exercise. Individu- als should experiment not only with the type of carbohydrate-rich food and beverage, but also with the timing of their meals/snacks prior to exercise.

Gaining the Performance Edge

Athletes should strive to consume 1–4 grams of carbohydrate per kilogram of body weight in the 1 to 4 hours prior to exercise. Exper- imentation during training will help each athlete determine the optimal amount to include in the preexercise meal for performance enhancement.

Training Table 3.7: Carbohydrate-Rich Preexercise Meals (grams of carbohydrate)

• 1.5 cups cereal, 1 cup skim milk, and 1 cup orange juice (86 g)

• 2 pancakes, 3 tbsp syrup, ½ cup fresh fruit, and 1 cup skim milk (83g)

• 1 bagel, 2 tbsp peanut butter, 1 tbsp jelly, 0.5 cup unsweetened applesauce (71 g)

• 6 oz yogurt, 1 medium banana, 0.5 cup granola (85 g)

• ¾ cup oatmeal [dry], ¼ cup raisins, 2 tbsp walnuts, 1 cup skim milk (83 g)

• Turkey sandwich [2 slices bread, 6 slices turkey], 1 apple, 6 oz yogurt (101 g)

• 1.5 cup spaghetti with marinara sauce, 4 oz chicken, 2 cups garden salad, 2 tbsp salad dressing (87 g)

• Hummus/cheese wrap [4 tbsp hummus, 2 slices cheese, 1 cup lettuce, 1 flour tortilla], 1.5 cup vegetable soup, 10 Saltine crackers, 8 oz apple juice (95 g)

• 4 oz baked ham, 1 cup mashed potato, 1 cup fruit salad (96 g)

80 SECTION 1 The Basics of Sports Nutrition

oral sensory receptors that activate brain areas associated with reward and the regu- lation of motor activ- ity. Although the mechanisms are not clearly understood, the evidence is con-

vincing that mouth rinsing with carbohydrate solutions immediately prior to or during exercise may be a worth- while practice.47

What type, how much, and when should carbohydrates be consumed during exercise? Consuming carbohydrates during exercise has been shown to help delay fatigue in short-duration and long- duration activities.48–53 The theory is that carbohydrates provided during exercise can either reduce the reliance on the glycogen stored in the muscles and liver for energy or provide an alternative source of carbohydrates when glycogen is depleted. Various forms of carbohydrates have different properties related to digestion, absorption, avail- ability of glucose for oxidation, and taste. Because of their varying characteristics, the type of carbohydrate ingested during activity is of importance. Athletes need to develop a nutrition plan for during activity based on the nature of their sport, the availability of foods/beverages during training or competition, and individual tolerances.

What types of carbohydrates should be consumed during exercise or sport? Research has shown that glucose, sucrose, glucose poly- mers/maltodextrins, and starches are all absorbed and oxidized at high rates and therefore are appropriate fuels during exercise.54–61 Conversely, fructose and galactose are two simple sugars that are absorbed and oxidized at a slower rate. Fructose is absorbed half as fast as glucose and has to be converted to glucose in the liver before it can be metabolized. When consumed in large amounts, fructose can cause gastrointestinal distress, cramping, or diarrhea. As a result, fructose has been viewed as a less than desirable carbohydrate fuel during exercise.

However, this does not mean that fructose should not be consumed during exercise. Fructose increases the palatability of sports performance products. In addition, research has shown that a mixture of various sugars takes advantage of the different intestinal transporters and can actually enhance carbohydrate absorption and oxida- tion during exercise.22,40,62,63 As a result, sports nutrition products that contain a mixture of sugars can be highly valuable to athletes during exercise, particularly if it lasts longer than 1 hour. Common sports nutrition prod- ucts geared mainly for supplying carbohydrates during

exercise include sports beverages, carbohydrate gels, and energy bars (see TABLE 3.11 ).

How much carbohydrate should be consumed during exercise or sport? The quantity of carbohydrates consumed during exercise is dictated by two factors: (1) the rate of gastric emptying and intestinal absorption and (2) the rate at which the exogenous carbohydrate is utilized (i.e., exogenous oxi- dation rate) by the muscle during the activity. It appears that the rate of gastric emptying and intestinal absorption is the limiting factor to exogenous carbohydrate utiliza- tion during exercise. A study conducted by Jeukendrup et al.64 compared varying doses of exogenous carbohy- drates during exercise to the appearance of glucose from the gut into the systemic circulation and the subsequent muscle oxidation rates. A low dose of ingested carbohy- drates (0.43 grams of carbohydrate per minute) produced an equivalent appearance rate of glucose in the blood- stream (0.43 grams per minute), and the muscle was capa- ble of metabolizing 90–95% of the delivered glucose during exercise. When a high dose of carbohydrates was con- sumed (3 grams of carbohydrate per minute) the appear- ance of glucose into the bloodstream was only 33% of the amount ingested (0.96–1.04 grams of carbohydrate per minute), thus indicating that this was the maximum rate of digestion/absorption of glucose. It is interesting to note that the muscle was still able to oxidize 90–95% of the delivered glucose for energy. The authors concluded that intestinal absorption of glucose was the limiting fac- tor in regard to the ability of muscle to oxidize exogenous carbohydrates during exercise. Therefore, recommending the ingestion of carbohydrates at levels above the rates of intestinal absorption is not beneficial and can cause cramping and diarrhea, because any carbohydrate not absorbed will remain in the GI tract. Research indicates that the maximal intestinal absorption rate of glucose is 1.0–1.1 grams of glucose per minute. As a result, the cur- rent recommendation is that athletes consume approxi- mately 30–60 grams of glucose per hour during exercise to help maintain energy output while preventing gastro- intestinal upset.22

Because the oxidation rate is limited by intestinal absorption, it has been widely held that the oxidation rate of exogenous carbohydrates for energy by muscle is the same as the intestinal absorption rate of approximately 1.0–1.1 grams of glucose per minute.65 However, several factors, such as exercise intensity, muscle glycogen sat- uration, fitness level, and the mixture of carbohydrates ingested, have the potential to alter carbohydrate avail- ability to the muscle and thus exogenous carbohydrate oxidation rates during exercise.66 Research by Jentjens and colleagues67–69 has shown that mixtures of different forms of carbohydrate can increase intestinal absorption above that of glucose alone. For example, it was shown that ingesting a carbohydrate mixture of glucose, fructose, and sucrose supplying 2.4 grams of carbohydrate per minute

Gaining the Performance Edge

Performing a 10-second mouth rinse with a 6% carbohydrate solu- tion before and during exercise may improve athletic performance.

Chapter 3 Carbohydrates 81

(i.e., 1.2 gram of glucose + 0.6 grams of fructose + 0.6 grams of sucrose) during exercise resulted in exogenous carbohy- drate oxidation rates of greater than 1.5 grams per minute during exercise.67 The higher oxidation rate is believed to be the result of greater intestinal absorption. The greater intestinal absorption is thought to be due to the use of multiple intestinal transporters for the different forms of carbohydrates [i.e., a sodium-dependent glucose trans- porter (SGLUT1) for glucose, a sodium-independent facil- itative fructose transporter (GLUT 5) for fructose, and a possible disaccharidase-related transporter for sucrose]. The end result is more carbohydrate absorbed than glu- cose alone, and thus more exogenous carbohydrates deliv- ered to the active muscle. As a result, it has been suggested that the recommended range of 30–60 grams of carbohy- drate per hour be expanded to 30–90 grams per hour dur- ing exercise, especially during ultra-endurance exercise.66

Clearly, this is a wide recommendation range, but it must be understood that individual variances in the

quantity of carbohydrates tolerated during exercise may be great. Some individuals can consume 60–70 grams of carbohydrates per hour without gastrointestinal distress, whereas others start cramping and feeling bloated after ingesting 40 grams of carbohydrates per hour. Experimen- tation during training will reveal the ideal quantity for each athlete. The form of carbohydrate ingested can affect the quantity an athlete feels comfortable consuming. Athletes should try different combinations of sports drinks, bars, gels, and other foods to determine the best mix of solids and fluids to consume during training and competition.

Sports beverages provide a convenient means for con- suming not only carbohydrate, but also fluid and electro- lytes during exercise. It is generally recommended that athletes choose a sports beverage containing 6–8% car- bohydrate (i.e., 14–20 grams of carbohydrate per 8-ounce serving) to optimize gastric emptying and fluid absorp- tion during exercise.70 Beverages containing greater than 8% carbohydrate can be included in the athlete’s diet, but

Table 3.11 Carbohydrate Content of Commonly Used Sport Drinks, Gels, and Bars

Sports drink Calories Carbohydrates % Sugar solution Carbohydrates sources (all values per serving)

Skratch Exercise Hydration 40 10 g 4 Cane sugar, dextrose, lemon juice

Heed 50 14 g 6 Maltodextrin, xylitol, stevia

Generation Ucan 80 21g 9 Corn, sucralose

All Sport 70 20 g 8 High fructose corn syrup

Gatorade 50 14 g 6 Sucrose, glucose, fructose

Powerade 70 19 g 8 High fructose corn syrup, maltodextrin

Carbohydrate Gels

(all values per one packet)

Clif Organic Energy Food 110 23 g Banana puree, beet juice, ginger

Honey Stinger Gels 100 24 g Tapioca syrup, honey

Huma Gels 100 22 g Strawberry puree, cane juice, brown rice syrup, chia seeds, strawberry concentrate

Gu Energy Gel 100 25 g Maltodextrin, fructose

Hammer Gel 90 23 g Maltodextrin, fructose

PowerBar PowerGel 110 26 g Maltodextrin, fructose

Energy Bars/Chews

Clif Bar (1 bar) 240 45 g Brown rice, oats, cane sugar

Hammer Bar (1 bar) 220 25 g Date paste, agave nectar

PowerBar (1 bar) 230 45 g Oats, rice crisps, glucose syrup

Clif Bloks (3 pieces) 100 24 g Tapioca syrup, cane syrup, maltodextrin, juice colorings

Honey Stinger Chews (1 pkg) 160 39 g Tapioca syrup, honey, cane juice, grape juice

Gu Chomps (4 pieces) 90 23 g Tapioca syrup, cane sugar, maltodextrin

82 SECTION 1 The Basics of Sports Nutrition

preferably not during training or competition (an excep- tion to this rule is during ultra-endurance activities). These more concentrated carbohydrate beverages can also be useful during carbohydrate loading or for athletes who are struggling to consume enough total calories or carbohydrates.

When should carbohydrates be consumed during exercise or sport? Limited research has been conducted on a wide range of carbohydrate feeding schedules. The results from recent studies suggest that athletes should begin ingesting car- bohydrates early in a training session and continue to consume carbohydrates at a steady rate throughout the exercise period.

One schedule variation that has been investigated is the difference in oxidation rates between a bolus carbo- hydrate feeding at the start of an exercise session ver- sus the equivalent amount of carbohydrates consumed in repetitive feedings throughout a bout of exercise. Sev- eral studies provided subjects with a single glucose load of 100 grams at the onset of exercise lasting 90 to 120 minutes.71–73 These studies have shown a similar oxida- tion pattern: oxidation rates increase during the first 75 to 90 minutes of exercise, followed by a plateau thereafter. When the equivalent amount of carbohydrates (100 grams) is consumed in repetitive feedings throughout an exercise bout lasting 90 to 120 minutes, the same oxidation pat- tern is observed.74–76 In general, repetitive small feedings are easier to tolerate than one large bolus feeding while exercising. If the oxidation rate is the same, then repetitive feedings may be more desirable if food and beverages are readily available. If not, then infrequent, larger doses of carbohydrates before and during pro- longed exercise may provide the same effect for endurance performance.

If an athlete chooses to con- sume carbohydrates at regular intervals during exercise, the feedings should begin soon after the onset of exercise. A study conducted by McConell et al.77 investigated the per- formance effects of consuming carbohy- drates throughout exercise versus the ingestion of an equal amount of carbo- hydrates late in the

exercise session. The results revealed a performance ben- efit versus controls only when carbohydrates were con- sumed throughout exercise. Ingestion of carbohydrates late in the exercise session did not improve performance despite an increase in circulating glucose and insulin after ingestion. Therefore, the consumption of sports drinks, energy bars, gels, or other sports-related foods and bever- ages should begin soon after the initiation of exercise to enhance performance during training and competition.

What type, how much, and when should carbohydrates be consumed after exercise? Muscle and liver glycogen are used partially or completely during moderate-intensity/moderate-duration and high- intensity/long-duration activities, respectively. After exer- cising, it is critical to feed the muscles with carbohydrates to replenish stores of muscle and liver glycogen to be used in the next exercise session.

Unless sufficient carbohydrates are consumed in the diet after training or competition, muscle glycogen will not normalize on a daily basis and performance will suf- fer. A study conducted by Costill et al.78 studied the per- formance effect of a low-carbohydrate diet fed to runners on successive training days. After 3 days on the low-car- bohydrate diet, muscle glycogen was depleted progres- sively, and, subsequently, some runners found it difficult to complete the prescribed workouts (see FIGURE 3.11 ).

When devising a postexercise recovery nutrition plan for athletes, several important factors must be considered:

• The timing of carbohydrate ingestion • The type of carbohydrates and inclusion of other

macronutrients • The quantity of carbohydrates in the postexercise

meal or snack

When should carbohydrates be consumed after exercise or sport? Replenishing glycogen stores used during exercise can take 20 hours or more even when consuming a diet con- sisting of 60% of total calories from carbohydrates.79 This relatively slow rate of glycogen replenishment does not pose major problems for recreational athletes or others who train aerobically three to four times per week and ingest adequate carbohydrates because usually there is sufficient time between workouts to allow for glycogen recovery. However, the slow glycogen recovery rates can pose problems for endurance athletes who train daily or who perform multiple workouts per day. In these cases, the timing and type of carbohydrates ingested are important.

Research indicates that muscles absorb blood glu- cose and restore glycogen at higher rates when carbo- hydrates are ingested within 2 hours after cessation of training/sport performance.80 Delaying carbohydrate con- sumption until 4 hours or more after training can cut the

Gaining the Performance Edge

Carbohydrate ingestion during exer- cise has been shown to help delay fatigue and thus improve exercise performance. Carbohydrate con- sumption of approximately 30–60 grams of carbohydrates per hour should begin near the onset of exercise and continue throughout the session. Individuals engaging in ultra-endurance exercise may tolerate up to 90 grams of carbohy- drate per hour. The impact of exog- enous carbohydrates increases as the duration of exercise increases. Individualized nutrition plans are required for each athlete, including fluids and foods containing carbo- hydrates that have been tested and evaluated during training.

Chapter 3 Carbohydrates 83

glycogen synthesis rate in half compared to when carbo- hydrates are consumed immediately after exercise.80 To take advantage of this window of opportunity, athletes should begin consumption of carbohydrate sources as soon as possible—some suggest as soon as 15 minutes after exercise.81 Eating immediately or as soon as pos- sible after exercise will allow time to digest and absorb the carbohydrates into the bloodstream and shuttle it to the cells.80 An athlete’s nutrition plan should include snacks and beverages that will be available for consump- tion immediately postexercise. In many cases, athletes are away from home and without refrigeration during this time frame; therefore, nonperishable foods and drinks are the best options.

What type of carbohydrates should be consumed after exercise or sport? Because the quick delivery of carbohydrates to the mus- cles is of utmost importance, choosing carbohydrate-rich foods that are digested and absorbed quickly is essential. Several factors have been suggested to enhance glyco- gen resynthesis after exercise, including liquid forms of carbohydrates, and beverages combining carbohydrates and protein.

Liquid carbohydrate sources may not necessarily be more beneficial than solids in regard to the rate of gly- cogen synthesis. Several studies have found similar gly- cogen restoration rates after the ingestion of an equal amount of carbohydrates in liquid and solid form.82,83

Because no differences between liquids and solids exist, individual preferences can determine the form of carbo- hydrates ingested after exercise. Some athletes are ready for a full meal after training; therefore, a balanced meal with sufficient carbohydrates will be appropriate. Other athletes have a small appetite after exercising, so a liquid meal has more appeal. The Soccer Smoothie recipe in Train- ing Table 3.3 provides an example of a liquid source of car- bohydrates as well as other nutrients. Depending on the size of the athlete and the duration of exercise, foods or beverages in addition to the smoothie might be required to supply sufficient amounts of carbohydrates to the body after a training session or a competition.

It has been suggested by some researchers that the combination of carbohydrates and protein in a postex- ercise beverage enhances glycogen storage beyond that of a carbohydrate-only product. One of the first studies to report this phenomenon was completed by Zawadzki and colleagues.84 They reported an impressive 39% greater rate of glycogen repletion with a combined carbohydrate-protein versus carbohydrate-only supple- ment after exercise. However, the results are difficult to interpret because the carbohydrate-protein supplement provided 43% more energy than the carbohydrate-only supplement. Other studies have not been able to rep- licate the differences reported in the Zawadzki study when supplying isoenergetic beverages of varying mac- ronutrient content.85–87 It appears that both carbohy- drate-only and carbohydrate–protein supplements can

Modified from Costill DL, Miller JM. Nutrition for endurance sport: carbohydrate and fluid balance. Int J Sport Nutr. 1980;1:2–14.

Figure 3.11 Effects of low- versus high-carbohydrate diet on glycogen stores. A high-carbohydrate diet replenishes glycogen stores better than a low-carbohydrate diet does.

Days

1 2 3

M u

sc le

C el

l G ly

co g

en L

ev el

High

Low

Aerobic Exercise Session

High Carb Diet

Low Carb Diet

84 SECTION 1 The Basics of Sports Nutrition

glycemic and insulin response as well as the extent of muscle glycogen resynthesis.

How much carbohydrate should be consumed after exercise or sport? To maximize glycogen synthesis, athletes should con- sume carbohydrates at a rate of 1.0–1.2 grams per kilogram of body weight every hour for 4 hours postexercise.22,89 For example, Sue is a soccer player. She weighs 150 pounds (68.2 kg). After a 1- to 2-hour practice or game, her carbo- hydrate needs are 68–82 grams of car- bohydrates (68.2 kg × 1.0–1.2 grams of car- bohydrate per kilo- gram of body weight = 68–82 grams of carbohydrates) to be consumed within 30 minutes of the end of her train- ing session/competition, and then again every hour for 4 hours. She can obtain 68–82 grams of carbohydrates by consuming:

• A banana and 8 ounces of yogurt • 6–8 ounces of juice and a bagel • 8 ounces of milk and 1 to 1½ cups of cereal

What are some examples of good meals/snacks for after exercising? Meals and snacks postexercise should supply adequate amounts of carbohy- drates as well as other nutrients. The best way to obtain a balance of all required postex- ercise nutrients is to consume whole foods. TABLE 3.12 presents a variety of ideas for postexercise meals/snacks that provide 50–100 grams of carbohydrates.

enhance glycogen resynthesis postexercise to a similar extent.88 Therefore, at this time it can be concluded that the energy content of a postexercise beverage is more critical than macronutrient content is in determining the

Gaining the Performance Edge

Consuming carbohydrates after exercise accelerates the recovery process. A carbohydrate intake of 1.0 to 1.2 grams per kilogram of body weight every hour for 4-6 hours postexercise will ensure a complete restoration of glycogen levels.

Food for Thought 3.2

You Are the Nutrition Coach

Apply the concepts from this chapter to several case studies.

Table 3.12 Quality Food and Beverage Choices for Postexercise Carbohydrate Replenishment

Meals and snacks supplying 50–75 grams of carbohydrates Food/Beverage Serving size Quantity of

carbohydrates Juice Bagel w/peanut butter

Tomato juice Turkey sandwich Cottage cheese w/

pineapple

8 fl oz 1 medium + 2 tbsp

12 fl oz 2 slices bread + 3 oz meat 1 cup + ½ cup

27 g 45 g

16 g 24 g 25 g

Dried apricots Bran muffin Yogurt (with fruit)

Soccer Smoothie

Veggie chili Corn bread

5 halves 1 small 6 oz

1 smoothie

8 oz 1 piece

11 g 24 g 33 g

50 g

25 g 29 g

Meals and Snacks Supplying 75–100 Grams of Carbohydrates

Food/Beverage Serving size Quantity of carbohydrates

Raisin bran Skim milk Apple

Whole wheat toast and jam

Banana Yogurt

Macaroni and cheese Green salad Skim milk

Spaghetti Marinara sauce Mixed vegetables

1 cup 8 fl oz 1 medium

1 slice + 1 tbsp

1 medium 6 oz

2 cups 1½ cups 8 fl oz

1½ cups ¾ cup ¾ cup

47 g 12 g 21 g

27 g

27 g 33 g

80 g 7 g 12 g

60 g 18 g 18 g

Chapter 3 Carbohydrates 85

The Box Score Key Points of Chapter

n Adequate carbohydrate intake is essential for opti- mal sport performance. Carbohydrate intake should be in the range of 3–12 grams per kilogram of body weight per day, which should amount to approxi- mately 45–65% of total daily calories.

n Athletes may not consume adequate calories to meet training and competition needs. Encouraging athletes to consume adequate calories during train- ing and competition will help ensure appropriate carbohydrate intake.

n Carbohydrates are synthesized by plants via a pro- cess known as photosynthesis. Photosynthesis is an energy-requiring process that relies on the sun’s light energy to combine water and carbon dioxide to make carbohydrates.

n Carbohydrates are commonly classified as simple or complex based on their chemical composition and structure. Both simple and complex carbohy- drates provide energy, but have different nutrient profiles related to vitamins, minerals, fiber, and phytochemicals.

n Glucose is the most abundant simple carbohydrate found in nature and serves as an important energy source for cells in the human body.

n The storage form of carbohydrates in plants and ani- mals is starch and glycogen, respectively.

n Fiber is a plant form of carbohydrate that is indigest- ible by the body and therefore provides minimal to no energy. However, fiber is an important part of a normal diet and helps to prevent high cholesterol, diabetes, and constipation.

n Artificial sweeteners can be derived from carbo- hydrates, amino acids, and other substances but are less digestible, thus limiting their caloric value to the body. Athletes may use artificial sweeten- ers to help control caloric intake; however, over- use can be unhealthy and detrimental to athletic performance.

n Carbohydrates are the sole energy source during very intense physical activity and thus are a key source of energy for many sport activities. Failure to ingest adequate amounts of carbohydrates not only robs the athlete of energy, but also can affect mental focus.

n The timing and type of carbohydrates consumed in the days and hours leading up to competition can be critical to performance. Experimenting with new foods or beverages on competition day can be disas- trous. Always experiment weeks ahead of time for

the best combination, types, and amounts of carbo- hydrates to consume.

n The richest sources of carbohydrates are grains, fruits, and vegetables. These nutrient-dense foods make up over half of the entire MyPlate food guid- ance system. Dairy/alternatives and legumes, nuts/ seeds, and soy products from the protein food group also provide quality sources of carbohydrates. Carbo- hydrates obtained from sweets, desserts, and sodas are part of empty calories of the MyPlate food guid- ance system and should be moderated because they lack other nutrients important for optimal health and performance.

n The glycemic index (GI) and glycemic load of foods have been suggested as dietary tools for optimal sports performance. However, neither of these con- cepts appear to be as important as the total carbohy- drate and energy content of the diet.

n The body stores limited amounts of carbohydrates (approximately 400–600 grams), which is why ath- letes must pay particular attention to carbohydrate intake in their diet. Failure to replace glycogen stores used during training or competition can lead to low energy levels and decreased motivation, both of which can spell disaster for an athlete.

n Diets consisting of 55–70% of total calories from carbohydrates have been shown to increase resting muscle glycogen levels. High muscle glycogen lev- els have been shown to delay the time to fatigue in endurance athletes, which is one of the primary rea- sons endurance athletes carbohydrate-load in the week leading up to a competition.

n There is no one best precompetition meal, sports beverage, or postexercise snack that fits everyone’s likes or tolerances. Athletes should follow the gen- eral guidelines of carbohydrate intake and experi- ment prior to competition with different meals, snacks, and/or drinks to find which best suits their unique requirements.

n Glucose polymer drinks and other carbohydrate- rich foods consumed during sport performance can increase blood glucose levels and delay onset of fatigue.

n Muscles are most receptive to uptaking blood glu- cose to replenish glycogen stores within 4 hours of exercise or competition. As a result, postgame snacks or meals should contain high-carbohydrate foods and should be consumed as soon as possible after the cessation of exercise.

86 SECTION 1 The Basics of Sports Nutrition

Study Questions

1. Explain why restricting carbohydrates in the diets of athletes is detrimental.

2. Briefly discuss where carbohydrates come from and how they are formed in nature.

3. What roles do carbohydrates play in the body and how do these roles relate to athletic performance?

4. How many calories are derived from ingested carbo- hydrates that are classified as dietary fiber? What are the different types of fiber, and what role do they play in the body?

5. What are the basic building blocks of carbohydrates? Based on the number of building blocks, how are dif- ferent carbohydrates classified?

6. What is the difference between starch and glycogen? 7. Name and briefly discuss four of the commonly used

artificial sweeteners. Are artificial sweeteners carbo- hydrates? What are some of the positives and nega- tives associated with using artificial sweeteners?

8. Discuss the various sources of carbohydrates in our diet. Which sources of carbohydrates should

predominate in our diet? Which sources of carbohy- drates should be limited? Explain.

9. Jason is an elite cross-country athlete who is cur- rently training 2 hours per day. He weighs 135 pounds. Based on his body weight, what should his daily car- bohydrate intake be? Defend your answer.

10. What is carbohydrate loading? Which athletes would benefit most from it? Defend your answer.

11. Describe the crossover concept and its relevance to sport performance.

12. Jim is excited to be competing in his first half-mara- thon (13.1 miles) and comes to you for dietary advice for during the race. What advice regarding intake of carbohydrates might you give him to improve his chances of having a successful race?

13. Sarah is an elite triathlete who is currently training twice a day. What nutritional advice would you give her in regard to optimizing her recovery between workouts?

References

1. Duyff RL. American Dietetic Association’s Complete Food and Nutrition Guide. Minneapolis, MN: Chronimed Pub- lishing; 1996.

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88 SECTION 1 The Basics of Sports Nutrition

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50. Coyle EF, Coggan AR, Hemmert MK, Ivy JL. Mus- cle glycogen utilization during prolonged strenu- ous exercise when fed carbohydrate. J Appl Physiol. 1986;61(1):165–172.

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53. Ivy JL, Miller W, Dover V, et al. Endurance improved by ingestion of a glucose polymer supplement. Med Sci Sports Exerc. 1983;15(6): 466–471.

54. Decombaz J, Sartori D, Arnaud MJ, Thelin AL, Schurch P, Howald H. Oxidation and metabolic effects of fruc- tose and glucose ingested before exercise. Int J Sports Med. 1985;6(5):282–286.

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56. Leijssen DPC, Saris WHM, Jeukendrup AE, Wagen- makers AJ. Oxidation of orally ingested [13C]-glucose and [13C]-galactose during exercise. J Appl Physiol. 1995;79(3):720–725.

57. Massicotte D, Peronnet F, Allah C, Hillaire-Marcel C, Ledoux M, Brisson G. Metabolic response to [13C] glu- cose and [13C] fructose ingestion during exercise. J Appl Physiol. 1986;61(3):1180–1184.

58. Massicotte D, Peronnet F, Brisson G, Bakkouch K, Hill- aire-Marcel C. Oxidation of a glucose polymer during exercise: comparison with glucose and fructose. J Appl Physiol. 1989;66(1):179–183.

59. Moodley D, Noakes TD, Bosch AN, Hawley JA, Schall R, Dennis SC. Oxidation of exogenous carbohydrate during prolonged exercise: the effects of the carbo- hydrate type and its concentration. Eur J Appl Physiol. 1992;64(4):328–334.

60. Rehrer NJ, Wagenmakers AJM, Beckers EJ, et al. Gas- tric emptying, absorption and carbohydrate oxi- dation during prolonged exercise. J Appl Physiol. 1992;72(2):468–475.

61. Saris WHM, Goodpaster BH, Jeukendrup AE, Brouns F, Halliday D, Wagenmakers AJ. Exogenous carbohydrate oxidation from different carbohydrate sources during exercise. J Appl Physiol. 1993;75(5):2168–2172.

62. Jeukendrup AE, Moseley L. Multiple transportable car- bohydrates enhance gastric emptying and fluid deliv- ery. Scand J Med Sci Sports. 2010;20(1):112–121.

63. Hulston CJ, Wallis GA, Jeukendrup AE. Exogenous CHO oxidation with glucose plus fructose intake during exercise. Med Sci Sports Exerc. 2009;41(2):357–363.

64. Jeukendrup AE, Wagenmakers AJ, Stegen JH, Gijsen AP, Brouns F, Saris WH. Carbohydrate ingestion can com- pletely suppress endogenous glucose production dur- ing exercise. Am J Physiol. 1999;276:e672–e683.

65. Jeukendrup AE, Jentjens R. Oxidation of carbohy- drate feedings during prolonged exercise. Sports Med. 2000;29(6):407–424.

66. Burke LM, Hawley JA, Wong SH, Jeukemdrup AE. Car- bohydrates for training and competition. J Sports Sci. 2011;29(suppl 1):17S–27S.

67. Jentjens RL, Achten J, Jeukendrup AE. High oxidation rates from combined carbohydrates ingested during exercise. Med Sci Sports Exerc. 2004;36(9):1551–1558.

68. Jentjens RL, Venables MC, Jeukendrup AE. Oxida- tion of exogenous glucose, sucrose, and maltose during prolonged cycling exercise. J Appl Physiol. 2004;96(4):1285–1291.

69. Jentjens RL, Jeukendrup AE. High rates of exogenous carbohydrate oxidation from a mixture of glucose and fructose ingested during prolonged cycling exercise. Br J Nutr. 2005;93(4):485–492.

70. Convertino VA, Armstrong LA, Coyle EF, et al. Exer- cise and fluid replacement. Med Sci Sports Exerc. 1996;28(1):i–vii.

71. Guezennec CY, Satabin P, Duforez F, Merino D, Peron- net F, Koziet J. Oxidation of corn starch, glucose and fructose ingested before exercise. Med Sci Sports Exerc. 1989;21(1):45–50.

72. Krzentowski G, Jandrain B, Pirnay F, et al. Availability of glucose given orally during exercise. J Appl Physiol. 1984;56(2):315–320.

73. Pirnay F, Lacroix M, Mosora F, Luyckx A, Lefebvre P. Effect of glucose ingestion on energy substrate utili- zation during prolonged muscular exercise. Eur J Appl Physiol. 1977;36(4):247–254.

74. Burelle Y, Peronnet F, Charpentier S, Lavoie C, Hill- aire-Marcel C, Massicotte D. Oxidation of an oral [13C] glucose load at rest and during prolonged exer- cise in trained and sedentary subjects. J Appl Physiol. 1999;86(1): 52–60.

75. Massicotte D, Peronnet F, Brisson G, Boivin L, Hillaire- Marcel C. Oxidation of exogenous carbohydrate dur- ing prolonged exercise in fed and fasted conditions. Int J Sports Med. 1990;11(4):253–258.

76. Massicotte D, Peronnet F, Adopo E, Brisson GR, Hill- aire-Marcel C. Effect of metabolic rate on the oxida- tion of ingested glucose and fructose during exercise. Int J Sports Med. 1994;15(4):177–180.

77. McConell G, Kloot K, Hargreaves M. Effect of timing of carbohydrate ingestion on endurance exercise per- formance. Med Sci Sports Exerc. 1996;28(10):1300–1304.

78. Costill DL, Bowers R, Branam G, Sparks K. Muscle gly- cogen utilization during prolonged exercise on suc- cessive days. J Appl Physiol. 1971;31(6):834–838.

79. Costill DL, Miller JM. Nutrition for endurance sport: car- bohydrate and fluid balance. Int J Sports Med. 1980;1:2–14.

Chapter 3 Carbohydrates 89

80. Ivy JL, Katz AL, Cutler CL, Sherman WM, Coyle EF. Muscle glycogen synthesis after exercise: effects of time of carbohydrate ingestion. J Appl Physiol. 1988;64(4):1480–1485.

81. Storlie J. The art of refueling. Train Cond. 1998;8:29–35. 82. Keizer HA, Kuipers J, van Krandenburg G, Geurten P.

Influence of liquid and solid meals on muscle gly- cogen resynthesis, plasma fuel hormone response and maximal physical work capacity. Int J Sports Med. 1986;8(2):99–104.

83. Reed MJ, Brozinick JT, Lee MC, Ivy JL. Muscle glycogen storage post-exercise: effects of mode of carbohydrate administration. J Appl Physiol. 1989;66(2):720–726.

84. Zawadzki KM, Yaspelkis BB, Ivy JL. Carbohydrate–pro- tein complex increases the rate of muscle glycogen storage after exercise. J Appl Physiol. 1992;72:1854–1859.

85. Carrithers JA, Williamson DL, Gallagher PM, Godard MP, Schulze KE, Trappe SW. Effect of post-exercise

carbohydrate–protein feedings on muscle glycogen restoration. J Appl Physiol. 2000;88:1976–1982.

86. Roy BD, Tarnopolsky MA. Influence of differing macro- nutrient intakes on muscle glycogen resynthesis after resistance exercise. J Appl Physiol. 1998;84:890–896.

87. Wojcik JR, Walberg-Rankin J, Smith L, Gwazdaus- kas FC. Comparison of carbohydrate and milk-based beverages on muscle damage and glycogen following exercise. Int J Sport Nutr Exerc Metab. 2001;11(4):406–419.

88. Tarnopolsky MA, Bosman M, MacDonald JR, Vandeputte D, Martin J, Roy BD. Postexercise pro- tein–carbohydrate and carbohydrate supplements increase muscle glycogen in men and women. J Appl Physiol. 1997;83(6):1877–1883.

89. DeMarco HM, Sucher KP, Cisar CJ, Butterfield GE. Pre- exercise carbohydrate meals: application of glycemic index. Med Sci Sports Exerc. 1999;31(1):164–170.

Additional Resources

Bergstrom J, Hermansen L, Hultman E, Saltin B. Diet, mus- cle glycogen and physical performance. Acta Physiol Scand. 1967;71(2):140–150.

Bergstrom J, Hultman E. Muscle glycogen synthesis after exercise: an enhancing factor localized to the muscle cells in man. Nature. 1967;210(33): 309–310.

Blom PCS, Hostmark AT, Vaage O, Kardel KR, Maehlum S. Effect of different post-exercise sugar diets on the rate of muscle glycogen synthesis. Med Sci Sports Exerc. 1987;19(5):491–496.

Casa DJ, Armstrong LE, Hillman SK, et al. National Athletic Trainers’ Association position statement: fluid replace- ment for athletes. J Athl Train. 2000;35(2):212–224.

Cummings JH. Microbial digestion of complex carbohy- drates in man. Proc Nutr Soc. 1984;43(1):35–44.

Giovannucci E, Ascherio A, Rimm EB, Stampfer MJ, Colditz GA, Willett WC. Intake of carotenoids and retinal in relation to risk of prostate cancer. J Natl Cancer Inst. 1995;87:1767–1776.

Ivy J. Glycogen resynthesis after exercise: effect of carbohy- drate intake. Int J Sports Med. 1998;19(suppl.):142S–145S.

Ivy JL, Lee MC, Brozinick JT, Reed MJ. Muscle glycogen stor- age after different amounts of carbohydrate inges- tion. J Appl Physiol. 1988;65(5): 2018–2023.

McBurney MI, Thompson LU. Fermentative characteris- tics of cereal brans and vegetable fibers. Nutr Cancer. 1990;13(4):271–280.

Siu PM, Wong SH. Use of the glycemic index: effects on feeding patterns and exercise performance. J Physiol Anthropol Appl Human Sci. 2004;23(1):1–6.

U.S. Food and Drug Administration. Chapter 7—Nutrition Labeling. Center for Food Safety and Applied Nutri- tion. 2009. Available at: http://www.fda.gov/Food/ GuidanceRegulation/GuidanceDocumentsRegulato- ryInformation/Labeling-Nutrition/ucm2006828.htm. Accessed July 18, 2013.

U.S. Food and Drug Administration. Chapter 6—Ingredi- ent Lists. Center for Food Safety and Applied Nutri- tion. 2009. Available at: http://www.fda.gov/Food/ GuidanceRegulation/GuidanceDocumentsRegulato- ryInformation/Labeling-Nutrition/ucm2006828.htm. Accessed July 18, 2013.

U.S. Food and Drug Administration. Chapter 8—Claims. Center for Food Safety and Applied Nutrition. 2009. Available at: http://www.fda.gov/Food/Guidance-Reg- ulation/GuidanceDocumentsRegulatoryInformation/ LabelingNutrition/ucm2006828.htm. Accessed July 18, 2013.

U.S. Food and Drug Administration. Food additives per- mitted for direct addition to food for human con- sumption: aspartame. Fed Register. 1984;49: 6672–6677.

U.S. Food and Drug Administration. Food additives per- mitted for direct addition to food for human con- sumption: sucralose. Code of Federal Regulations Title 21, 172.63.

Van Munster IP, deBoer HM, Jansen MC, et al. Effect of resistant starch on breath—hydrogen and meth- ane excretion in healthy volunteers. Am J Clin Nutr. 1994;59:626–630.

90 SECTION 1 The Basics of Sports Nutrition

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Key Questions Addressed 1. What’s the big deal about fats?

2. What are fats?

3. How are lipids (fats) classified?

4. How much fat is recommended in an athlete’s diet?

5. Which foods contain fat?

6. How can the percentage of calories from fat be calculated for specific foods?

7. What’s the big deal about cholesterol?

8. How can fats affect daily training and competitive performance?

9. What type, how much, and when should fats be consumed before exercise?

10. What type, how much, and when should fats be consumed during exercise?

11. What type, how much, and when should fats be consumed after exercise?

You Are the Nutrition Coach Shelley is a marathoner from Austin, Texas. She has been competing in marathons for more than 5 years and is the type of person who enjoys taking on new physical challenges. Although she is not an experienced swimmer, she has agreed to join some friends in tackling the chal- lenge of swimming the English Channel. The plan is to train for a year and then make an attempt at swimming the Channel. Because of the energetic demands of her sport, she is extremely lean and in excellent cardiovascular shape. She loves the warm temperatures in the South and gets chilled easily, which is a concern of hers because she knows the water temperatures in the Channel are very cold.

Question • What nutrition recommendations would you give Shelley in regard to fat intake to address both

her physical and dietary needs over the next 12 months as she trains for the swim? Include sug- gestions for fat intake before, during, and after the actual Channel swim.

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CHAPTER 4

What’s the big deal about fats? Fats, similar to carbohydrates, are an important nutrient for both athletes and nonathletes. They serve as a primary energy source at rest and during light- to moderate-inten- sity exercise. In addition, dietary fat provides essential fatty acids required for normal physiological functioning of the body, adds flavor to foods, and is a calorie-dense nutrient capable of meeting the high daily energy needs of athletes.

However, fat is an often-maligned nutrient because of its historical association with an increased risk for obesity and heart disease. The thought of body fat also raises neg- ative feelings, particularly in athletes who are aware of the potential impact excessive levels of body fat can have on sport performance. In some instances, extreme behav- iors are adopted to maintain or decrease body fat levels. The purpose of this chapter is to provide the reader with the knowledge required to keep a healthy and informed perspective on an essential nutrient that is often feared and shrouded in misconceptions.

What are fats? Fats are molecules that belong to a group of compounds known as lipids. Lipids are organic, carbon-containing compounds that are hydrophobic (water insoluble), lipo- philic (fat soluble), and have a physical characteristic of

feeling greasy to the touch. The fact that lipids are not water soluble affects how they are digested, absorbed, and trans- ported throughout the body compared to the other macro-

nutrients, such as carbohydrates and proteins. Calorically, lipids are an energy-rich nutrient yielding 9 calories per gram, compared to only 4 calories per gram for both car- bohydrates and proteins.

Similar to other nutrients, lipids are obtained from foods and beverages. Lipids are found in foods of both plant and animal origin. In addition, non-lipid molecules can be converted into lipids within the body. For example, if carbohydrates or proteins are consumed in excess, they will be converted into lipids (i.e., fats) and stored in adi- pose tissue for later use as energy.

How are lipids (fats) classified? A number of different chemical compounds are found in food and within the body that are classified as lipids. However, the most important ones fall into three main categories based on their molecular structure: triglyc- erides, phospholipids, and sterols. Although all three of these are lipids, each plays a significantly different role in the body.

Triglycerides make up the majority of lipids found within the body and in foods and beverages. In fact, triglyc- erides provide much of the flavor and texture in foods. Phospholipids are found in both plants and animals and have a unique molecular structure that allows them to be

both fat and water soluble. Phospholip- ids constitute the cell membranes of vari- ous tissues found throughout the body. In addition, because they are water solu- ble, phospholipids help suspend other hydrophobic lipids in water. Finally, a very small percentage of fats in the body exist as sterols. Sterols are quite different from both triglycerides and phospholipids in

their structure and function. The most commonly known sterol is cholesterol. Triglycerides, phospholipids, and ste- rols are discussed in more detail in the following sections.

What are triglycerides? Triglycerides are commonly occurring fats that are more accurately classified as simple lipids. Triglycerides, also referred to as triacylglycerols, are the predominant form of fats found in the human diet. An estimated 98% of dietary

fats are triglycerides.1 In addition, triglycer- ides are the most common type of fat found in the human body. Triglycerides serve as a major energy reserve and

are stored primarily in adipocytes located throughout the body. Triglycerides are also stored in lesser amounts in the liver and muscle, where they are more readily available for use as energy during exercise. Because triglycerides make up the overwhelming majority of fats found in the diet and body, the terms triglycerides and fats are used interchange- ably throughout this text.

What is the molecular structure of a triglyceride? The structure of a triglyceride is a combination of glycerol and three fatty acids. The glycerol “backbone” of a triglyc- eride molecule is always constant; however, the three fatty acids attached to the glycerol may differ (see

FIGURE 4.1 ). During triglyceride break- down, one fatty acid may be removed, leaving a diglyceride,

hydrophobic Term used to describe molecules or compounds that are water insoluble. Lipids are hydrophobic substances.

lipophilic Substances that are fat soluble.

phospholipid A type of lipid that consists of a glycerol backbone, two fatty acids, and a phosphate group. Phospholipids are derived from both plant and animal sources and are both water and fat soluble. Phospholipids constitute the cell membranes of tissues throughout the body.

triacylglycerols A category of lipids composed of a glycerol mol- ecule with three attached fatty acids; more commonly referred to as triglycerides.

glycerol A three-carbon molecule that makes up the backbone of mono-, di-, and triglycerides.

sterols A category of lipids that possess carbon rings in their struc- ture rather than carbon chains. Cholesterol is the most commonly known sterol.

92 SECTION 1 The Basics of Sports Nutrition

carbohydrates as glycogen. Second, because fats are hydrophobic, they are stored with much less water than carbohydrates. Carbohydrates are hydrophilic— each gram of stored carbohydrate (i.e., glycogen) is associated with 3 grams of water. Therefore, fats not only yield twice the energy, but also are a much lighter

storage form of energy for the body (see TABLE 4.1 ). 3. Visceral and subcutaneous fat provide protection to vital

organs and serve as a thermal and electrical insulator in the

or two fatty acids may be removed, leaving a monoglyc- eride. The fatty acids cleaved from the glycerol backbone become what are known as free fatty acids (see “What are fatty acids?” later in this chapter) and are available for use by the body as needed. When all three fatty acids have been stripped from the triglyceride, the remaining glyc- erol backbone can be metabolized for energy or used to form blood glucose in the liver.

What are some of the functions of triglycerides in the body? As noted earlier, triglycerides are the predominant form of fat found in the body. Fats perform a variety of criti- cal roles and thus are considered essential nutrients. The following are the six main functions of fats in the body; the functions of other lipids in the body, primarily phos- pholipids and sterols, are discussed later in this chapter. 1. Triglycerides serve as an important source of energy at

rest and during exercise. At rest, in well-fed individu- als, dietary and stored fats can supply approximately 60–80% of the body’s energy needs. During exercise, both fats and carbohydrates serve as fuel sources, with fats being the predominant energy source dur- ing low to moderate exercise intensities.

2. Fat serves as an abundant energy reserve for the body. In athletic populations, fat tissue accounts for approxi- mately 8–12% and 18–22% of body weight in males and females, respectively. Some is stored as vis- ceral fat (i.e., in adipocytes surrounding the internal organs), but most fat is stored subcutaneously (i.e., beneath the surface of the skin). Small amounts of fat are stored in muscle, where it serves as a readily available energy source. In total, as much as 80,000– 100,000 calories can be stored as fat in a 70-kilogram man who is within a healthy body fat range. These fats are available to provide fuel when energy intake is lower than expenditure.

Energy stored as fat in the body is advantageous for two reasons. First, fats yield more than twice the number of calories per gram (9 kcal/gram) than pro- teins or carbohydrates (4 kcal/gram). In other words, fats are a concentrated storage form of energy in that twice the calories can be stored for an equiv- alent increase in body weight resulting from stored

Figure 4.1 Generic triglyceride structure.

body. Visceral fat stores act like gel-packing used to pro- tect fragile materials during shipping. Essentially, their gel-like consistency helps to cushion internal organs, thus preventing damage during falls, jarring types of activities, and contact sports. Visceral fat is relatively inert and is less likely to be utilized as an energy source unless adipose tissue is depleted. Subcutaneous fat pro- vides a layer of protection for skeletal muscles and also acts as a thermal insulator for the body. Fat keeps heat from transferring away from the body, especially in cold weather and water sports. This is critical because main- tenance of body temperature is important for normal internal organ and cellular function. In the case of dis- tance swimmers, body fat not only serves as an energy source and insulator, but also buoys the swimmer in the water, thus decreasing drag, which can potentially increase performance. Finally, fats are also used in the formation of myelin, a fatty substance that serves as insulation for nerve cells. This fatty myelin insulation helps speed conduction of electrical signals along the appropriate neural pathway and prevents unwanted spread of electrical activity to adjacent nerves. In other words, myelin is analogous to the plastic sheath found on electrical wires that directs the electrical flow along the length of the wire but prevents it from spreading to any other wires that may be lying beside it.

4. Fats play an important role as carriers of substances into the body and within the bloodstream. Fats carry fat-sol- uble vitamins A, D, E, and K; carotenoids; and other

A generic triglyceride

Table 4.1

Difference in Weight with Fat Versus Carbohydrate Storage

Average calories stored in body fat = 80,000–100,000 calories

Fat Carbohydrate

80,000 calories ÷ 9 kcal/gram 8889 grams × 0.1 grams water stored/gram fat 889 additional grams

80,000 calories ÷ 4 kcal/gram 20,000 grams × 3 grams water stored/gram

carbohydrate 60,000 additional grams

889 + 8889 = 9778 grams of energy stored as fat

60,000 + 20,000 = 80,000 grams of energy stored as carbohydrate

9778 ÷ 454 g/lb = 21.5 lb 80,000 ÷ 454 g/lb =176 lb

Chapter 4 Fats 93

fat-soluble phytochemicals. Without fat in the diet, fat-soluble vitamins would not be absorbed and defi- ciencies would result. Fats also aid in the absorption of other fat-soluble substances such as lycopene. Lycopene, a phytochemical, is absorbed more readily when tomato-based products contain some fat. For example, canned tomatoes mixed with an olive oil vinaigrette dressing will enhance the absorption of lycopene. When fat is removed from a product such as skim milk, the fat-soluble vitamins are removed as well. Therefore, as indicated on the label, nonfat milk is “Vitamin A and D fortified” because the fat-soluble vitamins need to be added back into the product.

5. Fats enhance the sensory qualities of foods. Chemicals within the fat molecules of food provide flavor, odor, and tex- ture. Cooking fatty foods or frying foods in fat releases the odors and seals in flavor. Fats in baked goods pro- vide products with a moist and light texture and a flaky structure. Fats also offer a creamy, smooth mouthfeel to many products, thus enhancing their appeal.

6. Fat consumption during meals or snacks can enhance sati- ety level. Fats are calorically dense compared to car- bohydrates or proteins. Fats take longer to digest and can provide a physical feeling of satiation for a longer time between meals.

What are fatty acids? Fatty acids are basically carbon atoms linked in a chain- like fashion. All fatty acids have an organic acid group or a carboxyl acid (COOH) at one end and a methyl (CH3) group at the other end (see FIGURE 4.2 ). The carboxyl group is referred to as the alpha end, and the methyl group makes up the omega end of the fatty acid. Paying attention to the different ends of the fatty acid chain is important because

Figure 4.2 Generic fatty acid structure.

Figure 4.3 Fatty acid chain length. Fatty acids can be classified by their chain length as short-, medium-, and long-chain fatty acids.

it provides for a consistent way of classifying fatty acids based on chain length and the number and location of single and/or double bonds. These differences determine not only the type of fatty acid, but also its physical char- acteristics, how it is digested and assimilated, and the role it will play within the body.

What is the effect of fatty acid chain length? As mentioned earlier, the carbon chains of fatty acids vary in length. The number of carbons in a chain affects how the fatty acid is digested, absorbed, and used in the body. Short-chain fatty acids (SCFAs) consist of 2 to 4 car- bons in a chain, medium-chain fatty acids (MCFAs) con- tain between 6 and 10 carbons, and long-chain fatty acids (LCFAs) contain 12 or more carbons (see FIGURE 4.3 ). The shorter the carbon chain, the more liquid the fat is at room temperature and the more soluble it is in water. SCFAs and MCFAs are digested and absorbed more quickly than LCFAs. Rarely are SCFAs found naturally in food sources, with the exception of butyric acid, which is found in milk fat. The SCFAs are a by-product of bacterial fermentation of undigested food in the large intestine. Most commonly, bacteria work on soluble fiber in the colon and produce SCFAs. The short-chain fatty acids that are produced in this process are absorbed by the colon cells and used as

H C C

C C OH

H O

H C C

C C CC

C C OH

H O

H C C

C C C CC

C C C

C C CC

C C OH

H O

Short-chain fatty acid (2–4 carbons)

Butyric acid C4:0

Medium-chain fatty acid (6–10 carbons)

Caprylic acid C8:0

Long-chain fatty acid (12 or more carbons)

Palmitic acid C16:0

H C C

C C OH

H O

H C C

C C OH

H O

H H

Butyric acid

Methyl group –CH3 end

For simplicity, in most of these pictures the hydrogens are omitted from all but the end carbons.

Carboxyl group –COOH end

94 SECTION 1 The Basics of Sports Nutrition

atoms. Unsaturated fatty acids have one or more double bonds between carbons in the chain. With unsaturated fats, the carbons attached by the double bond can accept only one hydrogen atom. A monounsaturated fatty acid (MUFA) has one double bond in its carbon chain, whereas a polyun- saturated fatty acid (PUFA) has two or more double bonds (see Figure 4.4).

Hydrogenation is a chemical process in which hydrogen

atoms are added to unsaturated fatty acids. The intro- duction of the hydrogen atoms breaks some of the double

an energy source. The fermentation process is anaerobic; thus, less energy is recovered from fiber than the 4 cal- ories/gram recovered from other carbohydrates.1 The number of actual calories is still unclear, but it is likely that the energy yield is 1.5–2 calories per gram.2,3 Some research suggests that butyric acid stimulates colon cells to suppress cancer growth, a finding that may explain how dietary fiber, when bacteria attack fiber and release other SCFAs, may aid in the prevention of colon cancer.4

What does fatty acid saturation level indicate? Each carbon in a fatty acid carbon chain has four bonds. The bonds between the carbons can be either single bonds or double bonds. The remaining bonds that branch from the carbon backbone can be filled by other atoms. Hydro- gen is the atom commonly filling the other bonds in fatty acids (see FIGURE 4.4 ). When the carbons in a chain are linked by single bonds and the remaining two bonds are

filled with hydro- gen, the fatty acid is termed saturated. This means that all bonds are full (satu- rated) with hydrogen

Figure 4.4 Saturation of fatty acids. Saturated, monounsaturated, and polyunsaturated fatty acids. Hydrogens saturate the carbon chain of saturated fatty acids. Unsaturated fatty acids are missing some hydrogens and have one (mono) or more (poly) carbon–carbon double bonds.

monounsaturated fatty acid (MUFA) A fatty acid in which the hydrocarbon chain contains one double bond.

polyunsaturated fatty acid (PUFA) A fatty acid in which the hydrocarbon chain contains two or more double bonds.

hydrogenation A chemical pro- cess in which hydrogen atoms are added to unsaturated fatty acids. Hydrogenation of fatty acids leads to the formation of trans fatty acids, which are a growing health concern in regard to cardiovascular disease.

unsaturated fatty acid A fatty acid in which the hydrocarbon chain contains one or more double bonds.

saturated fatty acid A fatty acid in which all hydrogen-binding sites are filled, and thus no double bonds exist in its hydrocarbon chain.

Oleic acid

Stearic acid

Linoleic acid

Omega end

Omega-9

(an omega-9 fatty acid)

(an omega-6 fatty acid)

Omega-9Omega-6

Saturation Notation (no. of C: no. of double bonds)

Name and full letter depiction Simplified structure

Monounsaturated 18:1

Saturated 18:0

Polyunsaturated 18:2

H C

C OH

H C C

C C C CC

C C C

C C CC

C C

C C OH

H O

H C C

C C C CC

C C C OH

C C C

C C

H H H

H C C

C C C

C C C C C

C C CC

C C

C C OH

H H H

H O

Chapter 4 Fats 95

bonds between the carbons and thus causes the previ- ously unsaturated fat to become more saturated. This artificial hydrogenation process allows foods containing unsaturated fats to take on the somewhat desirable physi- cal properties of saturated fats. As the saturation content of the fat in food increases, the food becomes harder at room temperature. For example, stick margarine is pro- duced through the hydrogenation of unsaturated vegeta- ble oils. Vegetable oil is liquid at room temperature, but it becomes solid after hydrogenation, making it more desir- able for baking and cooking.

Although foods are often labeled as containing either saturated or unsaturated fatty acids, it is important to realize that foods actually contain a combination of unsat- urated and saturated fats. Plant foods generally are lower in saturated fats than foods from animal sources. How- ever, food labels can help individuals identify the total

and saturated fat content of foods. TABLE 4.2 lists com- mon foods that contain fat and their respective amounts of saturated and unsaturated fats.

Information regarding the total fat content and the type of fat in foods is important because saturated fats have been implicated in cardiovascular disease. They have been found to contribute to atherosclerosis, the buildup

of fatty plaques on the interior arterial walls, particularly in the arteries of the heart and neck. Reducing saturated fat intake by reducing total fat intake and substituting mono- and polyunsaturated

atherosclerosis The progressive narrowing of the lumens of arteries caused by fatty deposits on their interior walls. Over time these fatty plaques can block blood supply to vital tissues, causing poor deliv- ery of oxygen; complete blockage results in cell death.

Table 4.2

Fat Content of Various Foods

Food item Serving size Total fat (grams) Saturated fat (grams)

Monounsaturated fat (grams)

Polyunsaturated fat (grams)

Grains

Oatmeal, dry ½ cup 2.5 0.5 1.0 1.0

English muffin 1 muffin 1 0.1 0.2 0.5

Pasta, cooked 1 cup 0.9 0.1 0.1 0.4

Brown rice 1 cup 1.8 0.4 0.6 0.6

Whole wheat bread 1 slice 1.2 0.3 0.5 0.3

Whole wheat pita 1 pita (6½ in) 1.7 0.3 0.2 0.7

Blueberry muffin, made from a mix 1 muffin 6.2 1.2 1.5 3.1

Biscuit 1.2 oz 4.6 0.9 2.8 0.2 Fruits/Vegetables

Pear 1 medium 1 < 0.1 0.1 0.2

Orange 1 medium 0 0 0 0

Watermelon 1 cup 0.7 0.1 0.2 0.2

Banana 1 medium 0.5 0.2 < 0.1 0.1

Spinach, raw ½ cup 0 0 0 0

Broccoli, cooked ½ cup 0.1 < 0.1 < 0.1 < 0.1

Carrots, cooked ½ cup 0.1 < 0.1 < 0.1 < 0.1

Avocado 1 medium 27 5.3 14.8 4.5 Dairy/Alternative

Skim milk 8 oz 0.5 0.4 0.2 < 0.1

1% milk 8 oz 2.6 1.6 0.7 0.1

2% milk 8 oz 4.7 2.9 1.4 0.2

Whole milk 8 oz 8 5.1 2.4 0.3

Cottage cheese, 2% ¼ cup 4.4 2.8 1.2 0.1

Swiss cheese 1 oz 8 5.0 2.1 0.3

Soy milk 8 oz 5 0.5 1.0 3.0 Protein Foods

Ground beef, lean 3 oz 13.2 5.2 5.8 0.4

96 SECTION 1 The Basics of Sports Nutrition

fats in the diet are recommended to reduce cardiovascu- lar disease risk.

What is a trans fatty acid? Unsaturated fatty acids that are identical in molecu- lar makeup but exist in different geometric forms (i.e., shapes) are known as isomers. The location of the hydro- gen atoms on each side of the double bond in the fatty

acid determines whether the fat is in the cis or trans posi- tion. In the cis posi- tion, the hydrogen atoms on either side of the double bonds are on the same side of the carbon chain. This causes the fatty acid to bend slightly. In the trans position, the hydrogen atoms on either side of the double bond are on opposite sides of the carbon chain, and thus the fatty acid is straight rather than bent (see FIGURE 4.5 ). Fatty acids in nature are almost exclu- sively found in the cis

isomer Compounds like unsatu- rated fats that may have the exact same molecular makeup as another compound but exist in a different geometric shape.

Figure 4.5 Structure of cis and trans fatty acids. Fatty acids with the cis form are more common in food than those in the trans form.

trans A type of molecular configu- ration in which the atoms surround- ing a double bond are arranged on opposite sides of the molecule. Trans fatty acids are not common in nature but are formed during the process of hydrogenation.

cis A type of molecular configura- tion in which the atoms surround- ing a double bond are arranged on the same side of the molecule. Most naturally occurring unsatu- rated fatty acids exist in the cis configuration.

Table 4.2

Fat Content of Various Foods

Food item Serving size Total fat (grams) Saturated fat (grams)

Monounsaturated fat (grams)

Polyunsaturated fat (grams)

Protein Foods

Chicken with skin 3 oz 9 2.4 3.4 1.9

Chicken without skin 3 oz 3.1 0.9 1.1 0.7

Turkey, white meat, without skin 3 oz 3 1.0 0.6 0.9

Turkey, dark meat, without skin 3 oz 6 2.2 1.5 2.0

Pork chop 3 oz 6.9 2.5 3.1 0.5

Salmon, pink 3 oz 4 1.0 0.8 0.6

Orange roughy 3 oz 1 < 0.1 0.5 < 0.1

Veggie burger 1 patty 0.5 0.1 0.3 0.2

Almonds 1 oz 15 1.1 9.5 3.6 Oils

Margarine, stick 1 tbsp 11 2.1 5.2 3.2

Butter 1 tbsp 12 7.2 3.3 0.4

Olive oil 1 tbsp 14 1.8 9.9 1.1

Salad dressing, ranch 2 tbsp 18 2.5 NA NA

Salad dressing, reduced calorie ranch 2 tbsp 5 0.4 NA NA

H H

These two neighboring hydrogens repel each other, causing the carbon chain to bend.

These two hydrogens are already as far apart as they can get.

Cis form (bent)

Trans form (straighter)

C C C

H H H

......

C C C

H H

......

Chapter 4 Fats 97

formation; however, the commercial processing of foods has increased the occurrence of trans fats in our diets.

The commercial process of hydrogenation adds hydrogen at some of the double-bond locations creating the trans positioning at one or more of the bonds. Most trans fatty acids are monounsaturated (contain one dou- ble bond) and are found in foods such as stick margarine, solid vegetable shortenings, snack items, and packaged foods. The problem with trans fats is that recent studies have implicated them with raising blood cholesterol levels.

What are omega fatty acids? The methyl end of a fatty acid is the omega end. The double bond that occurs closest to this end identifies the omega classification. Because there are double bonds in all of these classifications, the omega fatty acids are all unsaturated fatty acids. The omega-3, -6, and -9 classifications signify that the first double-bond location from the omega end is at the third, sixth, or ninth carbon in the chain, respectively. A common omega-3 fatty acid is linolenic acid; linoleic acid is the most commonly known omega-6 fatty acid, and oleic acid is the most common omega-9 fatty acid.

The omega fatty acid chain can have more than one double bond; the classification merely signifies the first double bond from the omega end. All of these omega fats are utilized as an energy source. However, these fatty acids may be used to synthesize other compounds, and they can have quite different functions in the body. For example, omega-3 fatty acids are used to form local- ized hormones known as eicosanoids that cause dila- tion of blood vessels and reduce inflammation and blood

clotting. In contrast, eicosanoids formed from omega-6 fatty acids do the oppo- site. They promote

the inflammatory process, increase blood clotting, and cause vasoconstriction. Therefore, the presence and ratio of omega-3 to omega-6 fatty acids in the diet is attracting the attention of researchers because of the possible nega- tive role that higher levels of omega-6 fatty acids play in cardiovascular disease.

Which fatty acids are considered essential? Linoleic acid (an omega-6 fatty acid) and linolenic acid (an omega-3 fatty acid) are considered essential fatty acids

because the body cannot manufac- ture these fats. The body can make sat- urated and omega-9 fatty acids; there- fore, they are consid- ered nonessential fatty acids. However, nonessential does

nonessential fatty acid A fatty acid that can be made by the body and thus does not have to be con- sumed in the diet.

essential fatty acids Fatty acids that must be obtained from the diet. Linoleic acid and linolenic acid are considered essential fatty acids.

not mean unimportant; it simply means it is not essen- tial to consume these fats in the diet. The body can pro- duce an adequate supply of the nonessential fatty acids as demand occurs.

Linoleic acid is found primarily in vegetable oils such as safflower, soy, corn, sunflower, and peanut oils. Lino- lenic acid is found in leafy greens, soy products, seafood, nuts, seeds, and canola oil. Dietary recommendations for adequate intake of essential fatty acids are met if fat comprises approximately 5% of total calorie intake. The AI for linoleic acid is 17 g/day for men 19–50 years of age (14 g/day for 50+ years) and 12 g/day for women 19–50 years of age (11 g/day for 50+ years); the AI for linole- nic acid is 1.6 g/day and 1.1 g/day for men and women 19 years of age and older, respectively.1

What are phospholipids? Phospholipids are another classification of lipids, although they are not as abundant in the body and diet as triglycer- ides. Phospholipids are found in a small number of specific foods such as egg yolks, liver, soybeans, and peanuts. Fortu- nately, phospholipids are not essential in the diet because the body can readily synthesize them when needed.

Phospholipids have the same glycerol backbone as triglycerides but with only two fatty acids attached to it rather than three (see FIGURE 4.6 ). The third site on the glycerol is attached to a phosphate group. The unique structure of phospholipids allows them to be both water and fat soluble. The fatty acids in the structure attract and attach to fat-soluble substances, and the phosphate/ nitrogen compound attracts and attaches to water-solu- ble substances. Phospholipids are located primarily in the cell membranes of tissues throughout the body.

What functions do phospholipids serve both inside and outside of the body? Because of their unique structure, phospholipids are ideal emulsifiers. Emulsifiers keep fat-soluble substances sus- pended in a watery environment. Emulsification is a pro- cess that allows two substances that normally do not mix (water and fat in this case) to mix. Phosphatidylcholine, or lecithin, is an emulsifier found naturally in foods of animal origin and in the body. Lecithin is a food additive that can also be derived from plant oils. Lecithins in foods help keep fats from separating, such as the water and oil in dressings, and keep fats in suspension and dispersed in foods such as canned soups, chili, and frozen entrees.

Phospholipids are a major component of cell mem- branes, which consist of a double layer of phospholipids. The hydrophilic glycerol and phosphate heads line up adja- cent to the watery environments of both the outside and the inside of the cell. The inside of the double phospholipid layer contains the fatty acid tails that are hydrophobic.

Phospholipids also provide transport functions in the body. Their ability to combine with water and fatty sub- stances allows them to break fats in the stomach into

eicosanoids A group of localized, hormone-like substances produced from long-chain fatty acids.

98 SECTION 1 The Basics of Sports Nutrition

• Providing for the proper structure of cell membranes, especially in nerve and brain tissues

• Producing vitamin D in the body (cholesterol is the precursor to vitamin D)

• Forming steroid hormones such as progestins, gluco- corticoids, androgens, and estrogen

• Manufacturing bile acids

Approximately 0.5–2 grams of cholesterol are pro- duced in the liver, small intestine, and walls of arteries daily, so it is therefore not considered an essential nutri- ent in the diet.

Two compounds that are similar in structure to cho- lesterol but also are very different from cholesterol are the plant sterols and plant stanols. The plant sterols and sta- nols are found only in plants, whereas cholesterol is found in animals and humans. Plant sterols are found naturally in small quantities in many vegetables, fruits, nuts, seeds, legumes, cereals, and vegetable oils. Plant stanols are found naturally in similar foods but in much lower quan- tities than the plant sterols. Both plant sterols and stanols are found in greater quantities in certain margarines and dressings as well as in some dietary supplements.

Both plant sterols and stanols have cholesterol-low- ering effects in the body. With consumption of adequate amounts, the most prominent effect on blood lipid lev- els is the lowering of low-density lipoprotein (LDL) cho- lesterol. The maximum cholesterol-lowering benefits are achieved at doses of 2–3 grams/day.5–7 To achieve this level of plant sterols and stanols, consumption of certain mar- garines and dressings and/or supplements is necessary because the quantities naturally found in food are signifi- cantly lower than the therapeutic dosage. The food labels of products that contain at least half the amount per serv- ing of the recommended daily doses of the stanols and

smaller particles during digestion; bile contains phospho- lipids that help produce emulsifying effects. Phospholip- ids also coat the surface of lipoproteins that carry lipid particles to their destinations in the body.

What are sterols? Sterols are a category of lipids found in both plants and animals. Although sterols are classified as lipids, they dif- fer significantly from triglycerides and phospholipids in structure and function. Unlike the other lipids discussed thus far, most sterols do not contain fatty acid chains. Instead, sterol molecules consist of multiple rings made primarily of carbon and hydrogen atoms that are attached to each other. Despite their different molecular makeup, they have the same hydrophobic and lipophilic character- istics as triglycerides.

Cholesterol is a sterol consisting of a hydrocarbon with a multiple-ring structure (see FIGURE 4.7 ). Although it is much maligned because of its historical relationship to heart disease, cholesterol serves some critical roles in the body. It is essential for:

Figure 4.6 Phospholipid structure. A phospholipid is soluble in both oil (i.e., fat) and water. This is a useful property for trans- porting fatty substances in the body’s watery fluids.

Figure 4.7 Structure of cholesterol. Sterols are multi-ring structures. Cholesterol is the best known sterol because of its histori- cal relationship to heart disease.

Oil Water

O–O P

O C

N+

CH3

CH3H3C Phosphate group

Choline

Hydro- phobic tails

Hydro- philic head

Glycerol

H H

H HC

C C

C C C

O O

Two fatty acids

CH3

CH3 CH3

CH3

H H

C H

Cholesterol

At every plain bend in the line, there is a carbon and two hydrogens

Chapter 4 Fats 99

sterols include a health claim that describes the health benefits of plant sterols and stanols in reducing the risk of heart disease.

Is there such a thing as artificial fats? Because of an increase in the public demand for low- fat and lower calorie foods, food manufacturers have responded by formulating artificial fats, better known as fat substitutes. Fat substitutes are popular in a variety of foods, including “luxury” foods such as ice cream, salad

dressings, and des- serts. The goal of using fat substitutes is to decrease calo- ries while maintain- ing the texture and taste functions of

fat in foods. Fat substitutes can be made from carbohy- drates, proteins, or fats. TABLE 4.3 provides examples of some of the more common fat substitutes found in the U.S. food supply.

The common carbohydrate-based fat substitutes are made from starches, fibers, and gums. They typi- cally reduce calories because carbohydrates contain only 4 calories per gram versus 9 calories per gram of fat. Car- bohydrate-based fat substitutes bind water in the prod- uct, increasing moisture and thickness, thereby creating the same smooth mouthfeel as fats but with fewer calo- ries. These substitutes are used primarily in baked goods such as cookies, cakes, biscuits, and muffins. Oatrim is a carbohydrate-based fat substitute that is a flour-like

product extracted from whole oats (see Table 4.3). It is used as a replacement for half the amount of fat in baked goods and can also be used to thicken sauces, gravies, and salad dressings.

Proteins can also be modified to produce similar qual- ities to fats but with fewer calories. Typically, whey protein from dairy or egg whites is the protein used to produce these protein-based fat substitutes. Proteins are generally broken down by high heat; therefore, fat substitutes made from protein are not heat stable. Simplesse is a patented, multifunctional dairy ingredient made from whey protein concentrate that undergoes a unique microparticulation process. It is approved for use as a thickener or texturizer in frozen desserts, but it is not heat stable and cannot be used in baking or frying (see Table 4.3).

Specialty fats have been produced to provide the mar- ket with fat substitutes that are more heat stable and have more of the qualities of whole fats. These are engi- neered molecular structures that manipulate the degree of saturation and fatty acid chain length to produce simi- lar qualities in food products as fats and oils. Olestra and salatrim are two such fat substitutes that have gained popularity in the last decade (see Table 4.3). Benefat is the trade name for salatrim, which is made of a triglyceride blend of short- and long-chain fatty acids. Benefat con- tains 5 kcal/gram instead of the 9 kcal/gram in traditional fat. It provides the same creaminess and mouthfeel as fat and maintains these sensory qualities in baking but not during high-temperature frying.

Olestra (trade name Olean) is a unique combination of sucrose and fat. Instead of the glycerol backbone with

fat substitutes Artificial fats derived from carbohydrates, pro- teins, or fats that provide foods with the same texture and taste func- tions of fat but with fewer calories.

Table 4.3

Common Fat Substitutes

Fat substitute name

Main ingredient Calories Typical uses Approval Comments

Oatrim Whole oats with beta-glucan

4 kcal/g Sauces, gravies, baked goods

GRAS* Can be used in baked products as a substitute for some or all of the fat; consumers can alter the amount substituted to meet acceptable texture

Simplesse Whey protein 1–4 kcal/g depending on water content

Frozen desserts, dressings, and spreads

GRAS* Not as versatile as other substitutes because it cannot be used in heated products

Benefat Glycerol and fatty acids

5 kcal/g Reduced-fat candies, baked goods

GRAS* Variety of uses in many types of candies; can also be used in heated products but not in high- temperature frying

Olean Sucrose and fatty acids

0 kcal/g Fried snack foods FDA approved for use in select fried snack foods only

Can bind fat-soluble vitamins; therefore A, D, E, K are added; may cause oily diarrhea and abdominal cramping, especially if too much product is consumed

*GRAS = Generally Recognized As Safe

100 SECTION 1 The Basics of Sports Nutrition

three fatty acids, as in a triglyceride, olestra is a sucrose polyester that has a sucrose backbone with six to eight fatty acids attached. Different fatty acids can be attached to the sucrose backbone, altering olestra’s characteristics to produce fat-like qualities in foods. The arrangement of olestra prevents hydrolysis and therefore olestra is non- digestible and not absorbed, making olestra calorie free. Olestra is also highly heat stable and has been approved for use in limited amounts of fried snack foods such as potato and corn chips.

How much fat is recommended in an athlete’s diet? Fat is an essential nutrient in the diet; however, no RDA or AI is set for total fat intake because there is insuffi- cient data to determine a defined level of fat intake at which risk of inadequacy or prevention of chronic disease occurs.1 The AMDR for fat intake has been set at 20–35% of total energy for adults.1 For a summary of the general daily fat intake recommendations, see TABLE 4.4 .1,8

In general, athletes report an average fat intake of 35% of total calories; however, fat intake varies among athletes in different sports.9 Endurance athletes tend to have lower fat and higher carbohydrate intake than sprinters and short-distance runners.9 Athletes dieting for weight loss and those involved in sports requiring weigh- ins or judging on appearance also tend to have lower fat intakes. Appearance sport athletes such as ice skaters,

divers, cheerleaders, and gymnasts may become so fix- ated on low-fat/low-caloric intake that in some cases they may exhibit disordered eating habits that can lead to more serious conditions such as anorexia nervosa or bulimia nervosa.10,11 Conversely, collegiate athletes, many of whom are living away from home, may consume too much dietary fat because of an overreliance on fast foods. Overconsumption of fats usually leads to ingesting too many calories. Excessive calories can lead to increases in body fat deposition, and in most cases this has det- rimental effects on sport performance. Clearly, athletes must be aware of their dietary fat intake to ensure opti- mal energy levels, body composition, and, ultimately, sport performance.

Athletes should focus not only on the total amount of fat in their diet but also on the type of fat consumed. Satu- rated and trans fats should be kept to a minimum. These fats have been shown to be the most detrimental to cardio- vascular health. Saturated fats are found mainly in meat and high-fat dairy products. Trans fats are widespread in processed, packaged foods. Athletes should look for “hydro- genated” or “partially hydrogenated” oils within the ingre- dients listing of the food label because these terms indicate trans fats. Monounsaturated and polyunsaturated fats are beneficial to health, decreasing the risk for cardiovascu- lar disease and possibly aiding in the prevention of can- cer and arthritis. Monounsaturated fats are found mainly in plant-based foods, including olives, olive oil, canola oil, nuts, seeds, and avocados. Polyunsaturated fats can be fur- ther broken down into omega-3 and omega-6 fatty acids.

Recently, the omega-3 fatty acids have received attention for their beneficial effects on the cardiovascu- lar system. Research thus far has suggested that these fatty acids are protective by lowering triglyceride levels and blood pressure and decreasing the growth of athero- sclerotic plaque and inflammation.12 Because of these positive effects, and because most Americans are defi- cient, athletes are encouraged to increase their intake of omega-3 fatty acids. As with many nutrients, it appears that focusing on food sources of omega-3 fatty acids, versus supplements, is the best approach. The American Heart Association recommends that individuals consume at least two servings of fish per week (providing EPA + DHA), as well as vegetable sources of omega-3 fatty acids (providing alpha-linolenic acid).12 Vegetable sources of these fats include walnuts, flaxseed, soybeans, and canola oil (see TABLE 4.5 ). Americans appear to be consuming plenty of omega-6 fatty acids, which are found in corn, sunflower, and safflower oils. These oils can be included in a healthy diet but should not be emphasized as heavily as omega-3 fatty acids. By focusing mainly on plant sources of fats, athletes will consume mainly beneficial fats, lead- ing to good health and optimal performance. Although there is no direct evidence that omega fatty acids enhance athletic performance, there is some evidence to suggest that omega-3 fatty acids may decrease inflammation and improve blood flow during exercise.13 Clearly, decreasing

Table 4.4

Daily Fat Intake Recommendations

Fats Recommendation Total intake 20–35% of total calories

Saturated < 7%, with a maximum of 10% of total calories

Trans fats < 1% of total intake

Monounsaturated ~15–20% of total calories while keeping within the total fat limits

Polyunsaturated ~10–15% of total calories

Omega-3 (Linolenic acid) ~0.6–1.2% of total calories as alpha- linolenic acid

1.6 grams/day for men* 1.1 grams/day for women* Up to 10% of total calories from EPA +

DHA, or at least 500 mg EPA + DHA

Omega-6 (Linoleic acid) ~5–10% of total calories 17 grams/day for men** 12 grams/day for women**

*19 years of age or older

**19-50 years of age

Chapter 4 Fats 101

acids can no longer viewed in general categories, such as saturated and unsaturated, because individual fatty acids within these categories have different influences on health status and disease risk.”8 Thus, sports nutrition professionals will need to stay tuned for new information regarding the health effects of all types of dietary fats, not just unsaturated fats.

Can a diet be too high in fat? Consuming too much fat can lead to the overconsumption of total calories, resulting in weight gain in the form of body fat. Excess body fat in athletes inhibits performance in most sports. Body fat is a less active tissue and does not produce energy for exercise as eas- ily as stored carbo- hydrates. Because fat tissue does not help produce move- ment, it acts as “dead weight.” In sports such as track, gym- nastics, basketball, volleyball, and many others, the overfat athlete is weighted down by excess fat, and his or her performance can be hindered. Yet in some sports, higher body weights are beneficial. Athletes in football or other throwing and contact sports may ben- efit from some additional body fat weight (as well as mus- cle tissue) to provide extra mass for their activities.

muscle pain due to inflammation and improving blood flow during exercise can both positively affect athletic performance; however, much more research regarding the impact of omega fatty acids in athletic performance is needed before specific recommendations can be made.

Can a diet be too low in fat? Because dietary fat contributes a significant amount of calories per gram, low fat intakes can affect energy bal- ance. Low dietary fat intake combined with low total caloric, carbohydrate, and protein intake can lead to neg- ative energy balance in individuals. For athletes, negative energy balance is counterproductive except in athletes for whom weight loss is indicated. However, when energy balance is negative, training often suffers. Therefore, ath- letes need to balance their fat and calorie intake with gen- eral health and weight-loss goals.

Essential fatty acid deficiency is rare in the United States. A lack of the essential omega-6 fatty acid, linoleic acid, is characterized by rough, scaly skin and dermati- tis. Lack of essential and other fatty acids decreases the body’s ability to transport fat-soluble vitamins and phy- tochemicals throughout the body. The omega-3 essen- tial fatty acid, linolenic acid, can be converted to EPA and DHA, which have been shown to be beneficial in reducing vascular disease. A lack of linolenic acid could decrease the amount of converted EPA or DHA, thus reducing these positive health benefits.

Finally, the current Academy of Nutrition and Dietet- ics position statement on dietary fatty acids states: “Fatty

Food for Thought 4.1

The Importance of Fat Intake for Athletes

In this exercise, you will define types of fats, list sources, and con- sider health benefits of appropri- ate fat intake.

Table 4.5

Omega-3 Fatty Acids in Selected Foods

18:3 (mg) 20:5 (EPA) (mg) 22:6 (DHA) (mg) 1 tbsp canola oil 1279 0 0

1 tbsp soybean oil 923 0 0

1 tbsp walnut oil 1414 0 0

1 tbsp flaxseed oil 7258 0 0

3 oz canned sockeye salmon (fatty fish) 46 440 637

3 oz cooked mackerel (fatty fish) 96 428 594

3 oz cooked flounder (lean fish) 18 143 112

3 oz cooked shrimp 10 115 120

1 tbsp cod liver oil 127 938 1492

1 tbsp salmon oil 144 1771 2480

Data from U.S. Department of Agriculture, Agricultural Research Service. USDA Nutrient Database for Standard Reference, Release 27. 2015. Available at: www.ndb.nal.usda. gov. Accessed June 30, 2015.

Some of the numbers seem to indicate a lot of omega-3. But remember, these are milligrams! Dietary fat is usually measured in grams. For example, the 245 milligrams (0.245 g) of ALA, EPA, and DHA in a serving of shrimp is not much in relation to a diet that has 50+ grams of fat and is a bit less than half the recommendation for daily intake.

102 SECTION 1 The Basics of Sports Nutrition

coming from saturated fat. Low-fat or nonfat dairy prod- ucts, such as skim milk, low-fat yogurt, and cottage cheese,

may have only 1–4 grams of fat or less per serving. To help minimize the intake of saturated fats, as well as overall fat, low-fat and nonfat dairy products are the preferred choice.

Most soy, rice, or other dairy alterna- tive products contain approximately 1–6 grams of fat per serv- ing. The fats in dairy alternative choices

are mainly unsaturated fats, and therefore are excellent substitutes for full-fat dairy products.

If fortified, the low-fat/nonfat dairy and alternative products contain the equivalent amounts of calcium and vitamin D as their full-fat counterparts. Therefore, ath- letes should choose the lower-fat options to gain the pro- teins, carbohydrates, calcium, and vitamin D benefits of dairy/alternative foods without the drawback of higher fat and saturated fat consumption. Table 4.2 lists a variety of dairy/alternative products and their respective fat con- tent. TRAINING TABLE 4.3 provides tips on including low-fat dairy/alternative products in meal planning.

Which foods contain fat? Fats are found within most food groups of the MyPlate food guidance system. The richest sources of fat are found within the oils. Some grain products as well as certain vegetables provide a small to moderate amount of fat. Fruits provide minimal or no fat. Dairy/alternative prod- ucts and protein food products can vary from low to high in fat. Because the type of fat consumed is important for overall health and performance, it is imperative that ath- letes choose the healthiest selections within each food group to include a variety of fat sources in sufficient, but not excessive, amounts each day.

How much fat is in the grains group? Many of the foods within the grains group of MyPlate are very low in fat, although specific selections can be very high in fat. Whole grains, such as oatmeal, barley, bulgur wheat, millet, and spelt, contain less than 1–3 grams of fat per serving. The fat in these grains is mainly unsatu- rated. At the other end of the fat spectrum are foods such as biscuits and croissants. These foods are high in fat, with a larger percentage coming from saturated and trans fats, and therefore intake should be minimized. Table 4.2 earlier in the chapter lists a variety of bread, cereal, rice, and pasta options and their respective fat content.

TRAINING TABLE 4.1 provides some tips on including low-fat grains in meals.

How much fat is in the fruit and vegetable groups? In general, fruits and vegetables contain minimal to no fat. However, certain vegetables, such as avocados and olives, contain a considerable amount of fat, although mainly unsaturated. The higher-fat vegetables should be included in a well-balanced diet in moderate amounts because of their favorable fat profile. Table 4.2 lists a vari- ety of fruits and vegetables and their respective fat con- tent. TRAINING TABLE 4.2 provides some tips on using fruits and vegetables rich in unsaturated fats.

How much fat is in the dairy/alternative group? Dairy/alternative foods and beverages span both ends of the spectrum in regard to fat content. Full-fat dairy products, such as whole milk or hard cheeses, may con- tain 8–10 grams of fat per serving, with a high percentage

Gaining the Performance Edge

Unsaturated fats are found mainly in plant products, including olives, olive oil, canola oil, avocados, nuts, seeds, and flax, as well as in fish of all types. Saturated and trans fats are found mainly in meats, high- fat dairy products, cheeses, but- ter, margarine, desserts, and snack foods. Athletes should focus mainly on unsaturated fats while minimiz- ing saturated and trans fats.

Training Table 4.1: Meal Planning Tips for Using Low-Fat Grains

• Cook bulgur wheat with oatmeal for a hot cereal in the morning, topped with fresh fruit.

• Use kamut or wheat berries for stir-fry and casseroles.

• Make a pilaf with couscous, canned beans, chopped tomatoes, and fresh parsley for a light summer lunch.

• Add dry oatmeal to pancake batter for fluffier and heartier pancakes.

Training Table 4.2: Meal Planning Tips for Using Fruits and Vegetables Rich in Unsaturated Fats

• Toss olives on top of fresh green salads.

• Make homemade guacamole for burritos or a chip dip. (See the Goalie Guacamole recipe.)

• Include olives in pasta primavera.

• Slice avocado for sandwiches or burgers.

Goalie Guacamole

2 avocados, peeled and chopped

2 tomatoes, chopped

1 tsp chili powder

½ tsp garlic salt

1–2 tsp chopped cilantro

juice of one lime

Mash the avocados in a medium-sized mixing bowl. Stir in the tomatoes and mash together slightly. Add the remaining ingredients, mixing well. Serve with chips, tacos, or burritos.

Serving Size: 3–4 tbsp (Recipe makes 4 servings)

Calories: 165 kcal

Protein: 2.4 grams

Carbohydrates: 9.2 grams

Fat: 15.0 grams (12.75 grams unsaturated)

Chapter 4 Fats 103

How much fat is in the protein foods group? Foods in this group vary greatly in regard to the quantity of fat per serving as well as the type of fat predominating in the product. In general, beef contains a higher quantity of fat and a higher percentage of saturated fat than most other foods in this group. Therefore, athletes should focus mainly on lean cuts of beef. Chicken, turkey, and pork contain moderate amounts of total fat and saturated fat. Some fish are very lean, such as orange roughy, whereas other choices are higher in fat, such as salmon. However, a majority of the fat in fish is unsaturated, and the higher- fat fish are a rich source of omega-3 fatty acids.

Eggs are relatively low in fat, especially the egg white. Nuts and seeds contain higher levels of fat, but, similar to fish, contain mainly unsaturated fats. Legumes are very low in fat, and the little they do contain is unsaturated. Soy

products range from low-fat choices such as tofu to higher- fat choices such as soy nuts, but they also consist mainly of unsaturated fats. Table 4.2 lists a vari- ety of protein foods and their respec- tive fat content.

TRAINING TABLE 4.4 pro- vides meal-planning tips for using low-fat protein foods.

How much fat is in the oils? This category contains the richest sources of fat. The best choices include the unsaturated oils, such as olive, canola, flax, and sesame oils. Saturated and trans fatty acids found in butter, margarine, snack items, desserts, and other fried or processed foods should be kept to a minimum. Table 4.2 lists a variety of fats, sweets, and oils and their respective fat content. TRAINING TABLE 4.5 provides some healthier options within the oils.

How can the percentage of calories from fat be calculated for specific foods? The fat intake recommendations are often stated as a per- centage of total calories rather than an absolute number. Many athletes wonder, “What does the percentage mean, and how do I figure out the percentage of fat in the foods I eat?” This section explains how to interpret the percent- age and how to calculate the percentage of calories from fat in specific foods.

Training Table 4.3: Meal Planning Tips Using Lower-Fat Dairy/Alternatives

• Choose 1%, skim, or soy milk for cereal.

• Replace half the fat in a recipe with low-fat yogurt.

• Order a latte or café mocha with skim or soy milk.

• Substitute low-fat yogurt for a portion or all of the sour cream in dips or sauces. (See the Volleyball Veggie Dip recipe.)

Volleyball Veggie Dip

1 cup plain low-fat yogurt

1 cup nonfat sour cream

1 10 oz package frozen spinach, thawed and drained

¼–½ cup chopped green onions

¼ tsp salt

¼ tsp ground black pepper

2 tbsp fresh dill or 1 tbsp dried dill

Mix all ingredients together and refrigerate for several hours to chill. Serve as a dip for crackers or raw vegetables.

Serving Size: ¼ cup (Recipe makes 16 servings)

Calories: 28 kcal

Protein: 2.0 grams

Carbohydrates: 4.9 grams

Fat: 0.3 grams

Training Table 4.4: Meal Planning Tips for Using Lower-Fat Protein Foods

• Choose 90–95% lean ground beef for sloppy joes and meatloaf.

• Cook salmon on the grill and serve with a couscous pilaf.

• Scramble 2–3 egg whites together and add low-fat cheese.

• Use tempeh for a barbeque sandwich. (See the Baseball Barbeque Sandwiches recipe.)

Baseball Barbeque Sandwiches

1 package of tempeh, cut into cubes (or a 13 oz can of chicken)

½–¾ cup barbeque sauce

2 whole wheat buns

Preheat oven to 350oF. Mix cubed tempeh (or chicken) and barbeque sauce together in a small mixing bowl. Transfer tempeh to a lightly greased baking dish. Bake in the oven for 10–15 minutes. Serve tempeh on buns for an open face or closed sandwich.

Serving Size: one sandwich (half tempeh mixture and one bun)

Calories: 498 kcal (600 kcal)*

Protein: 27.7 grams (56 grams)*

Carbohydrates: 69.6 grams (51 grams)*

Fat: 12.7 grams (17 grams)*

*Nutrient content when using chicken.

Training Table 4.5: Meal Planning Tips for Healthier Food Flavoring with Oils

• Dip whole-grain bread in olive oil for an appetizer.

• Use 1–2 tbsp of sesame oil in tofu or chicken stir-fry.

• Spread peanut butter or almond butter on toast, English muffins, pita bread, or homemade bran muffins.

• Marinate vegetables for the grill in a mixture of olive oil, balsamic vinegar, and spices.

104 SECTION 1 The Basics of Sports Nutrition

Gaining the Performance Edge

Fats are found throughout the MyPlate food guidance system. Athletes should focus on the con- sumption of unsaturated fats and minimize saturated fats and trans fatty acids. It is nutritionally ideal to obtain fats from foods such as vege- tables and low-fat dairy that contain other nutrients, instead of from high- fat, low-nutrient-density choices, such as dressings and desserts.

The percentage of total calories from fat, saturated fat, or trans fat for any food item can be calculated by the following basic formula:

% calories from fat = (calories from fat/total calories) × 100

In order to complete the equation, an athlete will need to do some fact-finding on the Nutrition Facts panel and also know how to calculate the calories from fat.

The total calories per serving and amount of total fat, saturated fat and trans fat are listed near the top of the Nutrition Facts panel on any food product (see FIGURE 4.8 ). Multiply the number of grams of total fat, saturated fat, or trans

Figure 4.8 Calculating the percentage of total calories from fat using the food label. Athletes need to know how to calculate the percentage of fat in foods they consume. The food label lists the total number of calories and the total grams of fat in one serving, which can be used to calculate this percentage. In this example, the calculation is: 4 grams fat x 9 calories per gram = 36 calories from fat; 36 calories from fat/150 total calories) = 0.24 x 100 = 24%, meaning 24% of the total calories are contributed from fat.

fat by 9 (because there are 9 calories per gram of any type of fat) to obtain the total number of calories from fat. The resulting num- ber of calories from fat, and the total calories per serving, can then be plugged into the previously mentioned equation. For example, if a package of crackers has 130 total calories per serving and 3 grams of total fat, the calculation would be as follows:

3 grams of total fat × 9 calories per gram = 27 calories from fat

(27 calories from fat/130 total calories) × 100 = 20.7% of total calories from fat

If the calculated percentage for total fat is less than 35% (<10% for saturated fat, <1% for trans fat), the athlete knows the product fits within healthy eating guidelines (see Table 4.4). However, athletes should keep in mind that the recommendation for 20–35% of total calories coming from fat is a guideline for the overall diet—not necessarily for every individual food eaten in the diet. Sometimes ath- letes will take this recommendation too far and exclude all foods that do not fall into this category. However, this approach is not necessary and can steer athletes away from healthy choices. An example of a very healthy food that does not fall into the 20–35% range is peanut butter. By studying the label and calculating the percentage of calo- ries from total fat, the consumer will determine that pea- nut butter typically contains 50–80% of its calories from fat. Therefore, peanut butter does not fall into the 20–35% goal. However, if an athlete has a peanut butter sandwich on whole wheat bread with an apple and a cup of yogurt, then the percentage of calories from the whole meal is less than 30%, which would be classified in the healthy category. Plus, nuts are full of other nutrients, such as fiber, protein, and zinc, and the fat in nuts is mainly unsaturated fat. Use the percentage of calories from fat, along with other nutritional benefits or drawbacks, to fully evaluate a food or beverage in the context of an entire meal.

The FDA approved a regulation in 2003 that all food labels must list the amount of trans fats contained in the product.14 The trans fats must be listed in grams and shown on all food labels directly below the listing for saturated fats. Trans fats, similar to saturated fats, can raise LDL cholesterol levels, potentially increasing risk for cardiovascular disease. Currently, there is not an RDA for trans fats and no specific recommendations for the maximum number of grams of trans fat to consume daily. Therefore, trans fats will not have a Percent Daily Value (%DV) listed on the food label. However, athletes who want to limit trans and saturated fats can use the gram amounts listed on the food label. By combining the grams of saturated fat and trans fat on the food label, similar products can be compared for their fat content. Athletes should choose the product with the least amount of these two fats combined.

Athletes need to be careful not to confuse the per- centages listed under the Percent Daily Value column as the respective percentage of calories from fat. The %DV is based on a 2000-calorie diet. At this calorie level, the FDA

Nutrition Facts 4 servings per container Serving size

Amount per serving

1 cup (248g)

Calories 150 % Daily Value*

Total Fat 4g Saturated Fat 2.5g Trans Fat 0.5g

Cholesterol 20mg Sodium 170mg Total Carbohydrate 19g

Dietary Fiber 0g Total Sugars 14g

Protein 11g Includes 11 g Added Sugars

6% 12%

7% 6%

22%

* The % Daily Value (DV) tells you how much a nutrient in a serving of food contributes to a daily diet. 2,000 calories a day is used for general nutrition advice.

Vitamin D 0mcg Calcium 400mg Iron 0mg Potassium 82mg

40% 0%

Total calories

Total Fat

Chapter 4 Fats 105

recommends consuming no more than 65 grams of total fat and 20 grams of saturated fat. Therefore, the %DV is providing the relationship between eating one serving of a product and how that compares to total daily needs. Refer to the label of the package of instant oatmeal in FIGURE 4.9 for an example.

Another common labeling statement that often cre- ates questions is when foods are labeled “95% fat-free.” An athlete might assume that 95% fat-free means that only 5% of the total calories come from fat and that this would be a healthy choice. However, these statements are based on the total weight of the food product, not on

Figure 4.9 Difference in the percentage of calories from fat and the Percent Daily Value for Fat. A serving of a product may have 150 total calories with 36 calories coming from fat (4 grams of fat x 9 calories per gram = 36 calories from fat), which equals 24% of the total calories from fat. The label lists the %DV associated with total fat as 6%. This means 4 grams is 6% of the total daily recommendation of 65 grams, not that the product has 6% of its total calories from fat. Therefore, use the %DV as an indication of how much fat one serving contributes to total daily needs; use the numbers indicated for Calories and Total Fat to deter- mine whether the product is low fat.

the total calorie content of the product. Some foods have higher water contents, and therefore the amount of fat compared to the total weight will be small; however, the percentage related to total calorie content may be moder- ate or high. For example, these statements are commonly found at the meat counter describing options for ground meats. A 95% fat-free meat does not mean that only 5% of the total calories are coming from fat. These meats can still have a significant amount of fat and saturated fat compared to the calorie content of one serving of meat. However, these statements can still be a good tool for decision making, regardless of whether they help an ath- lete determine exactly how much fat is in a product. An athlete should look for a product labeled as a higher per- centage fat free, which indicates a leaner item and thus a healthier choice. For example, a meat product labeled as 98% fat free is leaner than a 95% fat-free product.

What’s the big deal about cholesterol? As mentioned earlier in the chapter, it is recommended that fat intake be kept at a moderate level to prevent car- diovascular disease. So, what is the connection between dietary fat and an increased risk of cardiovascular dis- ease? On the basis of ongoing research in the area of car- diovascular health, blood cholesterol has been associated with a higher risk for cardiovascular disease. Therefore, blood cholesterol levels have been targeted as one of the lines of defense in the prevention of the disease. One of the most influential ways to modify blood cholesterol lev- els is to adapt lifestyle behaviors such as exercise and diet, with specific attention to dietary intake of saturated fats and trans fats.

What is dietary cholesterol, and which foods contain it? As mentioned previously, cholesterol is a sterol. It is only found in animal products (see TABLE 4.6 ). All meats con- tain cholesterol, with organ meats having the highest amounts. Eggs and dairy products also contain choles- terol, with nonfat dairy options having the least. Breads, muffins, and baked goods will have cholesterol if they were made with eggs and/or dairy products.

Plant products, such as fruits, vegetables, whole grains, legumes, and soy, are cholesterol free. These foods do contain plant sterols, however, which have a similar ring structure to cholesterol. Plant sterols or stanols have been researched for their potential effects as blood cho- lesterol-lowering substances. Plant sterols and stanols are poorly absorbed by humans and, therefore, may reduce the amount of cholesterol absorbed in the intestinal tract.

How is blood cholesterol classified? Cholesterol is measured by taking a sample of blood and analyzing for various parameters, which typically include total cholesterol, high-density lipoprotein (HDL), very-low-density lipoprotein (VLDL), lipoprotein(a), and

Nutrition Facts 4 servings per container Serving size

Amount per serving

1 cup (248g)

Calories 150 % Daily Value*

Total Fat 4g Saturated Fat 2.5g Trans Fat 0.5g

Cholesterol 20mg Sodium 170mg Total Carbohydrate 19g

Dietary Fiber 0g Total Sugars 14g

Protein 11g Includes 11 g Added Sugars

6% 12%

7% 6%

22%

* The % Daily Value (DV) tells you how much a nutrient in a serving of food contributes to a daily diet. 2,000 calories a day is used for general nutrition advice.

Vitamin D 0mcg Calcium 400mg Iron 0mg Potassium 82mg

40% 0%

% Daily Value

106 SECTION 1 The Basics of Sports Nutrition

12-hour fast. Total cholesterol can be estimated with por- table machines, often used at health fairs, which require

only a finger stick to obtain a small drop- let of blood to be quickly analyzed. These results should be verified by tak- ing a cholesterol test after a fast.

Athletes inher- ently are helping to lower their choles- terol levels because of their active life- styles. However, many athletes are not focused on dietary approaches that are protective

and therapeutic. Physical activity alone is not enough to keep cholesterol levels in the desirable range; a healthy diet is also critical.

What is total cholesterol? Total cholesterol is a measurement that combines the lev- els of HDL, LDL, and triglycerides in the blood. It can pro- vide a general estimate of risk, but it is not as informative as the breakdown of the various lipoprotein components. Total cholesterol can be lowered by making dietary and physical activity changes that will decrease LDL and tri- glyceride components.

What is HDL? HDL is often referred to as the “good” cholesterol. HDL has a higher protein content and a smaller triglycer- ide and cholesterol content than LDL. HDL is a “scaven- ger,” picking up cholesterol from the bloodstream and arteries and delivering it to the liver to be packaged into bile and excreted from the body. Because of this action, HDL often is considered as protective against cardio- vascular disease. However, researchers have not con- clusively determined that alterations to HDL through modifications to diet and exercise lead to a reduced risk of cardiovascular disease. More research is required before firm dietary and physical activity guidelines can be set based on a proven track record of protection. In the meantime, individuals should focus on the lifestyle factors that have been shown to increase HDL—weight management and regular exercise. In terms of the influ- ence of diet on HDL, very low-fat eating plans can lead to a lowering of HDL levels. Therefore, individuals should follow a moderate-fat diet, with 20–35% of total calories coming from fat, with a strong emphasis placed on the unsaturated fats.

low-density lipoprotein (LDL). Each component can pro- vide unique information regarding an individual’s risk for heart disease; however, it should be noted that cur- rent guidelines focus most on LDL and HDL levels. Blood cholesterol measurements are most accurate after a 9- to

Gaining the Performance Edge

Athletes should aim for 20–35% of their total calories from fat. The percentage can be calculated from information provided within the Nutrition Facts panel on the food label. Athletes should keep in mind that the 20–35% guideline is for the overall diet, not necessarily for every individual food. A specific food should be evaluated based on both its total fat percentage and its overall nutrient contribution to a healthy diet.

Table 4.6

Cholesterol Content of Various Foods

Food item Serving size Cholesterol content (mg)

Grains

Bran flakes ¾ cup 0

Bagel 1 bagel 0

Spelt ½ cup 0

Fruits/Vegetables

Apple 1 medium 0

Plum 1 medium 0

Acorn squash ½ cup 0

Olives 10 medium 0

Dairy/Alternative

Skim milk 8 fl oz 4

1% milk 8 fl oz 10

2% milk 8 fl oz 18

Whole milk 8 fl oz 33

Low-fat yogurt 6 oz 0

Cheddar cheese 1 oz 30

Soy milk 8 fl oz 0

Protein Foods

Ground beef, lean 3 oz 82

Chicken breast with skin 3 oz 82

Chicken breast without skin 3 oz 73

Turkey, white meat, without skin 3 oz 69

Turkey, dark meat, without skin 3 oz 85

Pork chop 3 oz 79

Salmon, pink 3 oz 20

Orange roughy (deep sea perch) 3 oz 22

Whole egg 1 large 212

Egg white 1 egg white 0

Veggie burger 1 patty 0

Almonds 1 oz 0

Oils

Margarine, stick 1 tbsp 0

Butter 1 tbsp 33

Olive oil 1 tbsp 0

Salad dressing, ranch 2 tbsp 5

Salad dressing, reduced-calorie ranch

2 tbsp 10

Chapter 4 Fats 107

increased quantities of enzymes involved in fat metabo- lism are adaptations that help explain the enhanced ability of trained muscles to utilize fats for energy.17,18 Clearly, the adaptations that occur with endurance training indicate the importance of fats as an energy source.

However, despite the body’s abundant fat reserves and ability to increase fat utilization in response to endurance training, fats are still not the most efficient fuel for work- ing active muscles, particularly at higher levels of exer- cise intensity. The limitation of fat utilization for energy during exercise is the relatively slow rate of ATP produc- tion as compared to carbohydrates. Fats must be aerobi- cally metabolized to produce ATP. There must be adequate availability of oxygen to the muscle cells for fats to be broken down, not to mention that fat metabolism is a complicated process involving three metabolic pathways

What are VLDL and lipoprotein(a)? VLDLs contain a triglyceride-rich core.15 Lipoprotein lipase digests some of the triglycerides from the VLDL, leaving an intermediate-density lipoprotein (IDL). The IDL travels through the bloodstream to the liver, where it is converted into LDL. VLDL level can be measured in a blood test, similar to HDL and LDL.

Lipoprotein(a) has been receiving more attention over the years as an indicator of risk for heart disease. Lipoprotein(a) is structurally similar to LDL and has been linked to heart disease because of its involvement in ath- erogenesis and thrombogenesis. More research is needed to determine the recommended levels of lipoprotein(a) for use in screening individuals, as well as the influence of diet and exercise in modifying VLDL and lipoprotein(a) levels over time.

What is LDL? LDL is the rival to HDL and is termed the “bad” cholesterol. This cholesterol-rich lipoprotein delivers cholesterol to the cells of the body to be used for a variety of functions. The problems begin when cells, specifically those in the arterial walls, are damaged as a result of a variety of envi- ronmental factors, including genetics, disease states, or medical conditions. White blood cells rush to the areas of damage and bind to LDL, which releases its cholesterol, leading to a buildup on the arterial wall and eventually escalating into atherosclerosis (see FIGURE 4.10 ). Because of this action and the large volume of evidence linking LDL to greater risk for cardiovascular disease, LDL has become the primary target of therapy.

The American Heart Association and the American College of Cardiology have developed a list of dietary recommendations for lowering LDL blood levels and preventing cardiovascular disease. See Fortifying Your Nutrition Knowledge for an explanation of the therapeu- tic dietary changes. Also listed in TRAINING TABLE 4.6 are two diets—a typical American diet and an example of a cho- lesterol-lowering diet plan. Recognizing the difference in these meal plans can help athletes achieve their nutri- ent needs while minimizing their risk for heart disease.

How can fats affect daily training and competitive performance? Fats are a major fuel source for muscle cells. Fats are the primary source of energy at rest, during low- to moder- ate-intensity activities, and in periods of recovery between intense bouts of activity. Endurance training improves the body’s ability to utilize fats for energy by enhancing the body’s ability to mobilize fats from adipocytes, thus making more fatty acids available to the working muscle.16 In addi- tion, endurance training improves the working muscle’s capacity to oxidize the fats that are delivered. Increased muscle blood flow, improved transport of fats into the mus- cle cells, larger and more numerous mitochondria, and

Figure 4.10 Buildup in an artery leads to atherosclerosis. High LDL cholesterol levels can contribute to plaque formation in artery walls and atherosclerosis.

Fatty deposits accumulate in the wall of the artery

Damaged endothelium

Fatty streak

Fibrous plaque

Fibers

Fats

Large plaque obstructing artery

Normal smooth muscle cell

108 SECTION 1 The Basics of Sports Nutrition

(see FIGURE 4.11 ). Finally, although some fats are stored within the muscles, research evidence to date does not sup- port the contention that these fats provide much energy during exercise.19,20 This means that the fats must be released from adipocytes and then delivered to the work- ing muscles via the blood. Taking all of this into account, the delivery and metabolic disassembly of fats for energy is not only slower than that of carbohydrates at respond- ing to changes in activity, but also slower at producing ATP. The advantage of fat utilization is that the metabolic mill for producing ATP from fats can produce almost limitless amounts of ATP. If fats could be made more readily avail- able to muscle via dietary manipulation, then conceivably endurance sport performance could be enhanced. The fol- lowing discussions explore what is currently known about dietary fat intake and sport performance.

Figure 4.11 Metabolic mill for fats. The metabolic mill for fats can produce nearly limitless amounts of ATP; however, the delivery and metabolic disassembly of fats to the working muscle are slow.

ATP

e–

FATS

Acetyl CoA

Citric acid cycle

Beta oxidation

Electron transport chain

Fatty acids

Training Table 4.6: How Can the AHA/ACC Lifestyle Management Guidelines Be Applied to a Daily Meal Plan?

High-Fat, High-Cholesterol Diet LDL Cholesterol-Lowering Diet

Breakfast Breakfast

2 eggs scrambled with 2 tbsp cheddar cheese

2 cups bran flakes with 1 cup skim milk and ½ cup strawberries

2 pieces of toast with 2 tsp butter 2 pieces toast with 2 tbsp peanut butter

Banana

12 oz 2% milk 12 oz orange juice

Snack Snack

2 oz pretzels Banana

Lunch Lunch

3 oz roast beef sandwich on white bread with 1 tbsp mayonnaise

3 oz turkey sandwich on whole wheat bread with 2 tsp mustard

1.5 oz bag of potato chips 1½ cups black bean soup

20 oz diet soda Pear

Snack Snack

Protein sports bar 8 oz low-fat yogurt

2 tbsp raisins

Dinner Dinner

9 oz steak 6 oz chicken stir-fry with 2 cups of broccoli, carrots, and mushrooms, and 1 cup brown rice

1.5 cups mashed potatoes 2 cups green salad with 2 tbsp olive oil and vinegar dressing

½ cup green beans 12 oz skim milk

12 oz 2% milk 2 oatmeal cookies

2 cups ice cream

Daily Totals Daily Totals

Calories: 3400 Calories: 3130

Fat: 148 grams (39% of total calories)

Fat: 71 grams (20% of total calories)

Saturated fat: 63 grams (17% of total calories)

Saturated fat: 16 grams (5% of total calories)

Trans fat: 24 grams Trans fat: 6 grams

Chapter 4 Fats 109

Fortifying Your Nutrition Knowledge

AHA/ACC 2013 Report on Lifestyle Management to Reduce Cardiovascular Disease Risk In 2013, the American Heart Association (AHA) and the Ameri- can College of Cardiology (ACC) released updated guidelines for lifestyle management techniques to aid in reducing the risk of cardiovascular disease. The dietary guidelines focused spe- cifically on lowering LDL cholesterol, and include the following:

■ Consume a diet that emphasizes intake of vegetables, fruits, and whole grains; includes low-fat dairy products, poultry, fish, legumes, nontropical vegetable oils, and nuts; and limits intake of sweets, sugar-sweetened bev- erages, and red meats. Adapt this diet to meet appro- priate calorie requirements, personal and cultural food preferences, and nutrition therapy recommendations for medical conditions (if present).

■ Aim for a dietary pattern that achieves 5–6% of calories from saturated fats.

■ Reduce the percentage of calories contributed from sat- urated and trans fats.

For more information on the AHA/ACA Guideline on Life- style Management to Reduce Cardiovascular Risk, visit http://circ.ahajournals.org/content/129/25_suppl_2/S76.

What type, how much, and when should fats be consumed before exercise? Current research has focused on the potential of dietary fat to enhance performance, mainly in endurance activ- ities.21–25 Some information suggests that an increase in dietary fat in the weeks leading up to a competition, sometimes referred to as fat loading, can enhance the body’s ability to utilize fat and therefore spare glycogen and prolong exercise. Others claim that a permanent shift to higher fat intakes allows the body to burn more fats for fuel, decreasing adipose stores and therefore improving an athlete’s body composition. The following sections will explore the ability of fat to enhance performance in a sin- gle high-fat meal prior to exercising, a short-term pattern of high-fat meals and snacks, and a long-term diet plan consisting of high-fat foods. In conclusion, recommenda- tions will be stated for fat intake prior to exercise based on the research and information presented.

Is a single high-fat meal prior to exercise beneficial? Previous research has demonstrated that the rate of fat utilization for energy during exercise increases as the availability of fatty acids in the blood increases.26,27 In other words, the more fat that is delivered or made available to a working muscle, the more fat the work- ing muscle will metabolize for energy. Therefore, it has been proposed that a high-fat meal prior to competition would increase fatty acid levels in the blood and, in turn, enhance endurance performance compared to a high- carbohydrate meal. Some studies have provided meals to athletes with as high as 60–75% of total calories from fat in the 4 hours prior to exercise. Others have experi- mented with ingestion of medium-chain (6 to 10 carbons) and long-chain (>12 carbons) fatty acids with the hope of increasing fatty acids in the blood by providing a fat source that is readily broken down and absorbed. Unfor- tunately, to date the majority of studies have not found any benefit to ingesting high-fat meals prior to competi- tion when compared to high-carbohydrate meals.27,28 In fact, many athletes find that a meal high in fat eaten 1 to 4 hours prior to an exercise session, or especially a competition, leads to gastrointestinal distress, including bloating, diarrhea, stomach cramping, and a sense of full- ness.29 Therefore, it is not recommended that athletes eat a high-fat meal immediately prior to exercise.

Is a short-term pattern of eating high-fat meals beneficial to exercise performance? “Short-term” for the purposes of this question includes periods of time less than 2 weeks. Carbohydrate stores in the body are limited and can be depleted by 3 hours or less of continuous exercise. The significance of depleting car- bohydrate stores is that it results in fatigue and decreases exercise performance. However, fat stores on even very lean individuals are ample enough to fuel activity for several days. A theory has developed that if an athlete

consumes a relatively high-fat diet in the 1 to 2 weeks prior to an important training session or competi- tive event, the body will adjust to the higher fat intake and become more effi-

cient at using fat for fuel during exercise. This has been termed “fat adaptation.” In other words, if an athlete is able to shift to a heavier reliance on fat for energy, carbo- hydrate usage declines, thus delaying the depletion of car- bohydrate stores and increasing the time to exhaustion.

Several studies have shown an increase in fat oxi- dation during submaximal exercise after fat adapta- tion.30–32 Fat intakes in these studies have ranged from 60–70% of total calories, and the exercise tests are gener- ally conducted at 60–70% of maximal oxygen uptake for relatively short periods of time. Unfortunately, when the effects of a short-term dietary manipulation of fat intake on athletic performance are examined, the switch to a high-fat diet does not appear to increase time to exhaus- tion. In fact, the majority of studies involving short-term alteration of fat intake show the opposite effect, caus- ing a decreased time to exhaustion, increased perceived exertion, and an impaired ability to metabolize carbohy- drates for energy.27,32–34 However, several studies do exist that report an increase in endurance performance after a high-fat diet adaptation.35,36 Therefore, more research with consistent methodology is warranted in this area. At this time, however, short-term high-fat intake does not appear to be an effective practice for improving athletic performance.

Is a long-term pattern of eating high-fat meals beneficial to exercise performance? For the purposes of this question, “long-term” includes patterns of eating followed for longer than 2 weeks. Although short-term high-fat diets to date have not con- sistently panned out as a good dietary practice for endur- ance athletes, it has been suggested that 2 weeks or less is not enough time for the body to make sufficient met- abolic adjustments. Numerous studies investigating the effects of long-term high-fat dietary interventions have been published.37–39 Overall, no benefit has been found over balanced, high-carbohydrate, moderate-protein, low- to moderate-fat diets.40 It appears that although high- fat diets can cause favorable shifts in fat metabolism, they also lead to lower muscle glycogen stores. Unfortu- nately, the improvement in fat utilization is not enough to offset the effect of diminished glycogen stores. Even in cases when adaptation to a high-fat diet is followed by a short carbohydrate-loading period, suboptimal endur- ance performance persists, suggesting deleterious effects of a high-fat diet beyond carbohydrate availability.38 In

110 SECTION 1 The Basics of Sports Nutrition

Gaining the Performance Edge

It is not recommended that ath- letes eat a high-fat meal immedi- ately prior to exercise because of the potential for gastric upset.

addition, high-fat diets have resulted in higher perceived exertion ratings despite maintaining comparable training intensities.37 This also can have negative ramifications if the athletes are not as motivated to train during the high- fat dietary period. Only a few studies have explored the effects of a long-term high-fat diet on high-intensity activ- ities. Fleming et al.37 performed 30-second Wingate anaer- obic tests on subjects following a high-fat diet (61% of total calories) for 6 weeks. Peak power output decreased in the high-fat group as compared to the low-fat control group.

More research on high-intensity activ- ities needs to be con- ducted to determine the short- and long- term effects on ath- letic performance.

Typically, diets containing 20–35%

fat are recommended for athletes to allow adequate carbohydrate intake and to assist weight management when needed. Specific recommendations for fat intake should be individualized and based on body size, weight, and body composition goals, as well as the sport played and sport performance goals. The broad recommendation of 20–35% of calories from fat provides flexibility in the amount of fat intake to meet specific total macronutrient needs of individual athletes with varying training sched- ules and performance goals.

What are the recommendations for fat intake prior to exercise? As with any macronutrient, athletes need to experiment with the best preexercise meal for their digestive system and sport. Fat will create a feeling of satiety to prevent an athlete from feeling hungry before exercising. However, consuming too much fat 4 hours or less prior to exercise can cause bloating, intestinal cramping, or diarrhea. There- fore, meals and snacks within 4 hours of training sessions and/or competitions should be low in fat and focused mainly on the unsaturated fats.41 Athletes should deter- mine their personal upper limit of fat ingestion for the 1 to 4 hours prior to exercise. Encourage athletes to start con- servatively in their experimentation, limiting fat to small quantities. A “small amount” of fat may be obtained by consuming peanut butter (1-2 tbsp) on toast or olive oil (1–2 tsp) on a salad. These quantities are generally well tol- erated before exercise, but individual tolerances will vary.

If the athlete finds that he or she becomes hungry before starting exer- cise, have the athlete try eating the same meal closer to exer- cise or add a little more fat to the same

What type, how much, and when should fats be consumed during exercise? Our bodies use fat for energy during exercise. The fat stored in adipose tissue is burned relatively slowly as com- pared to intramuscular fats. Recent studies have explored ways to increase the amount of fat burned during exercise and/or to increase the body’s reliance on fat for energy, thus sparing carbohydrates. In the previous section, it was determined that at this point existing research does not consistently reveal a benefit to consuming high-fat meals in the hours, days, or months leading up to exercise or competition. But what about if fat is consumed during

exercise? Would the body then rely more heavily on fats for fuel versus carbo- hydrates? To answer these questions, studies have focused on the effects of long-chain triglyc- erides (LCTs) and medium-chain tri- glycerides (MCTs).

As mentioned earlier in this chap- ter, LCTs (dietary

fats) are composed of three long fatty acid chains con- nected to a glycerol backbone. They are digested by bile acids in the liver and by lipase from the pancreas. The absorption rate of LCTs is slow, and therefore consuming high-fat foods during exercise is not beneficial. Athletes can include small amounts of fat in their preexercise meal or snack but should avoid consuming fat while exercising.

meal in the same time frame. For example, if an athlete eats a breakfast of toast with 1 tablespoon of peanut but- ter and a banana 3 hours before training, ask the athlete to test (1) eating the same meal 1.5 to 2 hours before train- ing or (2) adding 2 tablespoons of peanut butter to the toast instead of 1. The breakfast, lunch, or snack options in TRAINING TABLE 4.7 contain a small amount of fats, while maintaining a balance of carbohydrates and proteins.

Training Table 4.7: Examples of Preexercise, Well-Bal- anced Meals Containing Small Amounts of Fat (grams of fat)

• 1½ cups cold cereal, 1 cup 1% milk, 1 cup orange juice (3 g)

• 2 pancakes, 2 tbsp syrup, 6 oz fruited low-fat yogurt (4 g)

• Grilled chicken sandwich: 1 bun, 3 oz chicken, lettuce, tomato, 2 tsp light mayonnaise (7 g)

• Granola bar or sports bar (6 g)

• 2 scrambled eggs, 1 slice of whole wheat toast, 1 tbsp jelly (11 g)

• Fruit smoothie: 1 cup low-fat yogurt, ½ cup of frozen berries, 1 banana, ½ cup 1% milk (5 g)

Chapter 4 Fats 111

Gaining the Performance Edge

Short-term (i.e., 2 weeks or less) high-fat diets do not appear to be effective for improving endurance performance.

Gaining the Performance Edge

Long-term (i.e., more than 2 weeks) high-fat dietary intakes are not rec- ommended as a means to improve athletic performance.

Gaining the Performance Edge

Keep preexercise fat intake to a minimum. Include just enough for flavoring and to sustain satiety for several hours. Athletes will vary in their tolerance for preexercise fat; allow time, months in advance, for preexercise fat intake trial-and- error before an important race or competition.

Conversely, the theory surrounding the proposed ben- eficial effects of MCTs is based on the fact that, unlike LCTs, MCTs are easily digested, readily absorbed into the blood, and oxidized rapidly.42,43 MCTs are broken down into medium-chain fatty acids (MCFAs), which are water- soluble and therefore do not delay gastric emptying and are absorbed rapidly through the intestinal wall into the bloodstream. MCFAs are then delivered to muscle cells, where they pass through the plasma membrane and enter the mitochondria for oxidation. MCTs are oxidized in the first 30 minutes of exercise and can be absorbed across the mucosal membrane, similar to glucose. For these rea- sons, MCTs have spurred interest in the potential bene- fit of including MCTs in sports beverages, foods, or other products to delay fatigue.

Early studies regarding MCTs’ effects on performance involved consuming small amounts (~30 grams) of MCTs before exercise.44,45 These studies reported no effect on carbohydrate or lipid oxidation. Therefore, subsequent studies increased the MCT dosage to determine whether the quantity ingested was a limiting factor on changes in metabolism.46,47 Researchers reported that intakes of ~45–85 grams of MCTs either before or during exercise can affect metabolism, shifting away from a reliance on car- bohydrates and thus improving time-trial performance. However, more recent studies on MCT ingestion have not reproduced these positive results.40 When a carbohy- drate-rich meal is consumed several hours prior to exer- cise and MCT ingestion, the glycogen-sparing effects and performance improvements have not been shown.48–50

In many MCT stud- ies, subjects com- plain of moderate to severe gastrointes- tinal distress, thus hindering athletic performance.

What type, how much, and when should fats be consumed after exercise? Unlike carbohydrates and proteins, it is not essential to replace fats used during exercise by consuming certain quantities or types of fat immediately following training or competition. The body’s stores of fat are so great that they will not be depleted in an exercise session, even after prolonged endurance events. Carbohydrates and proteins are the main priorities after exercising to replace, restore, and replenish muscles. Therefore, fats should be kept to a minimum immediately after exercise. Fats cause the stomach to empty more slowly than do carbohydrates

and proteins, which could potentially delay the delivery of nutrients to the muscles in a timely fashion. However, fats add flavor to foods and create a sense of satiety and therefore can be included in small amounts in the postex- ercise meal or snack.

Consuming fats in meals after exercise has received much less research attention in the sports arena than has consuming carbohydrates and proteins. In one small study, seven active individuals were studied to determine the effect of adding fat calories to meals after exercise and its effects on glucose tolerance.51 They found that the addition of approxi- mately 1500 calories as fat after exhaus- tive exercise did not alter muscle glyco- gen resynthesis or glucose tolerance the next day. The subjects consumed the same amount of carbohydrates in a low-fat versus high-fat postexercise diet trial. The high-fat diet increased intramuscular triglyceride stor- age after exercise. Because the study’s purpose was to

determine the effect of high- or low-fat diets on glucose tol- erance, it is not clear whether there are implications to the increased intramus- cular triglycerides as an attempt at improving postex- ercise recovery or utilization of more intramuscular tri-

glycerides in subsequent exercise bouts. TRAINING TABLE 4.8 provides some examples of postexercise meals that con- tain small amounts of fats.

Training Table 4.8: Examples of Postexercise Meals Containing Small to Moderate Amounts of Fat (grams of fat)

• 6 oz low-fat yogurt, 2 tbsp mixed nuts, ¼ cup oatmeal (12 g)

• Scrambled tofu [3 oz tofu, ¼ cup onions, 1/4 cup peppers, 2 tbsp sunflower seeds], 1 slice toast, 1 tbsp jelly (14 g)

• Turkey sandwich: 2 slices whole wheat bread, 2 oz turkey, 1 slice tomato, 2 slices cucumber, 2 slices avocado (11 g)

• Chicken and bean burrito, ¼ cup salsa, 2 tbsp guacamole (12 g)

• Spaghetti with meat sauce: 1½ cups spaghetti, ¾ cup marinara sauce, 3 oz 95% lean ground beef (11 g)

• Tuna melt sandwich: 2 slices whole wheat bread, 3 oz tuna (canned in water), 1 oz sliced cheddar cheese (17 g)

112 SECTION 1 The Basics of Sports Nutrition

Gaining the Performance Edge

Consumption of fats, in any form, during exercise is not recommended as a performance enhancer.

Gaining the Performance Edge

The dietary guidelines for fats that pertain to daily meal planning can also be applied to the postexercise meal. The focus should be placed on unsaturated fats, in small quan- tities. The postexercise meal should be consumed as soon as possible after exercise.

Food for Thought 4.2

You Are the Nutrition Coach

Apply the concepts from this chapter to several case studies.

The Box Score Key Points of Chapter

n Fats are an important nutrient for athletes. Not only are dietary fats a primary energy source dur- ing rest, light to moderate exercise, and recovery, but they also provide the body with essential fatty acids, serve as vitamin carriers, and provide taste and tex- ture to food.

n Fats belong to a group of compounds known as lip- ids and can be obtained in the diet from both plants and animals.

n Fats are classified based on their molecular struc- ture. Triglycerides make up the majority of fats in the body; however, other classifications include phospholipids and sterols.

n Triglycerides are composed of a glycerol backbone with three attached fatty acid chains. The fatty acid chains vary in length and saturation level.

n Fatty acids are carbon atoms linked in a chainlike fashion. They can be short (≤ 4 carbons), medium (6 to 10 carbons), or long chains (≥ 12 carbons). In addition, fatty acids can be classified as saturated or unsaturated, and essential or nonessential.

n Fat substitutes have been formulated from carbo- hydrates, proteins, or fats and offer fewer calories without sacrificing the texture and taste of food. Examples include Oatrim, Benefat, Simplesse, and Olean.

n No RDA or AI has been set for total dietary fat because of insufficient data to determine a defined level of fat intake at which risk of inadequacy or prevention of chronic disease occurs. The AMDR for

fat intake has been set at 20–35% of total energy for adults.

n The formula for calculating the percentage of calo- ries from fat equals the total fat calories divided by the total calories, multiplied by 100.

n Cholesterol serves several vital functions in the body. However, high levels of cholesterol in the blood can increase the risk for cardiovascular disease. Of particular concern is the level of low-density lipo- protein (LDL) in the blood.

n Fats are an important energy source during endur- ance activities. However, high-fat diets either weeks before or hours before competition have not been shown to improve endurance performance.

n Fat consumption during exercise, particularly in ultra-endurance sports, has garnered research inter- est because of the extreme caloric demands of the sports. However, recent research has not supported the practice of fat intake during exercise. Perfor- mance decrements and gastrointestinal distress make fat intake during exercise a dietary practice to avoid. Care must be taken when ingesting MCTs during exercise because they can cause gastrointes- tinal upset.

n Fat intake after exercise is not as critical as carbo- hydrate and protein intake because of the body’s ample stores of fat; however, small amounts of fats in the postexercise meal or snack can add taste and create a sense of satiety.

Study Questions

1. How do fats differ from carbohydrates both structur- ally and energetically (i.e., in the number of calories they yield)?

2. What functions do fats serve in the body? 3. What is cholesterol, and what is its role in the body? 4. Discuss the advantages and disadvantages of fat

substitutes. 5. Would cutting out all dietary fat be an appropriate

recommendation for an athlete wanting to decrease body fat? Defend your answer.

6. What is the difference between unsaturated, satu- rated, and hydrogenated fatty acids?

7. Explain how to find and calculate the percentage of calories from saturated fat in a particular food.

8. What would be an appropriate suggestion for fat intake prior to a morning exercise session for an ath- lete who does not like nuts or seeds?

9. How would you counsel/respond to an endurance athlete who enjoys eating potato chips during long- duration training sessions because they taste salty?

Chapter 4 Fats 113

References

1. Institute of Medicine. Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids (Macronutrients). Food and Nutrition Board. Washington, DC: National Acade- mies Press; 2005.

2. Livesey G. Energy values of unavailable carbohydrate and diets: an inquiry and analysis. Am J Clin Nutr. 1990;51:617–637.

3. Smith T, Brown JC, Livesey G. Energy balance and thermogenesis in rats consuming nonstarch polysac- charides of various fermentabilities. Am J Clin Nutr. 1998;68:802–819.

4. Archer SY, Meng S, Shei A, Hodin RA. p21(WAF1) is required for butyrate-mediated growth inhibition of human colon cancer cells. Proc Natl Acad Sci USA. 1998;95(12):6791–6796.

5. Jones PJ, Ntanios FY, Raeini-Sarjaz M, Vanstone CA. Cholesterol-lowering efficacy of a sitostanol-contain- ing phytosterol mixture with a prudent diet in hyper- lipidemic men. Am J Clin Nutr. 1999;69(6):1144–1150.

6. Miettinen TA, Puska P, Gylling H, Vanhanen H, Vartiainen E. Reduction of serum cholesterol with sitostanol-ester margarine in a mildly hypercholesterolemic population. N Engl J Med. 1995;333(20):1308–1312.

7. Jones PJ, Raeini-Sarjaz M, Ntanios FY, Vanstone CA, Feng JY, Parsons WE. Modulation of plasma lipid levels and cholesterol kinetics by phytosterol versus phyto- stanol esters. J Lipid Res. 2000;4:697–705.

8. Academy of Nutrition and Dietetics. Position of the Academy of Nutrition and Dietetics: Dietary Fatty Acids for Healthy Adults. J Am Diet Assoc. 2014;114:136–153.

9. Hawley JA, Dennis SC, Lindsay FH, Noakes TD. Nutri- tional practices of athletes: are they sub-optimal? J Sports Sci. 1995;13:S75–S81.

10. Sundgot-Borgen J. Risk and trigger factors for the development of eating disorder in female elite ath- letes. Med Sci Sport Exerc. 1994;26(4):414–419.

11. Powers P, Johnson C. Targeting eating disorders in elite athletes. Part 1. Eating Disord Rev. 1996;7:4.

12. Kris-Etherton PM, Harris WS, Appel LJ. Fish consump- tion, fish oil, omega-3 fatty acids, and cardiovascular disease. Circulation. 2002;106:2747–2757.

13. Spano M. Functional foods, beverages, and ingredi- ents in athletics. Strength Cond J. 2010;32(1):79–86.

14. Food and Drug Administration. Food labeling: trans fatty acids in nutrition labeling. Federal Register. July 11, 2003; 68 FR 41433.

15. Insel P, Ross D, McMahon K, Bernstein M. Nutrition. Burlington, MA: Jones & Bartlett Learning; 2017.

16. Issekutz B, Miller HI, Paul P, Rodahl K. Aerobic work capacity and plasma FFA turnover. J Appl Physiol. 1965;20:293–296.

17. Kiens B. Effect of endurance training on fatty acid metabolism: local adaptations. Med Sci Sports Exerc. 1997;29:640–645.

18. Martin WH III. Effect of acute and chronic exercise on fat metabolism. Exerc Sport Sci Rev. 1996;24:203–231.

19. Kiens B, Richter EA. Utilization of skeletal muscle tria- cylglycerol during postexercise recovery in humans. Am J Physiol. 1998;275(2):E332–E337.

20. Bergman BC, Butterfield GE, Wolfel EE, et al. Net glu- cose uptake and glucose kinetics after endurance training in men. Am J Physiol. 1999;277:E81–E92.

21. Goedecke JH, Christie C, Wilson G, et al. Metabolic adaptations to a high-fat diet in endurance cyclists. Metabolism. 1999;48:1509–1517.

22. Helge JW. Adaptation to a fat-rich diet: effects on endurance performance in humans. Sports Med. 2000;30(5):347–357.

23. Helge JW. Long-term fat diet adaptation effects on performance, training capacity, and fat utilization. Med Sci Sports Exerc. 2002;34(9):1499–1504.

24. Kiens B, Helge JW. Effect of high-fat diets on exercise performance. Proc Nutr Soc. 1998;57(1):73–75.

25. Okana G, Sato Y, Takumi Y, Sugawara M. Effect of 4h pre-exercise high carbohydrate and high fat meal ingestion on endurance performance and metabo- lism. Int J Sports Med. 1996;17(7):530–534.

26. Hawley JA. Fat metabolism during exercise. In: R. Maughan, ed. Nutrition in Sport. Oxford: Blackwell Scientific; 2000:184–191.

27. Jeukendrup AE, Saris WH, Wagenmakers AJ. Fat metabolism during exercise: a review—part III: effects of nutritional interventions. Int J Sports Med. 1998;19(6):371–379.

28. Hawley JA. Effect of increased fat availability on metabolism and exercise capacity. Med Sci Sport Exerc. 2002;34(9):1485–1491.

29. Rehrer NJ, van Kemenade M, Meester W, Brouns F, Saris WH. Gastrointestinal complaints in relation to dietary intake in triathletes. Int J Sport Nutr. 1992;2(1):48–59.

30. Burke LM, Angus DJ, Cox GR, et al. Effect of fat adapta- tion and carbohydrate restoration on metabolism and performance during prolonged cycling. J Appl Physiol. 2000;89:2413–2421.

31. Staudacher HM, Carey AL, Cummings NK, Hawley JA, Burke LM. Short-term high-fat diet alters substrate utilization during exercise but not glucose tolerance in highly trained athletes. Int J Sports Nutr Exerc Metab. 2001;11:273–286.

32. Stepto NK, Carey AL, Staudacher HM, Cummings NK, Burke LM, Hawley JA. Effect of short-term fat adapta- tion on high-intensity training. Med Sci Sports Exerc. 2002;34:449–455.

33. Burke LM, Hawley JA. Effects of short-term fat adap- tation on metabolism and performance of prolonged exercise. Med Sci Sports Exerc. 2002;34(9):1492–1498.

34. Stellingwerff T, Spriet LL, Watt MJ, et al. Decreased PDH activation and glycogenolysis during exercise

114 SECTION 1 The Basics of Sports Nutrition

following fat adaptation with carbohydrate restora- tion. Am J Physiol Endocrinol Metab. 2006;290:E380–E388.

35. Lambert EV, Gordecke JH, van Zyl C, et al. High-fat diet versus habitual diet prior to carbohydrate loading: effects on exercise metabolism and cycling perfor- mance. Int J Sports Nutr Exerc Metab. 2001;11:209–225.

36. Lambert EV, Speechly DP, Dennis SC, Noakes TD. Enhanced endurance in trained cyclists during mod- erate intensity exercise following 2 weeks adaptation to a high fat diet. Eur J Appl Physiol. 1994;69:287–293.

37. Fleming J, Sharman MJ, Avery NG, et al. Endurance capacity and high-intensity exercise performance responses to a high-fat diet. Int J Sports Nutr Exerc Metab. 2003;13:466–478.

38. Helge JW, Richter EA, Kiens B. Interaction of training and diet on metabolism and endurance during exer- cise in man. J Physiol. 1996;492:293–306.

39. Havemann L, West S, Goedecke JH, et al. Fat adapta- tion followed by carbohydrate-loading compromises high-intensity sprint performance. J Appl Physiol. 2006;100:194–202.

40. Burke LM, Hawley JA. Fat and carbohydrate for exer- cise. Clin Nutr Metab Care. 2006;9(4):476–481.

41. Rodriguez NR, DiMarco NM, Langely S. Position of the American Dietetic Association, Dietitians of Can- ada, and the American College of Sports Medicine: nutrition and athletic performance. J Am Diet Assoc. 2009;109:509–527.

42. Jeukendrup AE, Saris WH, Van Diesen R, Brouns F, Wagenmakers AJ. Effect of endogenous carbohy- drate availability on oral medium-chain triglyceride oxidation during prolonged exercise. J Appl Physiol. 1996;80(3):949–954.

43. Jeukendrup AE, Saris WH, Schrauwen P, Brouns F, Wagenmakers AJ. Metabolic availability of

medium-chain triglycerides coingested with carbo- hydrates during prolonged exercise. J Appl Physiol. 1995;79(3):756–762.

44. Decombaz J, Arnaud M, Milton H, et al. Energy metab- olism of medium-chain triglycerides versus carbohy- drates during exercise. Eur J Appl Physiol. 1983;52:9–14.

45. Massicotte D, Peronnet F, Brisson GR, Hillarie-Marcel C. Oxidation of exogenous medium-chain free fatty acids during prolonged exercise: comparison with glucose. J Appl Physiol. 1992;73(4):1334–1339.

46. Satabin P, Portero P, Defer G, Bricout J, Guezennec C. Metabolic and hormonal responses to lipid and car- bohydrate diets during exercise in man. Med Sci Sports Exerc. 1987;19(3):218–223.

47. Van Zeyl CG, Lambert EL, Hawley JA, Noakes TD, Den- nis SC. Effects of medium-chain triglyceride ingestion on fuel metabolism and cycling performance. J Appl Physiol. 1996;80(6):2217–2225.

48. Goedecke JH, Elmer-English R, Dennis SC, Schloss I, Noakes TD, Lambert EV. Effects of medium-chain tri- acylglycerol ingested with carbohydrate on metab- olism and exercise performance. Int J Sports Nutr. 1999;9:35–47.

49. Jeukendrup AE, Thielen JJHC, Wagenmakers AJM, Brouns F, Saris WHM. Effect of MCT and carbohy- drate ingestion during exercise on substrate utiliza- tion and subsequent cycling performance. Am J Clin Nutr. 1998;67(3):397–404.

50. Goedecke JH, Clark VR, Noakes TD, et al. The effects of medium-chain triacylglycerol and carbohydrate ingestion on ultra-endurance exercise performance. Int J Sport Nutr Exerc Metab. 2005;15:15–28.

51. Fox AK, Kaufman AE, Horowitz JF. Adding fat calories to meals after exercise does not alter glucose toler- ance. J Appl Physiol. 2004;97:11–16.

Additional Resources

Institute of Medicine. Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate. Food and Nutrition Board. Washington, DC: National Acade- mies Press; 2004.

Miller SL, Wolfe RR. Physical exercise as a modulator of adaptation to low and high carbohydrate and low and high fat intakes. Eur J Clin Nutr. 1999;53(Suppl):112s–119s.

Chapter 4 Fats 115

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Key Questions Addressed 1. Why is protein important to athletes?

2. What are proteins?

3. What are the main functions of proteins in the body?

4. What is nitrogen balance?

5. How much protein should athletes consume daily?

6. Which foods contain protein?

7. Are protein supplements beneficial?

8. Why is protein essential for daily training?

9. What type, how much, and when should protein be consumed before exercise?

10. What type, how much, and when should protein be consumed during exercise?

11. What type, how much, and when should protein be consumed after exercise?

You Are the Nutrition Coach Jamar is a 17-year-old high school junior who has a chance of starting as a linebacker on the foot- ball team his senior year. He is 6 feet tall and weighs 175 pounds. His coach has recommended that he gain 10–15 pounds over the next 8 months, but not at the sacrifice of his speed and quick- ness. Jamar eats home-cooked, well-balanced meals for breakfast and supper. At breakfast he also drinks a mega-protein supplement that contains 56 grams of protein. For school, he packs his own lunches, which usually include two tuna or chicken sandwiches with potato chips and milk. He also has a mid-morning and mid-afternoon snack, which typically consists of a protein bar (24 grams of protein/bar). He works out in the high school weight room two to three times per week in the late afternoon. When he arrives home, he studies until the family eats supper, around 7 PM. His final snack of the day occurs just before bedtime, when he consumes another mega-protein supplement that contains 56 grams of protein.

Questions • Is Jamar getting enough dietary protein to achieve his goals?

• What are the recommended guidelines for protein intake for an athlete wanting to gain weight?

• Is it detrimental to consume a diet containing too much protein?

Proteins

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lin ov

CHAPTER 5

The amino acids that make up a protein are held together via peptide bonds. The peptide bonds that link amino acids are formed when the amine group of one amino acid con- nects with the acid group of another amino acid (see FIGURE 5.2 ). In the course of peptide bond formation, a water molecule is formed. The process in which water is created during the formation of a chemical bond is known as condensation. Conversely, if large amounts of protein are consumed in the diet, the body must break the peptide bonds between amino acids holding

Why is protein important to athletes? If the tissues of the body had an ingredient list similar to the ones on food labels, for most, proteins would be sec- ond on the list after water. Most athletes are well aware of the importance of proteins, particularly in regard to mus- cle, and tend to be concerned that they may not be con- suming adequate amounts to meet the body’s demands for protein resulting from training/competition. The pro- tein–muscle mass connection is just one of many reasons protein is an essential nutrient to athletes and untrained individuals alike.

Proteins are constantly being turned over in the body. In other words, they are continuously being broken down, transformed, and/or rebuilt. They also can be metabo- lized for energy, which is of particular concern to athletes involved in energy-demanding endurance sports, such as triathlons or marathons. Any part of the molecular pro- tein structure that is not used is excreted from the body. As a result, proteins, which are a macronutrient, must be replaced on a daily basis through proper diet. Research suggests that athletes engaged in endurance, strength/ power, or team sports have higher protein requirements than their sedentary counterparts; however, this does not mean that protein supplementation of their diet is required. This chapter explores proteins, their constitu- ent amino acids, their functions in the body, and specif- ics about food sources, supplements, and protein needs before, during, and after training.

What are proteins? Proteins consist of a series of amino acids. Individual amino acids are molecules composed of atoms of carbon (C), hydrogen (H), oxygen (O), and nitrogen (N). The dif- ferent amino acids have similar basic s t ructures ( see FIGURE 5.1 ). All amino acids contain a central carbon atom that is bound to an amino group (NH2), a carboxylic acid group (COOH), a carbon side chain, and a hydrogen atom. The presence of the nitrogen-containing amino group and the carbox- ylic acid group in the chemical structure of these mol- ecules accounts for why they are called “amino acids.” The carbon side chain gives each amino acid its unique structure, physical characteristics, and specific name. The side chains vary in shape, size, electrical activity, and pH. When two or more amino acids link to form a protein, it is the side chain characteristics of the amino acids that determine the protein’s specialized function and shape.

amino acid A molecule that serves as the basic building block for pro- teins. Amino acids are composed of atoms of carbon (C), hydrogen (H), oxygen (O), and nitrogen (N). peptide bond A type of chemical

bond that links the amine group of one amino acid to the acid group of another amino acid when forming a protein.

Figure 5.1 Structure of an amino acid. All amino acids have a similar structure. Attached to a carbon atom is a hydrogen (H) atom, shown here but not in later illustrations of amino acids; an amino group (NH2); a carboxylic acid group (COOH); and a side group (R). The side group gives each amino acid its unique identity.

condensation A che mical pro- cess that results in the formation of water molecules. Condensation occurs when peptide bonds are formed between amino acids.

H N C C OH

O H

H N C C OH

CH H

H N CC OH

H H

O R

Generic amino acid

Glycine

Phenylalanine

One of 20 unique side groups

Carboxylic acid group, –COOH

Amino group, –NH2

Chapter 5 Proteins 117

intake of phenylala- nine and methionine (both essential amino acids) is low, the body will need exogenous tyrosine and cysteine from the diet, and thus they become essential. Arginine may also be considered conditionally essential during seri- ous illness, stress, and growth spurts in young individuals.

Although the main role of amino acids is to build proteins needed by the body, they can also be metabo- lized in the liver and muscle for energy. However, to be used for energy, most amino acids must be converted to glucose via gluconeogenesis in the liver and then deliv- ered via the blood to the working muscle. The branched chain amino acids (BCAAs), which are essential amino acids, can be metabolized for energy directly within the muscle itself. BCAAs comprise approximately one-third of the protein content of muscle and include the amino acids leucine, isoleucine, and valine. BCAAs have gar- nered recent research attention because of their role as an energy source during exercise and because they also may play a role in regulating muscle protein synthesis. BCAAs are relatively abundant in whole foods. Dairy products, meat, wheat protein, soy, and whey protein isolates are rich sources of BCAAs.

Proteins are chains of amino acids that are linked in a very specific sequence (see FIGURE 5.3 ). The specific sequence of the amino acids in the chain gives the protein not only its physical characteristics, but also its three-dimensional shape. The shape of the protein in many instances dictates its function in the body, which is particularly true for those proteins that serve as enzymes or hormones.

Figure 5.2 Peptide bond formation. When two amino acids join together, the carboxylic acid group of one amino acid is matched with the amino group of another.

the dietary proteins together. To do so, a process known as hydrolysis, which is the opposite of condensation,

must occur. Hydro- lysis uses water in the process of breaking the pep- tide bonds of the ingested proteins. As a result, the digestion of high-

protein diets can contribute to water loss resulting from hydrolysis and eventually lead to dehydration if fluid intake is not maintained.

Twenty different amino acids are available for use in the human body. Nine of these are considered essential amino acids because they cannot be produced in the body.

Therefore, they must be consumed in ade- quate amounts through dietary intake. Eleven addi- tional amino acids are considered non- essential. They can be produced in the body and therefore do not need to be con- sumed in the diet

(see TABLE 5.1 ). Two of the nonessential amino acids, tyro- sine and cysteine, can become essential amino acids under certain conditions. They are considered conditionally essential. Under normal conditions, the body makes tyro- sine from phenylalanine and cysteine from methionine. If

hydrolysis A chemical process that requires utilization of water to break the chemical bond between elements or molecules. Hydrolysis is required to break peptide bonds between amino acids.

conditionally essential amino acid An amino acid that under nor- mal conditions is not considered an essential amino acid, but because of unusual circumstances (e.g., severe illness) becomes essential because the body loses its ability to make it.

essential amino acid An amino acid that must be obtained from the diet because the body is unable to make it on its own.

nonessential amino acid A type of amino acid that can be made by the body from other amino acids or compounds and thus does not need to be supplied by diet.

H N C C

OH H2O

H N C C

N C C OH

CH H

N C C OH

CH H

Glycine Phenylalanine

Dipeptide

OH H

H H

Table 5.1 Essential and Nonessential Amino Acids

Essential amino acids Nonessential amino acids Leucine* Alanine

Isoleucine* Arginine

Valine* Asparagine

Histidine Aspartic acid

Lysine Cysteine

Methionine Glutamic acid

Phenylalanine Glutamine

Threonine Glycine

Tryptophan Proline

Serine

Tyrosine

*Branched chain amino acids

118 SECTION 1 The Basics of Sports Nutrition

Proteins can be classified according to the length of their amino acid chain. When two amino acids are linked, the result is a dipeptide protein. A tripeptide is a protein made of three amino acids. There are also oligopeptides (chains of 4 to 10 linked amino acids) and polypeptides (chains with more than 10 amino acids). Most proteins found in the body and in foods are polypep- tides made up of hundreds of amino acids. Foods eaten daily must provide

the amino acids required to maintain these complex poly- peptides found in the body.

What is the difference between a “complete” and an “incomplete” protein? Consuming protein-rich foods on a daily basis is neces- sary to obtain appropriate amounts of the essential amino acids. Protein is found in both animal- and plant-based foods. The terms complete and incomplete often are used to categorize protein sources. It should be noted that these terms should not be inferred to mean “superior” and “inferior.” Each food provides a unique profile of proteins

polypeptide A protein molecule made up of more than 10 amino acids that are linked via peptide bonds.

Figure 5.3 Primary protein structure. Each protein becomes folded, twisted, and coiled into a shape all its own. This shape defines how a protein functions in your body. The simplest depiction of a protein reveals its unique sequence of amino acids.

dipeptide A simple protein con- sisting of two amino acids linked via peptide bonds.

tripeptide A protein molecule made up of three amino acids linked via peptide bonds.

oligopeptide A protein molecule made up of 4 to 10 amino acids that are linked via peptide bonds.

aa3 aa4

aa7 aa8

aa2

aa5

aa1

aa6

aa9 aa10

aa1 aa2

aa22 aa 23 aa24

aa 21

aa20

aa1 aa 2 aa3 aa

4 aa5

aa3 aa4 aa5 aa6 aa7

Primary structure

Secondary structure

Tertiary structure

Quaternary structure

The primary structure of a protein is its sequence of amino acids forming its polypeptide chains.

The secondary structure of a protein is the coiling or folding of its polypeptide chains.

Coiling occurs, forming a helix ("spiral staircase"), due to the formation of hydrogen bonds between the nitrogen of one amino acid and the oxygen of another located in another part of the polypeptide chain.

Folding occurs, forming pleated sheets, due to hydrogen bonding between different polypeptide chains lying side by side.

The tertiary structure of a protein is the three-dimensional shape of the polypeptide caused by weak interactions among R groups, and between R groups and the fluid environment.

The quaternary structure of a protein is the final three-dimensional structure formed by all the polypeptide chains making up the protein. This molecule of hemoglobin is composed of 4 polypeptide chains. The square plates represent nonprotein portions of the molecule (heme) that carry oxygen.

Amino acid

Chapter 5 Proteins 119

and amino acid content, as well as other health benefits, and therefore a variety of protein sources should be con- sumed throughout the day.

Animal proteins, such as eggs, dairy products, meat, and fish, contain all of the essential amino acids in high amounts and therefore are considered complete proteins. Animal proteins are also commonly referred to as high-quality proteins. A high-quality protein (1) contains all of the

essential amino acids, (2) has extra amino acids available for nonessential amino acid synthesis, and (3) has good digestibility. Animal proteins pro- vide all of the essen- tial amino acids, as well as extra nones- sential amino acids, and are about 95% digestible (as com- pared to plant pro-

teins, which are 85% digestible); animal proteins thus deserve the high-quality rating.

An incomplete protein source lacks one or more essential amino acids. The essential amino acid that is in

short supply in a spe- cific food is called the limiting amino acid. All plant prod- ucts (grains, beans, vegetables, fruits, nuts, and seeds), with the exception of soy, are categorized as incomplete pro-

teins. Soy is unique in that it is the only plant product that provides a full profile of essential amino acids in high amounts, similar to animal proteins; thus, soy is consid- ered a complete protein. In regard to other plant proteins, a variety of foods should be consumed daily to consume

all the amino acids in sufficient amounts. Consuming proteins from a variety of food sources so that the diet contains all the essential amino acids in a meal or within a day is called complementing proteins. If two different foods are eaten in the same meal or in the same day, one food may contain all but one essential amino acid in suffi- cient amounts while the other may provide this limiting amino acid, thus com- plementing both foods. For example, grains’ limiting amino acid is lysine, but grains are high in the amino acid methionine. Therefore, grains match well with legumes, which are low in methionine but high in lysine. Refer to FIGURE 5.4 for examples of complementary protein combi- nations. Examples of plant-based meals combining com- plementing proteins include the following:

• Stir-fried vegetables and tofu over rice (soy and grains) • Vegetable chili with cornbread (legumes and grains) • Barbecued tempeh on whole wheat bun (soy and

grains) • Oatmeal with nuts and soy milk (grains, nuts, and

soy) • Spinach salad with vegetables, garbanzo beans, and

sunflower seeds (legumes and seeds) TABLE 5.2 provides the protein content of a variety of

plant-based foods. Complementing proteins also can occur when combin-

ing a plant food with an animal product. The bottom line is that variety is best. Adequate protein can be consumed through all animal foods, all plant foods, or a combination of the two. The variety of protein sources and the daily meal plan developed for athletes should be derived from their preferences and tolerances for various protein sources.

The term incomplete given to most plant protein sources is often misinterpreted as meaning “inadequate” or “useless” because of the concept of a limiting amino acid. Not only can sufficient amounts of all amino acids be obtained by consuming a variety of plant protein sources

complete protein A protein source that supplies the body with all of the essential amino acids in high amounts.

incomplete protein Sources of proteins that do not contain the full complement of essential amino acids.

limiting amino acid The essential amino acid that is in short supply in an incomplete protein source.

complementing pro teins A group of two or more incomplete protein foods that when eaten together provide the full comple- ment of essential amino acids.

Figure 5.4 Complementary protein combinations. Because animal and soy products contain high levels of all essential amino acids, they can be consumed with any grain, legume, or nut/seed. Grains are complemented by legumes, and legumes are complemented by nuts/seeds. Grains are not a complementary match to nuts/seeds, but these two groups make a tasty combination in recipes.

high-quality protein Source of protein that contains a full com- plement of all the essential amino acids, has extra amino acids that are available for nonessential amino acid synthesis, and has good digestibility.

Animal products (i.e., meat, dairy, eggs) Soy products (i.e., tofu, tempeh, soy milk)

Legumes (i.e., kidney, black or pinto beans, lentils, split peas)

Nuts and seeds (i.e., peanuts, almonds, walnuts, flaxseeds, sunflower seeds)

Grains (i.e., whole grain bread, cereal, rice, pasta)

120 SECTION 1 The Basics of Sports Nutrition

Figure 5.5 Functions of protein in the body.

throughout the day, but additional health benefits also can be derived from focusing heavily on a plant-based diet. Plant proteins con- tain fiber, are low in fat, contain no cho- lesterol, and are usu- ally lower in calories than animal pro-

teins. They also contain antioxidants and phytochemi- cals that can provide protection against heart disease and some cancers. A more thorough discussion of protein intake for vegetarian athletes can found in Chapter 15.

What are the main functions of proteins in the body? Proteins have a role in almost all major body functions (see FIGURE 5.5 ). They provide structure to muscles and other tissues, act as regulators of cell functions, assist in maintaining fluid and acid–base balance, help transport

Gaining the Performance Edge

For health and optimal sport perfor- mance, the body requires adequate amounts of essential amino acids on a daily basis. Athletes can meet protein needs by consuming a vari- ety of protein-rich foods from both plant and animal sources.

Table 5.2 Protein Content of Plant-Based Foods

Protein source Protein content (g) Grains

Brown rice, 1 cup 5

Wheat bread, 2 slices 6

Spaghetti, 1 cup 6.7

Legumes

Lentils, 1 cup 7.9

Kidney beans, 1 cup 15.4

Chickpeas, 1 cup 14.5

Nuts/Seeds

Peanut butter, 2 tbsp 9

Walnuts, 1 oz 6.9

Sunflower seeds, 1 oz 6.5

Soy Products

Soy milk, 1 cup 7

Tempeh, ½ cup 16

Soybeans, 1 cup cooked 26

Soy nuts, ¼ cup 8

Hormones

Enzymes

Structural and mechanical

Acid–base balance

Transport

PROTEINS

Energy

Cellular signaling

Fluid balance

Antibodies

Chapter 5 Proteins 121

substances throughout the body, and serve as an energy source when needed. Overall health and sport perfor- mance can be impaired if protein intake is too low or if protein catabolism is too high.

Proteins make up the constituent parts of many structures, including bones, ligaments, tendons, hair, fingernails/toenails, muscles, teeth, and organs. Without adequate protein intake, these structures, particularly muscle, cannot be maintained, much less strengthened, in response to training. Thus the end result of chronic low dietary protein intake is decreased sport performance and increased risk for injury.

Dietary proteins are also used by the body to make enzymes. Enzymes serve as catalysts for a variety of bio-

chemical reactions. Every cell contains and/or produces many types of enzymes, each with

its own purpose. Digestive enzymes are produced and released by cells found in the stomach, intestines, and pancreas to break down carbohydrates, proteins, and fats into monosaccharides, amino acids, and fatty acids, respectively, so that they can be absorbed and utilized by the body. In regard to sport performance, all of the bio- energetic pathways responsible for the formation of ATP, which is the ultimate energy source for muscles, are dependent on enzymes. Without adequate dietary intake of protein, the body cannot maintain enzyme levels, and critical body functions begin to decline.

Many of the body’s hormones are structurally derived from proteins. Most hormones are produced by specialized glands located throughout the body and serve a variety of regulatory functions. The pan- creas produces insulin and glucagon, protein-derived hormones that help regulate blood glucose levels. Hormones also stimulate certain tissues to assist the body in meeting physical challenges. For example, the adrenal glands produce epinephrine and norepine- phrine, which are protein-derived hormones that play a large role in preparing and helping the body to perform physical activity. These hormones stimulate the heart to beat faster and more forcefully so that more blood can be delivered to working muscles. They also stimulate enzymes in fat cells to release fatty acids into the blood- stream, supplying the muscles with energy. Hormones clearly play an important role in the athlete’s ability to perform, and thus dietary proteins are required to ensure normal hormone production.

Proteins also are important to the body’s immune function. Protein-derived antibodies attack and destroy bacteria, viruses, and other foreign substances. Immu- nizations such as the flu shot include inactive viruses. When injected into the body, these viruses stimulate the body to develop antibodies to the specific virus. The anti- bodies “remember” the virus to which they were exposed.

If an individual is exposed to the virus again, the body initiates its defense mechanism and produces more anti- bodies to fight off the infection. If dietary protein needs are not met, the immune system can be compromised, and the athlete’s risk for illness is increased.

Circulating proteins in the blood play a role in main- taining the body’s fluid balance. Proteins cannot diffuse freely through cell membranes, so they help establish an osmotic pressure within the blood. To maintain equi- librium, fluids must be moved back and forth between the blood and the intracellular (inside the cells) or extracellular (outside the cells) spaces. Albumin is the major blood protein that helps main- tain fluid balance between the tis- sues and the blood. If inadequate blood protein levels occur, the osmotic pressure within the blood is high, and fluid “leaks” into the surrounding tissues, causing swelling, or edema.

Proteins also help control the acidity level (i.e., pH balance) within the body. Under normal conditions, the body’s fluids are close to neutral, neither acidic nor basic. However, during exercise, lactic acid is produced. Lactic acid increases the acidity of body fluids, and if not buff- ered can cause fatigue within the muscle. Proteins buffer the lactic acid and thus delay the onset of fatigue, which is critical to an athlete’s performance.

Although not a major source of energy, protein can be used as energy during or following exercise. The body pre- fers to burn carbohydrates and fats for energy at rest and during exercise; however, if carbohydrate stores are low, energy expenditure is high, and/or calorie intake is inad- equate, proteins can be converted to glucose and used for energy. This is one of the reasons why endurance athletes must ensure that they consume adequate carbohydrate and protein in their diet.

Proteins, particularly BCAAs, play important roles in cellular signaling. Leucine, for example, has been shown to control anabolic action by stimulating protein synthe- sis. Other amino acids signal cellular activity through the expression of specific genes. The full extent of the roles that proteins play in cell signaling and the potential effects of supplementation are currently areas of active research.

Many of the body’s transporter molecules also are made of protein. A prime example is hemoglobin. Hemo- globin is a protein-derived carrier molecule that trans- ports oxygen in the blood to tissues throughout the body. If hemoglobin levels are low, less oxygen is delivered to muscle cells, greatly reducing exercise capacity and endurance.

enzymes A group of complex pro- teins whose function is to catalyze biochemical reactions in the body.

intracellular A term used to describe structures, fluids, or other substances found inside the cell.

extracellular A term used to describe structures, fluids, or other substances found outside of the cell.

122 SECTION 1 The Basics of Sports Nutrition

What is nitrogen balance? Because proteins in the body are con- stantly breaking down and have to be resynthesized, daily input of new amino acids into the body’s amino acid pool is required. The goal of any dietary plan should be to sup- ply enough amino acids to support the increase in protein synthesis resulting from training and competition, while at the same time meeting the body’s basic maintenance needs. One way to determine whether an individual’s protein needs are being met is through the measurement of nitrogen balance.

Nitrogen bal- ance occurs in the body when dietary input of nitrogen (i.e., protein gain) equals the output of nitrogen (i.e., protein loss). The state of nitrogen balance can be calculated using the follow- ing equation:

(nitrogen in) – (nitrogen out) = nitrogen status

Because dietary protein is the main source of nitro- gen, the amount of “nitrogen in” can be estimated by monitoring daily protein intake. Determining “nitrogen out” is much more complicated.

Proteins are constantly being lost from the body. Some proteins are lost from the external surface of the body as a result of mechanical wear (e.g., sloughed off skin, broken fingernails, lost hair), but the majority are lost via cellular metabolism. When amino acids are bro- ken down internally, the nitrogen group is cleaved from the molecule. The released nitrogen can be lost from the body via the formation of urea in the liver or, to a much lesser extent, as ammonia. By measuring the urea lev- els in urine and sweat, it is possible to estimate nitrogen loss. If the body is in nitrogen balance, then the difference between nitrogen in (i.e., dietary protein intake) and nitro- gen out (i.e., urea excreted) is zero.

A positive nitrogen balance indicates that dietary pro- tein intake (nitrogen in) is greater than protein loss (nitrogen out). When nitrogen is being retained by the body, it indi- cates that it is being used to make lean tissue.1 A positive

nitrogen balance can occur in an athlete who is weight train- ing to build muscle mass and is consum- ing adequate calories along with a high, but appropriate, protein intake.1 Conversely, some athletes may find themselves in negative nitrogen balance. For example, an endurance athlete who is training intensely but not eating enough food to meet her or his daily caloric needs will start mobilizing proteins for energy and thus increase nitrogen loss.2 A neg- ative nitrogen status is not desirable because it is an indi- cation that lean body tissue is being metabolized by the body. At a minimum, the goal for any athlete is to maintain nitrogen balance; ideally, he or she should try to achieve a positive nitrogen balance.

How much protein should athletes consume daily? It is clear that protein is critical for optimal athletic per- formance. It is also known that athletes have higher pro- tein needs than their sedentary counterparts. However, even among athletes, protein recommendations are not one-size-fits-all. Recommendations exist for different categories of athletes, with variances in individual pro- tein requirements based on a variety of factors. Current body weight, total energy intake, desire to lose or gain weight, carbohydrate availability, exercise intensity and duration, training status, quality of dietary protein, age of the individual, and injury status all need to be considered when calculating protein recommendations and develop- ing a dietary plan for athletes.

How can protein requirements be calculated based on body weight? The easiest and most reliable way to determine individual protein needs is to calculate daily requirements based on current body weight. The RDA for the general public is 0.8 grams of protein per kilogram of body weight (0.8 g/kg).3 The adult acceptable macronutrient distribution range (AMDR) for protein is 10–35% of daily calories.3 Current research indicates that athletes need more protein than the general public to support training, athletic perfor- mance, and injury rehabilitation. The recommended range for daily protein intake for athletes is 1.2–2.0 g/kg.4–6

A majority of the recent research has focused on the amount of protein required to keep strength athletes in positive nitrogen balance despite the breakdown of mus- cle tissue and the subsequent increased protein synthesis

nitrogen balance A way of moni- toring nitrogen status in the body. When dietary input of nitrogen (i.e., protein gain) equals the out- put of nitrogen (i.e., protein loss), then nitrogen balance has been achieved.

Gaining the Performance Edge

Without adequate protein intake, cells cannot make many key enzymes, hormones, and other compounds. In addition, body structures, such as muscle, can- not be maintained, repaired, or strengthened with intense train- ing. Athletes should consume protein-rich foods daily to ensure overall health, optimize perfor- mance, and prevent athletic- related injuries.

Gaining the Performance Edge

By consuming adequate daily cal- ories and protein, athletes can maintain nitrogen balance or even achieve positive nitrogen status. A positive nitrogen balance indi- cates that an athlete is in a “protein- building state” versus one of protein breakdown, which can negatively affect athletic performance.

Chapter 5 Proteins 123

Calculating the percentage of total calories from pro- tein is an excellent way to double-check the accuracy and appropriateness of estimated individual protein recom- mendations. Ideally, protein should contribute 15–35% of total calories. Although no tolerable upper limit (UL) has been set for protein, it is suggested that all Ameri- cans, including athletes, consume no more than 35% of total calories from protein to decrease the risk of chronic disease.3

How do various dietary and training factors affect protein recommendations? As mentioned previously, individual protein require- ments will vary based on a variety of factors. When cal- culating daily protein needs for a specific athlete, begin with the recommended ranges stated in the previous section. Then consider the following factors to ulti- mately determine whether protein requirements will be calculated at the low or high end of the recommended ranges:

Total energy intake If an athlete is consuming an adequate number of calo- ries, protein requirements can be calculated in the middle of the recommended range. Adequate energy intake, par- ticularly in the form of carbohydrates, spares muscle pro- tein and promotes protein synthesis. In general, athletes who consume adequate calories tend to have adequate protein intakes as well, even meeting their increased needs for training and competition.14 However, it is not always easy for athletes to maintain an adequate calorie and protein intake. For example, athletes who train one or more times a day and those involved in endurance sports have higher calorie and protein needs. It is often difficult for these athletes to have the time, energy, desire, and appetite to eat the number of calories needed to main- tain nitrogen balance. Athletes should focus on consum- ing calorie-dense foods and fluids, along with additional snacks, during intense training sessions and long-dura- tion exercise to spare protein.

Desire to lose or gain weight Many athletes have the goal of either gaining or losing weight. In both of these situations, protein needs are increased and should be calculated at the high end of the recommended range. For example, a football player may be working intensely in the weight room during pre- season training to increase muscle mass, which requires a higher level of protein to ensure proper recovery from training and to assist the body in synthesizing new mus- cle tissue. Conversely, a triathlete may be aiming to lose 5–10 pounds during off-season training, which typically consists of weekly swim, bike, and run workouts with long-duration sessions of each discipline, plus an empha- sis on strength training in the weight room. More protein

during and after resistance training.4–7 Endurance ath- letes also have increased daily needs for dietary protein because of factors such as repetitive muscle contractions, high-impact activities, increased demand for mitochon- dria and enzymes involved in aerobic metabolism, and some oxidation of amino acids during aerobic exercise.8–13 Research regarding the protein needs of team sport ath- letes is sparse. Because of the nature of most team sports, which use a combination of strength/power and endur- ance, it can be assumed that protein needs would fall in the middle of the recommended range for athletes. There are several unique, typically short-term, situations which may increase protein needs for any athlete to levels higher than 2.0 g/kg such as very intense training peri- ods, when reducing energy intake, and during injury reha- bilitation.4-6 TABLE 5.3 provides a summary of the protein needs for various athletes.

Protein intake for athletes should contribute approx- imately 15–35% of total calories. After calculating an estimated range of protein requirements (in grams) for an ath- lete based on body weight, always com- pare the recommen- dation to total calorie requirements. The percentage of total calories from protein is calculated as follows:

1: total grams of protein × 4 calories per gram of protein = total calories from protein

2: (total calories from protein ÷ total calorie requirements) × 100 = % of total calories contributed by protein

For example, an athlete who weighs 82 kilograms requires 98–164 grams of protein per day (1.2–2.0 g/kg). If this individual consumes 2800–3300 calories per day, pro- tein will be contributing 14–20% of total calories:

98 × 4 = 392 calories from protein

(392 ÷ 2800) × 100 = 14% of total calories from protein

or 164 × 4 = 656 calories from protein

(656 ÷ 3300) × 100 = 20% of total calories from protein

Gaining the Performance Edge

Current research indicates that ath- letes have higher protein needs than nonathletes.

Table 5.3 Daily Protein Recommendations

Type of athlete Daily grams of protein/kilogram body weight

Percentage of total calories contributed by protein

Sedentary individuals 0.8 g/kg 10–20%

Athletes 1.2–2.0 g/kg 15–35%

Injured Athletes ≥2.0 g/kg 25–35%

124 SECTION 1 The Basics of Sports Nutrition

is required, not only to recover from the workouts, but also to ensure that the athlete stays in positive nitrogen balance when calorie intake is lower than normal.

In either scenario, adequate daily calories should be consumed in order to maximize the use of ingested pro- tein. If caloric intake is inadequate, proteins will be increas- ingly relied upon to provide energy both at rest and during exercise. When amino acids become an energy source, it is at the expense of being used for their primary pur- poses, such as making enzymes and hormones, repairing and developing structural tissues, and providing transport needs. In addition, low calorie and protein intake can lead to a loss of muscle mass, which will ultimately decrease an athlete’s strength, power, endurance, and metabolism. It is imperative that sports nutrition pro- fessionals counsel athletes on the detri- mental impact of not meeting total energy needs, the consequences of following a very-low-calorie diet, and athletes’ ability to meet their weight goals as well as to recover from and adapt to physical training.

Carbohydrate availability Carbohydrates are the primary fuel for working muscles at moderate and high exercise intensities. Carbohydrates are the only fuel that can be metabolized anaerobically and thus become the primary source during intense aer- obic activity. Because of their energetic value and their role in maintaining blood sugar levels, if carbohydrate stores become depleted the body will begin manufactur- ing carbohydrates (i.e., glucose) from proteins. Adequate daily carbohydrate intake keeps carbohydrate stores at an optimal level and thus spares proteins. In short, as car- bohydrate availability increases, protein metabolized for energy decreases, thus moderating protein requirements.

Exercise intensity and duration Training intensity and duration both increase protein requirements. Exercise intensity refers to how much effort is being put forth to perform an exercise. In other words, as the intensity of exercise increases, so does an athlete’s rating of perceived exertion. Duration refers to how long the exercise bout lasts. Although the role of protein in the body is more functional and struc- tural than energetic, whenever the body’s metabolism increases, the energetic role of proteins in the body also increases. Protein utilization appears to be positively related to both the intensity and the duration of exer- cise. This is particularly the case with endurance-type exercise and is exacerbated when carbohydrate stores are depleted or low during exercise. Increasing the dura- tion of exercise begins to deplete glycogen reserves in

the liver and muscle, and, as already noted, whenever carbohydrate levels fall in the body, protein utilization increases. This is often seen when athletes exercise in an already glycogen-depleted state or when carbohydrate stores become depleted during a single bout of long- duration or high-intensity exercise.

Unlike endurance training, single sessions of resis- tance exercise, regardless of the length or intensity of the workout, do not appear to increase the use of protein dur- ing the workout itself. However, amino acid uptake after the resistance training session does increase, indicating that the amino acids are being used for muscle repair and construction rather than for energy. The additional use of protein for energy in endurance ath- letes, and for muscle repair and synthesis with intense resistance training, explains the recommendations for increased daily pro- tein intakes.

Training state/fitness level Protein utilization appears to be higher for athletes who are less fit. When endurance training is initiated, nitro- gen balance may be negative for the first 2 weeks. When strength training is first initiated, protein requirements may be higher in the first weeks to support new muscle growth.4 As both strength- and endurance-focused ath- letes continue their training, nitrogen balance becomes neutral or positive. After 1 to 2 weeks on the program, the utilization of protein decreases as the body adapts to the training. The take-home message is that protein needs appear to increase during the first couple weeks of a new training regimen and return to baseline levels soon there- after. Based on this knowledge, temporarily increasing the protein intake of individuals starting a new training pro- gram or athletes starting a new phase in their training cycle (i.e., from off-season training to in-season training) may be a practice worth considering.

Dietary protein quality Athletes need to consume adequate amounts of all essen- tial amino acids to sustain protein functions. Athletes who consume animal proteins (complete proteins) will have all the essential amino acids available for protein functions. Vegetarian athletes have slightly higher pro- tein needs because of the intake of incomplete proteins, and therefore protein intake levels should be calculated at the high end of the recommended range. Vegetarians may also need to plan more diligently to consume adequate levels of daily protein through complementary plant pro- tein sources. Whether athletes consume animal or plant proteins, variety is the key to consuming all of the essen- tial amino acids.

Gaining the Performance Edge

Adequate calorie intake reduces the need for amino acid oxidation and thus spares dietary protein and muscle tissue.

Gaining the Performance Edge

Adequate daily carbohydrate intake keeps carbohydrate stores at an optimal level and thus spares proteins.

Chapter 5 Proteins 125

Age The RDAs for young people are 0.95 g/kg per day for those ages 4 to 13 years and 0.85 g/kg per day for those 14 to 18 years.3 Youth and teenage athletes have a slightly higher RDA for protein for several reasons. Body growth and development increase greatly around puberty, which place tremendous energy and protein demands on the body. When combined with the physiologic energy and protein demands imposed by training and sport partici- pation, the concern regarding calorie and protein intake becomes evident. The concern surrounding young ath- letes is further exacerbated by their typically poor dietary habits, particularly in the teenage group. Young athletes need to focus on achieving adequate energy and protein intakes for growth and development, as well as for the added energy demands of sport training/competition. Doing so will help spare body proteins needed not only for growth and development, but also for recovery and adaptive purposes.

The number of older adults (i.e., individuals 65 years of age and older) exercising and/or competing in sports is rising. Unlike young athletes, protein needs caused by growth and development are not an issue; however, this does not mean that protein intake is inconsequen- tial. Research clearly indicates that older individuals can tolerate and respond to exercise training. Their tissues retain the ability to adapt by becoming larger and stron- ger. For example, Esmark et al. found a 25% increase in mean muscle fiber area in elderly males after a 12-week resistance training program.15 This program also included a protein/carbohydrate supplement (10 grams protein + 7 grams carbohydrate) immediately after resistance train- ing to aid in muscle recovery and construction. Amino acids are needed to meet older adults’ adaptive needs, similar to younger athletes. Unfortunately, elderly indi- viduals often have poor nutritional habits, may lack an appetite, or lack the knowledge to purchase and prepare high-quality, nutrient-dense foods. Sports nutrition pro- fessionals should pay close attention to total calories consumed and protein intake of older athletes. Despite previous misconceptions, the bodies of older adults are capable of adapting to training regardless of age. Educat- ing older adult athletes on the importance of consum- ing adequate total calories and nutrient-dense protein sources is essential.

Injury status and rehabilitation Recovering from an injury increases the protein needs of an athlete.16,17 The extra dietary protein is used for two main functions: repair of damaged tissues and prevention of muscle loss. As mentioned previously, protein is a com- ponent of muscle, bone, skin, and other body tissues. In order to rebuild and repair, adequate intake of protein is critical to the healing process. Injury rehabilitation typi- cally requires an athlete to decrease their training volume and intensity, potentially to the extent of immobiliza- tion. This can result in loss of skeletal muscle, especially

during the first few weeks. Recent research suggests that by placing an emphasis on the quantity, timing, and type of dietary protein intake, athletes can minimize muscle and strength losses during the rehabilitation process.16,17 Therefore, injured athletes should ingest protein at a level of 2.0 g/kg or higher, consume protein in 20–30 gram doses throughout the day, and focus heavily on food sources of BCAAs (e.g., dairy, meat, soy).17,46

Can too much protein be harmful? Although adequate protein consumption is of great impor- tance to athletes, more is not always better. Based on the AMDR for protein, individuals should generally not exceed 35% of total calories from protein. Protein is a hot topic for athletes, par- ticularly strength/ power athletes and those attempting to lose weight. Many of these athletes con- sume more than 35% of their total calories from pro- tein. Although these athletes believe they are enhancing their performance, very high levels of protein can actually hinder health and perfor- mance. All athletes need to understand the potential safety and health con- cerns associated with excessive protein intake.

Questions have been raised about the effects of high protein intake on kidney function. The kidneys fil- ter waste from the liver, including urea, which is one of the waste products of protein metabolism. When protein intake exceeds the body’s ability to use it, the excess pro- tein is stripped of its amino group and the remaining car- bon skeleton is used for energy or converted to fat. The nitrogen-containing amino group forms urea, which is then carried via the blood to the kidneys for excretion in the urine. As a result, high-protein diets can place addi- tional stress on the kidneys to remove urea. Although in theory a concern, the increased stress on the kidneys does not appear to affect athletes with normal kidney function.4,10

Dehydration also can be a result of a high-protein diet. The breaking of peptide bonds during digestion of proteins requires water. In addition, the excretion of urea resulting from protein degradation increases body water loss in the form of urine. If athletes consume excessive amounts of protein via food or through supplementation, the body’s fluid needs are increased. Failure to meet fluid needs results in dehydration, which can jeopardize not only athletic performance, but also the athlete’s health and safety.

Gaining the Performance Edge

Youth and teenage athletes have increased protein requirements to support growth and develop- ment, as well as sport performance. Despite previous misconceptions, the bodies of older adults are capa- ble of adapting to training regard- less of age. Educating older adult athletes on the importance of con- suming adequate total calories and nutrient-dense protein sources is essential.

126 SECTION 1 The Basics of Sports Nutrition

acids. TABLE 5.4 lists a variety of healthy whole grain options and their respective protein levels. TRAINING TABLE 5.1 pro- vides some menu ideas for including whole grain sources of protein in the diet.

Which foods in the fruit and vegetable groups contain protein? Vegetables contain a small amount of protein, contribut- ing approximately 1–2 grams of protein per serving. Fruits contain minimal amounts of protein and therefore should not be considered a protein source. However, both fruits and vegetables contribute valuable nutrients such as fiber, vitamins, minerals, and water that high-protein foods are often lacking. One vitamin that is of particular importance when eating high-protein foods is vitamin C. The nonheme iron present in beans and grains can be absorbed much

The fat and total calorie content typi- cally associated with high protein intake is also of concern. Many high-protein foods, such as full-fat meat and dairy prod- ucts, are a signifi- cant source of total fat and saturated fat. These factors have been associated with an increased risk of cardiovascular disease and some cancers. If high-pro- tein food selections are also high in total calories, weight gain is possible, which will negatively affect health and performance.

Often an emphasis on high-protein foods displaces carbohydrate rich, nutrient-dense foods such as fruits, vegetables, whole grains, and plant proteins. Decreased carbohydrate and fiber intake can, in turn, cause fatigue, loss of muscle mass, sleep disruption, constipation, and decreased performance. Therefore, athletes should be encouraged to consume appropriate amounts of protein, include a variety of protein sources, and eat whole foods rather than supplements. Additional protein intake, if needed, should not be at the expense of other macro- and micronutrients. If protein intake is increased, ath- letes should be counseled to also increase fluid intake to prevent any potential for dehydration.

Which foods contain protein? Proteins are found within most food groups of the MyPlate food guidance system. The richest sources of protein are found in the dairy/alternative and protein foods groups. Grain products as well as vegetables provide a small to moderate amount of protein. Fruits and oils provide mini- mal to no protein. Because protein is not found univer- sally within each food group, it is imperative that athletes include a variety of protein sources in sufficient amounts every day for optimal performance and health. Not only do athletes need adequate protein intake but that intake should be distributed evenly throughout the day.

Which foods in the grains group contain protein? Foods from the grains group are moderate sources of protein. The grains are considered an incomplete protein source because they contain lower levels of lysine. The

key is to consume whole grain prod- ucts in conjunction with legumes, nuts, or seeds throughout the day to balance the intake of amino

Gaining the Performance Edge

Athletes should be encouraged to achieve adequate protein intakes but not by carelessly consuming excessive amounts through large quantities of food or supplementation.

Gaining the Performance Edge

The recommended protein intake for athletes is 1.2–2.0 g/kg per day.

Table 5.4 Protein Content of Various Foods

Protein source Protein content (g) Grains

Whole wheat bread, 1 slice 3

Brown rice, ½ cup 3

Pasta, ½ cup 3.5

Fruits/Vegetables

Apple, 1 medium 0.3

Banana, 1 medium 1.2

Carrots, ½ cup 1

Broccoli, ½ cup 1.3

Dairy/Alternative

Skim milk, 8 fl oz 8

Low-fat yogurt, 6 oz 6

Cheddar cheese, 1 oz 7

Soy milk, 8 fl oz 5

Soy yogurt, 6 oz 7

Protein Foods

Beef, 3 oz 25

Chicken, 3 oz 27

Turkey, 3 oz 26

Pork, 3 oz 24

Tuna, 3 oz 22

Black beans, 1 cup 15

Lentils, 1 cup 18

Tofu, ½ cup 20

Tempeh, ½ cup 16

Mixed nuts, 1 oz 5

Source: Adapted from Pennington JA, Douglass JS. Bowes & Church’s Food Values of Portions Commonly Used. 18th ed. Philadelphia, PA: Lippincott Williams and Wilkins; 2005.

Chapter 5 Proteins 127

more readily when consumed with vita- min C. Therefore, fruits and vegeta- bles should accom- pany plant-based protein sources in meals. Table 5.4 lists a variety of veg- etables and their respective protein

levels. TRAINING TABLE 5.2 includes menu ideas for includ- ing protein-containing fruits and vegetables in the diet.

Which foods in the dairy/alternative group contain protein? Dairy/alternative foods and beverages provide an excel- lent source of protein. Most dairy and soy products con- tain approximately 6–8 grams of protein per serving. However, some dairy/alternative products, other than soy, may not be excellent sources of protein. Rice and other grain or nut milks often provide only 2–3 grams of pro- tein per serving, but, if fortified, are still good sources of calcium and vitamin D. Low-fat dairy products contain lower levels of saturated fat and cholesterol compared to their full-fat dairy counterparts while contributing equiv- alent levels of protein. Table 5.4 lists a variety of dairy/ alternative products and their respective protein levels. TRAINING TABLE 5.3 includes menu ideas for how to include

dairy/alternative sources of protein in the diet.

Which foods make up the protein foods group? Meat, fish, poultry, eggs, and soy products are excel- lent sources of a complete protein, containing the high- est level of protein per serving within the MyPlate food guidance system. Legumes, nuts, and seeds are also rich in protein; however, these should be com- bined with grains, soy, meat, or dairy throughout the day to obtain high levels of all amino acids. A 3-ounce serv- ing of food within this group provides approximately 20–30 grams of protein. Table 5.4 lists a vari- ety of protein foods and their respective protein levels. TRAINING TABLE 5.4 contains menu ideas for incorporating

protein foods.

Do foods in the oils and empty calories group contain protein? Foods in this category do not contain protein. However, these foods complement other protein-rich foods to make meals and snacks more flavorful and enjoyable. Sweets, highly sugared, and high-fat foods make up empty calo- ries and will have variable amounts of protein depend- ing on the food item. Sugars and artificial sweeteners are often found in protein supplements, including bars,

Gaining the Performance Edge

Fruits and vegetables round out any meal, providing carbohydrates, vita- mins, minerals, and phyto chemicals. Therefore, a high-protein-containing food should be paired with a fruit and/or a vegetable at every meal.

Gaining the Performance Edge

Athletes should focus on protein sources from the “heavy hitters” in the dairy/alternative and meat and protein foods groups. Grains and vegetables make up the “second string,” while fruits are “bench warmers” in regard to sources for daily protein.

Training Table 5.1: Menu Ideas for Grain Sources of Protein

• Beans and rice make a balanced, hearty meal. (See Badminton Beans and Rice recipe.)

• Pack an almond butter and wheat bread sandwich for long days away from home.

• Make a beef barley soup with extra vegetables for a hot dinner in the winter months that also freezes well for quick meals during the week.

• Add ground turkey to marinara sauce and serve over whole wheat pasta.

Badminton Beans and Rice

1 cup brown rice, uncooked

1–2 tbsp olive oil

1 medium onion, chopped

2 cloves of garlic, minced

4 oz can of chopped green chilies

1½ tsp chili powder

2 tsp cumin powder

2 tbsp chopped fresh cilantro

juice of 1–2 limes

3 cans pinto beans, drained and rinsed

Cook brown rice according to package directions. Sauté onion, garlic, and green chilies in oil until onions are translucent. Add the lime juice and seasonings; cook several minutes to blend the seasonings. Add the beans to the onion mixture and cook over low to medium heat for 10–15 minutes. Serve over brown rice.

Serving Size: 2¼ cups (Recipe makes four servings)

Calories: 316 kcals

Protein: 15 grams

Carbohydrate: 53 grams

Fat: 6 grams

Training Table 5.2: Menu Ideas for Combining Fruits and Vegetables with Protein Foods

• Drink a glass of orange juice with an iron-fortified cereal and milk.

• Add onions, carrots, and extra tomatoes to a meat and bean chili.

• Include spinach in meat lasagna.

• Alternate chicken and peppers, squash, and/or mushrooms for grilled kabobs.

Training Table 5.3: Menu Ideas for Dairy/Alternative Sources of Protein

• Drink a cold glass of milk with lunch and dinner.

• Top tomatoes or potatoes with ½ cup cottage cheese.

• Keep yogurt on hand to have as a midday snack.

• Sprinkle parmesan or romano cheese on top of cooked vegetables.

128 SECTION 1 The Basics of Sports Nutrition

• What is the sup- plement’s cost?

• Will the supple- ment enhance performance?

• Are there any risks associated with taking the supplement?

What is the quantity of protein or amino acids in the product? Is the supplement necessary? Most athletes consume plenty of protein to meet their needs through their daily diet, if they are consuming enough total calories and eating a balanced diet. Simi- lar to carbohydrates and fats, adequate protein intake is essential to optimal sport performance; however, if pro- tein is consumed in quantities greater than daily needs, the excess calories will lead to fat weight gain. A common misconception is that consuming large quantities of pro- tein, often through supplements, will lead to greater gains in muscle mass. Protein intake and overall nutrition are certainly part of the muscle growth equation, but are not the sole reason for muscle mass gains. The other compo- nents of the formula include the athlete’s strength train- ing program and genetic predisposition for muscle mass. Protein supplements may be indicated for an athlete with huge calorie and protein needs, but for most athletes, the focus should be placed on whole foods. TABLE 5.5 provides a comparison of various types of protein supplements. The quantity of protein or amino acids can vary greatly from one product to another. As a result, athletes should look for the Supplement Facts label on protein supple- ment products, which provides information similar to that found on food labels.

Protein supplements can be used when athletes are traveling or do not have easy access to food or refriger- ation, and before or after training or competitions. For example, a dry protein powder can be mixed with water and poured over cereal when a cooler or refrigerator is not available for fluid milk. However, when athletes have access to other food sources, protein supplements should not be used preferentially over whole foods.

The Supplement Facts label on protein supplement products will list the grams of protein or milligrams of amino acids in one serving of the product (see FIGURE 5.6 ). Often, the quantity of protein supplied in a bar or shake is equivalent to a well-balanced meal. Athletes should be aware when reviewing the label of amino acid supple- ments that the content will most likely be expressed in milligrams versus grams. For example, a product might contain 500 milligrams of an amino acid, or 0.5 grams. One ounce of beef, chicken, or turkey contains 7 grams, or 7000 milligrams, of amino acids in the form of whole pro- teins. Obviously, in this example, if an athlete is aiming to consume more amino acids and protein, the food option would be a better choice than the amino acid supplement.

powders, and drinks. TRAINING TABLE 5.5 contains menu ideas for combining fats with protein-rich foods.

Are protein supplements beneficial? A variety of protein supplements are heavily marketed to athletes; some purport to increase muscle-building capac- ity, enhance endurance performance, and speed recovery from exercise. Intact protein and amino acid supplements come in a variety of forms including bars, shakes, pow- ders, and pills. Before choosing to use or not to use a pro- tein supplement, athletes should consider the following:

• What is the quantity of protein or amino acids in the product? Is the supplement necessary?

Food for Thought 5.1

Protein Intake for Athletes

In this activity, you will compare the protein content of whole foods and supplements, as well as calculate protein recommenda- tions for an athlete.

Training Table 5.4: Menu Ideas for Protein Food Sources • Coat chicken breast with breadcrumbs, bake with marinara sauce, and

serve alone or over pasta. (See Cross-Country Chicken Parmesan recipe.)

• Order salads in restaurants with grilled lean meats and lots of extra vegetables.

• Try a tofu sandwich with cheese, lettuce, and cucumber—flavored, baked tofu tastes the best for sandwiches.

• Make a weekend omelet with spinach and peppers, and serve with whole wheat toast topped with peanut butter.

Cross-Country Chicken Parmesan

4 chicken breasts

3 egg whites

½–1 cup Italian-flavored breadcrumbs

32 oz jar of spaghetti sauce

8–12 oz dry pasta, any shape

Grated parmesan cheese

Preheat oven to 400°F. Place breadcrumbs in a shallow bowl. Lightly beat the egg whites with a fork in a separate bowl. Dip the chicken breasts in the egg whites, then the breadcrumbs to coat on both sides, and repeat. Place chicken breasts in a greased 9 × 13 pan and cover with spaghetti sauce. Cover the pan with foil and bake in the oven for 30–40 minutes or until the centers of the breasts are no longer pink. Cook pasta according to the package directions. Serve one chicken breast plus sauce over 1–2 cups of cooked pasta. Sprinkle parmesan cheese on top.

Serving Size: 1 chicken breast, 1–2 cups pasta (Recipe makes four servings)

Calories: 740 kcals

Protein: 58 grams

Carbohydrate: 89 grams

Fat: 16 grams

Training Table 5.5: Menu Ideas for Complementing Protein-Rich Foods with Oils and Empty Calories

• Sauté beef or chicken and vegetables in 1–2 tbsp of olive oil for a stir-fry.

• Brush chicken or pork with a sweet barbeque sauce while cooking on the grill.

• Use 1–2 tbsp of sesame oil in an oriental salad including grains, lentils, and vegetables.

• Mix honey with orange juice as a glaze for a roast.

Chapter 5 Proteins 129

Table 5.5 Protein Supplement Comparison*

Supplement product

Serving size Calories per serving (kcal)

Protein per serving (g)

Protein source Carbs per serving (g)

Fat per serving (g)

Other ingredients

Designer Whey Protein Powder

1 scoop (28 g) 100 18 Whey 6 2 Natural flavors, stevia leaf extract

Optimum Nutrition 100% Egg Protein

1 scoop (30 g) 100 22 Egg 4 0 Natural and artificial flavors, sucralose

MuscleTech NITRO- TECH Hardcore

1 scoop (33 g) 130 25 Whey 3 1.5 Natural and artificial flavors, acesulfame K, sucralose

Naturade 100% Soy Protein

1 scoop (30 g) 110 25 Soy 0 1 Natural flavors

Optimum Nutrition 100% Soy Protein

1 scoop (31.5 g) 120 25 Soy 2 1.5 Natural and artificial flavors, sucralose, acesulfame K

MET-Rx Protein Plus 1 scoop (31 g) 110 23 Milk, casein, egg, whey

4 1 Natural and artificial flavors, sucralose, acesulfame K

EAS Myoplex Original Ready-to- Drink Shakes

500 mL 300 42 Milk, casein, whey

20 7 Natural and artificial flavors, fortified with vitamins and minerals, acesulfame K, sucralose

EAS Myoplex Strength Formula Ready-to-Drink

414 mL 210 25 Milk soy, whey, casein

23 2.5 Natural and artificial flavors, fortified with vitamins and minerals, acesulfame K, sucralose

EAS 100% Whey Protein Powder

2 scoops (39 g) 150 26 Whey 7 2 Natural and artificial flavors, acesulfame K, sucralose

CytoSport Muscle Milk Ready-to-Drink

500 mL 340 34 Milk, casein, whey

17 16 Natural and artificial flavors, fortified with vitamins, minerals, MCT, acesulfame K, sucralose

PROLAB N-Large 2 4 scoops (152 g) 600 52 Whey 86 6 Natural and artificial flavors, sucralose

PROLAB Premium Whey Powder

1 scoop (30 g) 120 23 Whey 3 0 Natural and artificial flavors, sucralose, acesulfame K

Champion Nutrition Heavyweight Gainer 900

4 scoops (154 g) 600 30 Beef, whey, egg

102 7 Fortified with vitamins and minerals, MCT, natural and artificial flavors, aspartame, acesulfame K

ABB XXL Weight Gainer

4 scoops (154 g) 1040 42 Whey, casein, egg

208 4 Creatine, artificial flavors, fortified with vitamins and minerals, medium-chain triglycerides, acesulfame K

Champion Nutrition Pure Whey Shot 45

88 mL 190 45 Whey, casein 4 0 Natural flavors, acesulfame K, sucralose

Champion Nutrition Heavyweight Gainer

4 scoops (154 g) 600 30 Beef, whey, egg

102 7 Medium-chain triglycerides, fortified with vitamins and minerals, natural and artificial flavors, aspartame, acesulfame K

Genisoy Soy Protein Powder

1 scoop (30 g) 100 25 Soy 0 0 Natural flavors

*Nutrition information obtained from manufacturers’ websites.

130 SECTION 1 The Basics of Sports Nutrition

A variety of protein sources is used in protein sup- plements. Whey protein is quite popular and is heavily promoted as an ideal protein source for athletes. Soy, casein, and egg proteins or combinations of any of these proteins and/or amino acids are also commonly found in protein supplements. Some supplements contain spe- cific single amino acids, or they may contain primarily BCAAs. Manufacturers often trademark (™) their specific formulation of protein and use that formulation in their products. Although there are differences in the absorp- tion rate of the various proteins used in supplements, the actual gram amount of protein in supplements is impor- tant to review when choosing a supplement. Food sources of protein can provide as many or more grams of protein than many supplements. Whether soy or whey, casein or amino acids, many whole food sources provide a comple- ment of amino acids that meets protein needs for muscle maintenance, repair, and growth.

What is the cost of protein supplements? Protein supplements are often much more expensive than whole foods. Products will vary greatly in cost. Examine the Supplement Facts labels carefully to determine the

number of servings in one container and then calculate the cost per serving. In general, by choosing whole foods, athletes can obtain protein, plus many other nutrients, for a significantly lower cost. See TABLE 5.6 for a compari- son of various protein sources and their respective costs per serving.

Will protein supplements enhance performance? Research based on monitoring changes in nitrogen bal- ance has shown that athletes have higher protein needs than the sedentary population. Other studies have exam- ined changes in body composition (i.e., lean body mass) in response to training while manipulating dietary protein intake and have indicated that higher protein intakes may be beneficial, particularly when using supplements that contain essential amino acids. However, no studies have been conducted directly investigating the effects of pro- tein supplements on sport performance. Any protein sup- plement claims related to performance are based on the positive impact supplementation has on protein synthe- sis, which may or may not ultimately affect physical capa- bilities. Furthermore, there is little to no research showing

Figure 5.6 Sliced turkey Nutrition Facts label compared to an L-Tyrosine Supplement Facts label. Amino acid supplements often have far fewer amino acids and less total protein than protein-rich foods.

Supplement Facts Serving Size: 1 Capsule Servings Per Container: 100

L-Tyrosine

*Percent Daily Values are based on a 2,000 calorie diet. Certi�ed Free of: Yeast, Wheat, Corn, Milk, Eggs, Soy, Glutens, Sugar, Starch, Arti�cial Colors, and Added Preservatives

Other Ingredients: Magnesium Stearate, Gelatin (Capsule).

Recommended Use: As a Dietary Supplement, take 1–3 Capsules Daily, or as Directed by your Quali�ed Health Consultant.

500 mg

Amount Per Serving

% Daily Value*

Nutrition Facts Serving size

Amount per serving

3 oz

Calories 112 % Daily Value*

Total Fat 3g Saturated Fat 0g Trans Fat 0g

Cholesterol 38mg Sodium 788mg Total Carbohydrate 6g

Dietary Fiber 0g Total Sugars 2g

Protein 15g Includes 2 g Added Sugars

1% 0% 0%

13%

33% 2%

* The % Daily Value (DV) tells you how much a nutrient in a serving of food contributes to a daily diet. 2,000 calories a day is used for general nutrition advice.

Vitamin D 0mcg Calcium 0mg Iron 1mg Potassium 0mg

0% 6%

Chapter 5 Proteins 131

a conclusive benefit of engineered protein supplements over whole food products.

Some athletes find it challenging to meet their pro- tein needs through only whole food in the diet because of the large volume of total calories and protein required in one day. In this case, a supplement that supplies the protein lacking in the diet, hence pre- venting a deficiency, may enhance perfor- mance. However, a poorly planned and executed diet should not be remedied by relying on a supple- ment; focus should first be placed on consuming a well-balanced diet, and then if needs are still not being met, a protein supplement can be considered.

Are there any risks associated with taking the supplement? There are a few specific precautions related to protein supplementation. Look at the ingredients listing closely. Many protein supplements will include artificial flavors,

sweeteners, or colorings that may cause allergic reac- tions in some individuals. Supplements can also include other substances that are purported to “increase muscle size and strength,” such as creatine or androstenedione. These substances, as well as other chemicals or addi- tives, can cause unwanted side effects. Without a close review, athletes can potentially be putting themselves at risk for disqualification if a substance in a consumed supplement is on their sport’s list of banned agents. Also, consuming large amounts of one amino acid may affect the absorption of other amino acids in the diges- tive tract. Because amino acids share carriers for absorp- tion, excess consumption of one amino acid may impair the absorption of other amino acids that share the same carriers in the digestive tract. However, the actual risk of consuming excessive amounts of one single amino acid is currently unknown.

Why is protein essential for daily training? Carbohydrates and fats provide the main sources of energy for training and competition. Protein, conversely, is not a significant source of energy during most forms of exercise because of the slow conversion of amino acids to glucose or ATP. Protein has been shown to contribute

Gaining the Performance Edge

The need for a protein supple- ment should be evaluated on an individual basis. Adequate protein consumption is particularly impor- tant to individuals beginning a new exercise program or athletes who have increased the intensity or volume of their training.

Table 5.6 Cost Comparison of Protein Supplied from Protein Supplements Versus Whole Foods

Protein source Grams of protein per serving Cost per serving Cost per 8 grams of protein Supplement Products (serving size)

EAS 100% Whey Protein Powder (39 g) 26 g $2.29 $0.70

Genisoy UltraSoy-XT Protein Powder (36 g) 25 g $1.71 $0.55

Optimum Nutrition 100% Egg Protein Powder (29.4 g) 22 g $2.00 $0.73

MLO BioProtein Bar (1 bar) 21 g $1.96 $0.75

PowerBar Protein Plus Bar (1 bar) 23 g $2.49 $0.87

Meso-tech Bar (1 bar) 25 g $2.99 $0.96

PROLAB Amino 2000 Tablets (6 tablets) 12 g $0.72 $0.48

Twinlab Amino Fuel Liquid (3 tbsp) 15 g $1.80 $0.96

PBL Liquid Muscle (2 tbsp) 10 g $0.94 $0.75

Whole Food Items

Chicken breast (3 oz) 26 g $0.44 $0.13

Turkey (white meat) (3 oz) 26 g $0.44 $0.13

Ground beef, chuck (3 oz) 24 g $0.66 $0.22

Salmon, canned (3 oz) 22 g $1.52 $0.55

Whole egg, 3 19 g $0.48 $0.20

Skim milk, 8 oz 8 g $0.20 $0.20

Tofu, 1 cup 20 g $0.82 $0.33

Lentils, 1½ cups 27 g $0.46 $0.14

Walnuts, 1 oz 4 g $0.51 $1.02

132 SECTION 1 The Basics of Sports Nutrition

as little as 5% of the energy used during exercise. The percentage can increase to 15–18%, but only during pro- longed exercise. The small amount of amino acids used can be converted into energy through oxidation as well as by providing the substrates for gluconeogenesis.18 The glucose-alanine cycle is a metabolic process that enables amino acids in muscle to be converted to glucose. Dur- ing fasting or prolonged endurance exercise, when blood glucose levels begin to decrease, proteins in muscle are catabolized into amino acids and these amino acids are transaminated to form alanine. The newly formed alanine enters the bloodstream and makes its way to the liver, where it is converted to glucose. The glucose is, in turn, released into the blood, thus bolstering blood sugar levels. Proteins and their constituent amino acids also comple- ment carbohydrates and fats in providing the resources for growth and maintenance of muscles and other tissues, enzymes, hormones, and hemoglobin, as well as sustain- ing normal functioning of the immune system.

Sufficient dietary protein is required to maximize protein synthesis in the body in response to daily train- ing. Exercise induces changes in protein and amino acid metabolism, which translate into a greater need for pro- tein. Training and competition cause an increased break- down of protein resulting from microtrauma sustained by muscle tissue.19 If an athlete does not consume adequate amounts of protein, the body will rely on endogenous sources of protein for repair and resynthesis, ultimately leading to protein loss. If this process continues over time, performance will decline and illness may ensue.

Low dietary protein intake is one of several purported causes of what is referred to as sports anemia. Sports

anemia is not con- sidered a real clinical condition; however, it gives the appear- ance of anemia in that hemoglobin concentration in the

blood is decreased.20 The appearance of sports anemia is more prevalent in untrained individuals who are begin- ning exercise or in athletes who have undergone a recent increase in the intensity or volume of their training.20 If protein intake is inadequate during these new or adjusted training bouts, then a competition between tissues for amino acids occurs.3,21 The available amino acids are used to synthesize more myoglobin, mitochondrial proteins, and muscle proteins that are essential for oxygen utiliza- tion in the muscle during exercise instead of being used to make more hemoglobin.22 In addition, endurance train- ing, particularly in untrained individuals, causes blood plasma volume to increase, sometimes by as much as 20%.23,24 The expanded plasma volume decreases hemo- globin concentration, despite the fact that hemoglobin levels are relatively unchanged. Therefore, the combina- tion of increased plasma volume and little to no change in hemoglobin levels gives the appearance of anemia.

The ramifications of this apparent sports anemia appear to be relatively benign, and the decreased hemoglobin concen- tration does not sig- ni f icant ly a l ter aerobic capacity or endurance perfor- mance. In addition, hemoglobin levels begin to return to normal levels after the body has had several weeks to adjust to the new training.

For the body to maximize its utilization of daily pro- tein intake, total calorie and carbohydrate needs should also be met. If an athlete is consuming too few calories or restricting intake of carbohydrates, the body will increase protein catabolism. Maintaining an appropriate total calo- rie intake will ensure that protein is not being used for energy on a daily basis. Adequate carbohydrate intake will decrease amino acid oxidation as well as spare dietary and muscle protein, ultimately leading to improved athletic performance.

What type, how much, and when should protein be consumed before exercise? Much of the research concerning the optimal preactivity/ competition diet has focused on the importance of car- bohydrates. However, recent studies investigating meth- ods to manipulate the diet to enhance muscle building have provided insight into the role of protein in preactiv- ity meal planning.

Several reports by Lemon,25 Wolfe,26 and Tipton27 have demonstrated that muscle building is optimized when amino acids are consumed prior to training and thus cir- culating in the blood while exercising. The amino acids aid in:

• Providing energy for the muscle cells; however, as dis- cussed earlier, only minimal amounts of energy are supplied by amino acids during exercise

• Decreasing catabolism of protein in muscle tissue • Increasing protein synthesis in muscle tissue

An additional benefit of consuming protein prior to training or competition relates to the speed of digestion. Protein-rich foods take slightly longer to empty from the stomach than do carbohydrates, thus providing a sati- ety effect and a more gradual delivery of nutrients to the bloodstream. These actions will prevent an athlete from getting hungry before training, which can be mentally dis- tracting, and will sustain energy levels for a longer dura- tion, potentially increasing the amount of work an athlete can perform before fatiguing.

sports anemia A condition caused by the combination of intense train- ing and poor protein intake; it results in reduced levels of hemoglobin in the blood.

Gaining the Performance Edge

Protein has many roles in the body; however, it is particularly important for handling the stress of daily train- ing and competition. Adequate pro- tein consumption not only will lead to optimal performance, but also will prevent adverse health condi- tions such as sports anemia.

Chapter 5 Proteins 133

between consuming enough carbohydrates and proteins to enhance performance, while moderating the quantity of food and total calories ingested to avoid nausea, vomit- ing, cramping, or diarrhea. Individuals should plan meals with at least three different food groups, one of which is a protein-rich food and one of which is a carbohydrate- rich food.

Protein sources that are higher in fat, such as high- fat cuts of meat, full-fat dairy, nuts, and seeds, should be consumed in minimal amounts, if not eliminated, in the hours directly leading up to an exercise session. These foods take longer to digest and therefore can disrupt per- formance because of a sense of a “full stomach” or intes- tinal distress. In daily training, nuts and seeds are an excellent choice because of their favorable protein, fiber, and fat profile. However, instead of eating nuts and seeds prior to training, athletes can pack a small bag for a great postexercise snack. TRAINING TABLE 5.6 contains some ideas for protein-rich foods to eat prior to competition.

What type, how much, and when should protein be consumed during exercise? In the last couple of decades, the role of exogenous amino acids administered during exercise has garnered research attention. Amino acids ingested dur- ing exercise have been hypothesized to improve sport performance in sev- eral ways. Most of the current research has focused on the use of amino acids for energy production during exercise and the potential role of BCAAs in attenuating central fatigue.

Amino acids can be used as a source of energy dur- ing exercise. They can be transported via the blood to

To allow time for the longer digestion of proteins and absorption of amino acids into the bloodstream, protein- containing foods need to be consumed 1 to 4 hours prior to the onset of exercise. Keep in mind that the preactivity meal should be a combination of proteins, carbohydrates, and fats. Carbohydrate foods should be predominant in the meal or snack, while protein foods are the comple- ment. Athletes should always experiment with the timing of the preexercise meal to determine the ideal quantity and timing of food and beverage consumption before training or competition.

There is some evidence that it is best to ingest pro- tein at least 3 hours prior to exercise to avoid unnecessary elevations in respiratory exchange ratio and perceived exertion during higher-intensity activities. A study con- ducted by Wiles et al.28 tested individuals running on a treadmill at 60, 80, 90, and 100% of VO2max after consum- ing a protein beverage 1 hour or 3 hours prior to exer- cise compared to the ingestion of only water. The results of the study revealed that the ingestion of the protein beverage, containing 0.4 g protein/kg body weight, led to a higher VO2 level and perceived exertion at all exercise intensities. The explanation of this finding focused on the increased metabolism, or thermic effect of food, in the hours immediately following protein ingestion. The authors noted that only a small increase in the thermic effect of food was noted after 3 hours; therefore, it can be implied that an athlete should consume a meal contain- ing protein at least 3 hours prior to exercise. This notion requires more investigation before exact recommenda- tions can be established.

What type and how much protein should be consumed 4 to 24 hours prior to training or competition? Similar to the guidelines for daily protein intake, athletes should choose lean protein sources such as lean cuts of beef, chicken, turkey, fish, low-fat dairy, or soy products in the 4 to 24 hours prior to training or a competition. Athletes should plan a meal that contains 3–6 ounces of a lean protein or 8–12 fluid ounces of dairy/alternative, as well as a significant source of carbohydrates and a small amount of fat. Legumes, which are very high in fiber, should be limited or consumed in small amounts in the 24 hours leading up to an important training session or competition. The extra fiber may cause gastrointestinal distress for some athletes. However, individuals who eat beans, lentils, and other legumes on a regular basis can generally tolerate these foods without consequence.

What type and how much protein should be consumed 1 to 4 hours prior to training or competition? Small amounts of lean protein sources (2–4 oz) can be consumed in the 4 hours prior to exercise. However, the focus should be placed mainly on carbohydrate-rich foods during this period. Athletes need to find a balance

Gaining the Performance Edge

Preactivity protein consumption can increase satiety, slow the diges- tion of carbohydrates to sustain energy levels, and decrease the catabolism of proteins, while also enhancing the synthesis of proteins during training. Intake of protein- rich foods and beverages should remain moderate in the 1 to 4 hours prior to training, focusing on low- fat, nutrient-dense protein source.

Training Table 5.6: Menu Ideas for Precompetition Protein Foods (grams of protein)

• 1½ cups cereal, 1 cup skim milk/soy milk, ½ cup blueberries, 1 slice wheat toast, 2 tbsp peanut butter (24 g)

• 2 scrambled eggs, 1 English muffin, 2 slices cheddar cheese, 8 oz orange juice (29 g)

• Ham sandwich: 2 slices rye bread, 6 slices ham; banana, 6 oz low-fat yogurt (22 g)

• Large salad: 2 cups romaine lettuce, ½ cup red pepper, ½ tomato, ½ cup cottage cheese, 3 slices turkey, ¼ cup garbanzo beans, 2 tbsp fat-free dressing; 1 cup skim milk (32 g)

134 SECTION 1 The Basics of Sports Nutrition

BCAAs started receiv ing more attention, especially for endurance sports, when researchers discovered that after 3 hours of exercise BCAA levels in the blood drop dramati- cally.29 During long- duration aerobic exercise, the activ- ity of the enzyme responsible for the catabolism of BCAAs, keto acid dehydro- genase, increases. The activity of this enzyme is greatest when carbohy- drate stores are low, thus supporting the theory that BCAAs may be providing energy to the active muscles.19 In addition, falling levels of BCAAs in the blood have been linked to central nervous system fatigue,30 which leads to decreased sport performance. Accordingly, ingestion of BCAAs may prevent the decrease of BCAAs in the blood, and thus be potentially beneficial, especially during pro- longed endurance exercise. Unfortunately, studies involv- ing endurance athletes ingesting BCAAs during exercise have not yielded consistent results, and, in fact, most have shown little to no positive effect on endurance. Although more investigation on the role of BCAAs during exercise is indicated, recommending the ingestion of BCAAs to improve performance is not currently warranted.

What type, how much, and when should protein be consumed after exercise? Protein is a critical nutrient for the postexercise recov- ery process in muscle. After exercise, protein breakdown diminishes while protein synthesis increases, resulting in a positive muscle protein balance (i.e., an anabolic state). The success of achieving a positive muscle protein bal- ance appears to be dependent on the amino acid compo- sition of the food ingested, the amino acid concentration of the blood supplying the muscle cells, and the timing of the protein feeding.4

Which type of protein or amino acid source is most beneficial to consume after exercise? The availability of amino acids to the muscles posi- tively influences muscle protein synthesis. Food sources that cause hyperaminoacidemia (i.e., high blood amino acid levels) have been shown to increase amino acid delivery to the mus- cle and transport

hyperaminoacidemia A condition describing abnormally high levels of amino acids in the blood.

Figure 5.7 Metabolism of BCAAs for energy. BCCAs are unique because they can be metabolized for energy within the muscle itself instead of needing to first be processed by the liver.

the liver, converted to glucose via gluconeogenesis, and released into the bloodstream. Thus, glucose formed from amino acids can help to prevent hypoglycemia (low blood glucose) during exercise and continue to provide glucose for sustained physical effort. Unfortunately, this gluco- neogenic avenue for deriving energy from amino acids is a slow, involved process that lacks the ability to sup- port the rapid energy needs of intense exercise or sport competition.

As discussed in the previous paragraph, most amino acids must be transported to the liver, converted into substrates or intermediates in the liver, and then trans- ported through the blood back to the active muscle cells where they can finally be used for energy. The excep- tions to this rule are the BCAAs, which are leucine, isoleucine, and valine. These amino acids are differ- ent because they can be metabolized for energy in the muscle itself (see FIGURE 5.7 ) instead of needing to be processed by the liver. Therefore, the energy supplied by BCAAs can be used directly in the muscle cell.

Gaining the Performance Edge

Although some of the research regarding the ergogenic effect of amino acid ingestion during exer- cise is promising, consumption guidelines have not been estab- lished and do not appear warranted at this time. If future research reveals a benefit, researchers will need to develop recommendations on the type, timing, and quantity of amino acid ingestion for enhancing sport performance.

ATP H2O

H+

CO2

NH2

Succinyl CoA

Acetyl CoA

Citric acid cycle

Electron transport chain

Metabolic Transformation

Branched Chain Amino Acid Metabolism

Leucine Isoleucine Valine

Deamination

Chapter 5 Proteins 135

into the muscle, thereby increasing the intracellular availability for muscle protein synthesis.26,31 Contrary to the belief of some athletes, hyperaminoacidemia is not solely dependent on the ingestion of free-form amino acid supplements. Consuming complete pro- teins, such as whey and casein found in milk, has been shown to increase amino acid levels in the blood, thus aiding in the recovery process.25,32

The amino acid composition of foods ingested follow- ing both resistance and endurance exercise appears to affect hyperaminoacidemia and subsequent muscle pro- tein synthesis. Ingesting foods or supplements supplying essential amino acids, rather than nonessential amino acids, is necessary for the greatest positive influence on muscle protein synthesis.27,33,34 Whey and casein proteins are high-quality proteins that contain essential amino acids. In addition, whey protein has a relatively high pro- portion of BCAAs.29,35 Soy protein is another postworkout protein option that also provides all the essential amino acids for muscle rebuilding and repair.36 Several studies have been conducted comparing soy and milk proteins on muscle protein anabolism during the first few hours of recovery with varying results.37–39 Additional research in the area of the type of protein to promote optimal muscle anabolism and recovery is warranted.

Research has focused not only on the importance of essential amino acids for triggering hyperaminoacidemia, but also on the form in which essential amino acids are consumed. Studies have investigated the potential differ- ence in protein absorption, synthesis, and catabolism after exercise between various protein and amino acid sources. In general, intact proteins are digested and absorbed more slowly than are hydrolyzed proteins. Hydrolyzed protein sources are usually in supplement form and contain proteins that have undergone a predi- gestion process, breaking the more complex proteins into smaller di- and tripeptide complexes. The hydrolyzed pro- teins are also absorbed slightly faster than are supple- ments composed primarily of free amino acid mixtures.40 The differences in absorption of these protein sources are most noticeable in special circumstances, such as when athletes are fasting or following a low-calorie diet, and are least noticeable in individuals who are gener- ously well fed, which is the case for most athletes. When various proteins are consumed without other energy sources such as carbohydrates or fats, whey proteins and amino acid mixtures appear to be absorbed more quickly than casein proteins. However, when any of these pro- teins or amino acids are ingested with carbohydrates or fats, the differences in absorption are diminished.41 The bottom line is that the consumption of essential amino

acids should be of greatest importance, regardless of the exact form in which they are ingested. Athletes should be encouraged to con- sume whole foods, containing essential amino acids, to pro- vide the protein and other important nutrients for muscle recovery and synthesis.

Is there a recovery benefit of combining carbohydrates and proteins after exercise? Some literature has suggested that consuming a combi- nation of proteins and carbohydrates, versus only carbo- hydrates or only proteins, enhances the recovery process. A study conducted by Zawadzki et al.42 compared the effects of carbohydrate, protein, and carbohydrate–pro- tein beverages after 2 hours of cycling. The researchers found that the combination beverage produced the great- est circulating levels of insulin, which in theory would enhance protein and carbohydrate intake into the mus- cle cells and promote protein synthesis, thus improv- ing the recovery process. Another study by Miller et al.43 reported that ingesting both proteins and carbohydrates together within 3 hours after exercise resulted in the greatest uptake of amino acids compared to ingesting proteins or carbohydrates alone. Timing of the ingestion of the postexercise carbohydrate–protein recovery drink or meal is important. Berardi et al.44 found that carbohy- drate plus protein supplements given early after exercise enhance glycogen resynthesis relative to carbohydrate only or placebo given later in recovery. Other studies have focused on other substances in the blood, such as levels of growth hormone or creatine kinase, and have also found positive results from a carbohydrate–protein combination after exercise. Taken together, it appears that ingesting carbohydrates and proteins as soon as possible and at least within 2-3 hours after exercise would be a prudent dietary practice for athletes.

How much protein should be consumed after exercise? Ingestion of as little as 10 grams of essential amino acids, both with and without carbohydrates, has been shown to increase muscle protein synthesis.27,33,46 Although highly variable depending on the protein source, a rule of thumb is that 15–25 grams of high-quality protein should pro- vide approximately 10 grams of essential amino acids. Nonessential amino acids, in and of themselves, do not appear to have the same protein synthesis effect. Although the availability of essential amino acids does increase protein synthesis, there appears to be a ceiling

hydrolyzed protein A source of protein that is usually in supple- ment form and contains proteins that have undergone a prediges- tion process, breaking the more complex proteins into smaller di- and tripeptide complexes.

Gaining the Performance Edge

Essential amino acids stimulate pro- tein synthesis. Therefore, postexer- cise protein sources should consist of high-quality or complement- ing proteins that provide all of the essential amino acids.

136 SECTION 1 The Basics of Sports Nutrition

• 2 cups pasta, ½ cup marinara sauce, 3 oz lean ground beef, 1 cup broccoli (49 g)

• 4 oz chicken breast sandwich with 1 oz mozzarella cheese, 1 pear, 8 oz skim milk (55 g)

When should protein or amino acids be consumed after exercise? The timing of protein feeding after exercise is also impor- tant. Several studies have demonstrated the importance of essential amino acids in stimulat- ing muscle protein synthesis within 2–3 hours of exer- cise.27,33,34,43,46 Eat- ing protein sources as soon as possible after physical activ- ity takes advantage of the increased blood flow and hor- monal milieu (i.e., potential increases in growth hormone and testosterone) caused by the pre- viously performed exercise. Therefore, in practical terms, postexercise protein consumption should occur within 2–3 hours of exercise and include protein sources that provide all the essential amino acids.

to the dose response, above which increasing levels of essential amino acids do not increase protein synthesis.45 When net protein synthesis was compared between ath- letes consuming 20 grams or 40 grams of essential amino acids, there was no difference in synthetic rates between groups after resistance training.45 To date, the thresh- old and ceiling doses of essential amino acids (i.e., the ideal range) needed for optimal protein synthesis have not been determined and are most likely specific to the individual.

However, based on current research, ingesting approx- imately 15–25 grams of protein, or 0.25–0.30 g protein/kg body weight, in the postexercise meal will aid in the recov- ery process.46 Combining proteins with carbohydrates maximizes glycogen synthesis, causes hormones favorable for muscle growth to be secreted, and enhances protein synthesis. Fifteen to 25 grams of protein, along with a source of carbohydrates, can be obtained by consuming any one of the following (total grams protein):

• 8 oz low-fat yogurt, ¼ cup mixed nuts, 1 cup straw- berries (15 g)

• 3 oz tofu, 1½ cups mixed vegetables, 1 cup brown rice (20 g)

• 2 hard-boiled eggs, 1 slice wheat toast with 1 tbsp peanut butter, 8 oz orange juice (22 g)

Gaining the Performance Edge

Research suggests that ingesting carbohydrates and proteins imme- diately after or within 2-3 hours after exercise is a prudent dietary prac- tice for athletes.

Gaining the Performance Edge

Ingesting approximately 15–25 grams of protein, or 0.25–0.30 g pro- tein/kg body weight, in the postex- ercise meal will aid in the recovery process. Consuming carbohydrates in addition to this amount of pro- tein appears to further enhance exercise recovery.

Food for Thought 5.2

You Are the Nutrition Coach

Apply the concepts from this chapter to several case studies.

Chapter 5 Proteins 137

The Box Score Key Points of Chapter

n The protein–muscle mass connection is just one of many reasons protein is an essential nutrient to athletes and untrained individuals alike. Proteins also provide structure to many parts of the body, are needed for building and repairing body tissues, serve as enzymes that initiate cellular processes, and form hormones that help regulate a variety of processes in the body.

n Proteins are chains of amino acids that are linked via peptide bonds in a very specific sequence. The specific sequence of the amino acids in the chain gives the protein not only its physical characteris- tics, but also its three-dimensional shape. The shape of the protein in many instances dictates its func- tion in the body.

n The body uses 20 different amino acids to make pro- teins. Nine are essential and must be obtained from diet. Complete, high-quality proteins tend to come from animal sources and provide all the essential amino acids needed by the body. However, plant- derived complementary protein sources can also provide all essential amino acids.

n Monitoring nitrogen status is one way of determin- ing whether dietary protein intake is adequate to meet protein needs. When dietary input of nitro- gen (i.e., protein gain) equals the output of nitrogen (i.e., protein loss), then nitrogen balance has been achieved. At a minimum, the goal for any athlete is to maintain nitrogen balance and, in most cases, to achieve a positive nitrogen balance.

n Current research suggests that athletes have higher protein needs than nonathletes. The recommended daily protein intake for athletes is 1.2–2.0 g/kg.

n The protein needs of athletes can vary depend- ing on their current body weight, training status, total caloric intake, desire to lose or gain weight, carbohydrate intake, quality of protein sources

consumed, type of training, intensity of training, duration of training, injury status, and age.

n The richest sources of dietary protein are found in the dairy/alternative and protein foods groups. Grain products as well as vegetables provide a small to moderate amount of protein, while fruits provide little to none.

n The need for a protein supplement should be evalu- ated on an individual basis. Athletes should focus first on obtaining plenty of protein-rich foods in their daily diet; if protein needs are still not being met, then an appropriate and safe supplement can be considered.

n Protein has many roles in the body; however, it is particularly important for enduring the stress of daily training and competition. Adequate protein consumption not only will lead to optimal perfor- mance, but also will prevent adverse health condi- tions such as sports anemia.

n The pregame or preactivity meal should include a combination of proteins, carbohydrates, and fats. The carbohydrate foods should predominate in the preactivity meal, whereas protein foods should serve as a complement. To allow time for digestion, foods should be consumed 1 to 4 hours prior to the onset of exercise.

n Protein ingestion during sport competition or train- ing has not consistently been shown to enhance performance. Deriving energy from amino acids is a slow, involved metabolic process that lacks the ability to support the rapid energy needs of intense exercise or sport competition.

n Consumption of high-quality proteins that elevate blood levels of amino acids within 2 to 3 hours after competition or training has been shown to increase protein synthesis. Research suggests that ingesting carbohydrates along with proteins after exercise may actually enhance the recovery process.

Study Questions

1. How do proteins differ from carbohydrates and fats in regard to their molecular structure?

2. Discuss the various roles of proteins in the body. How does each of these roles apply to training, recovery, and/or sport performance?

3. How would the nitrogen balance of an athlete be determined? Once determined, what does nitrogen balance indicate?

4. What are “complete proteins,” and what food sources provide them? What are the ramifications of eating foods that do not provide complete sources of protein?

5. What are “incomplete proteins,” and what food sources provide them? Give several examples of com- plementary incomplete protein sources that provide all essential amino acids.

6. What are branched chain amino acids? What rela- tionship, if any, do they have to athletic performance?

7. Discuss the relationship between carbohydrate intake and protein requirements.

8. What are the recommended protein intake levels for athletes? Discuss why requirements for athletes are higher than for sedentary individuals.

138 SECTION 1 The Basics of Sports Nutrition

9. What dietary protein intake recommendations would you make to an elite athlete training for a marathon? How would those recommendations compare to rec- ommendations for an Olympic weightlifter training 12 to 15 hours a week?

10. What factors should be considered when determining the protein needs of an athlete?

11. Provide two suggestions for well-balanced preactiv- ity meals containing protein, as well as two examples of quick and easy postexercise snacks containing 15 grams of protein.

References

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20. McArdle WD, Katch FI, Katch VL. Vitamins, minerals, and water. In: Exercise Physiology: Energy, Nutrition, and Human Performance. 5th ed. Philadelphia, PA: Lippin- cott Williams and Wilkins; 2001:47–81.

21. Chatard JC, Mujika I, Guy C, Lacour JR. Anaemia and iron deficiency in athletes: practical recommenda- tions for treatment. Sports Med. 1999; 27(4):229–240.

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25. Lemon PW, Berardi JM, Noreen EE. The role of pro- tein and amino acid supplements in the athlete’s diet: does type or timing of ingestion matter? Curr Sports Med Rep. 2002;1(4):214–221.

26. Wolfe RR, Miller SL. Amino acid availability controls muscle protein metabolism. Diabetes Nutr Metab. 1999;12:322–328.

27. Tipton KD, Rasmussen BB, Miller S, et al. Timing of amino acid-carbohydrate ingestion alters anabolic response of muscle to resistance exercise. Am J Physiol. 2001;281:E197–E206.

28. Wiles J, Woodward R, Bird SR. Effect of pre-exercise protein ingestion upon VO2, R and perceived exer- tion during treadmill running. Brit J Sports Med. 1991;25(1):26–30.

29. Mero A. Leucine supplementation and intensive training. Sports Med. 1999; 27(6):347–358.

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Chapter 5 Proteins 139

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34. Tipton KD, Borsheim E, Wolf SE, Sanfor AP, Wolfe RR. Acute response of net muscle protein balance reflects 24-h balance after exercise and amino acid ingestion. Am J Physiol. 2003;284:E76–E89.

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36. Endres JG. Soy Protein Products: Characteristics, Nutri- tional Aspects, and Utilization. Champaign, IL: AOCS Press and the Soy Protein Council; 2001.

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glycogen storage after exercise. J Appl Physiol. 1992;72:1854–1859.

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45. Tipton KD, Ferrando AA, Phillips SM, Doyle D, Wolfe RR. Post-exercise net protein synthesis in human muscle from orally administered amino acids. Am J Physiol. 1999;276:E628–E634.

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Additional Resources

Chandler RM, Byrne HK, Patterson JG, Ivy JL. Dietary sup- plements affect the anabolic hormones after weight- training exercise. J Appl Physiol. 1994;76: 839–845.

Stryer L. Biochemistry. New York, NY: W.H. Freeman; 1995. Wagenmakers AJ. Muscle amino acid metabolism at rest

and during exercise: role in human physiology and metabolism. Exerc Sport Sci Rev. 1998;26: 287–314.

Wojcik JR, Walberg-Rankin J, Smith LL. Effect of post-exer- cise macronutrient intake on metabolic response to eccentric resistance exercise. Med Sci Sports Exerc. 1997;29(suppl):294.

140 SECTION 1 The Basics of Sports Nutrition

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Key Questions Addressed 1. What’s the big deal about vitamins?

2. What are vitamins?

3. How are the dietary needs for vitamins represented?

4. What are the water-soluble vitamins?

5. What are the fat-soluble vitamins?

6. Which vitamins or compounds have antioxidant properties?

7. What are phytochemicals?

You Are the Nutrition Coach Roger is a starting guard on his college basketball team. He is a leader on his team, stays after prac- tice to work on his shots, and is busy with academic and community life on campus. Because of his hectic schedule, he has little time for meal planning, grocery shopping, and food preparation. Din- ner is usually consumed at the athletics training table during the week, and the rest of his meals are consumed either at home or at local restaurants. A 3-day food record kept by Roger recently was analyzed using a nutrition software program. The analysis revealed overall energy intake was not meeting his estimated needs, and vitamins A, C, and folate were consistently low throughout the 3-day period. The rest of the vitamins and minerals met the minimum RDA or AI requirements.

Questions • What questions should you ask Roger about his typical daily diet?

• What recommendations do you have for Roger to improve his dietary intake of vitamins and his energy intake?

• How can you help Roger meet these recommendations?

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CHAPTER 6

What’s the big deal about vitamins? Vitamins play important roles throughout the body and are considered essential; without vitamins, the body could not function. Some vitamins can be synthesized in the body. Many are precursors for different processes, whereas others are critical for the development of various compounds in the body. For example, vitamin D serves as a precursor molecule in cholesterol formation, and beta- carotene serves as a precursor for vitamin A.

The role that vitamins play in sport performance has been studied over the years. Although it is clear that vita- mins are crucial for body functions, less is known about the potential role they play in improving or hindering sport performance. Many athletes perceive that adequate vitamin intake is crucial to peak performance. Although the performance effect may not be proven, certain athlete populations are more prone to nutrient deficiencies, thus justifying a greater emphasis on a specific vitamin or min- eral.1 For example, female athletes may be more suscepti- ble to iron deficiencies. Therefore, iron, as well as vitamins that enhance iron absorption such as vitamin C, should receive greater emphasis in the diet. Another example that has recently received more attention is the poten- tial for an increased need for some antioxidant vitamins and phytochemicals for those engaging in high-intensity training of long duration, which may increase oxidative stress within the body.

This chapter discusses the recommended levels of intake for vitamins, antioxidants, and phytochemicals for healthy individuals and for athletes. The functions of these nutrients, their effects on energy systems, defi- ciency and toxicity symptoms, their importance to sport performance, food sources, and meal-planning tips for athletes are discussed.

What are vitamins? There are two classifications of vitamins: water soluble and fat soluble. The water-soluble vitamins include the

B vitamins, vitamin C, and choline. These vitamins dissolve in water and are easily transported in the blood. Because of their water solubility, they are also turned

over in the body and as a result are not stored in the body in appreciable amounts. Utilization of water-soluble vita- mins occurs on an as-needed basis; excess B vitamins or vitamin C are excreted in the urine. Because little storage of water-soluble vitamins occurs, regular intake of these nutrients is important.

Fat-soluble vitamins do not dissolve easily in water and require dietary fat for intestinal absorption and trans- port in the bloodstream. Unlike water-soluble vitamins,

the fat-soluble vita- mins A, D, E, and K are stored in the body, primarily in fat tissue and the liver, as well as in other organs, though in smaller amounts. When taken in excess, stored levels of the fat-soluble vitamins can build up and become toxic to the body. Dietary intake from foods rarely causes a toxic buildup, but intake via high-dosage sup-

plements can quickly and easily build these vitamins to toxic levels.

How are the dietary needs for vitamins represented? The Dietary Reference Intakes (DRIs) include several ways to quantify nutrient needs or excesses of vitamins and minerals. As a summary, the DRIs include the Rec- ommended Dietary Allowance (RDA), Estimated Average Requirement (EAR), Adequate Intake (AI), and Tolerable Upper Intake Level (UL). Each vitamin may have one or more of the DRIs established, depending on availability of current research data (see TABLE 6.1 ). The majority of vita- mins have an established RDA or AI, and some have a UL.

What are the water-soluble vitamins? The water-soluble vitamins include the B-complex vita- mins (thiamin, riboflavin, niacin, B6, B12, folate, biotin, and pantothenic acid), choline, and vitamin C. Water-soluble vitamins are involved in many different processes within the body, including acting as coenzymes. A coenzyme is

an organic molecule, usually a B vitamin, that attaches to an enzyme and acti- vates or increases its ability to catalyze metabolic reactions.

Some of these metabolic reactions are critical for energy production, especially during exercise.

Water-soluble vitamins can be obtained naturally from a large variety of food sources as well as from vita- min-fortified foods and beverages. In general, water-solu- ble vitamins are destroyed or lost with excessive cooking. To maximize the benefit of eating foods rich in the B-com- plex and C vitamins, foods should be eaten raw or cooked

water-soluble vitamins A class of vitamins that dissolve in water and are easily transported in the blood. The water-soluble vitamins are the B vitamins, vitamin C, and choline.

fat-soluble vitamins A group of vitamins that do not dissolve easily in water and require dietary fat for intestinal absorption and transport in the bloodstream. The fat-soluble vitamins are A, D, E, and K.

coenzymes An organic molecule, usually a B vitamin, that attaches to an enzyme and activates or increases its ability to catalyze metabolic reactions.

142 SECTION 1 The Basics of Sports Nutrition

Gaining the Performance Edge

Water- and fat-soluble vitamins are vital to human health. An emphasis should be placed on food sources of vitamins, rather than on supple- ments. These high-vitamin foods should be consumed on a daily basis.

Table 6.1

Dietary Reference Intakes (DRIs) for Vitamins Life stage group

Vitamin A (μg/d)1

Vitamin D (IU/d)2

Vitamin E (mg/d)3

Vitamin K (μg/d)

Thiamin (mg/d)

Riboflavin (mg/d)

Niacin (mg/d)4

Panothenic acid (mg/d)

Biotin (μg/d)

Vitamin B6 (mg/d)

Folate (μg/d)5

Vitamin B12 (μg/d)

Vitamin C (mg/d)

Choline (mg/day)

Infants

0–6 months 400* 400* 4* 2.0* 0.2* 0.3* 2* 1.7* 5* 0.1* 65* 0.4* 40* 125*

7–12 months

500* 400* 5* 2.5* 0.3* 0.4* 4* 1.8* 6* 0.3* 80* 0.5* 50* 150*

Children

1–3 years 300 600 6 30* 0.5 0.5 6 2* 8* 0.5 150 0.9 15 200*

4–8 years 400 600 7 55* 0.6 0.6 8 3* 12* 0.6 200 1.2 25 250*

Males

9–13 years 600 600 11 60* 0.9 0.9 12 4* 20* 1.0 300 1.8 45 375*

14–18 years 900 600 15 75* 1.2 1.3 16 5* 25* 1.3 400 2.4 75 550*

19–30 years 900 600 15 120* 1.2 1.3 16 5* 30* 1.3 400 2.4 90 550*

31–50 years 900 600 15 120* 1.2 1.3 16 5* 30* 1.3 400 2.4 90 550*

51–70 years 900 600 15 120* 1.2 1.3 16 5* 30* 1.7 400 2.47 90 550*

> 70 years 900 800 15 120* 1.2 1.3 16 5* 30* 1.7 400 2.47 90 550*

Females

9–13 years 600 600 11 60* 0.9 0.9 12 4* 20* 1.0 300 1.8 45 375*

14–18 years 700 600 15 75* 1.0 1.0 14 5* 25* 1.2 4006 2.4 65 400*

19–30 years 700 600 15 90* 1.1 1.1 14 5* 30* 1.3 4006 2.4 75 425*

31–50 years 700 600 15 90* 1.1 1.1 14 5* 30* 1.3 4006 2.4 75 425*

51–70 years 700 600 15 90* 1.1 1.1 14 5* 30* 1.5 400 2.47 75 425*

> 70 years 700 800 15 90* 1.1 1.1 14 5* 30* 1.5 400 2.47 75 425*

Pregnancy

≤ 18 years 750 600 15 75* 1.4 1.4 18 6* 30* 1.9 600 2.6 80 450*

19–30 years 770 600 15 90* 1.4 1.4 18 6* 30* 1.9 600 2.6 85 450*

31–50 years 770 600 15 90* 1.4 1.4 18 6* 30* 1.9 600 2.6 85 450*

Lactation

≤ 18 years 1200 600 19 75* 1.4 1.6 17 7* 35* 2.0 500 2.8 115 550*

19–30 years 1300 600 19 90* 1.4 1.6 17 7* 35* 2.0 500 2.8 120 550*

31–50 years 1300 600 19 90* 1.4 1.6 17 7* 35* 2.0 500 2.8 120 550*

This table presents Recommended Dietary Allowances (RDA) and Adequate Intakes (AI). An asterisk (*) indicates AI. RDAs and AIs may both be used as goals for individual intake. 1As retinol activity equivalents (RAE). 2As cholecalciferol. 3As α-tocopherol. 4As niacin equivalents (NE). 5As dietary folate equivalents (DFE). 6In view of evidence linking folate intake with lessening of neural-tube defects in the fetus, it is recommended that all women capable of becoming pregnant consume 400 μg of folic acid from supplements or fortified foods in addition to intake of food folate from a varied diet. 7Because 10–30% of older people may malabsorb food-bound vitamin B12, it is advisable for those older than 50 years to meet their RDA mainly by consuming foods fortified with vitamin B12 or a supplement containing vitamin B12.

Data from Institute of Medicine’s Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline. Food and Nutrition Board. Washington, DC: National Academies Press, 1998; Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium and Zinc. Food and Nutrition Board. Washington, DC: National Academies Press, 2001; Dietary Reference Intakes for Vitamin C, Vitamin E, Selenium, and Carotenoids. Food and Nutrition Board. Washington, DC: National Academies Press, 2000; Dietary Reference Intakes for Calcium and Vitamin D. Food and Nutrition Board. Washington, DC: National Academies Press, 2011.

Chapter 6 Vitamins 143

Which foods are rich in thiamin? Thiamin is found in a variety of foods, including whole grains, legumes, wheat germ, nuts, pork, and fortified foods, such as refined flours, grains, and breakfast cere- als (see FIGURE 6.1 ). In the United States, thiamin needs are generally met with a well-balanced diet and adequate total daily calories.

What is a suggestion for a thiamin-rich meal or snack? Breakfast: One packet of instant oatmeal, made with 8 oz soy milk and topped with ¼ cup sunflower or pumpkin seeds

Total thiamin content = 0.768 milligrams

Do athletes need thiamin supplements? Research on the ergogenic effects of thiamin supplemen- tation is limited and has provided inconclusive results. Most studies have found that athletes who are restricting intake for the purposes of weight loss could potentially be low in thiamin3,5 and therefore would benefit from a sup- plement. However, as with all nutrients, the focus should first be on nutrient-rich foods, and then a supplement if indicated.

Why is riboflavin important for athletes? Riboflavin is also commonly referred to as vitamin B2. It is absorbed mainly in the small intestine. Riboflavin is highly involved in the aerobic production of energy (i.e., ATP) from carbohydrates, proteins, and fats. The two coenzymes flavin mononucleotide and flavin adenine dinucleotide contain riboflavin and are involved in the transport of electrons to the electron transport chain during aerobic energy production at rest and during exercise.

What is the RDA/AI for riboflavin? The RDA for riboflavin is 1.3 milligrams for males and 1.1 milligrams for females.2

What are the complications of riboflavin deficiency? Riboflavin deficiency is recognized by symptoms such as red lips, cracks at the corners of the mouth, a sore throat, or an inflamed tongue. In athletics, a riboflavin deficiency may contribute to poor performance. One investigation found that 19% of the young, active boys studied had poor riboflavin status. After 2 months of riboflavin supplemen- tation, performance in a maximal bicycle ergometer test improved as compared to presupplementation.6

What are the symptoms of riboflavin toxicity? As with most water-soluble vitamins, there appear to be no adverse effects of high doses of riboflavin because dietary excess is excreted in urine. Therefore, no upper limit has been set for riboflavin.

for short periods of time. The exception to this rule is any meat product. Meats should be cooked thoroughly to prevent foodborne pathogens found in undercooked meats. Because water-soluble vitamins are not stored to any great extent in the body, it is important to eat foods containing these vitamins on a daily basis.

Why is thiamin important to athletes? Thiamin is also referred to as vitamin B1. It is absorbed in the small intestine and is stored mainly in skeletal mus- cle, the liver, the kidneys, and the brain. Thiamin plays a major role in energy production and is also important for developing and maintaining a healthy nervous sys- tem. In relation to performance, thiamin is a component of the coenzyme thiamin pyrophosphate that converts pyruvate into acetyl CoA, which then enters into the Krebs cycle during aerobic energy production. Thiamin also plays a role in the conversion and utilization of gly- cogen for energy as well as the catabolism of branched chain amino acids. Some studies have shown that ath- letes with low intakes of thiamin have diminished exer- cise endurance.

What is the RDA/AI for thiamin? The RDA for thiamin is 1.2 milligrams for males and 1.1 milligrams for females.2 The RDA is based on the notion that humans need approximately 0.5 milligrams of thia- min per 1000 calories ingested daily. Therefore, thiamin requirements escalate with increased calorie intake. Ath- letes, who are generally expending more calories through training and competition relative to the sedentary popu- lation, will require more thiamin than the RDA on a daily basis. Thiamin is also critical for the proper metabolism of carbohydrates, so as carbohydrate intake increases, so will the requirement for thiamin.

What are the complications of thiamin deficiency? Thiamin deficiency is typically caused by an athlete consuming very few calories or having a diet composed mainly of processed foods. The signs and symptoms of thiamin deficiency include decreased appetite, mental confusion, headaches, fatigue, muscle weakness, nerve degeneration, and pain in the calf muscles. If a severe deficiency is left untreated for as little as 10 days, the dis- ease beriberi can develop, which can lead to damage to the heart and nervous system. In regard to performance, studies have found that athletes with low intakes of thia- min and other water-soluble vitamins over the course of 11 weeks suffer decreases in maximal work capacity, peak power, and mean power output.3,4

What are the symptoms of thiamin toxicity? As discussed earlier, water-soluble vitamins tend not to accumulate in the body because any excess is excreted in the urine. As a result, the risk for thiamin toxicity is low, and therefore no upper limit has been set for thiamin intake.

144 SECTION 1 The Basics of Sports Nutrition

a cycle ergometer at 75–85% of their maximal heart rate. Although the investigators found biochemical changes indicating riboflavin depletion, supplemental riboflavin did not enhance exercise performance or endurance. More research is warranted to make a recommendation on whether athletes require more riboflavin than the current RDA. Daily riboflavin needs can typically be met through a balanced and calorically adequate diet.

Why is niacin important for athletes? Niacin is a general term for two different substances: nic- otinic acid and nicotinamide. Some sources might refer to niacin as vitamin B3. A majority of niacin absorption occurs in the intestines, but a small amount is absorbed through the stomach. Niacin is highly involved in energy production and mitochondrial metabolism, thus affecting muscular and nervous system function. Niacin is a com- ponent of two coenzymes: nicotinamide adenine dinu- cleotide (NAD+) and nicotinamide adenine dinucleotide phosphate (NADP+). These coenzymes are involved in the transfer of hydrogen ions in the anaerobic and aerobic energy systems. During aerobic exercise, NAD+ can accept

Which foods are rich in riboflavin? FIGURE 6.2 lists some of the foods containing riboflavin.

Milk, yogurt, bread, cereal products, mushrooms, cottage cheese, and eggs are all good sources of riboflavin. Similar to thiamin, bread and cereal products in the United States are fortified with riboflavin.

What is a suggestion for a riboflavin-rich meal or snack? Salad bar creation: 2 cups of romaine lettuce with ½ cup each of mushrooms, carrots, and cottage cheese, and 2 tbsp of almonds

Total riboflavin content = 0.661 milligrams

Do athletes need riboflavin supplements? It is challenging to determine whether athletes need riboflavin supplements. Minimal research has been con- ducted on the riboflavin status of individuals exercis- ing strenuously5 or the performance effects of riboflavin supplementation. A study conducted by Winters et al.7 focused on women 50 to 67 years of age who exercised for 20 to 25 minutes, 6 days a week for 4-week periods on

Exceptionally good source

0.76 mg 0.63 mg 0.48 mg 0.43 mg 0.39 mg 0.39 mg 0.38 mg 0.38 mg 0.34 mg

2.0 mg

Pork, loin roast, lean only, cooked Ham, extra lean, cooked Bagel, plain Fish, tuna, cooked Soy milk Corn flakes cereal Cheerios cereal Fiber One cereal Oatmeal, instant, fortified, cooked

85 g (3 oz) 85 g (3 oz) 90 g (4" bagel) 85 g (3 oz) 240 mL 30 g (1 cup) 30 g (1 cup) 30 g (1/2 cup) 1 cup

High: 20% DV or more

Good: 10–19% DV

Sweet potato, cooked 140 g (1 potato)

THIAMIN Daily Value = 1.5 mg RDA = 1.2 mg (males), 1.1 mg (females)

Spaghetti, enriched, cooked Wheat germ Orange juice, chilled Sesame seeds Rice, white, enriched, cooked Salmon, cooked White bread, enriched Soybeans, cooked Black beans, cooked Pecans Grits, corn, enriched, cooked Whole wheat bread Brazil nuts Baked beans, canned Navy beans, cooked Oysters, cooked Lentils, cooked

140 g (1 cup) 15 g (1/4 cup) 240 mL (1 cup) 30 g (~1 oz) 140 g (~ 3/4 cup) 85 g (3 oz) 50 g (2 slices) 90 g (~1/2 cup) 90 g (~1/2 cup) 30 g (~1 oz) 1 cup 50 g (2 slices) 30 g (~1 oz) 130 g (~1/2 cup) 90 g (~1/2 cup) 85 g (3 oz) 90 g (~1/2 cup)

0.29 mg 0.28 mg 0.28 mg 0.24 mg 0.23 mg 0.23 mg 0.23 mg 0.23 mg 0.22 mg

0.20 mg 0.20 mg 0.20 mg 0.19 mg 0.19 mg 0.18 mg 0.16 mg 0.15 mg

Data from U.S. Department of Agriculture, Agricultural Research Service, 2012. USDA National Nutrient Database for Standard Reference, Release 25. Nutrient Data Laboratory home page. Available at: http://www.ars.usda.gov/ba/bhnrc/ndl.

Chapter 6 Vitamins 145

Figure 6.1 Food sources of thiamin. Pork, whole and enriched grains, and fortified cereals are rich in thiamin. Most animal foods, however, contain little thiamin. Note: The DV for thiamin is higher than the current RDA of 1.2 and 1.1 milligrams for males and females, respectively, age 19 and older.

a hydrogen ion and become NADH, carrying high-energy electrons to the electron transport chain for the produc- tion of ATP. In anaerobic metabolism, NADH is responsible for transferring hydrogen to pyruvate to form lactate dur- ing the breakdown of carbohydrates for energy.

What is the RDA/AI for niacin? The RDA for niacin is 16 milligrams for males and 14 mil- ligrams for females.2 Niacin is obtained through the diet but can also be formed within the body from the amino acid tryptophan. Therefore, the RDA refers to niacin equivalents (NE), reflecting intake from niacin-rich foods as well as sources of tryptophan that can be converted into niacin. For foods rich in tryptophan, 60 milligrams of tryptophan is equivalent to 1 milligram of niacin.

What are the complications of niacin deficiency? Niacin is critical for the progression of many metabolic pathways, and therefore a niacin deficiency will affect many bodily systems. Signs and symptoms of niacin

Figure 6.2 Food sources of riboflavin. The best sources of riboflavin include milk, liver, whole and enriched grains, and fortified cereals. Note: The DV for riboflavin is higher than the current RDA of 1.3 and 1.1 milligrams for males and females, respectively, age 19 and older.

deficiency include loss of appetite, skin rashes, mental confusion, lack of energy, and muscle weakness. If the deficiency is left untreated, the deficiency disease pella- gra develops. Pellagra is characterized by the three “Ds”: dementia (mental confusion), diarrhea, and dermatitis (skin rashes). If pellagra is left untreated, there is a fourth “D,” death.

What are the symptoms of niacin toxicity? The upper dietary limit is 35 milligrams per day. Common side effects of high niacin intake include flushing of the face, arms, and chest; itchy skin rashes; headaches; nau- sea; glucose intolerance; blurred vision; and ultimately, liver complications. Doses several times the RDA are used medicinally for lowering LDL and raising HDL cho- lesterol. Individuals taking niacin for its cholesterol-low- ering effect must be under the supervision of a physician to monitor any potential complications and decrease the risk for liver damage.

RIBOFLAVIN

Daily Value = 1.7 mg RDA = 1.3 mg (males), 1.1 mg (females)

Egg, hardcooked Soybeans, cooked Mushrooms, cooked Herring, cooked Almonds Pork, loin chops, lean only, cooked Turkey, dark meat, cooked Spinach, cooked Cottage cheese, 2% milkfat Chicken, dark meat, cooked Beef, porterhouse steak, cooked Ham, extra lean, cooked Soy milk White bread, enriched

50 g (1 large) 90 g (~1/2 cup) 85 g (~1/2 cup) 85 g (3 oz) 30 g (~1 oz) 85 g (3 oz)

85 g (3 oz) 85 g (~1/2 cup) 110 g (~1/2 cup) 85 g (3 oz) 85 g (3 oz)

85 g (3 oz) 240 mL (1 cup) 50 g (2 slices)

Exceptionally good sources

0.26 mg 0.26 mg 0.26 mg 0.25 mg 0.24 mg 0.23 mg

0.21 mg 0.20 mg 0.20 mg 0.19 mg 0.18 mg

0.17 mg 0.17 mg 0.17 mg

High: 20% DV or more

Good: 10–19% DV

Chicken liver, cooked Wheat bran flakes cereal

Yogurt, plain, nonfat Yogurt, plain, low-fat Milk, nonfat Corn flakes cereal Milk, 1%, 2%, whole (3.25%) Cheerios cereal Fiber One cereal Oatmeal, instant, fortified, cooked Squid, cooked Buttermilk, low-fat Clams, cooked

85 g (3 oz) 30 g (3/4 cup)

225 g (8-oz container) 225 g (8-oz container) 240 mL (1 cup) 30 g (1 cup) 240 mL (1 cup) 30 g (1 cup) 30 g (1/2 cup) 1 cup

85 g (3 oz) 240 mL (1 cup) 85 g (3 oz)

1.96 mg 1.77 mg

0.53 mg 0.48 mg 0.47 mg 0.46 mg 0.45 mg 0.43 mg 0.43 mg 0.40 mg

0.39 mg 0.38 mg 0.36 mg

85 g (3 oz) 2.9 mgBeef liver, cooked

146 SECTION 1 The Basics of Sports Nutrition

Which foods are rich in niacin? Along with thiamin and riboflavin, refined flours, grains, and cereals are fortified with niacin. Other dietary sources include protein-rich foods such as beef, poultry, fish, legumes, liver, and seafood, as well as whole grain prod- ucts and mushrooms (see FIGURE 6.3 ).

What is a suggestion for a niacin-rich meal or snack? Dining out—Italian: Chicken marsala (4 oz chicken in 1 cup mushroom sauce) on 2 cups spaghetti

Total niacin content = 24 milligrams

Do athletes need niacin supplements? Although niacin is crucial for facilitating energy production, recent research reviews have concluded that well-nourished athletes do not benefit from niacin supple- ments. In addition to the lack of apparent benefit of con- suming extra niacin, supplements are not recommended because high doses of niacin can:

Figure 6.3 Food sources of niacin. Niacin is found mainly in meats and grains. Enrichment adds niacin as well as thiamin, riboflavin, folic acid, and iron to processed grains. Note: The DV for niacin is higher than the current RDA of 16 and 14 milligrams for males and females, respectively, age 19 and older.

• Affect fat metabolism by blocking free fatty acid release from adipose tissue,8–10 increasing the reli- ance of the body on carbohydrate stores, thus deplet- ing glycogen stores.11

• Increase blood flow to the skin, which decreases heat storage. This may be beneficial/ergogenic for some athletes, but more research is needed.12

Why is vitamin B6 important for athletes? Vitamin B6 refers to all biologically active forms of vita- min B6, including pyridoxine, pyridoxal, pyridoxamine, pyridoxine phosphate, pyridoxal phosphate, and pyri- doxamine phosphate. Pyridoxine, pyridoxal, and pyridox- amine are the forms most commonly found in foods. All forms of vitamin B6 are absorbed mainly in the jejunum of the small intestine and are converted in the liver to the most active coenzyme form, pyridoxal phosphate. Vita- min B6 is important for health and athletic performance in many ways.

Chicken liver, cooked Salmon, cooked Tuna, canned Halibut, cooked Turkey, light meat, cooked Chicken, dark meat, cooked Beef, ground, extra lean, cooked Corn flakes, Cheerios cereals Fiber One cereal Oatmeal, instant, fortified, cooked All Bran cereal Peanut butter Pork, loin roast, lean only, cooked Tomato paste, canned

55 g (2 oz) 85 g (3 oz) 85 g (3 oz) 85 g (3 oz) 85 g (3 oz)

30 g (1 cup) 30 g (1/2 cup) 1 cup

30 g (1/2 cup) 2 Tbsp 85 g (3 oz)

130 g (~1/2 cup)

9.4 mg 8.6 mg 7.3 mg 6.1 mg 5.8 mg 5.6 mg 5.3 mg

5.0 mg 5.0 mg 4.8 mg

4.8 mg 4.3 mg 4.0 mg

4.0 mg

NIACIN

High: 20% DV or more

Good: 10–19% DV

Daily Value = 20 mg RDA = 16 mg (males), 14 mg (females)

Beef, T-bone steak, cooked Mushrooms, cooked Salmon, canned, solids + bones Ham, extra lean, cooked Beef, porterhouse steak, cooked Turkey, dark meat, cooked Barley, cooked Sardines, canned, solids + bones Clams, cooked Spaghetti, enriched, cooked Shrimp, cooked White bread, enriched Rice, brown, cooked Cod, cooked Rice, white, enriched, cooked

85 g (3 oz) 85 g (~1/2 cup) 55 g (2 oz) 85 g (3 oz) 85 g (3 oz) 85 g (3 oz) 140 g (~1 cup) 55 g (2 oz)

85 g (3 oz) 140 g (1 cup) 85 g (3 oz) 50 g (2 slices) 140 g (~3/4 cup) 85 g (3 oz) 140 g (~3/4 cup)

3.9 mg 3.8 mg 3.6 mg 3.4 mg 3.2 mg 3.1 mg 2.9 mg 2.9 mg

2.9 mg 2.3 mg 2.2 mg 2.2 mg 2.1 mg 2.1 mg 2.0 mg

85 g (3 oz) 85 g (3 oz) 85 g (3 oz) 85 g (3 oz)

14.9 mg 10.6 mg

Beef liver, cooked Chicken, light meat, cooked

Chapter 6 Vitamins 147

daily limit. Irreversible nerve damage can occur at levels of 1000–2000 milligrams per day.

Which foods are rich in vitamin B6 ? Vitamin B6 is found in a variety of foods (see FIGURE 6.5 ). The richest sources include high-protein foods such as beef, poultry, fish, and eggs. Other significant sources include whole grains, brown rice, wheat germ, white potatoes, starchy vegetables, fortified soy-based meat analogs, and bananas. It should be noted that refined grain products have been stripped of most of their B6 content. Unlike with thiamin, riboflavin, and niacin, the enrichment process does not replace the lost B6 in foods.

What is a suggestion for a vitamin B6-rich meal or snack? Lunch: Egg salad sandwich on whole wheat bread and a banana

Total vitamin B6 content = 0.834 milligrams

Do athletes need vitamin B6 supplements? The current research on the athletic performance benefits of vitamin B6 supplementation is equivocal. Some studies have found marginal or low vitamin B6 status in physi- cally active individuals.13,16 When a supplement was pro- vided over several weeks, erythrocyte activity coefficients increased,16 suggesting that exercise may further decrease vitamin status in active individuals who might already have low intakes of vitamin B6.17 Much of the exercise- related research has focused on determining the changes in vitamin B6 metabolism during training to establish whether additional vitamin B6 is indicated. Many studies involving short-duration and moderate-intensity exercise

• B6 is a component of more than 100 enzymes, which facilitate the following:

• The breakdown of glycogen for energy as well as gluconeo- genesis in the liver: Both processes are important dur- ing endurance activities.

• The synthesis of amino acids via transamination: This process produces amino acids endogenously, meaning that not all amino acids need to be consumed through the diet.

• The conversion of tryptophan to niacin: Daily niacin requirements are based on a combination of niacin consumed through foods and the amount made by the body from tryptophan.

• The formation of neurotransmitters: This is critical for the fine motor movement and control required for various sports.

• The production of the red blood cells’ hemoglobin ring: Hemoglobin is essential for endurance activities that rely on oxygen for energy. A deficiency in B6 can con- tribute to microcytic hypochromic anemia (small, low-hemoglobin red blood cells).

• The production of white blood cells: This is critical for proper immune function. Vitamin B6 has recently been heralded as a dietary

protector against heart disease. Research has found that individuals with low intakes of B6, as well as folate and vitamin B12, have higher blood levels of homocysteine, which is a risk factor for heart disease (see FIGURE 6.4 ).

What is the RDA/AI for vitamin B6? The RDA for men and women ages 19 to 50 is 1.3 mil- ligrams.2 Because of the role of vitamin B6 in protein metabolism, requirements are based on protein intake. Individuals following a high-protein diet may need to con- sume more vitamin B6.

What are the complications of vitamin B6 deficiency? Deficiencies in vitamin B6 in male and female athletes are rare.13 When athletes fail to ingest adequate vitamin B6, it is usually explained by low energy intakes and poor food choices.13 It is interesting to note that even when consum- ing a diet low in vitamin B6, one study demonstrated that muscle levels of vitamin B6 were not depleted.14 However, if low daily intake persists, or if an athlete is taking diuret- ics or oral contraceptives, B6 deficiency is still a possibility. For example, Manore et al.15 studied three different groups of women, active and sedentary, and found that the elderly groups had low intakes of vitamin B6 in their daily diets. A vitamin B6 deficiency can be detected by symptoms such as nausea, impaired immune function (because of low numbers of white blood cells), convulsions, depression (related to the improper functioning of neurotransmit- ters), skin disorders, mouth sores, weakness, and anemia (because of low levels of red blood cell production).

What are the symptoms of vitamin B6 toxicity? The upper limit for vitamin B6 is 100 milligrams per day. Impaired gait resulting from peripheral nerve damage can be caused by intakes at or slightly above the upper

Figure 6.4 Homocysteine and heart disease. Elevated homocysteine levels are linked to an increased risk of heart disease. B6, B12, and folate-dependent enzymes help lower the amount of homocysteine by converting it to cysteine and methionine.

B6-dependent enzymes

Folate and B12-dependent enzymes

Homocysteine

MethionineCysteine

Elevated homocysteine levels increase the risk of heart disease

Forming cysteine and methionine from homocysteine can lower homocysteine levels and reduce risk of heart disease

148 SECTION 1 The Basics of Sports Nutrition

sheath, which is the protective coating surrounding all nerve fibers. Vitamin B12 is critical for folate metabo- lism, which, in turn, relates to DNA synthesis and tissue growth. Adequate intakes of vitamin B12 prevent the onset of pernicious anemia. Vitamin B12 is also involved in pre- paring fatty acid chains to enter the citric acid cycle, thus facilitating energy production.

A health-related task of vitamin B12 is the lowering of homocysteine and thus the prevention of heart disease. High levels of homocysteine have recently been accepted as a valid risk factor for cardiovascular disease.20 Homo- cysteine is converted to methionine with the coenzyme assistance of vitamin B12, thus lowering blood levels of homocysteine and the risk for disease (see Figure 6.4).

What is the RDA/AI for vitamin B12? The RDA for vitamin B12 is 2.4 micrograms for adults aged 19 to 50 years.2 Older adults have the same requirement; however, many older individuals have a decreased ability to absorb B12. The synthetic form of B12 can be absorbed more readily than food sources for these individuals; therefore, they should focus on incorporating fortified foods and supplements into their daily diet.

have shown an increase in vitamin B6 in the blood within minutes of the onset of exercise and throughout the exer- cise bout. B6 then shows a slow decline after the cessation of exercise.15,18 An incremental increase during exercise is plausible in theory because of the increased reliance on gluconeogenesis for energy production, thus requir- ing more vitamin B6. However, a recent study examining the changes in plasma vitamin B6 in ultra-marathoners observed the opposite result, with postexercise levels lower than preexercise levels, with a further decline 60 min- utes after the completion of the ultra-marathon.19 More research is warranted to determine the exact changes in vitamin B6 metabolism during short- and long-duration exercise to establish recommendations for supplementa- tion during training or competition.

Why is vitamin B12 important for athletes? Vitamin B12 is also commonly referred to as cobalamin. Adequate intake and absorption of this vitamin are of special concern to older athletes as well as vegetarian and vegan athletes. Vitamin B12 plays a role in the health and performance of the nervous and cardiovascular systems, the growth and development of tissues, and energy pro- duction. Vitamin B12 maintains the integrity of the myelin

Figure 6.5 Food sources of vitamin B6. Meats are generally good sources of vitamin B6, as are certain fruits (e.g., bananas) and veg- etables (e.g., potatoes, carrots). Note: The DV for vitamin B6 is higher than the current RDA of 1.3 milligrams for males and females age 19 and older.

130 g (~1/2 cup) 140 g (9" banana) 30 g (1 cup) 30 g (1/2 cup) 30 g (1 cup) 85 g (3 oz) 85 g (3 oz) 85 g (3 oz)

0.9 mg 0.7 mg 0.6 mg 0.6 mg 0.5 mg 0.5 mg 0.5 mg 0.5 mg 0.5 mg 0.4 mg 0.4 mg

VITAMIN B6

High: 20% DV or more

Good: 10–19% DV

Daily Value = 2 mg RDA = 1.3 mg (males/females)

30 g (3 / 4 cup)

30 g (1/2 cup) 85 g (3 oz) 85 g (3 oz) 85 g (3 oz)

2.1 mg

1.8 mg

Ham, extra lean, cooked Halibut, cooked Potato, baked, w/skin Turkey, dark meat, cooked Chicken, dark meat, cooked Beef, porterhouse steak, cooked Herring, cooked Tomato juice, canned Sweet potato, cooked Sesame seeds Sunflower seeds

Exceptionally good source Wheat bran flakes cereal

All Bran cereal Beef liver, cooked Chicken, light meat, cooked Chicken liver, cooked Garbanzo beans, canned Banana, fresh Corn flakes cereal Fiber One cereal Cheerios cereal Turkey, light meat, cooked Pork, loin roast, lean only Beef, ground, extra lean, cooked

85 g (3 oz) 85 g (3 oz) 110 g (1 small) 85 g (3 oz) 85 g (3 oz)

85 g (3 oz)

85 g (3 oz) 240 mL (1 cup) 110 g (1 small) 30 g (~1 oz) 30 g (~1 oz)

0.3 mg 0.3 mg 0.3 mg 0.3 mg 0.3 mg

0.3 mg

0.3 mg 0.3 mg 0.3 mg 0.2 mg 0.2 mg

Chapter 6 Vitamins 149

What are the complications of vitamin B12 deficiency? Vitamin B12 deficiency is caused by either impaired absorp- tion or decreased intake. Because vitamin B12 is found naturally only in animal products, individuals following a vegetarian or especially a vegan diet will need to consume fortified foods or take daily supplements to avoid deficiency problems. The liver stores B12, and therefore deficiencies develop gradually over time. Vitamin B12 deficiency can result in neurological problems and pernicious anemia. B12 is criti- cal for the health of the myelin sheath, so low intake causes the myelin sheath to swell and break down, leading to brain abnormalities and spinal cord degeneration. Pernicious ane- mia leads to altered red blood cell formation, producing megaloblasts and macrocytes, meaning large, irregular cells. Pernicious anemia may lead to decreased endurance perfor- mance, but more research is needed before conclusions can be drawn and recommendations formulated.

In regard to cardiovascular health, a deficiency of vita- min B12 can lead to increasing levels of homocysteine and a greater risk for disease. A study conducted by Herrmann et al.21 found that 25% of study participants, all recreational

Figure 6.6 Food sources of vitamin B12. Vitamin B12 is found naturally only in foods of animal origin such as liver, meats, and milk. Some cereals are fortified with vitamin B12. Note: The DV for vitamin B12 is substantially higher than the current RDA of 2.4 micrograms for males and females age 14 and older.

athletes, had elevated homocysteine levels that were asso- ciated with low levels of both vitamin B12 and folate. Engag- ing in physical activity on a regular basis is a negative risk factor for cardiovascular disease. However, efforts to pre- vent disease through exercise may be negated if daily nutrition and adequate intake of B12 are neglected.

What are the symptoms of vitamin B12 toxicity? Because there are no recognized detrimental effects from high doses of B12, an upper limit has not been set.

Which foods are rich in vitamin B12? Vitamin B12 is naturally found only in animal products such as meats, dairy products, and eggs (see FIGURE 6.6 ). For vegetarians and vegans, fortified foods include break- fast cereals, soy milks, and other soy-based products.

What is a suggestion for a vitamin B12-rich meal or snack? Dinner: 3 oz slice of meatloaf with ¾ cup mashed potatoes, 1¼ cups salad, and 12 oz skim milk

Total vitamin B12 content = 2.45 micrograms

Exceptionally good sources

84.1 µg 71 µg

29.8 µg 18.0 µg 11.2 µg 9.8 µg 6.2 µg 6.2 µg 6.0 µg

VITAMIN B12

High: 20% DV or more

Good: 10–19% DV

Daily Value = 6 µg RDA = 2.4 µg (males/females)

Milk, 2% milkfat Milk, whole 3.25% milkfat Squid, cooked Milk, 1% milkfat Milk, nonfat Cod, cooked Frankfurter, beef Bologna, beef Cottage cheese, 2% milkfat Pork, loin chops, lean only, cooked

240 mL (1 cup) 240 mL (1 cup) 85 g (3 oz) 240 mL (1 cup) 240 mL (1 cup) 85 g (3 oz) 55 g (1 each) 55 g (2 slices) 110 g (~1/2 cup) 85 g (3 oz)

1.1 µg 1.1 µg 1.0 µg 1.0 µg 0.9 µg 0.9 µg 0.9 µg 0.8 µg 0.7 µg 0.6 µg

4.9 µg

2.6 µg 2.6 µg 2.2 µg

1.9 µg 1.7 µg

1.4 µg 1.3 µg 1.3 µg 1.2 µg

Sardines, canned, solids + bones Salmon, cooked Lobster, cooked Beef, ground, extra lean, cooked Beef, T-bone steak, cooked Tuna, canned Yogurt, plain, nonfat Shrimp, cooked Yogurt, plain, low-fat Halibut, cooked

Clams, cooked Beef liver, cooked Oysters, cooked Chicken liver, cooked Herring, cooked Crab, Alaska King, cooked Crab, blue, cooked Wheat bran flakes cereal All Bran cereal

55 g (2 oz)

85 g (3 oz) 85 g (3 oz) 85 g (3 oz)

85 g (3 oz) 55 g (2 oz) 225 g (8-oz container) 85 g (3 oz) 225 g (8-oz container) 85 g (3 oz)

85 g (3 oz) 85 g (3 oz) 85 g (3 oz) 85 g (3 oz) 85 g (3 oz) 85 g (3 oz) 85 g (3 oz) 30 g (3/4 cup) 30 g (1/2 cup)

150 SECTION 1 The Basics of Sports Nutrition

Do athletes need vitamin B12 supplements? As mentioned previously, vegetarian or vegan athletes may need supplemental B12 from fortified vegetarian foods, soy products, or multivitamins. Masters or elderly athletes may also need B12 supplements if they have atro- phic gastritis and/or low levels of intrinsic factor. Those with diagnosed pernicious anemia will have enhanced performance after consuming higher doses of B12. How- ever, studies following individuals without pernicious anemia who are consuming large doses of vitamin B12 through supplements or vitamin B12-rich foods have shown no effect on endurance, VO2max, or body build- ing. Therefore, a healthy athlete consuming a balanced diet may not benefit from vitamin B12 supplements.

Why is folate important for athletes? The terms folate and folic acid are often used interchange- ably, referring to the same nutrient. However, folate is the form of this vitamin found in whole foods, whereas folic acid is the most stable form or derivative of folate and is therefore used in supplements and fortified foods. The significance of folate for health and well-being is appar- ent at the moment of conception. Folate is critical for DNA synthesis and cell division, thus playing an important role in the growth and development of a fetus. Adequate folate intake has been recognized as a key in the prevention of neural-tube defects during pregnancy. It is critical for a woman to be consuming enough folate at the time of con- ception, because most neural-tube defects occur within the first month after conception. This discovery was the driv- ing force behind the 1998 Food and Nutrition Board man- date to fortify grains in the United States with folic acid.

Because of its role in cellular development through- out the body, folate also aids in the maturation of red blood cells and the repair of tissues. Adequate folate intake prevents the development of megaloblastic, mac- rocytic anemia. This type of anemia is also a result of vita- min B12 deficiency; therefore, it is critical to determine which nutrient is the cause of the anemia to establish the appropriate method of treatment. If anemia devel- ops, energy levels for training and competition may suffer.

Chapter 6 Vitamins 151

Fortifying Your Nutrition Knowledge

Vitamin B12 Absorption Vitamin B12 has a complex progression from ingestion to absorption. For elderly or ill individuals, several steps in the digestion pathway can cause suboptimal absorption:

1. R-protein is produced by the salivary glands in the mouth and travels unconnected to vitamin B12 to the stomach.

Stomach cells release intrinsic factor.

In the ileum, the B12–IF complex binds to an intestinal cell receptor and is absorbed. After 3–4 hours, B12 enters circulation bound to transcobalamin, a transport protein.

Salivary glands produce R-protein.

In the stomach, B12 binds with R-protein.

B12

Pancreatic enzymes partially degrade R-protein, releasing B12 to bind with intrinsic factor.

B12

2. In the stomach, R-protein binds with vitamin B12 as a protective mechanism as the complex travels to the small intestine. Intrinsic factor is secreted by the parietal cells of the stomach and travels with the B12–R-protein complex to the small intestine. For elderly individuals, the parietal cells become less functional, producing less intrinsic factor, thus affecting vitamin B12 absorption in the small intestine.

3. Pancreatic enzymes cleave B12 from the R-protein in the small intestine.

4. B12 then binds to intrinsic factor and travels to the ileum of the small intestine, where it binds to the brush border and is absorbed and transported throughout the body. For individuals who suffer from chronic diarrhea or sloughing of the brush border because of age, illness, or medications, vitamin B12 absorption will be diminished.

Absorption of vitamin B12 is a complex process that involves many factors and sites in the GI tract. Defects in this process, especially a lack of intrinsic factor, impair absorption and can result in deficiency.

Folate also facilitates muscle tissue repair after strenuous exercise, aiding in recovery.

In addition, folate has recently gained recognition in the area of cardiovascular health. Folate helps to lower levels of homocysteine in the blood, thus potentially low- ering the risk for heart disease.

What is the RDA/AI for folate? The RDA for folate is 400 micrograms per day for adult males and females.2 The RDA is expressed in Dietary Folate Equivalents (DFE). One DFE equals 1 microgram of folate from food, 0.6 micrograms of folic acid in forti- fied foods, or 0.5 micrograms of folic acid in supplements taken on an empty stomach.

What are the complications of folate deficiency? Because of folate’s role in basic cell development and division, deficiency of this vitamin affects many compo- nents of health and performance. During pregnancy and fetal development, if the mother consumes suboptimal levels of folate, the risk of neural-tube defects increases considerably. The lack of folate causes incomplete and altered neural-tube development within the spine, lead- ing to conditions such as spina bifida. Low folate causes a change in DNA, affecting various cells such as those in the lining of the intestines and causing absorption problems and chronic diarrhea. White blood cell development can also be impaired, contributing to poor immune function.

Insufficient intake of folate can lead to a type of anemia known as megaloblastic anemia. Because of an altered DNA synthesis, division of red blood cells is not normal, producing large, abnormal red blood cells with short life spans. These abnormal cells have a decreased oxygen-carrying capacity, leading to symptoms of anemia such as fatigue, weakness, irritability, and disturbed sleep. Because deficiencies in both B12 and folate can cause anemia, it is important to pay attention to all symptoms to prevent misdiagnosis and further complications. For example, if a B12 deficiency is mistaken for a folate defi- ciency, higher levels of folate will repair the megaloblas- tic anemia, but other neurological problems will continue to develop as a result of the low vitamin B12 intake. Low folate intake may also increase the risk for heart disease by allowing homocysteine levels to rise. Folate works with other water-soluble vitamins, B6 and B12, to reduce homo- cysteine levels in the blood.

What are the symptoms of folate toxicity? Folate toxicity is rare because ingesting excessive levels of folate is difficult to do through consumption of foods; in addition, excess folate is excreted in the urine. However, an UL has been established for adults at 1000 micrograms. The main reason for the UL is that high levels of folate can hide symptoms of vitamin B12 deficiency. Because ath- letes have an increased risk for vitamin B12 deficiency, observing the UL of folate will help prevent misdiagnosis and resulting complications.

Which foods are rich in folate? When thinking of folate, think “foliage” or plant foods. Folate-rich foods include many plant-based products, such as dark green leafy vegetables, strawberries, oranges, legumes, nuts, brewer’s yeast, and fortified grains (see

FIGURE 6.7 ). Folate fortification of grains and flours was mandated in 1996 and went into effect in 1998 in the United States as a result of a plethora of research show- ing the importance of adequate folate intake in reduc- ing the incidence of neural-tube defects. Fortification is estimated to increase the average American’s intake of folic acid by approximately 100 micrograms of folic acid per day. This increase in intake was designed to help Americans achieve the RDA of 400 micrograms per day, while not exceeding the upper limit of 1000 micrograms. For more information on folic acid fortification, visit the FDA’s website at www.fda.gov.

What is a suggestion for a folate-rich meal? Dinner: Black-Eyed Peas with Chinese Greens or Slow Cooker Navy Bean Soup (see TRAINING TABLES 6.1 and 6.2 )

Total folate content (per serving) = 407 micrograms for Black-Eyed Peas with Chinese Greens and 175 micrograms for Slow Cooker Navy Bean Soup.

Do athletes need folate supplements? Consuming a variety of plant-based, folate-rich foods should prevent problems such as anemia. Fortified grains should also be included as a significant source of folate for meeting the RDA. A multivitamin can be used for extra insurance of meeting needs. To date, there have been no studies suggesting an increased exercise capacity by con- suming extra folate.

Why is biotin important for athletes? In the 1920s, three similar compounds—bios II, vitamin H, and coenzyme R—were all found to be beneficial to the body. With further investigation, it was recognized that all three compounds were the same nutrient—bio- tin. Biotin plays a role in synthesizing DNA for healthy cell development and energy production for endurance activi- ties. Biotin is a cofactor for several carboxylase enzymes involved in the metabolism of carbohydrates, proteins, and fats. Biotin also helps produce energy by facilitating gluconeogenesis.

What is the RDA/AI for biotin? Currently, very little research exists on the biotin require- ments for a healthy adult. Therefore, no RDA has been set. The AI for adults is 30 micrograms per day.2

What are the complications of biotin deficiency? Biotin deficiency is rare because so little is required. A few cases of biotin deficiency have been observed in those with a prolonged consumption of raw egg whites and those dependent upon parenteral nutrition without biotin supplementation.22 Some documented signs and

152 SECTION 1 The Basics of Sports Nutrition

foodborne pathogens. Biotin content has not been deter- mined for most foods, and therefore is not listed on most food composition charts.

What is a suggestion for a biotin-rich meal or snack? Breakfast: 3 scrambled eggs with ¼ cup shredded ched- dar cheese and 2 tbsp peanut butter on 1 slice of whole wheat toast

Total biotin content = 57 micrograms

Do athletes need biotin supplements? Very little research has been conducted on biotin and exercise performance. Because no toxic level has been detected, supplemental biotin may not be harmful to health or performance, but it also may not be necessary.

symptoms of biotin deficiency include fatigue, depres- sion, nausea, dermatitis, and muscular pains.

What are the symptoms of biotin toxicity? No physical or mental signs or symptoms of biotin toxic- ity have been documented. Biotin appears to be safe even at high levels, so no upper limit has been set.

Which foods are rich in biotin? Biotin is found in a wide range of different foods. Legumes, cheese, egg yolks, nuts, and green leafy vegetables are all good sources of biotin. Raw egg whites will bind to bio- tin and may contribute to biotin deficiency if consumed on a regular basis. Cooking of egg whites alleviates this problem and also decreases the risk of sickness caused by

Figure 6.7 Food sources of folate. Good sources of folate are a diverse collection of foods, including liver, legumes, leafy greens, and orange juice. Enriched grains and fortified cereals are other ways to include folic acid in the diet.

85 g (3 oz) 30 g (1 cup) 30 g (1 cup)

Exceptionally good sources 491 µg 417 µg 400 µg

FOLATE

High: 20% DV or more

Good: 10–19% DV

Daily Value = 400 µg RDA = 400 µg (males/females)

Collards, cooked Sunflower seeds Beets, cooked Mustard greens, cooked White bread, enriched Tomato juice, canned Orange juice, chilled Crab, Alaska King, cooked Artichokes, cooked Kidney beans, canned Wheat germ Orange, fresh

85 g (~1/2 cup) 30 g (~ 1 oz) 85 g (~1/2 cup) 85 g (~2/3 cup) 50 g (2 slices) 240 mL (1 cup) 240 mL (1 cup) 85 g (3 oz) 85 g (~1/2 cup) 85 g (~1/2 cup) 15 g (1/4 cup) 140 g (1 medium)

79 µg 71 µg 68 µg 62 µg 56 µg 49 µg 45 µg 43 µg 43 µg 42 µg 42 µg 42 µg

All Bran cereal Beef liver, cooked Cheerios cereal Spinach, raw Lentils, cooked Pinto beans, cooked Black beans, cooked Asparagus, cooked Spinach, cooked Romaine lettuce, raw Black-eyed peas, cooked Corn flakes cereal Spaghetti, enriched, cooked Oatmeal, instant, fortified, cooked Turnip greens, cooked Soybeans, cooked Broccoli, cooked Rice, white, enriched, cooked

30 g (1/2 cup) 85 g (3 oz) 30 g (1 cup) 85 g (~3 cups) 90 g (~1/2 cup) 90 g (~1/2 cup) 90 g (~1/2 cup) 85 g (~1/2 cup) 85 g (~1/2 cup) 85 g (~11/2 cups) 90 g (~1/2 cup) 30 g (1 cup) 140 g (1 cup ) 1 cup

85 g (~2/3 cup) 90 g (~1/2 cup) 85 g (~1/2 cup) 140 g (~3/4 cup)

393 µg 221 µg 200 µg 165 µg 163 µg 155 µg 134 µg 127 µg 124 µg 116 µg 114 µg 110 µg 108 µg 101 µg

100 µg 100 µg 92 µg 81 µg

Chicken liver, cooked Wheat bran flakes cereal Product 19 cereal

Chapter 6 Vitamins 153

Why is pantothenic acid important for athletes? Because of the role pantothenic acid plays in energy metabolism, there is little question that it is important to athletes. Specifically, pantothenic acid is a component of coenzyme A, a molecule critical for the passage of meta- bolic intermediates from fat, carbohydrate, and protein metabolism into the citric acid cycle. The citric acid cycle is one of the major metabolic pathways involved in the

Training Table 6.1: Black-Eyed Peas with Chinese Greens 2 cups brown rice

2 tbsp minced ginger root

3 cloves garlic

1 tbsp peanut oil

1 tbsp sesame oil

2 lbs bok choy or napa cabbage

Three 15 oz cans of black-eyed peas

2 tbsp soy sauce

Bring 2 cups of water to a boil. Add the brown rice and cook at a simmer for 30 to 40 minutes until all the water is absorbed. In the meantime, sauté the ginger and garlic in the peanut and sesame oils in a Dutch oven for 5 to 10 minutes over medium-high heat. Cut the bok choy or cabbage into ½-inch strips and add to the ginger and garlic; cook for 5 to 7 minutes. Add the black-eyed peas and soy sauce, and cook for an additional 5 minutes.

Serve over brown rice.

Serving Size: 2 cups (Recipe makes 4–6 servings)

Calories: 540 kcals

Protein: 26 grams

Carbohydrate: 95 grams

Fat: 8 grams

Training Table 6.2: Slow Cooker Navy Bean Soup 1 lb dry navy beans

4 cups vegetable broth

4 cups water

1 cup carrots, chopped

3 celery stalks, chopped

2 garlic cloves, minced

1 cup onions, chopped

4 oz can chopped green chiles

15 oz can diced tomatoes

Rinse navy beans and put into large pot. Cover beans with 3 inches of water and soak overnight.

Rinse soaked beans and place in slow cooker. Add remaining ingredients and cook on low for 10 hours.

Serving size: 1.5 cups (Recipe makes 10 servings)

Calories: 186 kcals

Protein: 11 grams

Carbohydrate: 34 grams

Fat: 1 grams

aerobic production of ATP. The key question is whether pantothenic acid supplementation will improve athletic performance. Limited research has been conducted to date; however, pantothenic acid supplementation has not been shown to be beneficial to athletes.23,24

What is the RDA/AI for pantothenic acid? No RDA has been set for pantothenic acid. The AI is set at 5 milligrams per day for adults aged 19 to 50 years.2

What are the complications of pantothenic acid deficiency? Fatigue, sleep disturbances, impaired coordination, nausea, hypoglycemia, and muscle cramps can signal low levels of pantothenic acid. However, deficiencies are very rare.

What are the symptoms of pantothenic acid toxicity? There appear to be no risks with high intake of panto- thenic acid; therefore, no upper limit has been set.

Which foods are rich in pantothenic acid? Pantothenic acid can be found in beef, poultry, fish, whole grains, dairy products, legumes, potatoes, oats, and tomatoes (see FIGURE 6.8 ). Consuming fresh and whole foods is especially beneficial in regard to panto- thenic acid because freezing, canning, processing, and refining foods decrease the foods’ pantothenic acid con-

tent considerably.

What is a suggestion for a pantothenic acid–rich meal or snack? Lunch: Baked potato topped with ¾ cup garbanzo beans, ¼ cup salsa, and 2 tbsp melted cheese, and an 8 oz glass of skim milk

Total pantothenic acid content = 2.4 milligrams

Do athletes need pantothenic acid supplements? Because pantothenic acid is widespread in a balanced diet, and deficiencies are so rare, supplementation for athletes does not appear to be required. In addition, the existing research does not provide enough information to war- rant supplementation for enhanced athletic performance.

Why is choline important for athletes? Choline is a vitamin-like compound, but it is not con- sidered a B vitamin. Similar to biotin, choline is not well researched, and therefore limited information is available on its role in health and sport performance. Choline is involved in the formation of the neurotransmitter acetyl- choline, which is involved in muscle activation. In theory, higher intakes of choline would maintain higher blood levels of the nutrient and increased levels of acetylcholine in the nerve endings, thus preventing muscle fatigue and/ or failure. More research is needed to evaluate this theory,

154 SECTION 1 The Basics of Sports Nutrition

Do athletes need choline supplements? The current research results are equivocal for endurance sports as well as power and strength sports. A study by Hongu and Sachan25 reported that choline supplements given to healthy women promoted carnitine conservation

and favored incom- plete oxidation of fatty acids and dis- posal of fatty acid carbons in the urine. Earlier studies sug-

gest that this scenario, induced by the choline supple- ments, might reduce fat mass and increase fat oxidation during exercise.26,27 However, more research is needed to clarify choline’s role in physical activity and whether sup- plementation would be beneficial to athletes.

carnitine A compound that trans- ports fatty acids from the cytosol into the mitochondria, where they undergo beta-oxidation.

however. Choline has also been shown to help maintain the structural integrity of cell membranes.

What is the RDA/AI for choline? Because of the lack of research on choline, an RDA has not been set. The AI has been set at 550 and 425 milligrams per day for men and women, respectively.2

What are the complications of choline deficiency? The risk for choline deficiency is low because it is found in a wide variety of foods. The human body also makes choline endogenously, further decreasing the risk for deficiency.

What are the symptoms of choline toxicity? The signs and symptoms of choline toxicity include low blood pressure, diarrhea, and a fishy body odor. The upper limit for choline is set at 3500 milligrams per day, many times the AI level.

Which foods are rich in choline? Well-balanced diets provide sufficient levels of choline. Some of the richest sources of choline include lecithin, egg yolks, liver, nuts, milk, wheat germ, cauliflower, and soybeans. Choline can be produced in the body from the amino acid methionine. Therefore, ingesting protein-rich foods, which provide methionine, can indirectly contrib- ute to daily choline needs. Very few foods have been tested to determine choline levels, making food value databases containing choline unavailable.

What is a suggestion for a choline-rich meal or snack? Side dish for dinner: Roasted broccoli and cauliflower (see

TRAINING TABLE 6.3 ). Nutrient databases for choline are incomplete and therefore a nutrient analysis is not available.

Figure 6.8 Food sources of pantothenic acid. Pantothenic acid is found widely in foods, but it is abundant in only a few sources, such as liver. Note: The DV for pantothenic acid is higher than the current AI of 5 milligrams for males and females age 19 and older. Data from U.S. Department of Agriculture, Agricultural Research Service, 2012. USDA National Nutrient Database for Standard Reference, Release 25. Nutrient Data Laboratory home page. Available at: http://www.ars.usda.gov/ba/bhnrc/ndl.

Training Table 6.3: Roasted Broccoli and Cauliflower ½ lb broccoli

½ lb cauliflower

cooking spray

dried basil, oregano, and black pepper

Preheat oven to 500°F. Chop broccoli and cauliflower into 2-inch pieces and spread evenly on a cookie sheet coated with cooking spray. Spray more cooking spray on top of the vegetables and sprinkle with dried basil, oregano, and black pepper. Bake for 10 to 15 minutes and serve as a side dish to a favorite dinner.

Serving Size: 1½ cups (Recipe makes 2 servings)

Calories: 67 kcals

Protein: 5 grams

Carbohydrate: 13 grams

Fat: 1 gram

Beef liver, cooked Chicken liver, cooked Sunflower seeds

85 g (3 oz) 85 g (3 oz) 30 g (~1 oz)

6.0 mg 5.6 mg

PANTOTHENIC ACID

High: 20% DV or more

Good: 10–19% DV

Daily Value = 10 mg AI = 5 mg (males/females)

Mushrooms, cooked Yogurt, plain, nonfat Yogurt, plain, low-fat Turkey, dark meat, cooked Chicken, dark meat,

85 g (~1/2 cup) 225 g (8-oz container) 225 g (8-oz container) 85 g (3 oz) 85 g (3 oz)

1.8 mg 1.4 mg 1.3 mg 1.1 mg 1.0 mg

2.1 mg

cooked

Chapter 6 Vitamins 155

Why is vitamin C important for athletes? Vitamin C is also commonly referred to as ascorbic acid or ascorbate. It has received great attention in the last decade for its antioxidant properties. Vitamin C plays several roles

in promoting general health. It is critical for the formation of collagen, which is a fibrous protein found in connective tissues of the body such as tendons, ligaments, cartilage, bones, and teeth. Collagen syn- thesis is also impor-

tant in wound healing and the formation of scar tissue. Vitamin C plays a role in a healthy immune system and enhances iron absorption of nonheme iron, thus protect- ing the body against iron-deficiency anemia.

Cardiovascular research has indicated that vitamin C’s role as an antioxidant seems to be protective against heart disease, especially by preventing the oxidation of LDL, which can lead to atherosclerosis. Atherosclerosis is the progressive narrowing of the lumens of arteries caused by fatty deposits on their interior walls. Over time these fatty plaques can block blood supply to vital tissues, causing poor delivery of oxygen; with complete blockage, cell death occurs.

Vitamin C supplementation has recently been pro- moted to athletes as a potent antioxidant, helping to combat the oxidative damage that can occur during intense exercise. This potential function of vitamin C needs further investigation because current research is contradictory (see the section “Which vitamins or compounds have antioxidant properties?” later in this chapter). Vitamin C also aids in the formation of various hormones and in the production of neurotransmitters such as epinephrine.

What is the RDA/AI for vitamin C? The RDA for males is 90 milligrams per day and for females is 75 milligrams per day.28 If an individual smokes regularly, which increases oxidative stress and the meta- bolic turnover of vitamin C, the RDA increases by 35 mil- ligrams per day.28

What are the complications of vitamin C deficiency? The first signs of vitamin C deficiency are swollen gums and fatigue. If left untreated, the deficiency disease scurvy can develop, causing a degeneration of the skin, teeth, and blood vessels resulting from low collagen production. The physical manifestations of scurvy include bleeding gums, impaired wound healing, and weakness. However, deficiencies in the United States are rare because fruits

antioxidants Compounds that protect the body from highly reactive molecules known as free radicals.

collagen A fibrous protein found in connective tissues of the body, such as tendons, ligaments, carti- lage, bones, and teeth.

and vegetables that contain high levels of vitamin C are available year-round. As a protective mechanism, the body stores several grams of vitamin C in case of short periods of low vitamin C intake.

What are the symptoms of vitamin C toxicity? Vitamin C is a water-soluble vitamin, so it is relatively nontoxic. Intakes of greater than 1500 milligrams a day are not well absorbed, and excesses are excreted in the urine. However, at intake levels greater than the estab- lished upper limit of 2000 milligrams daily, side effects can include nausea, abdominal cramps, diarrhea, and nosebleeds. Long-term megadoses of vitamin C can also contribute to kidney stones, decrease the absorp- tion of other nutrients, and may increase the risk for heart disease.

Which foods are rich in vitamin C? The richest sources of vitamin C include citrus fruits and their juices, tomatoes and tomato juice, potatoes, green peppers, green leafy vegetables, kiwi, and cabbage (see

FIGURE 6.9 ).

What is a suggestion for a vitamin C–rich meal or snack? Snack: Fruit salad made with 1 orange, 2 kiwis, and ¾ cup cantaloupe

Total vitamin C content = 269 milligrams

Do athletes need vitamin C supplements? Some research supports the notion that athletes need higher levels of vitamin C than the RDA because of the oxi- dative stress of training and competition. Other research shows little or no benefit of vitamin C supplementation on athletic performance. It appears that in athletes with adequate vitamin C status, supplementation with vita- min C does not enhance exercise performance.29 The U.S. Olympic Committee has approved vitamin C supplements at levels of 250–1000 milligrams per day. Athletes can eas- ily obtain 200–500 milligrams of vitamin C per day through a well-balanced diet including plenty of fruits and vege- tables. Supplements used to achieve higher doses of vita- min C should be consumed with caution. As mentioned previously, vitamin C aids in iron absorption. For athletes who are low in iron, this action can be beneficial; how- ever, for those who are more susceptible to hemochro- matosis, which is a disorder that results in the excessive absorption of iron, vitamin C supplementation is not rec- ommended and may exacerbate symptoms.

Another condition, known as rebound scurvy, can occur in athletes or individuals taking in high levels of vitamin C. It is called rebound scurvy because it results when the body “rebounds” from long-term exposure to high levels of vita- min C to low levels. Long-term exposure to high dosages

156 SECTION 1 The Basics of Sports Nutrition

of vitamin C causes adaptations in the body. These adapta- tions increase daily excretion of vitamin C to help normalize vitamin C levels in the body. If the ath- lete suddenly stops supplementing, their body’s higher level of vitamin C excretion creates a deficiency that can cause scurvy. In this case, the scurvy is not caused by a poor intake of vitamin

Figure 6.9 Food sources of vitamin C. Vitamin C is found mainly in fruits and vegetables. Although citrus fruits are notoriously good sources, many other popular fruits and vegetables are rich in vitamin C. Note: The DV for vitamin C is lower than the cur- rent RDA of 90 milligrams and 75 milligrams for males and females, respectively, age 19 and older. Data from U.S. Department of Agriculture, Agricultural Research Service, 2012. USDA National Nutrient Database for Standard Reference, Release 25. Nutrient Data Laboratory home page. Available at: http://www.ars.usda.gov/ba/bhnrc/ndl.

C; it is caused by the rebound effect of adaptations resulting from high intake. This is another reason why caution should prevail when high dosages of supplements are being considered.

What are the fat-soluble vitamins? Vitamins A, D, E, and K make up the fat-soluble vitamins. These vitamins require small amounts of dietary fat to help the body absorb, transport, and utilize them. Unlike water-soluble vitamins, these vitamins can be stored in the body, primarily in fat tissues and the liver, but also

Chapter 6 Vitamins 157

Gaining the Performance Edge

Water-soluble vitamins include the B vitamins, vitamin C, and choline. Each vitamin has its own function in the body, DRI, complications of deficiency, symptoms of toxicity, unique food sources, and require- ments for supplementation. All water-soluble vitamins are critical to health, and therefore a variety of food sources should be consumed daily to meet the recommended levels for each nutrient.

Food for Thought 6.1

Importance of Vitamin Intake for Athletes: Water-Soluble Vitamins

Review the recommendations, food sources, and significance of water-soluble vitamins for athletes.

Strawberries, fresh Orange juice, chilled Orange, fresh Wheat bran flakes

Broccoli, cooked

140 g (~1 cup) 240 mL (1 cup) 140 g (1 medium) 30 g (3/4 cup)

Exceptionally good sources

82.3 mg 81.9 mg 74.5 mg 62.1 mg

VITAMIN C

High: 20% DV or more

Good: 10–19% DV

Daily Value = 60 mg RDA = 90 mg (males), 75 mg (females)

Potato, baked Peach, fresh Acorn squash, cooked Spinach, cooked Green beans, cooked Asparagus, cooked Corn flakes cereal Cheerios cereal

110 g (1 small) 140 g (2 small) 85 g (~1/2 cup) 85 g (~1/2 cup) 85 g (~3/4 cup) 85 g (~1/2 cup) 30 g (1 cup) 30 g (1 cup)

10.6 mg 9.2 mg 9.2 mg 8.3 mg 8.2 mg 6.5 mg 6.4 mg 6.0 mg

Cantaloupe, fresh Tomato juice, canned Mango, fresh Cauliflower, cooked

Spinach, raw Pineapple, fresh Watermelon, fresh Sweet potato, cooked Mustard greens, cooked Romaine lettuce, raw Beef liver, cooked Clams, cooked Cabbage, cooked Collards, cooked Soybeans, cooked Swiss chard, cooked Okra, cooked Blueberries, fresh Banana, fresh

140 g (1/4 medium melon) 240 mL (1 cup) 140 g (~3/4 cup) 85 g (~3/4 cup) 85 g (~1/2 cup) 85 g (~3 cups) 140 g (~1 cup) 280 g (1/16 melon) 110 g (1 small) 85 g (~2/3 cup) 85 g (~11/2 cups) 85 g (3 oz) 85 g (3 oz) 85 g (~1/2 cup) 85 g (~1/2 cup) 90 g (~1/2 cup) 85 g (~1/2 cup) 85 g (~1/2 cup) 140 g (~3/4 cup) 140 g (9" banana)

51.4 mg 44.5 mg 38.8 mg 37.7 mg 35.7 mg 23.9 mg 23.7 mg 22.7 mg 21.6 mg 21.5 mg 20.4 mg 19.6 mg 18.8 mg 17.1 mg 15.5 mg 15.3 mg 15.3 mg 13.9 mg 13.6 mg 12.2 mg

in other organ tissues in smaller amounts. As a result, the levels of fat-soluble vitamins in the body can build over time, potentially causing toxicity. Dietary intake from food rarely causes toxic buildup of the fat-soluble vita- mins, but the risk for accumulating toxic levels in the body increases with the use of supplements containing high levels of these vitamins.

Why is vitamin A important for athletes? Vitamin A has numerous functions in the body and is found in three different forms: retinol, retinal, and retinoic acid. These three forms are collectively called retinoids.

One of the crucial functions of vitamin A in the body is its role in vision (see FIGURE 6.10 ). Retinol is transported in the blood to the retina in the eye, where it is

converted to retinal. Retinal combines with the protein opsin to form the pigment rhodopsin, which allows humans to see black-and-white images. Iodopsin, another pigment that involves retinal, allows humans to see color

retinoids A class of compounds that have chemical structures similar to vitamin A. Retinol, retinal, and retinoic acid are three active forms of vitamin A that belong to the retinoid family of compounds.

Figure 6.10 Vitamin A and the visual cycle. Rhodopsin is the combination of the protein opsin and vitamin A (retinal). When stimu- lated by light, opsin changes shape, and vitamin A changes from its bent cis form to a straighter trans form. This sends a signal to the brain, allowing images to be seen in black and white. A similar process using a different protein called iodop- sin provides color.

VISUAL CYCLE IN RETINASTRUCTURE OF RETINA

Rhodopsin

Bleached rhodopsin

cis-Retinal

Rod

Cone

trans- Retinal

11 trans-Retinol

cis-Retinol

Opsin

Light

Cornea

Retina

Optic nerve

Sensory retina

Photoreceptor cells (rods and cones)

Responds to dim light. Processes black-and- white images.

Responds to bright light. Translates light to color images.

All trans-retinol circulating in bloodstream

Signal to brain

Opsin

images. Light entering the eye stimulates a process of sep- arating retinal from the opsin and iodopsin, causing the proteins to change shape. The change in protein shape stimulates optical receptors in the retina that send elec- trical impulses to the brain, which, in turn, enables sight. When vitamin A is deficient, blindness can occur.

Vitamin A also functions in cell differentiation, the process by which stem cells (i.e., cells that possess the capability of dividing and forming any body tissue) develop into specialized cells with specific functions within the body. For example, vitamin A is very important in the differentiation of epithelial cells, which are found throughout the body and form tissues such as the skin and mucous membranes. Epithelial cells also form the lin- ings of internal organs and passageways of the digestive, respiratory, and circulatory systems. Vitamin A actually activates specific genes within the stem cell nuclei that initiate the differentiation of the appropriate tissue type. Adequate vitamin A is essential for athletes to help repair those tissues that may be injured during sporting events. Vitamin A also appears to have a role in immune func- tion by helping to maintain the skin and mucous mem- branes (i.e., the epithelial tissues), which act as barriers to infection by bacteria and other pathogens. In fact, the

158 SECTION 1 The Basics of Sports Nutrition

maintenance of epithelial tissues in preventing infection is so important that vitamin A has been labeled as the “anti-infection” vitamin. Vitamin A also appears to play a role in bone formation and the maintenance of reproduc- tive health. Finally, vitamin A has shown some promise as an antioxidant that may help prevent cancer and cer- tain chronic diseases. For more information regarding the antioxidant role of vitamin A, see the section “Which vita- mins or compounds have antioxidant properties?” later in this chapter.

What is the RDA/AI for vitamin A? Vitamin A can be consumed in the diet from animal sources as retinoids or from plant sources as carotenoids. The RDA for vitamin A reflects recommendations based on typical

consumption of both plant (carotenoid) and animal (retinoid) sources. However, similar amounts of dietary retinoids and dietary carot- enoids do not pro- vide similar amounts of vitamin A. Carot- enoids are less bio- logically active than

are retinoids, and therefore greater amounts need to be consumed to meet daily requirements. Because of this dif- ference, the scientific community developed a standard- ized measurement that can be used for both carotenoid and retinoid consumption in the diet. This standard is the retinol activity equivalent (RAE). One RAE is the amount of

a given form of vita- min A equal to the activity of 1 micro- gram of retinol (see FIGURE 6.11 ). The RDA for vitamin A for adult males is 900

micrograms RAE and for adult females is 700 micrograms RAE.30 Although carotenoids may be slightly lacking in their ability to convert to vitamin A, their overall contribu- tion to physical health is expansive. Carotenoids are dis- cussed in more detail in the next section.

Vitamin A content is often expressed in another mea- surement called International Units (IU). This measure is outdated and does not accurately take into consideration

bioavailability or absorptive efficiency of the carotenoids. Nonetheless, IU is often the way vita- min A is expressed

on the labels of vitamin supplements. When using IU, the recommended intake is 5000 IU daily.

retinol activity equivalent (RAE) A unit of measure of the vi- tamin A content in foods. One RAE equals 1 microgram of retinol.

Figure 6.11 Retinol equivalents conversion. Retinol activity equiva- lent (RAE) is a unit of measurement for the vitamin A con- tent of a food. One RAE equals 1 microgram of retinol.

1 retinol activity equivalent (RAE) = 1 lg retinol

= 12 lg dietary beta-carotene

= 24 lg dietary carotenoids

= 2 lg supplemental beta-carotene

What are the complications of vitamin A deficiency? Deficiency of vitamin A is rare in the United States, but it does exist in many countries where general malnutrition is found. Blindness is the most common and devastat- ing result of deficiency. Night blindness is often an early symptom of vitamin A deficiency. Early treatment with supplemental vitamin A can reverse these symptoms and prevent further damage to the retina. The skin can develop hyperkeratosis from lack of vitamin A. Hyperker- atosis is caused by the overproduction of the protein kera- tin, which plugs skin follicles, thickens the skin surface, and causes it to become bumpy and scaly. Other epithelial cells are also affected. The mucous-producing cells may not secrete mucus, thus causing dryness in the mucous

membranes of the mouth, intestinal tract, female genital tract, male seminal vesicles, and lin- ings of the eyes. This increases the risk of infections and can cause infertility in women and sterility in men.

What are the symptoms of vitamin A toxicity? Toxicity of vitamin A is rare except in cases of megadoses of vitamin A supplements. Children may be at greater risk of toxicity. Vitamin A toxicity produces a wide range of symptoms, including skin conditions, vomiting, fatigue, blurred vision, and liver damage. Vitamin A toxicity can be fatal. The tolerable UL for vitamin A is 3000 micrograms per day of retinol.

Which foods are rich in vitamin A? Animal food sources of retinoids are beef and chicken liver (see FIGURE 6.12 ) and milk. Fruits and vegetables that contain high amounts of carotenoids provide substantial

International Units (IU) An outdated system used to measure vitamin activity.

carotenoids A class of colorful phytochemicals that give plants and their fruit the deep colors of orange, red, and yellow. There are hundreds of different carotenoids; however, the ones most identified as vital to health include alpha- and beta-carotene, lycopene, lutein, zeaxanthin, and cryptoxanthin.

hyperkeratosis A clinical condi- tion resulting from the overpro- duction of the skin protein known as keratin. Overproduction of keratin plugs skin follicles, thickens the skin surface, and causes skin to become bumpy and scaly. Vitamin A deficiency is related to hyper- keratosis.

Chapter 6 Vitamins 159

vitamin A in the diet when converted to retinol equiv- alents. Vitamin A–fortified dairy products provide addi- tional sources of vitamin A in the United States.

What is a suggestion for a vitamin A–rich meal or snack? Lunch: Mix ½ can of salmon (oil-packed), 1 tsp light salad dressing, and chopped onion, celery, and tomato; serve on 2 slices of whole grain bread with ½ cup fresh fruit and 1 cup low-fat milk

Vitamin A content: 365 micrograms (RAE)

Do athletes need vitamin A supplements? Helping athletes meet the RDA for vitamin A from food sources appears to be the most prudent current recommen- dation. Research on supplementing vitamin A in amounts greater than the RDA to improve sport performance has not shown any ergogenic value. Therefore, encouraging athletes to obtain vitamin A from food sources rather than supplements to avoid toxicity is recommended.

Why are the carotenoids important for athletes? The carotenoids are a group of naturally occurring com- pounds found in plants. They are colorful compounds that give plants and their fruit the deep colors of orange, red, and yellow. Dark green vegetables also contain carot- enoids, but the chlorophyll in these plants gives them their

green color and masks the carotenoid colors. Carotenoids are not vitamins; however, because some of them can be converted to vitamin A, discussion of these compounds has been included in this chapter. There are approxi- mately 600 different carotenoids identified in plants. The major carotenoids include alpha- and beta-carotene, lyco- pene, lutein, zeaxanthin, and cryptoxanthin. As discussed previously, some carotenoids are precursors to vitamin A. These provitamin A carotenoids are beta-carotene, alpha- carotene, and beta-cryptoxanthin. Because they have no vitamin A activity in the body, lycopene, lutein, and zea- xanthin are called non-provitamin A carotenoids.

Carotenoids as precursors to vitamin A play a role in vitamin A functions. However, they also have additional functions in the body that are exclusive to carotenoids. They have roles as antioxidants, bolster immune function, aid in cancer prevention, and enhance vision. Beta-caro-

tene and other carot- enoids are powerful antioxidants that interfere with free radical activity (refer to the “What are free radicals?” section later in this chapter). The carotenoids

Figure 6.12 Food sources of vitamin A. Vitamin A is found as retinol in animal foods and as beta-carotene and other carotenoids in plant foods. Units are IU to be consistent with DV definitions. Data from U.S. Department of Agriculture, Agricultural Research Service, 2012. USDA National Nutrient Database for Standard Reference, Release 25. Nutrient Data Laboratory home page. Available at: http://www.ars.usda.gov/ba/bhnrc/ndl.

VITAMIN A

Chicken liver, cooked

Spinach, cooked Spinach, raw Collards, cooked Romaine lettuce, raw Cantaloupe, fresh Peppers, red, cooked Broccoli, cooked Watermelon, fresh Oatmeal, instant, fortified, cooked Tomato juice, canned Mango, fresh

85 g (3 oz)

85 g (~1/2 cup) 85 g (~3 cups) 85 g (~1/2 cup) 85 g (~11/2 cups) 140 g (1/4 med. melon) 85 g (~1/2 cup) 85 g (~1/2 cup) 280 g (1/16 melon) 1 cup

240 ml (1 cup) 140 g (~1 cup)

Exceptionally good sources

12,221 IU

8,909 IU 7,970 IU 6,897 IU 4,936 IU 4,735 IU 4,265 IU 1,716 IU 1,593 IU 1,252 IU

1,094 IU 1,071 IU

High: 20% DV or more

Good: 10–19% DV

Daily Value = 5000 IU RDA = 900 μg (males), 700 μg (females)

Apricot, dried Wheat bran flakes cereal Prunes, dried Black-eyed peas, cooked Green beans, cooked Corn flakes cereal All-bran cereal Milk, 1%, 2%, nonfat

40 g (~3 Tbsp) 30 g (3/4 cup) 40 g (~5 prunes) 90 g (~1/2 cup) 85 g (~3/4 cup) 30 g (1 cup) 30 g (1/2 cup) 240 ml (1 cup)

856 IU 788 IU 705 IU 712 IU 595 IU 537 IU 524 IU 500 IU

Beef liver, cooked Sweet potato Carrots, cooked

85 g (3 oz) 110 g (1 small) 85 g (~1/2 cup)

22,175 IU 21,140 IU 19,152 IU

free radicals Highly reactive molecules, usually containing oxy- gen, that have unpaired electrons in their outer shell. Because of their highly reactive nature, free radicals have been implicated as culprits in diseases ranging from cancer to cardiovascular disease.

160 SECTION 1 The Basics of Sports Nutrition

work primarily to keep free radical pro- duction from becom- ing uncontainable and thus prevent any negative health effects. As an exam- ple, two carotenoids, lutein and zeaxan- thin, are found in the macula of the eye. The function of the macula is to provide detailed and sharp vision. It is theorized that lutein and zea- xanthin help filter

the harmful light entering the macula and scavenge free radicals in the retinal tissues. This theory is reinforced by recent epidemiological studies that have suggested that increased intake of lutein lowers the risk for age-related macular degeneration.

What is the RDA/AI for carotenoids? There are no established RDA/AIs for the carotenoids. However, carotenoid consumption was taken into con- sideration when developing the RAE used to establish the RDA and UL for vitamin A. A large body of obser- vational epidemiological evidence suggests that higher blood concentrations of beta-carotene and other carot- enoids obtained from foods are associated with lower risk of several chronic diseases.28 The evidence appears to be consistent in the studies but cannot be used to estab- lish specific RDAs for carotenoids because it is unclear whether the carotenoids alone or other substances in the foods consumed produced the desired effects. Although no DRIs are established for carotenoids, the Food and Nutrition Board recommends eating foods rich in carot- enoids and avoiding supplementation.28

Which foods are rich in carotenoids? Most colorful fruits and vegetables contain carotenoids. The best sources include deep red, yellow, and orange

fruits and vegetables. Tomatoes and tomato products, red peppers, leafy greens, apricots, watermelon, cantaloupe, pumpkin, squash, sweet potatoes, carrots, and oranges are all excellent sources of carotenoids.

Why is vitamin D important for athletes? Vitamin D is a unique fat-soluble vitamin because, in gen- eral, all of the body’s needs for it can be met by synthe- sis within the body. It is sometimes called the “sunshine vitamin” because the ultraviolet rays of the sun hitting the skin initiate vitamin D synthesis in the body. However, vitamin D may not be produced in high enough quantities in the following instances: in geographic locations where sunlight is marginal; during seasons when sunshine is insufficient; in instances when people are told to stay out of the sun; or in instances when individuals are physically disabled or infirm and cannot go outside. It is in these cases that vitamin D, from food or supplemental sources, is essential and, as a result, is considered a vitamin.

The primary role of vitamin D in the body is to control calcium levels in the blood, which, in turn, affects bone growth and development. However, vitamin D itself is not the active compound that affects the body’s calcium lev- els. It first must be converted through a series of reactions in the liver and then the kidneys to calcitriol (see FIGURE 6.13 ). Cholecalciferol (from animal foods and sun- light conversion) and ergocalciferol (from plant foods) can

both be converted to calcitriol. Sunlight exposure initiates the process by con- verting 7-dehydro- cholesterol in the

skin to cholecalciferol. This converted cholecalciferol is carried to the liver, where it and dietary cholecalciferol and ergocalciferol are converted to calcidiol. Calcidiol is then transported to the kidneys, where calcitriol is formed. Calcitriol is the active form of vitamin D in the body. Because calcitriol is produced in one area of the body (the kidneys), carried in the blood, and then exerts effects on tissues in other areas of the body (e.g., bone), it can also be considered a hormone.

The total extent to which vitamin D acts as a hor- mone is not fully understood; however, research is provid- ing compelling evidence that its importance to the body is more widespread than previously thought. Vitamin D is not only crucial for bone health, as previously noted, but also important for immune function, control of inflamma- tion, and even muscle function.31 In fact, vitamin D defi- ciency has been associated with increased risk for several chronic and autoimmune diseases, such as hypertension, cardiovascular disease, rheumatoid arthritis, depression, and certain cancers.31 The growing evidence regarding the importance of vitamin D and the fact that 77% of Ameri- cans are considered vitamin D insufficient32 has caused some nutrition professionals and researchers to question the current RDA for vitamin D as being too low.

calcitriol The active form of vitamin D in the body. It plays a vital role in calcium regulation and bone growth.

Chapter 6 Vitamins 161

Fortifying Your Nutrition Knowledge

Tips for Increasing Carotenoid Intake Athletes can increase their carotenoid intake by:

■ Eating 5 to 9 servings per day of fruits and vegetables. ■ Choosing more colorful vegetables and fruits, including

reds, yellows, blues, and purples. ■ Including at least one vegetable or fruit in each meal

and a serving of fruit or vegetables as a snack. ■ Drinking 6–8 oz of 100% fruit juice, such as grape,

orange, grapefruit, or cranberry, with breakfast.

Gaining the Performance Edge

Carotenoids are a unique cate- gory of plant-based substances that can positively affect overall health. Some functions, including improved immune function and antioxidant activity, may also be beneficial to athletic performance. Although no DRI has been set for these compounds, a diet rich in dark, colorful fruits and vegetables has been found to be advantageous to health and well-being.

Figure 6.13 Vitamin D: from source to destination. Vitamin D is unique because, given sufficient sunlight, the body can synthesize all it needs. Both dietary and endogenous vitamin D must be activated by reactions in the kidneys and liver. Active vitamin D (calcitriol) is important for calcium balance and bone health, and may have a role in cell differentiation.

Sun

VITAMIN D: FROM SOURCE TO DESTINATION

Dietary calciferol (ergocalciferol D2, cholecalciferol D3)

Small intestine Vitamin D is absorbed with fat

Parathyroid hormone

Kidney

Liver

Intestine Bone Other tissues

Ultraviolet light

Provitamin D3 in skin (7–dehydrocholesterol)

Cholecalciferol (vitamin D3)

Calcitriol (1,25(OH)2D3) Primary active form of vitamin D

Food sources

Ultraviolet light from the sun causes a form of cholesterol (7–dehydrocholesterol) to be converted to an inactive form of vitamin D (cholecalciferol, or D3).

Dietary vitamin D is incorporated into chylomicrons, and travels to the liver via the lymphatic system and bloodstream.

Calcitriol enhances the absorption of calcium and phosphorus in the small intestine.

Calcitriol assists parathyroid hormone in stimulating osteoclasts to break down bone and release calcium into the blood. Calcitriol also controls the rate of bone calcification.

Vitamin D receptors are found in a variety of other tissues. Vitamin D is believed to inhibit cell proliferation and enhance cell differentiation activity.

When stimulated by parathyroid hormone, the kidneys convert calcidiol to calcitriol (1,25(OH)2D3), the primary active form of vitamin D in the body.

The liver converts D3 to calcidiol (25(OH)D3).

C Chylomicrons

25(OH)D3 1,25(OH)2D3

D3 25(OH)D3

162 SECTION 1 The Basics of Sports Nutrition

What is the RDA/AI for vitamin D? The RDA for vitamin D assumes that no vitamin D is avail- able from synthesis from exposure to sunlight. For men and women aged 19 to 70 years, the RDA is 600 IU per day.33 For men and women older than 70, the RDA is 800 IU per day. As people age, they have less ability to synthesize vitamin D from sun exposure; therefore, as age increases, the RDA also increases. Similar to vitamin A, International Units (IU) are used to express vitamin D recommenda- tions. The IU is presented on food labels and is used as the unit level for %DV.

As noted earlier, a growing number of researchers and nutrition professionals feel the current RDA is too low. The Endocrine Society, an international medical organization whose membership comprises doctors and researchers in the fields of endrocrinology and metabolism, recom- mends that the daily intake of vitamin D for men and women age 19 and older, including those over age 70, should be 1500 to 2000 IU per day.34

What are the complications of vitamin D deficiency? Because of the profound effect vitamin D has on absorp- tion of dietary calcium, vitamin D deficiency can have devastating effects on bone health. In children, vitamin D deficiency leads to rickets, which results in poorly formed, weak, and soft bones. In adults, deficiency of vitamin D increases the risk for osteoporosis. The fortification of milk with vitamin D was intended to address deficiency problems in children and adults in the United States. However, fortification of milk has not alleviated this prob- lem. Therefore, adequate vitamin D intake in food or in supplement form is an essential part of developmental bone health, as well as prevention and treatment of osteo- porosis in the aging population.

In athletes, vitamin D deficiency may manifest itself in a variety of ways. Muscle weakness, muscle pain, chronic injury, frequent illness, changes in bowel function, and bone pain can all be signs of a vitamin D deficiency. Unfortunately, these symptoms are also indicative of other health conditions and as a result, screening for vitamin D deficiency via blood testing is recommended for athletes. See TABLE 6.2 for reference ranges of vitamin D screening.

What are the symptoms of vitamin D toxicity? Because it is stored in the body, toxicity of vitamin D can occur. Overexposure to the sun or dietary intake of vitamin D from food sources is unlikely to cause toxicity, but sup- plementation in high doses can cause problems. The UL for vitamin D for adults over age 19 is 4000 IU. Overdosing with vitamin D causes hypercalcemia, or high blood cal-

cium. Hypercalcemia causes a depressed function of the ner- vous system, muscu- lar weakness, heart

hypercalcemia A clinical condi- tion in which blood calcium levels are above normal.

Table 6.2

Serum Vitamin D [25(OH)D] Concentrations and Status

Serum concentration (nmol/L)*

Serum concentration (ng/mL)*

Status

< 50 < 20 Associated with vitamin D deficiency, leading to rickets in infants and children and osteomalacia in adults

50–80 20–32 Generally considered insufficient for bone and overall health.

≥ 80 ≥ 32 Generally considered sufficient for bone and overall health

100–250 40–100 Growing evidence suggests as optimal

> 375 > 150 Potential adverse effects due to toxicity

*Serum concentration of vitamin D are reported both in nanomoles per liter (nmol/L) and nanograms per milliliter (ng/mL).

Source: Ogan D, Pritchett K. Vitamin D and the athlete: risks, recommendations and benefits. Nutrients. 2013;5:1856–1868.

arrhythmias, and calcium deposits in the kidneys (i.e., kid- ney stones), blood vessels, and other soft tissues.

Which foods are rich in vitamin D? Food sources of vitamin D come in natural and fortified forms (see FIGURE 6.14 ). Fortified forms are included in milk, cereals, orange juice, and some margarines. Natu- ral sources include fish oils, salmon, sardines, herring, egg yolks, and liver. Plants are poor sources of vita- min D; therefore, strict vegetarians need to rely on the endogenous production of vitamin D from sun expo- sure or the consumption of fortified foods and the use of supplements.

What is a suggestion for a vitamin D–rich meal or snack? Bedtime snack: 12 oz skim milk and 2 oatmeal raisin cookies

Vitamin D content: 158 IU

Do athletes need vitamin D supplements? Vitamin D fortification in milk and other foods and the fact that it is manufactured in the body would seem to suggest that most individuals, athletes included, main- tain adequate amounts of vitamin D. However, few studies have reported on vitamin D status in athletes. A review of the literature on vitamin D and athletes revealed that many border on the line between inadequate and ade- quate intake of vitamin D as determined by blood serum analysis.31 This is why many nutrition professionals are

Chapter 6 Vitamins 163

now suggesting that athletes have their blood serum lev- els for vitamin D tested. Athletes who train extensively indoors or who consume lower or inadequate amounts of calories or whose food choices do not include vitamin D–rich sources daily may need and benefit from supple- mentation. In addition to supplementation, the follow- ing strategies will help contribute to vitamin D levels in the body:

• Obtain exposure to the sun for 15 minutes every day. Even exposure on the face and hands is enough to synthesize adequate vitamin D. However, athletes should protect their skin from too much sun expo- sure and sunburn.

• Drink milk with meals or as a snack. • Consume fortified cereals with milk for breakfast. • Try canned or fresh salmon as an alternative to tuna.

Why is vitamin E important for athletes? Vitamin E is actually a group of compounds that include the tocopherols and the tocotrienols. Both tocopherols and tocotrienols contain four compounds each: the alpha, beta, gamma, and delta configurations. The tocopherols are more widely distributed in nature than tocotrienols and contribute most of the dietary sources of vitamin E. Although all of these compounds can be absorbed in the body, only alpha-tocopherol is considered to have vita- min E activity in the body.28 It is the alpha-tocopherol configuration of vitamin E that is used to determine the RDA values.

The primary role of vitamin E in the body is as an antioxidant. Antioxidants protect the body from highly reactive molecules known as free radicals (refer to the

“What are free radicals?” section later in this chapter). Free radicals are molecules that have unpaired electrons, which give the molecules an electrical charge, thus mak- ing them unstable and highly reactive. If not neutralized, free radicals will react with molecules in the body, poten- tially changing these molecules’ structure and/or func- tion. The end result can be an increased risk for damage to tissues such as the skin and other connective tissues. The role vitamin E plays in protecting the skin and its under- lying connective tissues is one reason why vitamin E has been advertised as the “anti-aging” vitamin.

Vitamin E not only protects the skin and connective tissues, but also helps to protect the cell membranes and genetic material of virtually all tissues of the body. Free radicals are highly reactive with fatty acids. Because cell membranes are made up of phospholipids (i.e., they con- tain fats), cell membranes can be attacked by free radicals. Vitamin E protects cell membranes by directly reacting with free radicals, thus preventing them from reacting with the fatty acids in the cell membranes. Free radicals can also react with the genes inside the nuclei of cells, resulting in genetic mutations that could cause aberrant cell growth and/or cancer; vitamin E can help prevent these genetic alterations. Dietary intake of appropriate amounts of vitamin E helps to provide adequate levels of this very important antioxidant vitamin.

What is the RDA/AI for vitamin E? The RDA for vitamin E is 15 milligrams of alpha-tocoph- erol for men and women.28 As with vitamin A, the dis- continued International Units (IU) are still found on

Figure 6.14 Food sources of vitamin D. Only a few foods are naturally good sources of vitamin D. Therefore, fortified foods such as milk and some cereals are important, especially for people with limited exposure to the sun. Units are IU to be consistent with DV definitions.

Salmon, canned, solids + bones Sardines, canned, solids + bones Milk, nonfat Milk, 1%, 2% milkfat Fortified orange juice 240 mL (1 cup) 100 IU Milk, whole, 3.25% milkfat

55 g (2 oz) 55 g (2 oz) 240 mL (1 cup) 240 mL (1 cup)

240 mL (1 cup)

Exceptionally good source

343 IU 150 IU 105 IU 102 IU

98 IU

Fortified, ready-to-eat cereals Beef liver 85 g 40 IU Egg yolk

30 g

1 large

40–50 IU

37 IU

High: 20% DV or more

VITAMIN D

Daily Value = 400 IU RDA = 600 IU age 19–70 (males/females) 800 IU age 70+ (males/females)

Cod liver oil 1 Tbsp 1360 IU

Good: 10–19% DV

164 SECTION 1 The Basics of Sports Nutrition

supplement labels. To convert IU to milligrams of vitamin E, use the following equations:

1 IU = 0.67 mg of the natural form of alpha-tocopherol 1 IU = 0.45 mg of the synthetic form of alpha-tocopherol

To meet the RDA recommendations of 15 milligrams, the IU equivalent is 23 IU for the natural form and 34 IU for the synthetic form.

What are the complications of vitamin E deficiency? Overt deficiency of vitamin E is rare because it appears dietary intake is adequate in the general population. Indi- viduals who choose extremely low-fat or fat-free diets could develop vitamin E deficiency over time. Conditions resulting in malabsorption or maldigestion of lipids, such as cystic fibrosis, celiac disease, or hepatic or biliary dis- eases, may result in poor absorption of vitamin E and thus compromise vitamin E status. Common signs of vitamin E deficiency take time to develop and are related to the breakdown of cell membranes. Muscle weakness and loss of motor coordination can result because of cell mem- brane damage to muscle and nerve tissue, respectively. In addition, the breakdown of cell membranes of red blood cells results in hemolytic anemia, causing lack of energy and decreased physical functioning.

What are the symptoms of vitamin E toxicity? Vitamin E is less likely than other fat-soluble vitamins, such as A and D, to become toxic to the body. However, high doses of vitamin E resulting from supplementation

Figure 6.15 Food sources of vitamin E. Nuts and seeds, vegetable oil, and products made from vegetable oil, such as margarine, are among the best sources of vitamin E. Units are IU to be consistent with DV definitions. The DV for vitamin E is higher than the current RDA of 15 milligrams (23 IU) for males and females age 19 and older. Note: USDA tables list vitamin E in mg alpha-tocopherol equivalents. Conversion to IU was done using 1 mg ATE = 1.5 IU.

can affect vitamin K’s blood-clotting functions, leading to excessive bleeding and easy bruising. The UL for adults is 1000 milligrams of alpha-tocopherol.

Which foods are rich in vitamin E? Common food sources of vitamin E include both plant and animal products (see FIGURE 6.15 ). Plant oils such as corn, safflower, cottonseed, sunflower, soy, and palm oils are good sources of vitamin E. Products made from these oils, such as margarine, shortening, mayonnaise, and salad dressings, also contain vitamin E. Fortified cereals can be a good source of this vitamin; however, not all cere- als are fortified with vitamin E. Animal sources such as meat, poultry, and fish are at best moderate contributors to dietary vitamin E.

What is a suggestion for a vitamin E–rich meal or snack? Nutty black bean salad: Mix together 1 cup black beans; 1 tbsp sunflower seeds; ¼ cup each chopped tomato, corn, and green pepper; 1 tbsp corn oil; and 1 tbsp balsamic vin- egar. Serve with whole grain bread and fruit juice.

Total vitamin E content = 27 IU or 18 milligrams alpha-tocopherol

Do athletes need vitamin E supplements? Much research has been conducted on vitamin E sup- plementation in hopes of finding an ergogenic effect in athletes. This research has focused on vitamin E’s antioxi- dant effects during exercise. The impact of antioxidants is discussed later in the chapter.

Chapter 6 Vitamins 165

Corn oil Peanuts Spinach, frozen, cooked

1 Tbsp 30 g (~1 oz) 85 g (~1/2 cup)

Exceptionally good sources

4.2 IU 3.8 IU 3.0 IU

High: 20% DV or more

VITAMIN E

Daily Value = 30 IU RDA = 15 mg (males/females)

Good: 10–19% DV

Total cereal Product 19 cereal

Sunflower seeds Almonds Cottonseed oil Safflower oil Special K cereal Hazelnuts Tomato paste, canned

30 g (~3/4 cup) 30 g (~1 cup)

30 g (~1 oz) 30 g (~1 oz) 1 Tbsp 1 Tbsp 30 g (~1 cup) 30 g (~1 oz) 130 g (~1/2 cup)

30.2 IU 30.2 IU

15.5 IU 11.6 IU 7.2 IU 7.0 IU 7.0 IU 6.8 IU 6.0 IU

Wheat bran flakes cereal Wheat germ oil

30 g (~3/4 cup) 1 Tbsp

41.7 IU 30.5 IU

What are the symptoms of vitamin K toxicity? Vitamin K is excreted from the body much more readily than the other fat-soluble vitamins, making vitamin K toxicity rare. A UL has not been established because few adverse effects have been reported for individuals con- suming high amounts of vitamin K.

Which foods are rich in vitamin K? Like vitamin D, vitamin K can be made endogenously. However, the body cannot make enough vitamin K to meet all of its needs. The best dietary sources of vitamin K are green leafy vegetables such as spinach and broccoli. Other foods such as milk, eggs, wheat cereals, and some fruits and vegetables contain small amounts of vitamin K (see FIGURE 6.16 ).

What is a suggestion for a vitamin K–rich meal or snack? Green vegetable salad: 1 cup spinach, ½ cup chopped broc- coli, 1 chopped hard-boiled egg, 4 diced scallions, and ¼ cup carrot shreds served with 1 tbsp light ranch dressing

Total vitamin K content = 170 micrograms

Do athletes need vitamin K supplements? There are no known studies that support an increased need for vitamin K in athletes. Supplementation may be indicated for individuals with risks for deficiency or who present with deficiency symptoms. Supplementation should be provided with physician guidance and supervi- sion, and often requires a prescription. Athletes who are injured and require surgery should inform their physician prior to surgery about any vitamin supplements they use regularly. Most surgeons require their patients to stop tak- ing multivitamins prior to surgery because some vitamins can increase clotting times, increasing the risk of bleeding during surgery.

Which vitamins or compounds have antioxidant properties? Two of the fat-soluble vitamins, A (including the carot- enoids) and E, and the water-soluble vitamin C all have powerful antioxidant properties in the body. As men- tioned earlier, antioxidants protect tissues of the body from highly reactive molecules known as free radi- cals. The following sections discuss free radicals, their association with exercise, and the role that vitamins A, E, and C play in combating them.

What are free radicals? To understand the antioxidant functions of vitamins and other compounds in the body, it is important to first have a basic knowledge of free radicals, where they come from, and how they are eliminated. Free radicals are highly reactive molecules, usually containing oxygen,

Why is vitamin K important for athletes? Vitamin K belongs to the quinone family of compounds and is probably the least known of the fat-soluble vita- mins. The primary role of vitamin K in the body is in blood clotting. When a laceration or an abrasion occurs, a series of activation reactions involving clotting factors is required to stop the bleeding. Vitamin K is essential in many of the steps of the clotting process. Without vita- min K, even a single cut could be life-threatening from the potential blood loss. Vitamin K is also important to bone health. It assists in the mineralization of bone with calcium, thus keeping bones dense and strong.

What is the RDA/AI for vitamin K? Because of the lack of data regarding average requirements, no RDA has been established for vitamin K. As a result, AI is used to represent intake levels. The AI for vitamin K for men older than 19 years of age is 120 micrograms; for women older than 19 years of age, the AI is 90 micrograms daily.30

What are the complications of vitamin K deficiency? A deficiency of vitamin K impairs blood clotting and can lead to substantial hemorrhaging. Thus, vitamin K is important to athletes, who are much more likely than the general population to receive cuts, tears, and abrasions as a result of their sport participation. The body needs only small amounts of vitamin K, and it can produce some of the daily requirement through the action of intestinal bac- teria. The intestinal bacteria can produce approximately 10–15% of the vitamin K in the body.35 The vitamin K pro- duced by the body along with dietary vitamin K is absorbed with fat in the intestines, packaged into chylomicrons, and transported via the lymphatic system to the liver.

Individuals more prone to vitamin K deficiency include those with fat mal- absorptive condi- tions such as celiac disease, Crohn’s dis- ease, and cystic fibro- sis and those taking long-term antibiotics that may reduce the intestinal bacteria. Newborn babies may be at risk for vitamin K deficiency because they lack the intesti-

nal bacteria at birth that produce vitamin K. Breast milk also contains very little vitamin K. Most newborn babies are given a vitamin K injection at birth, and within sev- eral weeks the intestinal bacteria will provide adequate vitamin K for the newborn’s needs. Individuals using anti- biotics for a prolonged period may be at higher risk of defi- ciency because antibiotics may kill the naturally occurring bacteria in the gut that produce vitamin K.

166 SECTION 1 The Basics of Sports Nutrition

Gaining the Performance Edge

Fat-soluble vitamins include vita- mins A, D, E, and K. Each vitamin has its own function in the body, DRI, complications of deficiency, symptoms of toxicity, unique food sources, and requirements for supplementation. All fat-soluble vitamins are critical to health, and therefore a variety of food sources should be consumed daily to meet the needs of each nutrient.

molecules and thus may be involved in the development of cancer, cardiovascular disease, and possibly nerve degenerative diseases.

Free radicals are produced in the body as byproducts of normal cellular metabolism or can be taken into the body from outside sources. Outside sources of free radi- cals include the breathing of polluted air, such as when runners exercise in congested traffic. Within the body,

that possess unpaired electrons in their structure (see FIGURE 6.17 ). The unpaired electrons give free radicals an ionic charge, which makes them reactive with other charged molecules in the body. Free radicals basically cause molecules to give up electrons in a process known as oxidation so that they can match any unpaired elec- trons and become more stable. Undesirable free radical oxidation may damage DNA, lipids, proteins, and other

Figure 6.16 Food sources of vitamin K. The best sources of vitamin K are vegetables, especially those in the cabbage family. Liver, eggs, and milk are good sources as well. Note: The DV for vitamin K is lower than the current AI of 120 micrograms and 90 micrograms for males and females, respectively, age 19 and older.

Figure 6.17 Free-radical damage. Vitamin E helps prevent free-radical damage to polyunsaturated fatty acids in cell membranes.

Watery interior of cell

Damaged phospholipid molecules

Neutralized free radical

Key

Free radical

Vitamin E donates an electron to a free radical, lowering its damage potential to membrane molecules.

Vitamin E

Neutralized free radical

Chapter 6 Vitamins 167

Green beans, cooked Artichokes, cooked Tomato, green, raw

85 g (~2/3 cup) 85 g (~1/2 cup) 85 g (1 small)

Exceptionally good sources

14 µg 13 µg 8.6 µg

High: 20% DV or more

VITAMIN K

Daily Value = 80 µg AI = 120 µg (males), 90 µg (females)

Good: 10–19% DV

Spinach, raw Turnip greens, raw

85 g (~3 cups) 85 g (~3 cups)

410 µg 213 µg

Cauliflower, raw Broccoli, cooked Romaine lettuce, raw

85 g (~3/4 cup) 85 g (~1/2 cup) 85 g (~11/2 cups)

136 µg 120 µg 87 µg

Chicken liver, cooked Cabbage, raw Asparagus, cooked Okra, cooked Prunes, dried Soybean oil Blackberries, raw Blueberries, raw

85 g (3 oz) 85 g (~11/4 cups) 85 g (~1/2 cup) 85 g (~1/2 cup) 120 g (~1/2 cup) 1 Tbsp. 140 g (~1 cup) 140 g (~3/4 cup)

68 µg 51 µg 43 µg 32 µg 31 µg 27 µg 27 µg 27 µg

free radicals produced in the mitochondria of cells as hydrogen ions are transferred to oxygen to form water (H2O) in the electron transport chain. However, occa- sionally oxygen is not paired with hydrogen ions to form water and instead forms ionically charged free-radical molecules, such as superoxide (O2), hydroxyl (HO–), and peroxide (H2O2) radicals. These oxygen-containing mol- ecules are collectively known as reactive oxidative spe- cies (ROS). As noted earlier, if these reactive molecules

go unchecked in the body, they can be very destructive.

Fortunately, the body has access to compounds that help neutralize the oxidative stresses imposed by free radi- cals, thereby protect- ing the body from

damage. These protective compounds are collectively known as antioxidants. The body produces a variety of antioxidant enzymes capable of catalyzing reactions that neutralize free radicals. In addition, healthy dietary prac- tices supply the body with antioxidant vitamins such as vitamins A (including the carotenoids), E, and C. These nonenzymatic antioxidants either directly interact with free radicals (see FIGURE 6.18 ) or work as coenzymes. In summary, the body’s antioxidants, whether enzymatic or nonenzymatic, are crucial to helping the body protect itself from free radicals.

An example of the damage that can be caused by free radicals involves a process known as lipid peroxi- dation. During lipid peroxidation the double bond of an

unsaturated fatty acid is broken, yield- ing intermediate compounds that can react with oxygen to form peroxide free

radicals. A peroxide free radical has one unpaired elec- tron, making it highly reactive with other fatty molecules within the cell membrane. To help decrease the cell mem- brane damage, vitamin E responds to the free radical by donating an electron, thus preventing it from reacting with other fatty acids in the cell membrane and causing further damage (see Figure 6.17). At this point, vitamin E needs an electron and is essentially a free radical itself, though not a very reactive one. Vitamin E can get an elec- tron from another antioxidant, such as vitamin C. Vita- min C, in turn, regains its lost electron from glutathione. To stop this cascading process, the enzyme glutathione reductase restores glutathione to its original form with help from selenium, a mineral. Antioxidant vitamins are commonly referred to independently and do have dis- tinct and independent functions within the body; how- ever, they also work together to keep the body functioning and prevent cellular damage.

reactive oxidative species (ROS) Free radical molecules that contain oxygen in their molecular formula and that are formed dur- ing aerobic metabolism. Com- monly occurring reactive oxidative species in the human include superoxidases, hydroxyl radicals, and peroxide radicals.

What is the relationship between free radicals and exercise? Free radical production has been shown to increase dur- ing exercise, particularly sustained aerobic exercise per- formed at high intensity.36–38 The reason for the increase in free radical production with increasing levels of exercise is not well understood but is believed to be related to the increased presence and utilization of oxygen by the mito- chondria within the muscle cells to make ATP. As noted earlier, cells continuously produce free radicals as a part of normal metabolism.39 The free radicals that are produced are usually neutralized by an elaborate antioxidant defense system of enzymatic and nonenzymatic antioxidants. Exercise increases aerobic metabolism and thus may cre- ate an imbalance between free radical production and their neutralization by antioxidants.38,39 Interestingly, it appears that the body’s own natural antioxidant defense system is adaptable and up-regulates its response to extended training.40 This appears to strengthen the body’s antioxi- dant defense mechanism and serves to protect muscle and other tissues from damage during future exercise bouts.

Do athletes need antioxidant supplements? Antioxidants are beneficial compounds in the human body.36,41 Without them, oxidation would not be controlled and many processes would suffer. Supplementation with antioxidant vitamins and minerals would appear to make sense for individuals interested in the potential health benefits of antioxidants. Finding ways to prevent the dev- astation of chronic diseases such as heart disease, cancer, and other illnesses is important for athletes as well as the general population. Although the use of antioxidants is promising, there are still no governing bodies that rec- ommend regular intake of antioxidants at levels higher than the RDA/AIs.

Figure 6.18 Vitamin C minimizes free radical damage by donating an electron to the free radical.

Free radical

The available unpaired electron of a free radical can oxidize (and damage) important biological molecules, like DNA.

Vitamin C can donate an electron to neutralize a free radical.

Neutralized free radical

lipid peroxidation A chemical reaction in which unstable, highly reactive lipid molecules containing excess oxygen are formed.

168 SECTION 1 The Basics of Sports Nutrition

However, there is valid reasoning for the interest in antioxidant supplementation use by athletes.3,40 If, as noted earlier, exercise training can bolster the body’s nat- ural free radical defense mechanism, then why wouldn’t nonenzymatic antioxidant supplementation also increase

the defense against free radicals? Unfor- tunately, research into the effects of taking nonenzymatic antioxidant supple- ments (i.e., vitamins A, C, and E) on free radical levels during exercise is presently unclear. The prob- lem is that free radi- cal levels are difficult to measure directly because they are so highly reactive. Therefore, scientists

must rely on markers that might indicate the presence of free radicals, such as cellular damage or other mole- cules that result because of reactions with free radicals.

B12

Thiamin

Folate

Riboflavin

Biotin

Choline

Pantothenic Acid

ATPVitamins

Vitamin Functions

Energy production

Nervous system function

Blood

Immune system function

Growth and development

Vision

Bone

Antioxidant

Muscle Function

Endocrine function

Cardiovascular Health

Niacin

ATP

Free

Radical

Figure 6.19 Summary of the functions of vitamins. Refer to the specific vitamin sections for detailed explanations of each function.

However, using indi- rect indicators of free radical activity is prone to error and explains the equivo- cal research results to date. In addition, some argue that the real issue is the body’s 24-hour abil- ity to neutralize free radicals, and that the relatively brief intervals of exercise and their associated increased production of free radi- cals are just a minor, short-lasting spike in the 24-hour battle against free radicals. The bottom line is that so little is known about the effects of antioxidant supple- mentation on exercise that making recommendations to well-nourished athletes regarding antioxidant supple- mentation currently is neither necessary nor advisable.42 For now, the best nutrition advice is to incorporate more antioxidant-containing foods into the daily diet to ensure adequate intake of a variety of antioxidants and other nutrients. For a summary of all the vitamins’ respective functions, including those with antioxidant properties, see FIGURE 6.19 .

Chapter 6 Vitamins 169

Gaining the Performance Edge

Antioxidants are beneficial com- pounds in the human body that are particularly helpful in main- taining overall health and prevent- ing chronic disease. The ergogenic effects of antioxidants have not yet been clearly elucidated but continue to be a focus of exercise science research. Current recom- mendations call for intakes at the established RDA/AIs, with a strong focus on whole food sources.

Food for Thought 6.2

Importance of Vitamin Intake for Athletes: Fat-Soluble Vita- mins and Antioxidants

Review the recommendations, food sources, and significance of fat-soluble vitamins and antioxi- dants for athletes.

What are phytochemicals? Although phytochemicals are not nutrients, they have important health functions. The term phytochemicals comes from the Greek word phyto, meaning “plant”; they are so named because they are chemical substances found in plants. In their 1991 publication, Steinmetz and Potter43 identified more than a dozen classes of biologi- cally active plant chemicals known as phytochemicals. It is estimated that there are thousands of these plant chemicals that may or may not significantly affect the human body. Approximately 50 phytochemicals are com- monly consumed in the American diet. Research on the many benefits of phytochemicals to human health varies for different classes and specific compounds. Evidence clearly supports consumption of a diet rich in fruits, veg- etables, and whole grains in helping individuals stay healthy and reduce the risk of cardiovascular disease and cancer.44,45 However, further research is needed to deter- mine what role specific phytochemicals play in reducing these chronic diseases. The effect of phytochemicals on exercise and sport performance is not well researched.

Dietitians and other health professionals who edu- cate the public about healthful eating must be aware of the different types of phytochemicals in foods.46,47 Con- sumers are savvy about the latest research and want more information about how they can benefit by eating more nutrient-dense foods. In a study of the effects of one edu- cational session on functional food consumption, 79% of participants expressed intent to eat more tomatoes/ tomato products, and 75–77% indicated intent to con- sume purple grape juice, oats, and broccoli.48,49 In addi- tion, many consumers may not be aware of the health benefits of consuming more plant-based foods. Fruits, vegetables, and grain products contain many more com- ponents than just the vitamins and minerals found in a multivitamin supplement.

This section briefly describes three classifications of phytochemicals that have fairly solid research evidence suggesting a health-protective role. These classifications are the phenolic compounds, organosulfides, and one of the carotenoids, lycopene. More research is required to fully understand phytochemicals’ roles in the body, espe- cially in regard to disease prevention. Many of the food sources that contain phytochemicals discussed in the fol- lowing sections are excellent choices to include in a sports nutrition plan for athletes. Although research has focused on health and disease prevention and not on sport perfor- mance, athletes can also reap the benefits of good health by consuming a phyto-chemical-rich diet. TABLE 6.3 pro- vides a summary of a variety of phytochemicals and exam- ples of good food sources of these phytochemicals.

What are phenolic compounds? The phenolic compounds are a large and varied group of phytochemicals that are found in many different foods. The majority of the research on phenols is related to

their positive influence on heart disease prevention. The phenols are a broad category of antioxidant com- pounds that work to prevent the oxidation of LDL cho- lesterol. Common phenolic compounds that have been researched fairly extensively include flavonoids and phenolic acids.

Flavonoids became known to the public when research was published reporting that individuals who drink wine may have a decreased risk for heart disease. The flavonoids in wine and grapes started a revolution and much debate about the benefits of wine consump- tion in combating heart disease. The first link between wine intake and cardiovascular disease became appar- ent when a French research group50 found a strong neg- ative correlation between wine intake and death from ischemic heart disease in both men and women from 18 countries.47 The French have a relatively high con- sumption of dietary fat and saturated fat, yet a relatively low rate of cardiovascular disease. The increased wine consumption in France may help protect against heart disease, and thus the “French paradox” was born. Some of the reduction in cardiovascular disease may be from the alcohol’s ability to increase HDL cholesterol; how- ever, the nonalcohol components of wine, the flavonoids, hold promise as well.

Grape seeds and skins are considered good sources of polyphenolic tannins that provide the astringent taste to wine.51 The phenolic compounds catechin and antho- cyanin are also abundant in grapes.52 Red wine contains more flavonoids than white wine because the grape skins are incorporated into the fermentation process. The skins and sometimes seeds are used in wine mak- ing and in grape juices, making these products high in

Table 6.3

Phytochemicals in Foods

Phytochemical Food source Allium compounds Garlic, onion

Anthocyanins Blue and purple fruits, such as blueberries, grapes, cherries, raspberries

Carotenoids Yellow, red, and pink fruits and vegetables; dark green leafy vegetables

Catechins Green tea

Flavonoids Most fruits and vegetables

Indoles, isothiocynates Broccoli, cabbage, cauliflower, radish

Isoflavones Soy foods

Lignans Flax seeds, soybeans

Lycopene Tomato products, watermelon, other pink fruits

Phenolic acids Berries, grapes, nuts, whole grains

170 SECTION 1 The Basics of Sports Nutrition

researched for many possible health benefits, including reducing blood cholesterol levels and cancer risk, and for their antihypertensive potential. A review of more than 20 epidemiological studies suggests that allium vegetables, including onions, may confer a protective effect against cancers of the gastrointestinal tract.46

Athletes should include cruciferous vegetables, gar- lic, onions, and other pungent vegetables in their daily diet to gain the potential health benefits. However, con- sumption of these vegetables can produce intestinal gas and bloating that may be uncomfortable when training or competing in sport events. Therefore, athletes should avoid high-gas-producing vegetables within several hours before training. Consumption of these vegetables after workouts or competitions is the best practice to avoid uncomfortable gas production while reaping the health benefits.

What is lycopene? Lycopene is one of the most well studied of the carot- enoids and is more widely recognized by the public. Advertisements for vitamin and mineral supplements that “contain lycopene” abound. Lycopene is now added to many vitamin supplements marketed for men because of the strong correlation between lycopene intake and pros- tate health. Lycopene is the most abundant carotenoid in the prostate.63 In the now classic prospective cohort study of lycopene’s effect on the prostate, Giovannucci et al.64 found that men who consumed at least 10 or more servings of tomato products per week had less than one- half the risk of developing advanced prostate cancer. The proposed mechanism for the reduced cancer risk is the antioxidant property of lycopene.

Tomatoes and tomato products such as ketchup, tomato pastes and sauces, canned tomatoes, and tomato- based products such as enchilada sauce, pizza sauce, picante sauce, and salsa are good sources of lycopene. Fresh tomatoes appear to have less bio-available lyco- pene than processed tomatoes because cooking releases the lycopene stored in the cell walls of fresh tomatoes.

these phytochemicals. New evidence suggests that non- alcoholic wine and commercial grape juice can provide similar amounts of flavonoids and antioxidant capacity as red wine.53,54 Because alcohol consumption is gener- ally not recommended as part of an athlete’s diet, spar- kling grape juice can provide a healthy nonalcoholic alternative.

Teas contain both flavonols and polyphenols, most significantly catechins.55 Green and black teas both con- tain these phytochemicals; however, green tea has been found to be more concentrated in polyphenols. This might be related to how the different teas are prepared for con- sumption. Green tea leaves are steamed and dried, which prevents oxidation of the polyphenols, primarily cate- chins. Black tea leaves are fermented, which reduces the amount of catechin in black tea compared to green tea.56 Regardless of the type of tea, the primary antioxidant properties may act in cancer prevention57,58 and cardio- vascular disease protection.59 Consuming several cups of green or black tea daily will help athletes reap the poten- tial disease prevention benefits of this beverage. The teas can be found in decaffeinated varieties, containing the same beneficial ingredients. The decaffeinated versions are recommended to athletes to help them avoid exces- sive intake of caffeine.

What are organosulfides? A growing amount of evidence from epidemiological studies has provided consensus that diets rich in fruits and vegetables are associated with lower risks of devel- oping certain cancers. Several excellent reviews have been published to support this association.45,46,60 The more difficult determination is what specifically in fruits and vegetables is the protectant. Many of the nutrients, fibers, and non-nutrient compounds in fruits and veg- etables may play singular or additive roles in cancer risk reduction. The phytochemicals found in the cruciferous (sometimes called brassica) vegetables and allyl com- pounds in garlic and onions may play a singular or addi- tive protective role. The cruciferous vegetables contain a variety of organosulfide compounds, including gluco- sinolates, indoles, and isothiocyanates, and have long been touted for their anticancer properties.61 Vegetables including broccoli, brussels sprouts, cabbage, rutabaga, and cauliflower are part of the organosulfide group of phytochemicals. Talalay and Fahey62 present an excel- lent review of the role of glucosinolate and isothiocya- nate phytochemicals found in cruciferous vegetables in cancer prevention. They cite more than 10 studies and report that “these findings provide additional support for the pivotal role of the glucosinolates and isothiocya- nates derived from crucifers in chemoprotection against cancer” (p. 3029S).

Garlic and onions, along with leeks, chives, and shal- lots, contain allyl compounds that provide flavor and odor to foods. The allyl compounds in garlic have been

Chapter 6 Vitamins 171

• Use tomato sauces and pastes and spaghetti sauce as a basis for meals.

• Sprinkle nuts and seeds on salads. • Use garlic in cooking, dressings, marinades, and

sauces. • Prepare side dishes with green leafy vegetables such

as kale, spinach, and collards. • Use soy milk instead of dairy milk on cereal or as a

beverage. • Complement all meals with one or two fruits or

vegetables. • Use whole grain foods more often than processed

grains. • Try a new grain recipe that uses bulgur, barley, or oats. • Eat fruit for dessert such as a baked apple, chopped

melon, or chilled berries. Athletes should be encouraged to eat a wide vari-

ety of foods, including many plant-based items, to assist them in obtaining the energy they need while also consum- ing valuable nutri- ent and non-nutrient components in their diet. As research evolves, recommen- dations similar to the DRIs may be on the horizon for some phytochemicals.

Training Table 6.4: Sunshine Broccoli Salad 1 large broccoli head, cut into bite-sized pieces

¼ cup purple onion, chopped

¼ cup sunflower seeds

¼ cup orange juice

8 oz plain or vanilla low-fat yogurt

¼–½ cup raisins

Blend the yogurt and orange juice and set aside. Wash and prepare the broccoli and onion. Mix vegetables and sunflower seeds together in a large bowl. Pour orange juice and yogurt mixture over vegetables and seeds and mix thoroughly. Let salad sit in refrigerator for 2 to 4 hours before serving, if possible, to blend the flavors. Garnish with or mix in raisins.

Phytochemicals present: Organosulfides, polyphenols

Serving size: 1¼ cups (Recipe makes four servings)

Calories: 166 kcals

Protein: 6 grams

Carbohydrate: 27 grams

Fat: 5 grams

Absorption of lyco- pene is greater with the simultaneous intake of fat. For example, a tomato- based pizza sauce on a pizza with cheese or an oil and vinegar dressing mixed with canned tomatoes for a salad will enhance the absorption of lycopene.

Future research may find that lycopene is beneficial in a variety of ways for active individuals. A small study of 20 individuals found that lycopene supplementation of 30 milligrams per day provided some protection against exercise- induced asthma.65 Some research, primarily in animal studies, suggests that the antioxidant properties of lyco- pene may reduce oxidative stress.66 Research on the effect of lycopene supplementation for providing protection from ultraviolet sunlight has shown some promise,67,68 which could be significant for athletes who train and compete outdoors. However, many of these studies con- tained small sample groups, combined other antioxidant supplements with lycopene, and were conducted primar- ily in animals and not humans. Further research in larger human clinical trials, isolating lycopene, is needed before any definitive answers about lycopene’s effects in these areas can be drawn.

How can athletes increase phytochemical consumption through whole foods? Increasing phytochemical intake means focusing on a plant-based diet. This does not mean that meat needs to be eliminated; it simply means more effort should be spent on trying to incorporate a wide range of fruits, vegetables, and whole grains into the daily diet (see TRAINING TABLES 6.4 through 6.6 ). There is still a lot to learn about the actual amount of certain phytochemicals in plants, how they react in the body, a recommended dietary intake, and their effect on athletic performance. Research on the specific phytochemicals is relatively new, and there are many more different types of phytochemicals than there are vitamins. Establishing DRIs for the various phytochemicals is cur- rently an ongoing process that will take years to decipher; however, that does not diminish the importance of includ- ing these essential compounds in an athlete’s daily diet.

The following tips will help athletes consume more plant-based foods, thus increasing phytochemical intake:

• Serve hot or cold green tea with meals. • Keep red or green grapes washed and ready in the

refrigerator for snacks.

172 SECTION 1 The Basics of Sports Nutrition

Food for Thought 6.3

You Are the Nutrition Coach

Apply the concepts from this chapter to several case studies.

Gaining the Performance Edge

Phytochemicals are plant-based compounds that appear to have potent antioxidant and antican- cer effects. Although DRIs have not been established for these sub- stances, athletes can still reap the potential benefits by consuming a variety of fruits, vegetables, and other plant-based foods each day.

Training Table 6.6: Berry Soy Smoothie 1 cup frozen blueberries, strawberries, or other berries

1 cup soy milk

½ cup orange juice

4 oz silken tofu

Let berries thaw slightly. Blend all ingredients in blender until smooth. Add enough orange juice and tofu to obtain the desired texture.

Phytochemicals present: Isoflavones, carotenoids, and flavonoids

Serving size: 3 cups (Recipe makes one serving)

Calories: 295 kcals

Protein: 14 grams

Carbohydrate: 42 grams

Fat: 9 grams

Training Table 6.5: Salmon Pepper Salad 2 fresh salmon fillets

1 red bell pepper

2 cups spinach leaves, washed

1 mango or papaya, sliced

2 tbsp fresh lime juice

1 tbsp olive oil

1 clove garlic, crushed

1 tsp dried thyme

Mix lime juice, olive oil, garlic, and thyme together in a small bowl. Rinse and pat dry the salmon fillets. Place fillets in a shallow dish. Pour the lime juice marinade mixture over the salmon; turn to coat. Cover the dish, place it in the refrigerator, and let marinate for at least 10 minutes.

Wash the spinach and spin or pat dry; tear into bite-sized pieces. Wash and core the red pepper; slice into thin strips. Peel the mango or papaya; slice into thin strips or small pieces.

Grill the salmon on an indoor or outdoor grill until fish flakes (approximately 4 to 6 minutes per side). Arrange salmon on bed of spinach and red pepper. Garnish with mango on top and around the fish. Serve with balsamic vinaigrette salad dressing, if desired.

Phytochemicals present: Lutein, zeaxanthin, and organosulfides; also high in vitamins C and E, and beta-carotene

Serving size: 3 oz salmon, 2 cups vegetables (Recipe makes two servings)

Calories: 286 kcals

Protein: 19 grams

Carbohydrate: 25 grams

Fat: 13 grams

Chapter 6 Vitamins 173

The Box Score Key Points of Chapter

n Contrary to the body’s requirements for carbohy- drates, proteins, and fats, the daily dietary require- ments for vitamins are very small. However, these micronutrients serve vital functions in the body and thus are essential for survival.

n Vitamins are organic compounds that are essential to at least one vital chemical reaction or process in the human body. In addition, to be considered a vitamin the compound cannot be made by the body itself or be made in sufficient quantities to meet the body’s needs. In addition, vitamins contain no calories and are found in very small amounts (i.e., micrograms or milligrams) in the body.

n Vitamin requirements are presented as a collec- tion of dietary values termed the Dietary Reference Intakes (DRIs). The DRI expands on the previously established RDA and takes into consideration other dietary quantities such as EAR, AI, and UL. DRIs are continually being reviewed and updated as scientific data become available.

n Vitamins are categorized into two main groups: water soluble and fat soluble. The water-soluble vitamins include the B-complex vitamins, vitamin C, and choline. The fat-soluble vitamins include vita- mins A, D, E, and K.

n The B-complex vitamins are actually a group of eight different vitamins. In general, the B vitamins serve as coenzymes in the metabolic pathways that break down carbohydrates, fats, and proteins for energy. Because they are water soluble, they are not stored in any appreciable amounts and thus present a low risk for toxicity to the body.

n Choline is a vitamin-like compound, but is not con- sidered a B vitamin. Choline is involved in the for- mation of the neurotransmitter acetylcholine, which is needed for muscle activation. Choline has also been shown to help maintain the structural integrity of cell membranes. The risk for choline deficiency is low; however, toxicity can occur, presenting signs and symptoms of low blood pressure, diarrhea, and a fishy body odor.

n Vitamin C is one of the most recognized vitamins because of its supposed role in enhancing the immune system. It is a strong antioxidant, is critical for the formation of collagen, enhances iron absorp- tion, and aids in the formation of various hormones and neurotransmitters.

n The fat-soluble vitamins are dependent on the pres- ence of dietary fat for intestinal absorption and transport throughout the body. Fat-soluble vitamins can be more toxic to the body than water-soluble vitamins because they are stored in the liver and

adipose tissues and can accumulate over time. Cau- tion should be exercised when using supplements containing high doses of these vitamins.

n Vitamin A is associated with the retinoid and carot- enoid families of compounds and is important for vision, healthy skin, and cell differentiation. A vita- min A deficiency can result in blindness and hyper- keratosis. Toxicity is rare when the dietary focus is placed on whole foods; however, intake from supple- ments can quickly reach toxic levels.

n Vitamin D is not only crucial for bone health but is also important for immune function, control of inflammation, and even muscle function. In fact, vitamin D deficiency has been associated with increased risk for several chronic and autoimmune diseases, such as hypertension, cardiovascular dis- ease, rheumatoid arthritis, depression, and certain cancers. The growing evidence regarding the impor- tance of vitamin D has caused some nutrition pro- fessionals to recommend serum vitamin D screening for athletes. Toxicity can result in hypercalcemia and subsequent calcification of various soft tissues throughout the body.

n Vitamin E belongs to the tocopherol and tocotri- enol family of compounds and is most recognized for its antioxidant properties. Deficiencies are rare and so is toxicity. However, high levels of vitamin E can have a blood-thinning effect, thereby decreasing blood clotting, which can lead to bruising and other more serious complications.

n Vitamin K is probably the least recognized of the vitamins. The primary role of vitamin K is in blood clotting, but it also plays an important role in bone health. Deficiencies can result in substantial hemor- rhaging. Toxicity from food sources is rare.

n Free radicals are highly reactive compounds that can damage cell membranes and other structures, including DNA. They tend to be compounds contain- ing oxygen and can be formed during normal aero- bic metabolism. Free radicals can also be introduced into the body from exogenous sources (e.g., pollut- ants in the air).

n Antioxidants are the body’s primary defense against free radicals. They exist in enzymatic and nonenzy- matic forms. Vitamins A, C, and E along with other compounds known as phytochemicals serve as the body’s nonenzymatic antioxidants. The effective- ness of supplementing the diet with nonenzymatic forms of antioxidants is presently unclear.

n Exercise, particularly aerobic exercise, has been shown to increase free radical production. Although the reasons underlying the free radical increase are

174 SECTION 1 The Basics of Sports Nutrition

not clear, the body’s enzymatic antioxidant defense system may up-regulate as an adaptive response to extended training, thus increasing its natural defenses against free radicals. The effect of taking supplements of vitamins A, C, and E and phyto- chemicals on free radical levels during exercise is presently unclear. For now, making recommenda- tions regarding antioxidant supplementation is not necessary or advisable. The best nutritional advice is to incorporate more antioxidant-containing foods into the daily diet.

n Phytochemicals are biologically active plant chemi- cals that are not considered nutrients but play a vital role in health. Although there are many differ- ent phytochemicals, research has associated three classes as aiding human health: phenolic com- pounds, organosulfides, and carotenoids.

n Athletes should be encouraged to eat a wide vari- ety of fruits and vegetables to help ensure adequate intake of phytochemicals. Because DRIs have not been established for phytochemicals, the need for supplementation by athletes is currently unknown.

Study Questions

1. What are vitamins and how are they classified? List the specific vitamins that fall under each classifica- tion. Which classification of vitamins is potentially more toxic to the body? Explain why.

2. Taken as a group, what major role do the B vitamins play in the body? What implications does this have in regard to athletes and sport performance?

3. List two of the four fat-soluble vitamins and their respective roles/functions for overall health and ath- letic performance.

4. Should dietary substances that block absorption of fat by the digestive system be used? Defend your answer.

5. What are free radicals? Where do they come from, and what effect do they have on the body?

6. What are antioxidants? Which vitamins and related compounds serve as antioxidants in the body? Briefly describe how they work in the body.

7. Should athletes take supplements that boost the body’s level of antioxidants? Defend your answer with what is currently known about these substances.

8. What are phytochemicals, and where do they come from?

9. What are some of the commonly identified classes of phytochemicals? What roles do they play in the body?

10. What are the current recommendations for the intake of phytochemicals? Should athletes take phytochemi- cal supplements? Defend your answer.

References

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Chapter 6 Vitamins 175

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24. Webster MJ. Physiological and performance responses to supplementation with thiamin and pantothenic acid derivatives. Eur J Appl Physiol. 1998;77(6):486–491.

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26. Sachan DS, Hongu N. Increase in VO2 max and meta- bolic markers of fat oxidation by caffeine, carnitine and choline supplementation in rats. J Nutr Biochem. 2000;11:521–526.

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32. Ginde AA, Liu MC, Camargo CA. Demographic dif- ferences and trends of vitamin D insufficiency in the U.S. population, 1988–2004. Arch Intern Med. 2009;169:626–632.

33. Institute of Medicine. Dietary Reference Intakes for Cal- cium and Vitamin D. Food and Nutrition Board. Wash- ington, DC: National Academies Press; 2011.

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35. “Special K” takes on new meaning. Tufts Univ Health Nutr Newsletter. 1997;15(5):1–7.

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40. Jackson MJ. Free radicals in skin and muscle: dam- aging agents or signals for adaptation? Proc Nutr Soc. 1999;58:673–676.

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42. Jenkins RR. Exercise and oxidative stress methodol- ogy: a critique. Am J Clin Nutr. 2000;72:670S–674S.

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46. Ernst E. Can allium vegetables prevent cancer? Phytomed. 1997;4:79–83.

47. Hasler CM. Functional foods: their role in dis- ease prevention and health promotion. Food Tech. 1998;52(11):63–70.

48. Jones CM, Mes P, Myers JR. Characterization and inheritance of the Anthocyanin fruit tomato. J Hered- ity. 2003;94:449–456.

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50. St. Leger AS, Cochrane AL, Moore F. Factors associated with cardiac mortality in developed countries with particular reference to the consumption of wine. Lan- cet. 1979;1:1017–1020.

51. Yilmaz Y, Toledo RT. Major flavonoids in grape seeds and skins: antioxidant capacity of cate- chin, epicatechin, and gallic acid. J Agric Food Chem. 2004;52(2):255–260.

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52. Palma M, Taylor LR. Extraction of polyphenolic com- pounds from grape seeds with near critical carbon dioxide. J Chromatogr. 1999;849:117–124.

53. Day AP, Kemp HJ, Bolton C, Hartog M, Stansbie D. Effects of concentrated red grape juice consumption on serum antioxidant capacity and low-density lipo- protein oxidation. Ann Nutr Metab. 1998;41:353–357.

54. Serafini M, Maiani G, Ferro-Luzzi A. Alcohol-free red wine enhances plasma antioxidant capacity in humans. J Nutr. 1998;128:1003–1007.

55. Graham HN. Green tea composition, consumption and polyphenol chemistry. Prev Med. 1992;21:334–350.

56. Paquay JBG, Guido RMM, Stender G, et al. Protection against nitric oxide toxicity by tea. J Agric Food Chem. 2000;48:5768–5772.

57. Clydesdale FM. Tea and health. Crit Rev Food Sci Nutr. 1997;36:691–785.

58. Weisburger JH. Tea and health: the underlying mecha- nisms. Proc Soc Exp Biol Med. 1999;220(4):271–275.

59. American Dietetic Association. Position of the Ameri- can Dietetic Association: functional foods. J Am Diet Assoc. 1999;99(10):1278–1285.

60. Institute of Medicine. Dietary Reference Intakes: A Risk Assessment Model for Establishing Upper Intake Levels for Nutrients. Food and Nutrition Board. Washington, DC: National Academies Press; 1998.

61. Verhoeven DTH, Goldbohm RA, van Poppel G, Ver- hagen H. Epidemiological studies on brassica

vegetables and cancer risk. Cancer Epidemiol Biomark Prev. 1996;5(9):733–748.

62. Talalay P, Fahey JW. Phytochemicals from cruciferous plants protect against cancer by modulating carcino- gen metabolism. J Nutr. 2001;131:3027S–3033S.

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Additional Resource

Insel P, Ross D, McMahon K, Bernstein M. Nutrition. 6th ed. Burlington, MA: Jones & Bartlett Learning; 2017.

Chapter 6 Vitamins 177

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Key Questions Addressed 1. What’s the big deal about minerals?

2. What are minerals?

3. What are the major minerals?

4. What are the trace minerals?

You Are the Nutrition Coach Anne participates in triathlons. Recently, in a half-Ironman race, she experienced nausea, intestinal cramping, and diarrhea on the run, leading to a poor performance. The entire race took her nearly 6.5 hours. During the bike portion, she consumed 100 oz of a relatively new sports beverage that she has been training with this year, as well as two gels. On the run, she consumed sips of the sports beverage provided on the course but switched over to water once she started experiencing the nausea, cramping, and diarrhea. She was frustrated by her performance and wants to ensure that it does not happen again. You ask Anne to bring in the new sports beverage she has been consum- ing so that you can review the Supplement Facts label. Per 8 oz serving, the following nutrients are provided: 60 calories, 15 g carbohydrates, 0 g protein, 0 g fat, 100 mg sodium, 50 mg calcium, 30 mg magnesium, and 100 mg potassium.

Question • What could be a potential cause of Anne’s nausea, intestinal cramping, and diarrhea during

the race?

• What recommendations would you give to Anne to prevent the symptoms from occurring in future races?

Minerals

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What’s the big deal about minerals? Similar to vitamins, minerals play important roles throughout the body and are considered essential; with- out minerals, the body could not function. Many miner- als are involved in important catalytic reactions (e.g., iron aids in gluconeogenesis) or serve as key structural compo- nents of tissues (e.g., calcium provides structure to bones) throughout the body.

The role that minerals play in sport performance has been studied over the years. It is clear that minerals are crucial for a variety of bodily functions, keeping athletes healthy and training strong. Certain athlete populations are more prone to mineral deficiencies, warranting a special focus in the diet. For example, female athletes may be more susceptible to iron deficiencies. Therefore, iron as well as vitamins that enhance iron absorption, such as vitamin C, should receive greater emphasis in their diet. In addition to general health, the intake of several minerals, specifically electrolytes, has a great impact on sport performance. Sodium and potas- sium, the main elec- trolytes (minerals) lost in sweat, must be replaced on a daily basis as well as during endurance and ultra- endurance sports to optimize performance and prevent medical complications. Other minerals are still under investigation, and their ergogenic effects have yet to be elucidated.

What are minerals? Minerals are unique nutrients in several respects. Unlike carbohydrates, fats, proteins, and vitamins, minerals are not organic molecules. They are basically inorganic ele- ments or atoms. Also, unlike the macronu- trients, minerals con- tain no calories and, although essential, are needed by the body in very small amounts (i.e., milligrams or micrograms). Furthermore, after ingestion, the structure of minerals is not altered; this is unlike the reaction of macronutrients, which undergo dramatic changes in structure during diges- tion and utilization by the body. Unlike vitamins, which can be destroyed or altered by exposure to heat, light, alkalinity, or enzymes, minerals remain unaltered. Because of their stability, minerals are unaffected by cooking techniques, digestive processes, and/or exposure to enzymes. In other words, unlike many nutrients, minerals remain unaltered from food source to the human cells.

However, similar to all nutrients, minerals must be absorbed across the intestinal wall to serve their roles within the body. A variety of factors can affect the bio- availability of minerals. Some minerals are absorbed in proportion to the body’s needs. Absorption of other min- erals is affected by the fiber content of foods that are ingested simultaneously. High-fiber foods contain com- pounds that can bind to certain minerals, thus preventing their absorption during passage through the intestines. In some instances, high doses of one mineral, which can occur during supplementation, can cause competition for absorption and thus decrease intestinal uptake of other minerals. Therefore, despite the fact that minerals are needed in limited amounts and are very stable nutrients, athletes cannot afford to be cavalier about their mineral intake, nor can they rely on indiscriminant supplementa- tion to meet their body’s mineral requirements.

There are two classifications of minerals: major min- erals and trace minerals. The major minerals include cal- cium, phosphorus, magnesium, sodium, chloride, potassium, and sul- fur. Minerals are classified as “major” if they are required by the body in amounts greater than 100 milligrams per day. The trace minerals include iron, zinc, chromium, fluoride, copper, manganese, iodine, molybdenum, and selenium. Minerals are classified as trace if they are required by the body in quantities less than 100 milligrams per day. Both major and trace minerals are stored in the body; when consumed in excess, stored lev- els can build and become toxic to the body (e.g., high doses of iron can cause hemochromatosis, a condition discussed later in this chapter). Toxic levels can be achieved through dietary intake, but toxicity is much more likely to be caused by high-dosage supplements.

This chapter discusses the functions, dietary rec- ommendations, effects on energy systems and sport performance, deficiency and toxicity symptoms, food sources, meal-planning tips, and the appropriateness of supplements for athletes in regard to major and trace min- erals. Refer to TABLE 7.1 for a summary of the DRI values for major and trace minerals.

What are the major minerals? The major minerals are calcium, phosphorus, magne- sium, sodium, chloride, potassium, and sulfur. As men- tioned earlier, the daily requirements for these minerals exceed 100 milligrams per day. Many of these minerals

inorganic A descriptor given to a compound that does not con- tain carbon atoms in its molecular structure.

major minerals The minerals required by the body in amounts greater than 100 milligrams per day. The major minerals include calcium, phosphorus, magnesium, sodium, chloride, potassium, and sulfur.

electrolytes Positively or nega- tively charged ions found through- out the body. The body uses the electrolytes to establish ionically charged gradients across mem- branes in excitable tissues such as muscle and nerves so that they can generate electrical activity. The best-known electrolytes are sodium (Na+), potassium (K+), and chloride (Cl−).

trace minerals Minerals required by the body in quantities less than 100 milligrams per day. The trace minerals include iron, zinc, chro- mium, fluoride, copper, manganese, iodine, molybdenum, and selenium.

Chapter 7 Minerals 179

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180 SECTION 1 The Basics of Sports Nutrition

play a specific role in sport performance, such as enhanc- ing the integrity of bones to withstand impact during sports, providing electrolytes lost in sweat, and aiding in the prevention of muscle cramps. This section will review the functions, recommended intakes, signs of deficiency, symptoms of toxicity, food sources, and recommenda- tions for supplementation for each major mineral.

Why is calcium important for athletes? Calcium is widely recognized as a critical mineral for optimal bone health. However, calcium has many other important roles in the body for health and sport perfor- mance that are often unrecognized. An area that is receiv- ing more attention is the fact that many individuals are not meeting their calcium needs as a result of low calcium intake and poor calcium absorption. For those who are low in calcium, deficiency signals generated by the body will up-regulate calcium absorption. Diets high in oxa- lates, fiber, phosphorus, and sodium can negatively affect calcium absorption. However, the bottom line is that total calcium intake is the most critical component of the for- mula for ensuring a healthy body.

What is the RDA/AI for calcium? The RDA for calcium for men ages 19 to 70 years is 1000 milligrams per day.1 The RDA for women ages 19 to 50 years is 1000 milligrams per day. Daily recommendations are increased to 1200 milligrams per day for men older than 70 years and for women older than 50 years. For a complete listing of calcium recommendations across the lifespan, consult Table 7.1.

What are the functions of calcium for health and performance? Calcium is widely recognized as a bone-strengthening mineral. However, calcium’s role in health and perfor- mance extends beyond the skeleton:

• Blood clotting: Cal- cium helps to produce fibrin, t h e p r o t e i n responsible for the structure of blood clots.

• Ner ve transmis- sion: Calcium is required for proper nerve function, releasing neurotransmitters that facilitate the perpetuation of nerve signals and activation.

• Muscle contraction: Calcium is pumped into and out of muscle cells to initiate both muscle contraction and relaxation in smooth muscle, skeletal muscle, and the heart.

• Disease prevention and weight management: Calcium has received more attention recently in the disease pre- vention arena, specifically in regard to hypertension

and colon cancer. The Dietary Approaches to Stop Hypertension (DASH) study developed the DASH diet, which encourages a balanced diet focusing on calcium, magnesium, and potassium because of their role in moderating blood pressure.2 It has been proposed that a lack of calcium leads to the excessive contraction of smooth muscle, thereby increasing pressure in blood vessels. The DASH diet recommends consuming a minimum of three serv- ings of low-fat dairy products every day. Colon can- cer research has focused on the action of calcium combining with bile salts, which are then excreted from the body, thus protecting the cells within the colon from damage. Additional benefits of calcium specific to weight loss are being researched as they relate to increased dairy and calcium intake. Some of this research suggests that the increase in cal- cium intake aids in body weight and body fat reduc- tion.3–6 More research is warranted in all of these areas to fully understand the mechanisms involved and the optimal dietary intake guidelines for disease prevention.

• Bone and tooth formation: Bone is living tissue, provid- ing a framework for the human body. Bone is com- posed of two types of cells—osteoblasts (builders) and osteoclasts (destroyers), which are both in con- stant action. Osteoblasts secrete collagen and then pull calcium and phosphorus from the blood to form a hardened material that provides the structure of bone. Osteoclasts break down the hardened mate- rial, releasing calcium and phosphorus into the blood. During growth and maturation, until peak bone mass is achieved around age 30, the building process dominates over the breakdown process. Throughout adulthood, physical activity levels and diet help to determine whether an individual is in a net state of building or tearing down. The body adapts to stress- ors, strengthening in areas that are under stress. Weight-bearing exercises such as walking, running, and weightlifting can create stress that strengthens and builds bone. High calcium intakes help to sus- tain bone by providing the building blocks for newly hardened materials. Calcium is the main component of hydroxyapatite, the solid material of bone. Because calcium is critical for many different functions in the body, if sufficient calcium is not present in the blood, it will be pulled from the reserves located in bone to normalize blood levels. This protective mechanism will ultimately weaken bones if low calcium intake is continued over time.

What are the complications of calcium deficiency? The body can usually manipulate calcium status by increasing calcium absorption from the intestines or decreasing calcium excretion through the kidneys. Hypo- calcemia, or low blood calcium, is uncommon because the body works hard to maintain a constant supply of calcium

Gaining the Performance Edge

Major and trace minerals are vital to human health. An emphasis should be placed on food sources of miner- als, consumed in adequate quanti- ties on a daily basis.

Chapter 7 Minerals 181

in the blood. However, in cases of malfunctioning kidneys or other disease states or disorders, it can occur. Signs and symptoms of hypocalcemia include muscle spasms and convulsions. Even though hypocalcemia is rare and occurs mainly in disease states, calcium deficiency in the general population, as well as with athletes, is still one of the most common deficiencies in the United States. The National Osteoporosis Foundation states that more than 54 million people in the United States either have osteoporosis or have low bone mass, putting them at high risk for developing osteoporosis in the future (www.nof.org), caused in large part by individuals con- suming less than their full calcium requirements daily. Signs and symp- toms of calcium deficiency may include impaired muscle contractions and/or muscle cramps; however, these signs are usually rare because the body will pull reserves from bone.

If the body is constantly calcium-challenged, requir- ing calcium to be withdrawn from the “calcium bank” in the bones, osteoporosis will develop. Osteoporosis, the thinning and weakening of bones, is the most dramatic result of low calcium intake. A strong emphasis needs to be placed on consuming adequate calcium throughout a lifetime, with the younger years being the most influential in creating a high peak bone mass. To prevent low bone density and/or osteoporosis, the U.S. Surgeon General reports that diet and physical activity play a significant role.7 Consuming the recommended daily intake of cal- cium and vitamin D and achieving at least 30 to 60 min- utes of physical activity per day (including weight-bearing and strength-training activities) are lifestyle approaches that can be started at a young age to prevent poor bone health later in life.

Osteoporosis is also one component of a condition termed the female athlete triad. The triad typically begins with low total calorie intake, which usually equates to low calcium intake, leading to calcium deficiency and low bone density. The lack of sufficient calorie intake on a consistent basis produces hormonal changes resulting in estrogen deficiency. This deficiency, along with other hormonal changes, low calorie intake, and high exercise energy expenditure, can lead to the cessation of men- strual cycles, or amenorrhea. The combination of low cal- cium intake and amenorrhea contributes to an increased risk for stress fractures, lowered bone mineral density, and potentially osteoporosis.

What are the symptoms of calcium toxicity? The upper limit (UL) for calcium for men and women ages 19 to 50 is 2500 milligrams per day.1 For men and women over the age of 50, the UL decreases to 2000 milligrams per day. Toxicity is typically not a problem with food intake

but can be a concern with supplement intake. High cal- cium intake from supplements can impair the absorption of other minerals and in some individuals can contrib- ute to kidney stones.1 Excess calcium can be deposited in organs and soft tissues and cause altered function. Very high levels of calcium can lead to cardiac arrest and death. Hypercalcemia, or high blood levels of calcium, can be caused by cancer or the overproduction of the para- thyroid hormone, often signaled by fatigue, constipation, and loss of appetite.

Which foods are rich in calcium? Dairy products, including milk, yogurt, and hard cheeses, are some of the richest sources of calcium. Frozen dairy desserts also have calcium, but are higher in fat and cal- ories than other choices. Many plant-based alternatives to dairy are fortified with calcium and vitamin D, and in most cases provide equivalent amounts of calcium as their dairy counterparts. Green leafy vegetables are a good source of calcium; however, oxalates present in green vegetables bind to the calcium and prevent some absorption. Calcium-processed tofu is another option rich in both calcium and plant-based protein. Orange juices, breads, and some cereals are fortified with calcium, and in some cases provide amounts equivalent to that found in milk. Lactose-intolerant individuals can consume lactose-free products, as well as plant-based products that are fortified, to meet their calcium needs each day. Refer to FIGURE 7.1 for the calcium content of specific food sources.

What is a suggestion for a calcium-rich meal or snack? Breakfast: 1½ cups of a layered yogurt parfait including gra- nola and berries (see TRAINING TABLE 7.1 )

Total calcium content = 328 milligrams

Do athletes need calcium supplements? Calcium supplementation may be indicated for some ath- letes who are following calorie-restrictive diets. However, the focus should be on calcium-rich foods first. If an ath- lete is taking calcium supplements, there are a couple things to consider:

• Amounts of calcium greater than 500 milligrams are not well absorbed when consumed at one time; there- fore, it is best to spread supplements throughout the day.

• Calcium is absorbed best when broken down first by stomach acids; calcium supplements should be taken with a small bit of food to stimulate the secretion of digestive juices.

• Calcium tablets should not be taken with other sup- plements because of nutrient–nutrient interactions; for example, calcium competes closely with iron and zinc, altering the absorption of all nutrients involved and potentially creating other problems.

osteoporosis A clinical condition that can result from inadequate cal- cium intake and is characterized by a significant decrease in bone mass. The result is weak bones that can be easily fractured.

182 SECTION 1 The Basics of Sports Nutrition

What is the RDA/AI for phosphorus? The RDA for men and women is 700 milligrams per day.9

What are the functions of phosphorus for health and performance? Phosphorus leads to a healthy body in several ways:

• Phosphorus combines with calcium to form hydroxy- apatite and calcium phosphate, which provide rigid- ity to bones and teeth.

• Phosphorus combines with lipids to form phospho- lipids, which provide integrity to cell membranes.

• Phosphorus activates and deactivates enzymes through phosphorylation. In regard to athletic performance, phosphorus is a

component of ATP, which provides energy for all forms of cellular function. Phosphorus is also needed for the forma- tion of creatine phosphate (CP). In quick, explosive move- ments, CP provides an immediate form of energy for cells. During endurance activities, phosphorus buffers acidic end products of energy metabolism, allowing an athlete to sus- tain his or her effort and delay fatigue. Finally, phosphorus plays a role in energy production by phosphorylating glucose, preparing it to proceed through glycolysis.

What are the complications of phosphorus deficiency? Because of adequate intake and widespread sources in the American diet, phosphorus deficiencies are rare. Certain

Figure 7.1 Food sources of calcium. Calcium is found in milk and other dairy products, certain green leafy vegetables, and canned fish with bones.

• Not all supplements are created equal8; calcium car- bonate supplements tend to yield the highest amount of calcium per tablet but are not as well absorbed as calcium citrate supplements. Avoid calcium supple- ments that are derived from oyster shells or bone meal because they may be contaminated with lead.

Why is phosphorus important to athletes? Phosphorus is a mineral that is critical for many func- tions throughout the body. Because of the phosphorus- rich food supply in the United States, average intakes are well above the RDA, and deficiencies are rare. Unfortu- nately, Americans’ more-than-adequate intake has raised concerns regarding the health complications of excessive phosphorus consumption.

Training Table 7.1: Poolside Parfait 6 oz low-fat plain yogurt

¼ cup granola

½ cup fresh blueberries, raspberries, or blackberries

In a parfait cup or tall glass, layer 2 oz of yogurt, then 2 tbsp granola and ¼ cup berries; repeat. Top with remaining yogurt. Chill before serving.

Serving size: 1½ cups (Recipe makes one serving)

Calories: 290 kcals

Protein: 13 grams

Carbohydrate: 39 grams

Fat: 10 grams

*In spinach, oxalate binds calcium and prevents absorption of all but about 5% of the plant’s calcium.

CALCIUM

Daily Value = 1000 mg RDA = 1000 mg (males/females age 19–50) 1200 mg (males 70+/females age 50+)

30 g (~1 oz)

Good: 10–19% DV

High: 20% DV or more

Molasses, blackstrap Cheese, mozzarella Soybeans, cooked Collards, cooked Salmon, canned, with bones Spinach, cooked* Turnip greens, cooked Black-eyed peas, cooked All Bran cereal

1 tbsp 30 g (1 oz) 90 g (~1/2 cup) 85 g (~1/2 cup) 55 g (2 oz) 85 g (~1/2 cup) 85 g (~1/2 cup) 90 g (~1/2 cup) 30 g (~1/2 cup)

172 mg 151 mg 131 mg 119 mg 117 mg 116 mg 116 mg 115 mg 100 mg

Tofu, calcium processed Yogurt, plain, low-fat Milk, nonfat Milk, 2% milkfat Milk, 1% milkfat Sesame seeds, whole roasted, toasted Cheese, Swiss Sardines, canned Cheese, Cheddar

85 g (~1/3 cup) 225 g (1 8-oz container) 240 mL (1 cup) 240 mL (1 cup) 240 mL (1 cup)

30 g (1 oz) 55 g (2 oz) 30 g (1 oz)

581 mg 448 mg 352 mg 352 mg 349 mg 297 mg

237 mg 210 mg 209 mg

Chapter 7 Minerals 183

disease states, hyperparathyroidism, and taking large doses of antacids (which decrease phosphorus absorp- tion) can contribute to phosphorus deficiencies, produc- ing symptoms such as bone malformation, bone pain, and muscle weakness.

What are the symptoms of phosphorus toxicity? The upper limit for phosphorus is 4000 milligrams per day for adult men and women.9 As mentioned previously, phosphorus toxicity is of much greater concern in the United States than is phosphorus deficiency. Americans consume plenty of phosphorus but not enough calcium. This intake imbalance can lead to altered calcium metab- olism and an increased risk for osteoporosis.

Which foods are rich in phosphorus? Phosphorus is found predominantly in animal proteins including meat, fish, eggs, and dairy. Nuts, legumes, and cereals are moderate sources of phosphorus; however, these plant foods contain phosphorus in the form of phytic acid, which is not as well absorbed. Refer to FIGURE 7.2 for the phosphorus content of specific food sources.

What is a suggestion for a phosphorus-rich meal or snack? Summer barbeque: Grilled hamburger with cheese, 1 cup of fruit salad, and 1 cup of skim milk

Total phosphorus content = 571 milligrams

Do athletes need phosphorus supplements? Phosphorus supplements marketed to athletes claim to prevent fatigue as a result of the buffering capacity of phosphorus. Actual research results regarding this claim are equivocal. Studies have explored the effects of sodium phosphate, potassium phosphate, or calcium phosphate on maximal oxygen uptake, anaerobic threshold, and power. Some studies have found an increase in VO2 max and ventilatory anaerobic threshold or a decrease in the rating of perceived exertion during submaximal exer- cise with supplemental phosphates.10–12 Other investi- gators report no significant difference with these same parameters as well as power output with phosphate sup- plements.13,14 Because a positive result of phosphate sup- plementation has not been clearly defined, and because long-term excessive intakes of phosphorus can be detri- mental to bone health, athletes should focus on dietary intakes of phosphorus to meet daily needs for health and performance.

Why is magnesium important for athletes? Magnesium is involved in hundreds of enzymatic reac- tions, bone health, blood clotting, and the regulation of blood pressure. In addition to its many health-related functions, magnesium has recently been investigated for its performance-enhancing effects.15 Some magnesium research has focused specifically on its purported ability to prevent muscle cramps; however, findings to date have not been encouraging.16,17 Although its ergogenic effects

Figure 7.2 Food sources of phosphorus. Phosphorus is abundant in the U.S. food supply. Meats, legumes, nuts, dairy products, and grains tend to have more phosphorus than fruits and vegetables. Note: The DV for phosphorus is higher than the current RDA of 700 milligrams for males and females age 19 and older. Data from U.S. Department of Agriculture, Agricultural Research Service, 2012. USDA National Nutrient Database for Standard Reference, Release 25. Nutrient Data Laboratory home page. Available at: http://www.ars.usda.gov/ba/bhnrc/ndl.

Cheese, provolone Beef liver, cooked Yogurt, plain, nonfat Sunflower seeds All Bran cereal Milk, 2% milkfat Milk, nonfat Milk, 1% milkfat Herring, cooked Beef, ground, extra lean, cooked

PHOSPHORUS

Daily Value = 1000 mg RDA = 700 mg (males/females)

422 mg 355 mg 353 mg 347 mg 339 mg 275 mg 275 mg 273 mg 258 mg 224 mg

85 g (3 oz) 85 g (3 oz) 225 g (8 oz) 30 g (~1 oz) 30 g (~1/2 cup) 240 mL (1 cup) 240 mL (1 cup) 240 mL (1 cup) 85 g (3 oz) 85 g (3 oz)

85 g (3 oz) 85 g (3 oz) 90 g (~1/2 cup) 85 g (~1/3 cup) 85 g (~3 oz) 30 g (1 oz) 90 g (~1/2 cup) 240 mL (1 cup) 2 tbsp

184 mg 173 mg 162 mg 162 mg 152 mg 142 mg 126 mg 120 mg 106 mg

Chicken, white meat, cooked Oysters, cooked Lentils, cooked Tofu, calcium processed Chicken, dark meat, cooked Almonds Black beans, cooked Soy milk Peanut butter

High: 20% DV or more

Good: 10–19% DV

184 SECTION 1 The Basics of Sports Nutrition

are still under debate, there is no doubt that adequate daily magnesium intake is critical for overall health.

What is the RDA/AI for magnesium? The RDA for males 19 to 30 years old is 400 milligrams per day; for men ages 31 to 70 years it is 420 milligrams daily.9 Women require slightly less magnesium. The RDA for females 19 to 30 years old is 310 milligrams per day; for women ages 31 to 70 years it is 320 milligrams daily.9

What are the functions of magnesium for health and performance? Magnesium is involved in more than 300 enzyme func- tions, including DNA and protein synthesis as well as proper blood clotting. Magnesium helps to maintain bone strength through its role in bone metabolism. More recently, magnesium has been highlighted as an aid in the regulation of blood pressure. Research has uncovered that magnesium, potassium, calcium, and protein, as well as the long-time villain sodium, all have an effect on blood pressure. Magnesium has an inverse relationship with blood pressure, with adequate daily intakes protecting an individual from hypertension.

In regard to sports, magnesium plays important roles in bioenergetics. It serves to stabilize the structure of ATP and improves the effectiveness with which the enzyme adenosine triphosphatase acts on ATP and thus releases energy. Magnesium is also involved in glucose and lipid metabolism. It serves as a cofactor for seven key glyco- lytic enzymes and thus affects both anaerobic and aerobic carbohydrate metabolism. It also plays a role in lipid and protein metabolism. Inside the mitochondria, magnesium is essential for the aerobic production of ATP via the elec- tron transport chain. Finally, during activity, muscles rely on magnesium for proper contraction and relaxation. The important roles that magnesium plays in muscle function and bioenergetics are the driving force behind the devel- opment and marketing of sports-related supplements containing magnesium.

What are the complications of magnesium deficiency? Magnesium deficiency has been shown to cause a vari- ety of problems such as altered cardiovascular function, including hypertension, as well as impaired carbohydrate metabolism.18,19 Some of the symptoms of magnesium deficiency include loss of appetite, muscle weakness, and nausea. The first signs of a deficiency usually do not surface for several months because a significant amount of magnesium is stored in the bones. If an athlete con- tinues to consume a diet chronically low in magnesium, other symptoms, such as muscle cramps, irritability, heart arrhythmias, confusion, and possibly high blood pressure, will emerge. If the deficiency is left untreated, death can result.

As mentioned previously, magnesium has been con- nected to the regulation of blood pressure. Magnesium

blocks the stimulating effect of calcium, allowing muscles, particularly in the arterioles, to relax, thereby decreas- ing blood pressure. Insufficient magnesium intake will allow calcium’s contracting effect to dominate, and higher blood pressure will ensue.

Observation of the effect of exercise on magnesium levels in athletes is varied, and study results are equivocal. It has been suggested that prolonged or intense exercise may decrease magnesium levels as a result of increased excretion in sweat and urine as well as increased usage by the cells for energy production. A few studies have shown that levels may drop initially, but rebound to normal lev- els 2 to 24 hours postexercise.20,21 Some researchers have found that the decrease in serum magnesium levels dur- ing long-duration exercise contributes to cramping.22 As a result of this research, products have been developed, suggesting that increasing magnesium intake during prolonged exercise can prevent muscle cramps. How- ever, if athletes are consuming enough calories daily, they typically will consume sufficient amounts of mag- nesium and therefore do not require extra supplemen- tation during activity. Overall, few studies show a direct link between magnesium deficiency and cramping or impaired performance.23

What are the symptoms of magnesium toxicity? Hypermagnesemia, or high blood levels of magnesium, is uncommon except for those with kidney diseases or malfunction. The signs and symptoms of toxic levels of magnesium include nausea, vomiting, diarrhea, and weakness. The upper limit of 350 milligrams per day refers to the maximum daily dosage of magnesium only from supplements and medicines.9 There is no evidence of health or performance complications from high mag- nesium intakes from food sources.

Which foods are rich in magnesium? Magnesium is widely distributed in foods but is con- centrated in plant-based sources. Whole grains, green leafy vegetables, legumes, nuts, and seafood are all good sources of magnesium. Processing causes most of the magnesium to be leached from whole grains; therefore, athletes should incorporate whole, unprocessed grains into meals and snacks. Hard water, with a high mineral content, can also be a significant source of magnesium. Meats and dairy products provide moderate amounts of magnesium. High fiber, phosphorus, and calcium intakes, especially from supplements, can decrease magnesium absorption. If a fiber supplement is prescribed, it should be taken between meals. Refer to FIGURE 7.3 for the mag- nesium content of specific food sources.

What is a suggestion for a magnesium-rich meal or snack? Dinner: Teriyaki chicken stir-fry (see TRAINING TABLE 7.2 )

Total magnesium content = 139 milligrams

Chapter 7 Minerals 185

effects of magnesium supplements on anaerobic perfor- mance in young men after a 7-week strength training pro- gram. The supplemental group received approximately 500 milligrams of magnesium a day; after the experimen- tal period, peak knee-extension torque increased more in the supplemental group versus placebo. Other studies testing subjects involved in aerobic activities have found no benefit of magnesium supplementation versus con- trols. Overall, research has found the greatest benefit of supplementation in those who are currently consuming low dietary levels of magnesium.27 It has been reported that up to half of the athletic population consumes a diet containing less than the current RDA for magnesium.28 Therefore, similar to all vitamins and minerals, if an athlete is deficient in magnesium, achieving an optimal intake may be helpful in resolving poor performance or deficiency symptoms such as muscle weakness, muscle cramps, and irritability. Athletes should focus on con- suming more magnesium-rich foods versus relying on a supplement. The current volume of research is limited, and therefore recommendations for magnesium supple- mentation for athletes have not been established. If an athlete chooses to take a sport supplement containing magnesium, ensure that the total daily intake remains below the established upper limit by looking closely at the Supplement Facts label for the serving size and mag- nesium dosage.

Figure 7.3 Food sources of magnesium. Most of the magnesium in the diet comes from plant foods such as grains, vegetables, and legumes. Note: The DV for magnesium correlates with the current RDA for males ages 19 to 30. The DV is higher than the current RDA of 310 and 320 milligrams for females ages 19 to 30 and 31 to 70, respectively, and lower than the current RDA of 420 milligrams for males 31 to 70.

Do athletes need magnesium supplements? Recent studies on magnesium supplementation for ath- letes either are equivocal or show no benefit.24 Some studies have shown an ergogenic benefit of magnesium potentially enhancing carbohydrate and fatty acid metab- olism.25 A study conducted by Brilla and Haley26 tested the

Source: Data from U.S. Department of Agriculture, Agricultural Research Service, 2012. USDA National Nutrient Database for Standard Reference, Release 25. Nutrient Data Laboratory home page. Available at: http://www.ars.usda.gov/ba/bhnrc/ndl.

Training Table 7.2: Teriyaki Chicken Stir-Fry ⅓ cup uncooked brown rice

Cooking spray

1 cup broccoli

¼ cup sliced green or red peppers

3 oz diced chicken breast

1–2 tbsp teriyaki sauce

Cook rice according to package directions. While the rice is cooking, coat a skillet with cooking spray. Sauté the broccoli, peppers, and onions in the skillet over medium-high heat for 3 minutes. Add the teriyaki sauce and chicken and continue to cook for 5 to 10 more minutes until the chicken is cooked through. Serve over rice.

Serving size: 3 cups (Recipe makes one serving)

Calories: 443 kcals

Protein: 36 grams

Carbohydrate: 62 grams

Fat: 5 grams

High: 20% DV or more

Good: 10–19% DV

All Bran cereal Sesame seeds Halibut, cooked Almonds Oysters, cooked

MAGNESIUM

Daily Value = 400 mg RDA = 400 mg (males age 19–30), 310 mg (females age 19–30), 420 mg (males age 31–70), 320 mg (females age 31–70)

114 mg 107 mg 91 mg 83 mg 81 mg

30 g (~1/4 cup) 90 g (1/2 cup) 85 g (~3 cups) 90 g (~1/2 cup) 140 g (~3/4 cup) 2 tbsp 85 g (3 oz) 85 g (~1/3 cup) 90 g (~1/2 cup) 225 g (8-oz container) 50 g (2 slices) 1 tbsp 30 g (~3/4 cup)

30 g (1/2 cup) 30 g (~1 oz) 85 g (3 oz) 30 g (~1 oz) 85 g (3 oz)

78 mg 77 mg 67 mg 63 mg 60 mg 56 mg 54 mg 49 mg 47 mg 43 mg 43 mg 43 mg 42 mg

Cashews Soybeans, cooked Spinach, raw Black beans, cooked Rice, brown, cooked Peanut butter Crab, Alaska King, cooked Tofu, calcium processed Black-eyed peas, cooked Yogurt, plain, nonfat Whole wheat bread Molasses, blackstrap Wheat bran flakes cereal

186 SECTION 1 The Basics of Sports Nutrition

Why is sodium important for athletes? Sodium is a mineral that causes mixed reactions between the health and performance communities. Sodium is often called a demon to health, leading to hypertension and possibly heart disease. In the athletic world, espe- cially for endurance sports, sodium is heralded as a life saver. So, should athletes consume more sodium or less sodium? In general, moderation is the key, allowing for flexibility in recommendations based on individual needs.

What is the RDA/AI for sodium? To function properly, the body requires only approxi- mately 500 milligrams of sodium per day. The most cur- rent recommendation sets the AI for sodium at 1500 milligrams per day.29

What are the functions of sodium for health and performance? Sodium is important for maintaining blood pressure, nerve impulse transmission, and muscle contraction. Sodium is most noted for its role in blood pressure. A con- sistently high intake of sodium has been directly linked to high blood pressure. Approximately one in three Ameri- can adults have high blood pressure (www.nhlbi.nih.gov) caused in large part by intakes of sodium in excess of the recommended upper limit.29 A lower sodium intake has been the mantra of health professionals for many years, and it will be renewed when statistics become available in upcoming years on Americans’ massive sodium con- sumption as compared to the new stricter DRI guidelines (the current AI is 1500 milligrams; the previous recom- mendation was 2400 milligrams).

At the other end of the spectrum, sodium is crowned as a hero for its role during exercise, and its intake is often encouraged. Sodium aids in the absorption of glu- cose, which makes it a key component of sports bever- ages designed to provide energy during exercise. Sodium also serves as one of the body’s electrolytes. Electrolytes are minerals that become positively or negatively charged ions when dissolved in the fluid medium of the body. They play a role in any physiological function that requires the generation or conduction of electrical signals in the body. An example is the activation of muscle contraction via the spread of electrical activity from the nerves to the mus- cles. One of the most commonly occurring electrolytes in the body is sodium. The minerals chloride and potassium are other common electrolytes found in the body. Finally, sodium acts in conjunction with the minerals potassium and chloride to create concentration gradients that help maintain proper fluid balance throughout the body. Sodium is lost in sweat during exercise. If the loss is excessive, without replacement, a life-threatening condition called hypona- tremia can result.

hyponatremia Low blood sodium levels resulting from sodium defi- ciency and/or the intake of large volumes of water.

What are the complications of sodium deficiency? Sodium deficiency is not typically a problem on a daily basis because of the checks and balances of hor- mones regulating uptake and secretion of sodium as well as the high average daily intake. However, short- term sodium deficiency can be an issue for individuals who have prolonged diarrhea or vomiting or who are exercising for a long period of time and have excessive sweat loss. Signs and symptoms of low blood sodium (hyponatremia) include cramping, nausea, vomiting, dizziness, seizures, coma, and—left untreated—death. Hyponatremia can also be caused by consuming only water, versus sports beverages, during long-duration exercise or by routinely avoiding foods and beverages containing sodium.

What are the symptoms of sodium toxicity? A rapid intake of large volumes of sodium (e.g., drinking salt water) can cause hypernatremia and hypervolemia— high blood concentrations of sodium and thus high blood volume. This results in swelling and a rise in blood pressure. Most individuals can adequately regulate sodium intake and excretion through the action of aldosterone, the hor- mone made in the adrenal glands, signaling the kidneys to retain more sodium if intake is low. For those who cannot regulate sodium appropriately, both body fluid volume and blood pressure increase. For these individuals, a reduced- salt diet, below the upper limit of 2300 milligrams per day,29 can be helpful in regulating blood pressure. It must be noted that sodium is only one player in the game of high blood pressure. Potassium, magnesium, protein, and fiber also have been linked to blood pressure regulation, and therefore intake of all nutrients should be addressed.

Some research also shows that high intakes of sodium may lead to increased calcium excretion, thus contrib- uting to osteoporosis. Similar to blood pressure regula- tion, osteoporosis risk is increased through deficiencies of some nutrients and excessive intakes of others. Consider the whole picture when evaluating an athlete’s risk for osteoporosis to avoid tunnel vision on just one nutrient.

Which foods are rich in sodium? Sodium is widely distributed in the American diet. Table salt (1 tsp = ~2300 milligrams of sodium), soy sauce, condiments, canned foods, processed foods, fast foods, smoked meats, salted snack foods, and soups are all rich sources of sodium. Most Americans consume well above the upper limit of 2300 milligrams per day, with some intakes reaching into the 8000–11,000 milligrams per day range.29 Refer to FIGURE 7.4 for the sodium content of specific food sources.

What is a suggestion for a sodium-rich meal or snack? Lunch: Grilled cheese sandwich with 1 cup tomato soup

Total sodium content = 1391 milligrams

Chapter 7 Minerals 187

Do athletes need sodium supplements? In general, sodium supplements are not required; dietary sources of sodium are more than adequate to cover daily needs as well as losses through sweat. In activities last- ing more than 4 hours, such as long-distance triath- lons or adventure racing, sodium supplements may be indicated.

Why is chloride important for athletes? As the major extracellular anion, chloride is primar- ily involved in fluid balance within the body; however, it is also a key component to many other bodily func- tions. Chloride (Cl) is widely recognized as the partner to sodium (Na) in salt (NaCl), which in fact is the main source of chloride in the American diet.

What is the RDA/AI for chloride? The AI for chloride for both men and women is 2300 mg per day.29

What are the functions of chloride for health and performance? Chloride acts as a “disinfectant” to maintain health inside the body. Chloride combined with hydrogen forms hydro- chloric acid. In the stomach, hydrochloric acid helps to kill harmful bacteria that have been consumed. White blood cells also use chloride to kill invading bacteria

Figure 7.4 Sodium content of various foods.

throughout the body. In neurons, the movement of chlo- ride, as well as calcium, sodium, and potassium, allows for the transmission of nerve impulses throughout the body.

In regard to athletes’ performance, chloride is one of the extracellular electrolytes that is critical for maintain- ing fluid balance throughout the body.

What are the complications of chloride deficiency? Low chloride levels can be caused by frequent vomiting, which removes hydrochloric acid from the stomach. For example, individuals with the eating disorder bulimia can have low chloride levels in the body as a result of fre- quent vomiting as well as decreased intake. The result is dehydration and metabolic alkalosis, or high blood pH. Even a small rise in blood pH can result in abnormal heart rhythm, decreased blood flow to the brain, and reduced oxygen delivery to various tissues. If left untreated, chlo- ride deficiency can ultimately result in death.

What are the symptoms of chloride toxicity? For sensitive individuals, high intake of both sodium and chloride may cause hypertension. The upper limit for chloride has been set at 3600 milligrams per day.29

Which foods are rich in chloride? Salt, or sodium chloride (NaCl), is the richest source of chloride in the American diet. Chloride can also be found in small amounts in fruits and vegetables. The dietary sources of sodium shown in Figure 7.4 provide examples of chloride-rich sources of foods as well.

What is a suggestion for a chloride-rich meal or snack? Dinner: Meatball sub sandwich and a small bag of pretzels

Total chloride content = 3092 milligrams

Do athletes need chloride supplements? Even though chloride is lost in sweat, athletes generally consume plenty of chloride through a balanced diet. Chlo- ride supplements do not appear to enhance physical per- formance and therefore are not recommended.

Why is potassium important for athletes? Potassium is involved in the regulation of many bodily processes, including blood pressure. The most recent dietary recommendations for potassium have increased, creating a large gap between the typical American intake and the recommended values. This gap is caused in large part by the increased consumption of processed foods in the United States, which are generally low in or devoid of potassium. All individuals, including athletes, need to put a stronger emphasis on eating potassium-rich foods on a daily basis.

Data from U.S. Department of Agriculture, Agricultural Research Service. USDA National Nutrient Database for Standard Reference, Release 28. 2015. http://www.ars.usda.gov/Services/docs.htm?docid=8964. Accessed January 30, 2016.

Sodium Content of Various Foods

Food Serving Size Sodium (mg)*

Cucumber, with peel, raw 1 large (301 g) 6

Pickles, cucumber, dill 1 large (135 g) 1,092

Pork, loin, roasted 3 oz (85 g) 42

Ham, cured 3 oz (85 g) 1,128

Whole-wheat bread 1 slice (28 g) 146

Biscuit from recipe 4” biscuit (101 g) 586

Tomatoes, fresh 1 (123 g) 6

Spaghetti sauce, ready-to-serve

1/2 cup (132 g) 577

Milk, 2% milkfat 1 cup (244 g) 145

American cheese 1 oz (28.35 g) 468

Baked potato 1 (156 g) 8

1 oz (28.35 g) 148

*Note: As food becomes more processed, the sodium content increases.

Potato chips

188 SECTION 1 The Basics of Sports Nutrition

What is the RDA/AI for potassium? The most recent recommendation by the Food and Nutri- tion Board sets the AI for potassium at 4700 milligrams per day for men and women.29

What are the functions of potassium for health and performance? Potassium and sodium perform a balancing act through- out the body. Potassium counteracts the effects of sodium on blood pressure, helping to keep blood pressure low. The interchange and flow of potassium and sodium in and out of cells are responsible for the transmission of nerve impulses and muscle contractions. Potassium is one of the intracellular electrolytes that is critical for fluid balance in the body, especially during exercise. Unfortu- nately, Americans are not doing a good job of balancing their intake of potassium and sodium. Sodium intakes are too high while potassium intakes are too low, leading to problems such as high blood pressure. Athletes need to make an effort to choose potassium-rich foods while keeping sodium intake under control.

What are the complications of potassium deficiency? Hypokalemia, or low blood potassium, is caused by fre- quent vomiting, diarrhea, and use of diuretics, as well as low potassium intake. Athletes with high sweat losses are

Figure 7.5 Food sources of potassium. The best food sources of potassium are fresh fruits and vegetables, and certain dairy prod- ucts and fish. Note: The DV for potassium is lower than the current RDA of 4700 milligrams for males and females age 19 and older.

also at risk for potassium deficiency, which may result in muscle cramps. Common symptoms of potassium defi- ciency include muscle weakness and loss of appetite. A rapid change in potassium status or long-term low potas- sium levels can lead to heart arrhythmias.

What are the symptoms of potassium toxicity? In healthy individuals, the kidneys will excrete excess potassium, and therefore no upper limit has been set for potassium.29 However, in those with impaired kidney function, high intake of potassium (combined with low excretion) can lead to hyperkalemia. High potassium lev- els in the blood over time can lead to a slowing and even- tual stopping of the heart.

Which foods are rich in potassium? Fruits and vegetables are the richest sources of potas- sium, with potatoes, spinach, and bananas at the top of the list. Meat, milk, coffee, and tea are also significant sources. Food processing tends to remove potassium and add sodium, thereby contributing to the imbalanced intake of these two minerals. Even if potassium is not removed from a food or beverage, the addition of sodium disrupts the ratio of sodium to potassium, leading to potential health and performance complications. Refer to FIGURE 7.5 for the potassium content of specific food sources.

588 mg 574 mg 556 mg 534 mg 490 mg 487 mg 474 mg

473 mg 457 mg 443 mg 385 mg 374 mg 371 mg 363 mg

Potato, baked Yogurt, plain, nonfat Tomato juice Clams, cooked Halibut, cooked Banana Spinach, raw Orange juice, chilled Lima beans, cooked Milk, 1% milkfat Baked beans, canned Cantaloupe Acorn squash, cooked Apricot, fresh

110 g (1 small) 225 g (8-oz container) 240 mL (1 cup) 85 g (3 oz) 85 g (3 oz) 140 g (9" banana) 85 g (~3 cups) 240 mL (1 cup) 90 g (~1/2 cup) 240 mL (1 cup) 130 g (~1/2 cup) 140 g (1/4 medium melon) 85 g (~1/3 cup) 140 g (~4 apricots)

POTASSIUM

Daily Value = 3500 mg AI = 4700 mg (males/females)

Good: 10–19% DV

High: 20% DV or more

Chapter 7 Minerals 189

In regard to athletic performance, there is no evi- dence that the ingestion of excess sulfur is ergogenic.

What is a suggestion for a potassium-rich meal or snack? Snack: Summertime Salad (see TRAINING TABLE 7.3 )

Total potassium content = 457 milligrams

What is the RDA/AI for sulfur? There is no RDA, EAR, or AI for sulfur because of the fact that it can be obtained from food and water, as well as be derived from specific amino acids in the body.29

Gaining the Performance Edge

Food for Thought 7.1

Importance of Mineral Intake for Athletes: Major Minerals

Review the recommendations, food sources, and significance of major minerals for athletes.

Training Table 7.3: Summertime Salad This salad tastes best during the summer months when tomatoes are in season.

1 small tomato, diced

¼ whole cucumber, diced

¼ cup red onion, diced

2 tbsp light Italian dressing

Mix together the vegetables and dressing.

Chill before serving.

Serving size: 1½ cups (recipe makes one serving)

Calories: 95 kcals

Protein: 2 grams

Carbohydrate: 12 grams

Fat: 5 grams

190 SECTION 1 The Basics of Sports Nutrition

What are the functions of iron for health and performance? Iron is best known for aiding in the formation of com- pounds essential for transporting and utilizing oxygen; thus, it is critical for aerobic activities and endurance training. Heme is the iron-containing portion of both hemoglobin and myoglobin. Hemoglobin is a protein–iron compound in red blood cells that carries oxygen from the lungs to the cells and tissues of the body. Myoglobin is found in muscle and facilitates the transport of oxygen to the muscle cells. Iron also plays a role in healthy immune function and brain development as well as energy produc- tion through its inclusion in various enzymes.

What are the complications of iron deficiency? Iron deficiency is one of the most common nutrient defi- ciencies in the United States and worldwide. In contrast to many developing countries, in which iron deficiency affects a large proportion of the population (30–70%), the prevalence of iron deficiency is less than 20% in the industrialized countries of Europe and North America.31 Iron is lost through skin, hair, sweat, and the intesti- nal tract. Women lose significantly more iron than men because of monthly iron losses through menstruation. Iron deficiency occurs mainly as a result of poor intake

Fortifying Your Nutrition Knowledge

How Is Iron Status Evaluated? Iron status can be evaluated in several ways. The following blood test parameters are used to measure iron status:

■ Ferritin: Stores iron within cells; a small amount also cir- culates in the blood.

■ Serum iron: Represents the free iron in the blood (small amount) and the iron bound to transferrin.

■ Serum total iron binding capacity (TIBC): Measures the capacity of transferrin to bind to iron; as iron levels decrease, the binding capacity increases.

■ Hemoglobin: Measures the iron-containing protein in the blood that is a component of red blood cells.

■ Hematocrit: Determines the concentration of red blood cells in the blood.

■ Red blood cell count: Counts the number of red blood cells in the blood, which reflects iron status because of the need for iron to produce red blood cells. The total number of red blood cells is also related to hemoglo- bin levels.

■ Transferrin saturation: Transferrin is the transport protein for iron in the blood. The transferrin saturation reflects the percentage of transferrin saturated with iron.

Fortifying Your Nutrition Knowledge

What Factors Influence Iron Absorption? The amount of iron absorbed depends on several factors:

1. Iron status: The body absorbs iron at the rate needed by the body. If iron stores are low, iron is shuttled into the bloodstream packaged as transferrin (see FIGURE 7.6 ), carrying iron to organs and bodily tissues. If iron stores are high, the mineral is stored in the intestinal cells, sloughed off, and excreted when cell life comes to term. Therefore, those with iron-deficiency anemia will absorb iron at a greater rate than those with normal stores.

2. Gastrointestinal function: Iron is absorbed in the small intestine, but it must first be prepared for optimal absorption in the stomach. The gastric acids of the stomach help to dissolve iron and convert ferric iron into ferrous iron, which is more readily absorbed through the intestines. Those with altered or malfunctioning gastro- intestinal systems, for example, elderly individuals with low production of gastric acid, will have compromised iron absorption.

3. Type of iron source—heme vs. nonheme: Heme iron, found mainly in meat/animal products, is most read- ily absorbed in the body. Nonheme iron, found mainly in plant foods, is absorbed and utilized by the body, but to a lesser degree than heme iron. However, non- heme absorption can be enhanced by consuming vita- min C–rich foods or meat products with nonheme food sources.

4. Nutrient interactions: Dietary factors that decrease iron absorption include tannins from tea and coffee, fiber, soy, and high intakes of zinc, calcium, or manganese.

What are the trace minerals? The trace minerals are equally as important as the major minerals. These minerals are found in smaller amounts in the body than the major minerals and thus are termed trace minerals. The trace minerals include iron, zinc, chro- mium, fluoride, copper, manganese, iodine, molybdenum, and selenium.

Why is iron important for athletes? Iron is critical for proper health as well as optimal per- formance. Iron deficiency is one of the most common nutritional deficiencies in the United States and there- fore deserves special mention and attention.

What is the RDA/AI for iron? The RDA for men ages 19 to 50 years and postmenopausal women is 8 milligrams per day.30 The RDA for females ages 19 to 50 years is significantly higher at 18 milligrams per day.30 The difference is caused by the monthly loss of blood for menstruating women. It should also be noted that the requirements for vegetarians are 1.8 times higher

due the lower bioavailability of iron from plant sources (i.e., 14 milligrams and 32 milligrams per day for men and women, respectively).30

Chapter 7 Minerals 191

Figure 7.6 Iron absorption. The amount of iron absorbed depends on several factors—normal gastrointestinal function, the need for iron, the amount and kind of iron consumed, and dietary factors that enhance or inhibit iron absorption.

relative to daily needs. Iron deficiency occurs in three stages: 1. Iron depletion: Iron stores are depleted from the bone

marrow, which is indicated by a low blood ferritin level.

2. Iron-deficiency erythropoiesis: Blood results will show a continued decline in serum ferritin and an increase in serum transferrin, while hemoglobin levels remain in the normal range. Athletes will begin to feel the effects of iron deficiency through decreased physical performance results.

3. Iron-deficiency anemia: Ferritin and hemoglobin levels are low, resulting in insufficient and/or defective red blood cells. The red blood cells produced are small (microcytic) and pale (hypochromic) in color, and iron-deficiency anemia is diag- nosed. Athletes will complain of cold intolerance, low energy lev- els, decreased performance, and exercise intolerance. Athletes will also look pale and “sickly.” It is important to realize that there are several types

of anemia, and it is critical to diagnose the correct one to ensure that individuals receive proper treatment. Refer to TABLE 7.2 for an explanation of the anemias that

iron-deficiency anemia A clinical condition commonly resulting from poor iron intake that affects the red blood cells and their ability to trans- port oxygen.

are caused by iron, vitamin B6, vitamin B12, and folate deficiencies.

Why are athletes at risk for iron-deficiency anemia? Athletes are at a greater risk than the general popula- tion for iron-deficiency anemia. Beard and Tobin reviewed more than two decades of research on iron status and

Table 7.2 Types of Vitamin and Mineral Deficiency Anemias

Vitamin/mineral Type of anemia Cause of anemia Iron Microcytic,

hypochromic anemia

Lack of hemoglobin leading to small red blood cells that are pale in color

Vitamin B6 Microcytic, hypochromic anemia

Decreased production of the red blood cells’ hemoglobin ring

Vitamin B12 Pernicious anemia; macrocytic, megaloblastic anemia

Anemia caused by low levels of intrinsic factor, decreasing absorption of B12 and thus producing altered red blood cells

Folate Megaloblastic anemia

Impaired normal red blood cell development and division leads to large, irregular cells

Storage iron is excreted when cells slough off

The protein ferritin stores iron in the intestinal cell

Tissues store iron or incorporate it in heme

Red blood cells contain iron-rich hemoglobin

Intestinal cells turn away excess iron

Absorbed iron is carried in the blood by the protein transferrin

Blood loss (e.g., menstruation) removes iron from the body

192 SECTION 1 The Basics of Sports Nutrition

exercise.32 They state that three groups of athletes appear to be at greatest risk for developing altered body iron: female athletes, distance runners, and vegetarian ath- letes. In fact, similar reports state that as many as 26–60% of female athletes are affected by iron deficiency.33–36 Due to the large number of athletes at risk, it has been sug- gested that these groups should pay particular attention to maintaining an adequate consumption of iron in their diets.32 Although female athletes, distance runners, and vegetarian athletes may be at higher risk, they are not the only athletes at risk. The reasons that any athlete could be at an increased risk for iron deficiency include:

• Low dietary intakes for both males and females: Many athletes consume less than their daily requirements for both total calories and iron.

• Type of food intake: Vegetarians may be at higher risk if they do not consume enough nonheme sources of iron. Those following an omnivorous diet appear to be at lower risk for deficiency.

• Increased demand for myoglobin, hemoglobin, and energy- producing enzymes: Athletes who are training and competing regularly require more oxygen-carrying compounds and more enzymes to produce energy.

• Type of sport: Running and other impact sports appear to put athletes at a higher risk than nonimpact sports. Hematuria is the presence of hemoglobin or myoglo- bin in the urine, caused by a breakdown of red blood cells or hemolysis (releasing of hemoglobin from the kidneys) resulting from repeated impact. Hemolysis has also been observed in weight lifters because of the mechanical stress of lifting heavy weights. Non- impact sport athletes, such as rowers or cyclists, can also experience hemolysis resulting from loss from the intestinal wall or in urine or feces due to an irri- tation caused by equipment and body friction, or the consumption of nonsteroidal anti-inflammatory drugs.

• Loss through sweat: This factor may have a greater impact on the iron status of males because men tend to sweat more than women. Sports anemia is a unique condition and not a true

anemia. With sports anemia, hemoglobin levels are at the low end of the normal range, but other blood param- eters test normal. Short-term sports anemia can occur in individuals beginning an exercise program or initiat- ing a period of intense training. To compensate for a sud- den shift in duration or intensity of exercise, the athlete’s blood volume increases quickly. This rapid change dilutes the blood concentration, which shows up on a blood test as a relatively low level of hemoglobin. After 1 to 2 months of consistent training, blood concentration returns to nor- mal, and the sports anemia is remedied. Long-term sports anemia has been found in highly trained endurance ath- letes. It is theorized to occur because the red blood cells become very efficient at carrying and releasing oxygen to the tissues and therefore do not require a high level of concentration in the blood.

Fortifying Your Nutrition Knowledge

Dietary Assessment and Treatment of Iron Deficiency To properly diagnose and treat an athlete for iron-deficiency anemia, sports dietitians should follow these steps:

1. Consult with the athlete’s physician: Determine whether the type of anemia is caused by a lack of iron, B6, folate, or B12 in the diet; the athlete’s history of anemia; and the stage of iron-deficiency anemia, if anemia is connected to low iron levels.

2. Perform a diet analysis: Review iron intake from foods and supplements, the types of iron sources consumed (heme and/or nonheme), and dietary factors that are enhancing or inhibiting iron absorption at meals and snacks.

3. Consider the athlete’s primary sport and level of training: Impact versus nonimpact sport, beginner versus expe- rienced athlete, and recreational versus high-volume training regimen.

4. Inquire about other blood losses: This could be a result of such causes as a regular blood donation.

5. Develop a nutritional plan that will increase iron intake and availability, while being sensitive to the athlete’s typi- cal dietary patterns: For example, vegetarians do not have to eat meat to resolve an iron deficiency. Be sen- sitive to dietary beliefs and patterns and work within those boundaries, as long as the patterns are not related to disordered eating.

For adults, high intakes of iron have other com- mon complications. Excessive iron can cause decreased absorption of other nutrients, such as copper. For those who are genetically predisposed, high iron intakes can con- tribute to a condi- tion termed hemochromatosis. This condition causes an accumulation of iron in the liver, which can become toxic

hemochromatosis A clinical con- dition associated with the accumu- lation of iron in the body’s tissues, particularly the liver, which can result in liver failure or cancer.

To prevent iron-deficiency anemia in athletes, the development of standard protocols for the annual assess- ment and treatment of iron deficiency is recommended.34 Several important steps in the assessment and treatment of iron deficiency anemia are presented in the following Fortifying Your Nutrition Knowledge.

What are the symptoms of iron toxicity? The upper limit for iron is 45 milligrams per day.30 Iron toxicity is most common in young children who con- sume a large number of chewable vitamins/minerals at one time. Toxicity is characterized by nausea, vomiting, diarrhea, rapid heartbeat, and dizziness. If left untreated, toxic levels of iron can lead to death within hours.

Chapter 7 Minerals 193

Figure 7.7 Food sources of iron. Iron is found in red meats, certain seafoods, vegetables, and legumes and is added to enriched grains and breakfast cereals. Note: The DV for iron is higher than the current RDA of 8 milligrams for males age 19 and older and postmenopausal females.

and destroy the liver over time. More recent research has shown an increased risk of colon cancer and heart dis- ease with high iron intakes. The theory is that because iron is a pro-oxidant, it may contribute to cell damage, leading to cancerous growths in the colon, or it may accelerate the oxidization of LDL cholesterol, leading to atherosclerosis. The exact link or mechanism still needs to be determined by future research.

Which foods are rich in iron? The two types of iron are heme and nonheme. Heme iron is found only in animal foods such as beef, poultry, and fish and boasts a greater bioavailability than nonheme iron, which is primarily found in plant foods such as soy prod- ucts, dried fruits, legumes, whole grains, fortified cereals, and green leafy vegetables. Nonheme iron’s bioavailability can be enhanced when sources are consumed with either a meat product or a vitamin C source. For example, drink- ing a glass of orange juice, rich in vitamin C, at breakfast

will aid in the absorption of the iron from a fortified cereal. Iron absorption can be inhibited by calcium, tannins in tea, phytic acid in grains, or excessive fiber. Therefore, foods rich in these nutrients should be present in small amounts when consuming a good source of iron. Refer to FIGURE 7.7 for the iron content of specific food sources.

What is a suggestion for an iron-rich meal or snack? Dinner: 2 cups of meat and bean chili, a whole wheat din- ner roll, and 2 cups of spinach salad

Total iron content = 11.3 milligrams

Do athletes need iron supplements? If an athlete is diagnosed with iron-deficiency anemia, iron supplements are typically suggested, and normaliz- ing iron status will improve performance and endurance. For athletes with normal iron intake and blood levels, iron

Exceptionally good sources

IRON

Daily Value = 18 mg RDA = 8 mg (males and postmenopausal females), 18 mg (females)

Good: 10–19%

High: 20% DV or more

Product 19 cereal 30 g 1 cup 18.09 mg Whole-grain Total 30 g ¾ cup 18.00 mg

Cereals, oats, instant, regular 177 g 1 packet 10.55 mg Rice Krispies cereals 33 g 1¼ cup 10.04 mg Cream of Wheat cereal, cooked 251 g 1 cup 9.39 mg Cheerios cereal 30 g 1 cup 9.29 mg Lentils, cooked 198 g 1 cup 6.59 mg Spinach, cooked 180 g 1 cup 6.43 mg Bagels, plain 89 g 4" bagel 5.38 mg Semisweet chocolate 168 g 1 cup 5.26 mg Beef liver, cooked 85 g 3 oz 5.24 mg Kidney beans, cooked 177 g 1 cup 5.20 mg Chickpeas, cooked 164 g 1 cup 4.74 mg

Beets, canned 170 g 1 cup 3.09 mg Baked beans, plain canned 254 g 1 cup 3.02 mg Prune juice, canned 256 g 1 cup 3.02 mg Raisins, seedless 145 g 1 cup 2.73 mg Tomato sauce, canned 245 g 1 cup 2.50 mg Turkey, cooked 140 g 1 cup 2.49 mg Beef, steak, cooked 85 g 3 oz 2.44 mg Peas, green, frozen, cooked 160 g 1 cup 2.43 mg Lamb, shoulder, cooked 85 g 3 oz 2.30 mg Chicken liver, cooked 20 g 1 liver 2.28 mg Beef, ground (85% lean), cooked 85 g 3 oz 2.21 mg Potato, baked, with skin 202 g 1 potato 2.18 mg Collards, cooked 190 g 1 cup 2.15 mg Barley, cooked 157 g 1 cup 2.09 mg

194 SECTION 1 The Basics of Sports Nutrition

supplementation will probably not enhance performance and may actually cause harm. Nutrition experts suggest that the use of iron supplements should be based not on the likelihood of anemia but rather on hematologic evalu- ation.32 Individual iron supplements should be taken only under the care of a physician.

Because endurance athletes, in particular female endur- ance athletes, are at greater risk for iron deficiency, and it can take 3 to 6 months to reverse it,37 experts are increas- ingly recommending that athletes be screened regularly. Screening should involve both a nutrition assessment for iron intake and testing for blood ferritin levels. Identifying athletes at risk for anemia via ferritin testing can allow for early intervention. Unfortunately, the broad normal range of blood ferritin levels (i.e., 12–300 ng/mL and 12–150 ng/mL for men and women, respectively) has created debate over when supplementation should be started. Although deter- mination of a precise threshold for the onset of supplemen- tation has not been established, some evidence suggests that supplementation should be considered when blood ferritin levels fall within or below 20–35 ng/mL.38,39

Why is zinc important for athletes? Zinc is important for every living cell in the body. After ingestion, zinc is transported bound to albumin and is delivered mainly to muscle and bone, with the remainder sent to the liver, kidneys, skin, and other organs. Once at its destination, zinc goes to work to enhance health and athletic performance.

What is the RDA/AI for zinc? The RDA has been established at 11 milligrams per day for men and 8 milligrams per day for women.30

What are the functions of zinc for health and performance? Zinc is involved in a huge variety of bodily processes and, impressively, is associated with more than 200 enzymatic systems.40 In addition to its enzymatic role, zinc is critical for optimal health by:

• Playing a role in wound healing, which enhances immune function

• Aiding in the synthesis of RNA and DNA, thus influ- encing gene expression

• Ensuring the growth and maintenance of various tissues

• Producing hormones • Synthesizing protein • Facilitating the proper functioning of the reproductive

and gastrointestinal systems • Maintaining proper brain function

In the area of sport performance, zinc is a component of various enzymes related to carbohydrate, protein, and fat metabolism, especially during exercise. Zinc is a criti- cal nutrient for exercise recovery because of its role in pro- tein synthesis and repair of tissues. Zinc also interacts with insulin and increases the affinity of hemoglobin for oxygen.

What are the complications of zinc deficiency? Zinc deficiency is not usually an issue for those con- suming adequate total calories. Athletes on calorie- restricted diets or poorly planned vegetarian diets may be at increased risk for zinc deficiency resulting from low zinc intake. Increased needs such as during growth and development, malabsorption caused by chronic iron supplementation or high dietary phytate and fiber, and increased losses by means of chronic diarrhea, diabetes, or sweat losses also contribute to low zinc levels. Zinc deficiency can lead to impaired immune function, loss of appetite, diarrhea, dermatitis, and low testosterone levels in men. Similar to iron, if the body detects a low level of zinc, it compensates by increasing the intestinal absorp- tion of the mineral.

Research results are mixed in regard to the acute and chronic effects of exercise on zinc status. The effects vary for high-intensity, short-duration exercise as compared to lower-intensity, long-duration endurance exercise. In addition, the changes in zinc status vary depending on when the tests for zinc levels were performed. For example, immediately after short-duration, high-inten- sity exercise there is a reported increase in plasma zinc levels that return to baseline levels within 30 minutes after exercise.41 In regard to endurance training, plasma zinc levels have been reported to remain unchanged in response to chronic training,42,43 unchanged imme- diately after an acute bout of endurance exercise,44 or decreased when measured within minutes or hours postexercise.45,46 A study of 26 subjects who completed the Houston marathon showed that urinary and serum zinc concentrations measured 15 minutes after the race were unchanged from baseline data taken 2 weeks prior to the marathon.44 In the studies reporting postexercise zinc decreases, the explanations given include losses in sweat and urine, increased uptake by the liver and red blood cells, and/or acute inflammation resulting from the exercise. Clearly, controversy exists as to the acute effect of exercise on zinc status. Despite the fact that some stud- ies have reported decreases in plasma zinc levels after endurance-type exercise, the decreases do not appear to lead to long-term zinc deficiencies in endurance athletes, unless athletes are following a calorically restricted diet or are vegetarians.47,48

What are the symptoms of zinc toxicity? The upper limit for zinc is 40 milligrams per day.30 This level is set based on observed reductions in copper sta- tus with intakes of zinc at levels higher than 40 milli- grams per day.30 The body is fairly efficient at excreting excess zinc; therefore, toxicity is rare through a regular diet. However, many athletes are taking zinc supplements in addition to eating zinc-rich foods in their diet. High doses in supplement form can impair iron and copper absorption, which over time may contribute to anemia. Zinc doses of approximately 100 milligrams per day or greater can increase LDL and decrease HDL cholesterol,

Chapter 7 Minerals 195

leading to increased risk for heart disease. More immedi- ate and recognizable signs and symptoms of zinc overload are nausea and vomiting.

Which foods are rich in zinc? Zinc-rich foods include most animal products, especially beef and other dark meats; fish, with oysters ranking at the top; eggs; whole grains; wheat germ; legumes; and dairy products. Refer to FIGURE 7.8 for the zinc content of specific food sources.

What is a suggestion for a zinc-rich meal or snack? Thanksgiving leftovers: A sandwich with 3 oz dark meat turkey and 1 slice of Swiss cheese, ½ cup cranberry sauce and an 8 oz glass of skim milk

Total zinc content = 7.3 milligrams

Do athletes need zinc supplements? In general, zinc supplements are not essential. Athletes should focus on consuming zinc-rich foods on a daily basis. For individuals who have low dietary intakes and low body stores of zinc, a short-term supplement plan may provide health and performance benefits. For those with adequate intakes and stores, supplementation may have no effect. Research on the effects of zinc supple- mentation on athletic performance, for those with either low or adequate intakes, is limited and equivocal. Ath- letes should be encouraged to avoid taking large quan- tities of supplemental zinc over a long period of time because of toxic effects and mineral–mineral interactions. Zinc supplements are often marketed for common cold

prevention and remedy—a claim that is still under inves- tigation. Many zinc supplements recommend a dose that provides several times the RDA. If taken consistently over time, these high dosages can decrease the absorption of iron and copper, leading not only to the toxic effects of zinc, but also to iron and copper deficiency issues.

Why is chromium important for athletes? Chromium was virtually unnoticed and unheard of by the general population until it was proposed to aid in weight loss. Dietary supplements of chromium then began to fly off the shelves, only to disappoint most consumers, who found that the dream of effortless weight loss was unful- filled. Chromium is now receiving more attention in the health maintenance and diabetes prevention arenas.

What is the RDA/AI for chromium? The AI for chromium is 35 micrograms per day for men and 25 micrograms per day for women.30 As athletes age, the recommendations are lowered.

What are the functions of chromium for health and performance? The major function of chromium appears to be its abil- ity to enhance the action of insulin. In other words, chro- mium increases the effects of insulin on the metabolism of carbohydrates, fats, and proteins. Exactly how chro- mium enhances insulin activity is poorly understood; however, it is does appear that chromium increases the body’s tolerance to sugars through its interaction with glucose tolerance factor (GTF). GTF is a molecular

Figure 7.8 Food sources of zinc. Meats, organ meats, and seafood are the best sources of zinc. Note: The DV for zinc is higher than the current RDA of 11 and 8 milligrams for males and females, respectively, age 19 and older. Data from U.S. Department of Agriculture, Agricultural Research Service, 2012. USDA National Nutrient Database for Standard Reference, Release 25. Nutrient Data Laboratory home page. Available at: http://www.ars.usda.gov/ba/bhnrc/ndl.

ZINC

Daily Value = 15 mg RDA = 11 mg (males), 8 mg (females)

High: 20% DV or more

Crab, Alaska King, cooked Ground beef, extra lean, cooked Beef liver, cooked Turkey, dark meat, cooked Cheerios cereal Steak, porterhouse, cooked

85 g (3 oz) 85 g (3 oz)

85 g (3 oz) 85 g (3 oz) 30 g (~1 cup) 85 g (3 oz)

6.5 mg 6.0 mg

4.5 mg 3.8 mg 3.8 mg 3.5 mg

2.5 mg 2.4 mg 2.4 mg 2.3 mg 2.2 mg 1.8 mg 1.8 mg 1.5 mg

85 g (3 oz) 85 g (3 oz) 85 g (3 oz) 85 g (3 oz) 225 g (8-oz container) 30 g (~1/2 cup) 15 g (1/4 cup) 130 g (~1/2 cup)

Lobster, cooked Chicken, dark meat, cooked Ham, extra lean, cooked Clams, cooked Yogurt, plain, nonfat All Bran cereal Wheat germ Refried beans, canned

Oysters, cooked Wheat bran flakes cereal

85 g (3 oz) 30 g (~3/4 cup)

154 mg 15.8 mg

Good: 10–19% DV

Exceptionally good source

196 SECTION 1 The Basics of Sports Nutrition

complex that strengthens the interaction between insu- lin and its receptors on the cell membrane.40 In addition, chromium may increase the number of insulin receptors, thus further increasing insulin sensitivity and improving type 2 diabetes. Because of the relationship between chro- mium and insulin sensitivity, a deficiency in chromium has been suggested to be a contributing factor in a per- son’s risk for diabetes. Other health-related functions of chromium include a link to blood lipid levels and proper immune function.

What are the complications of chromium deficiency? Because of its association with insulin, chromium defi- ciency has been proposed as one cause for high blood glu- cose, which in the long term may lead to type 2 diabetes. Along with decreased insulin sensitivity and high blood glucose levels, lipid abnormalities can develop. If a chro- mium deficiency is impairing the action of insulin, the result is altered carbohydrate and protein metabolism. Changes in macronutrient metabolism can ultimately decrease endurance performance, as well as the body’s ability to build and repair muscle during and after exercise.

What are the symptoms of chromium toxicity? The absorption rate of chromium is very low. Therefore, toxicity is rare and thus no upper limit has been estab- lished.30 One side effect of chronic high intake of chro- mium that has been noted is interference with iron and zinc absorption.

Which foods are rich in chromium? Chromium is found in a unique mix of foods including mushrooms, prunes, nuts, whole grains, brewer’s yeast, broccoli, wine, cheese, egg yolks, asparagus, dark choco- late, and some beers. Chromium content in foods is highly variable; therefore, current databases lack thorough infor- mation on the quantity of chromium in various dietary sources.30

What is a suggestion for a chromium-rich meal or snack? Dinner: Homemade pasta primavera made with 2 cups of whole wheat pasta and ½ cup each of mushrooms, broc- coli, and asparagus in a light tomato sauce sprinkled with 1 tbsp parmesan cheese

Total chromium content = ~35 micrograms

Do athletes need chromium supplements? Small quantities of chromium have been found to be lost in sweat and urine with strenuous exercise.49,50 However, supplementation is not warranted for athletes consum- ing adequate total calories and chromium-rich foods. Ath- letes who are following a low-calorie diet for an extended

period of time, as is often the case with wrestlers, danc- ers, runners, or gymnasts, should be monitored for ade- quate daily chromium intakes. Chromium supplements are often marketed to athletes and touted as a fat burner and muscle builder. Typically the claims focus on chro- mium’s ability to enhance insulin action, which in the- ory might increase muscle anabolism and improve body composition.

A study of 20 male NCAA wrestlers assessed the use of chromium picolinate or placebo on body composition, weight, and sport performance.51 Researchers found that 14 weeks of supplementation of chromium picolinate enhanced neither body composition nor performance variables (strength, anaerobic power, or aerobic capacity) as compared to placebo or control subjects. In another report, Vincent reviewed over a decade of human stud- ies researching the effects of chromium picolinate and found that the supplement has not consistently demon- strated effects on the body composition of healthy indi- viduals, even when taken in combination with an exercise program.52

Athletes should avoid ingesting too much chromium through supplements. Excessive chromium intake can interfere with iron and zinc absorption, creating defi- ciency problems.53 Chromium also competes with iron for binding to transferrin, which could potentially decrease performance because of lower oxygen-carrying capac- ity.53 The long-term effects of high doses of chromium supplementation are not fully known at this time. Some research warns that excessive chromium intake over time may cause chromosomal damage, leading to a plethora of health and performance issues.54 In summary, chro- mium supplements do not appear to be warranted for health or performance reasons and therefore are not recommended.

Why is fluoride important for athletes? Fluoride is well-known for its role in the prevention of dental caries. A consistent supply of fluoride was intro- duced into the U.S. diet when the process of fluoridating water began in the 1940s. Fluoride is well absorbed and is transported to bones and teeth, which contain most of the body’s fluoride. More than 98% of the fluoride in the body is found in the skeleton.40

What is the RDA/AI for fluoride? The AI for adults is 4 milligrams a day for men and 3 mil- ligrams a day for women.1

What are the functions of fluoride for health and performance? Fluoride is critical for the mineralization of bones and teeth. Fluoride assists in the deposition of calcium and phosphate in bones and teeth, creating strength and sta- bility. Although not directly involved in energy produc- tion or metabolism, fluoride is a key mineral for athletes,

Chapter 7 Minerals 197

Which foods are rich in fluoride? Water is the main source of dietary fluoride in the United States, containing approximately 0.7–2 milligrams per liter. Community water suppliers often fluoridate their water to increase the concentration of fluoride in the drinking water. However, not all water in community supplies is fluoridated, and well water varies greatly in fluoride content. Bottled water has varied amounts of fluoride, and often the fluoride content is low.55 Teas, seafood, and foods that are prepared with water contain appreciable fluoride (see FIGURE 7.10 ).

What is a suggestion for a fluoride-rich meal or snack? Snack: 16 oz hot black tea with a teaspoon of honey

Fluoride content = 1.6 milligrams

Do athletes need fluoride supplements? Fluoride supplements are generally not recommended. Ingestion of fluoridated water and the topical application of fluoridated toothpaste, floss, and mouthwash are suffi- cient for protecting the teeth. Fluoride in drinking water is generally adequate for the proper development of bones. Short-term use of fluoride supplements under medical supervision may be appropriate for bone strengthening for those who have consistently low fluoride intake. Flu- oride supplements are inappropriate for long-term use because of toxic effects and the lack of research data on the safety of long-term use.

Figure 7.9 Tooth mottling in fluorosis. During tooth development, prolonged, excessive fluoride intake can cause fluorosis, which discolors and damages teeth.

Figure 7.10 Food sources of fluoride. Teas, seafood, and foods that are prepared with water contain appreciable levels of fluoride.

considering all sports require a skeleton that is sturdy and enduring. It has also been suggested that fluoride may help strengthen the resistance of interosseous ligaments or muscle tendons during dislocations and sprains and prevent tendonitis in athletes.40

What are the complications of fluoride deficiency? The manifestations of fluoride deficiency are increased dental caries and compromised integrity of bone. Poor denture can lead to a variety of problems in the mouth, which can potentially alter eating patterns or types of foods consumed. Compromised bone integrity can lead to fractures, bone pain, and ultimately decreased performance.

What are the symptoms of fluoride toxicity? The upper limit established for fluoride is 10 milligrams per day. There is a current debate on whether the U.S. population consumes fluoride in excess of this upper limit on a daily basis. Along with fluori- dated water, the use of fluoride tooth- paste, floss, mouth- wash, and other dental products is common, and thus in theory could lead to overload. Fluorosis occurs when too much fluoride is consumed over a period of time, leading to discoloration and pit- ting of tooth enamel (see FIGURE 7.9 ), altered bone forma- tion and fractures, chronic gastritis, and weak and stiff joints. Some claim that long-term high doses of fluoride can also contribute to a higher risk for a variety of dis- eases and poor health.

fluorosis A condition resulting from the overconsumption of fluo- ride that can lead to pitting and dis- coloration of the teeth and/or bone and joint problems.

Courtesy of the National Library of Medicine

Food or Beverage Fluoride (µg/100 grams) Tea, brewed, regular

Tea, brewed, decaffeinated

Raisins

Crab, canned

Grape juice, white

Wine, white

Shrimp, canned

Water, bottled, Dannon Fluoride To Go

Water, tap, all regions (municipal and well)

Water, bottled, Dannon

373

269

234

210

202

201

Data from U.S. Department of Agriculture, Agriculture Research Service, 2005. USDA National Fluoride Database of Selected Beverages and Foods. Nutrient Data Laboratory. Available at: http://www.ars.usda.gov/Services/ docs.htm?docid=6312.

198 SECTION 1 The Basics of Sports Nutrition

Why is copper important for athletes? Because of the rarity of deficiency complications, copper does not receive much attention. However, it does work “behind the scenes” in conjunction with other minerals to aid in optimal health and performance.

What is the RDA/AI for copper? The RDA for men and women is 900 micrograms per day.30

What are the functions of copper for health and performance? The health and performance benefits of copper are inter- twined. Copper is a component of the enzyme cerulo- plasmin, which is involved in iron metabolism. Copper converts ferrous iron to ferric iron, enabling iron to be transported in the blood by transferrin, thus aiding in oxygen metabolism and preventing anemia. Copper is an integral part of a variety of antioxidant enzymes, including superoxide dismutase. This enzyme, as well as other substances with antioxidant properties, helps to protect the body against free radical damage. Lysyl oxi- dase, another copper-dependent enzyme, is needed for the cross-linking of elastin and collagen to ensure the strength of connective tissues for cardiovascular and respiratory functions, among others.56 Copper also partic- ipates in the electron transport chain. Copper is needed as part of cytochrome c oxidase, the terminal enzyme in electron transport and an important part of energy production.56

What are the complications of copper deficiency? Copper deficiency is rare in the United States. High doses of iron and zinc can interfere with copper absorption and therefore contribute to copper deficiency problems. The signs and symptoms of copper deficiency are ane- mia, decreased white blood cells, and bone abnormalities. Menkes syndrome is a rare genetic disorder that involves a failure to absorb copper. Instead of being absorbed through the intestinal wall and into the bloodstream, copper accu- mulates in the intestinal wall and other organs. This buildup of copper can lead to neurological degeneration, abnormal connective tissue development, and low bone mass.

What are the symptoms of copper toxicity? The upper limit for copper intake is 10,000 micrograms per day.30 The results of copper overload are gastroin- testinal distress and liver damage. Wilson’s disease is a genetic disorder characterized by an excessive accumula- tion of copper, which leads ultimately to anemia, as well as to liver and neurological problems.

Which foods are rich in copper? Copper is found in organ meats, seafood, nuts, seeds, wheat bran, cereals, whole grains, and cocoa products. Refer to FIGURE 7.11 for the copper content of specific food sources.

What is a suggestion for a copper-rich meal or snack? Lunch: 1½ cups clam chowder, 15 wheat crackers, and 1 cup of fruit salad sprinkled with 1 tbsp sunflower seeds

Total copper content: 610 micrograms

Figure 7.11 Food sources of copper. Copper is found in a limited variety of foods. The best sources are seafood, legumes, and nuts. Note: The DV for copper is higher than the current RDA of 900 micrograms for males and females age 19 and older. Data from U.S. Department of Agriculture, Agricultural Research Service, 2012. USDA National Nutrient Database for Standard Reference, Release 25. Nutrient Data Laboratory home page. Available at: http://www.ars.usda.gov/ba/bhnrc/ndl.

High: 20% DV or more

Good: 10–19% DV

Beef liver, cooked Oysters, cooked

Lobster, cooked Crab, Alaska King, cooked Clams, cooked Sunflower seeds Hazelnuts Mushrooms, cooked

COPPER

Daily Value = 2 mg RDA = 900 µg (males/females)

12.4 mg 6.4 mg

1.6 mg 1.0 mg 0.6 mg 0.5 mg 0.5 mg 0.4 mg

0.3 mg 0.3 mg 0.3 mg 0.3 mg 0.3 mg 0.2 mg 0.2 mg 0.2 mg

85 g (3 oz) 85 g (3 oz)

85 g (3 oz) 85 g (3 oz) 85 g (3 oz) 30 g (~1 oz) 30 g (~1 oz) 85 g (~1/2 cup)

Tofu, calcium processed Baked beans, canned Navy beans, cooked Soy milk Peanuts All Bran cereal Refried beans, canned Cocoa, dry powder

85 g (~1/3 cup) 130 g (~1/2 cup) 90 g (~1/2 cup) 240 mL (1 cup) 30 g (1 oz) 30 g (~1/2 cup) 130 g (~1/2 cup) 1 tbsp

Exceptionally good sources

Chapter 7 Minerals 199

Figure 7.12 Food sources of manganese. Manganese is found mainly in plant foods such as grains, legumes, vegetables, and some fruits. Note: The DV for manganese is lower than the current RDA of 2.3 milligrams for males age 19 and older and higher than the current RDA of 1.8 milligrams for females age 19 and older.

Do athletes need copper supplements? Because most athletes generally consume adequate levels of copper, supplements are not needed or recommended. For example, Gropper et al. studied 70 female collegiate athletes to assess copper intake as well as ceruloplasmin and serum copper concentrations.56 They found that cop- per intake, serum copper, and ceruloplasmin levels were adequate in this population. In addition, high doses of copper can become toxic, leading to side effects such as nausea and vomiting.

Why is manganese important for athletes? Manganese is not a well-known trace mineral; however, its lack of popularity and recognition is not indicative of its importance to health and performance. Manganese is unique as compared to other minerals in that it can be better absorbed through drinking water and supplements than from whole food products.

What is the RDA/AI for manganese? The AI for manganese is 2.3 milligrams for men and 1.8 milligrams for women daily.30

What are the functions of manganese for health and performance? Manganese activates a variety of health-related enzymes that are involved in skeletal growth, protein and hemo- globin synthesis, metabolism of lipids and carbohydrates,

and antioxidant functions. One of these enzymes is super- oxide dismutase, which is important for its antioxidant properties. Another enzyme dependent on manganese is glutamic synthetase. Glutathione peroxidase and other antioxidant enzymes such as super-oxide dismutase, cat- alase, and glutathione reductase function to reduce lipid peroxidation.24,57 Manganese is also involved in energy metabolism and fat synthesis.

What are the complications of manganese deficiency? Manganese deficiency leads to poor growth, bone abnor- malities, and impaired fat and carbohydrate metabolism. Excessive dietary iron, calcium, and phosphorus inhibit the absorption of manganese. Iron and calcium supple- ments should be taken between meals to avoid nutrient– nutrient interactions.

What are the symptoms of manganese toxicity? The upper limit for manganese is 11 milligrams per day.30 Fatigue and weakness, neurological problems, and mental confusion can all result from large intakes of manganese.

Which foods are rich in manganese? Whole grains, legumes, green leafy vegetables, tea, and fruit are all good sources of manganese. Refer to FIGURE 7.12 for the manganese content of specific food sources.

Exceptionally good sources

High: 20% DV or more

Good: 10–19% DV

MANGANESE

Daily Value = 2 mg AI = 2.3 mg (males), 1.8 mg (females)

2.3 mg 2.2 mg 2.0 mg

0.3 mg 0.3 mg 0.3 mg 0.2 mg 0.2 mg

Pineapple, fresh All Bran cereal Wheat germ

Okra, cooked Turnip greens, cooked Beets, cooked Broccoli, cooked Cocoa, dry powder

140 g (~1 cup) 30 g (~1/2 cup) 15 g (1/4 cup)

1.7 mg 1.3 mg 1.2 mg 0.9 mg 0.8 mg 0.7 mg 0.7 mg 0.5 mg 0.5 mg 0.4 mg

Hazelnuts Oatmeal, cooked Whole wheat bread Blackberries, fresh Spinach, cooked Lima beans, cooked Soybeans, cooked Tea, brewed Sweet potato, cooked Baked beans, canned

30 g (~1 oz) 1 cup 50 g (2 slices) 140 g (~1 cup) 85 g (~1/2 cup) 90 g (~1/2 cup) 90 g (~1/2 cup) 240 mL (1 cup) 110 g (1 small) 130 g (~1/2 cup)

85 g (~1/2 cup) 85 g (~1/2 cup) 85 g (~1/2 cup) 85 g (~1/2 cup) 1 tbsp

200 SECTION 1 The Basics of Sports Nutrition

What are the complications of iodine deficiency? A lack of dietary iodine can lead to the development of goiter, or the enlargement of the thyroid gland. The lack of iodine inhibits the synthesis of the hor- mones T3 and T4 by the thyroid gland. As a result, the pitu- itary gland starts producing more thyroid-stimulating hormone in an attempt to initiate the thyroid’s produc- tion of T3 and T4. The higher blood levels of thyroid- stimulating hormone cause the thyroid gland to grow. In fact, the enlargement of the thyroid can cause a sizeable increase in the outward appearance of the neck. Symp- toms of iodine deficiency are similar to symptoms of hypothyroidism, including cold intolerance, weight gain, and decreased body temperature.

What are the symptoms of iodine toxicity? The UL of iodine is 1100 micrograms per day.30 Excessive iodine intake can also lead to the development of a goi- ter. Large intakes stimulate the thyroid to produce more hormones, thus stimulating the growth and enlargement of the gland.

Which foods are rich in iodine? The addition of iodine to salt began in 1924 to increase Americans’ intake of this mineral to prevent goiter and other related issues. Iodized salt remains one of the larg- est sources of dietary iodine in the United States, although not all salt is fortified with iodine. For example, salt used in processed foods is not iodized. As a result, it is impor- tant for athletes to purchase iodized salt when shopping at the grocery store. Iodine can also be found in seafood, dairy, grains, and cereals. Refer to FIGURE 7.13 for the iodine content of specific food sources.

What is a suggestion for an iodine-rich meal or snack? Lunch: A turkey sandwich on whole wheat bread with let- tuce and tomato and 1 cup of skim milk

Total iodine content = 105 micrograms

Do athletes need iodine supplements? Iodine supplements are neither needed nor beneficial for athletes. In general, food sources are sufficient for meet- ing daily iodine needs.

Why is molybdenum important for athletes? Molybdenum is often forgotten when discussing vitamins and minerals because deficiency and toxicity of molybde- num are rare. Regardless of the risk to consume too little or too much, this mineral is an important player in the game of health and performance.

What is a suggestion for a manganese-rich meal or snack? Dinner: Sweet potato fries (see TRAINING TABLE 7.4 )

Total manganese content = 0.85 milligrams

Do athletes need manganese supplements? Manganese supplements are neither needed nor recom- mended for athletes. Dietary intake from food sources and daily water intake should be adequate to meet the AI recommended for manganese.

Why is iodine important for athletes? Iodine has the glory and recognition of being the first vita- min or mineral to be incorporated into a successful fortifi- cation program. After more than 75 years, the fortification of salt with iodine is still a success in the prevention of a variety of diseases.

What is the RDA/AI for iodine? The RDA for iodine is 150 micrograms per day for both men and women.30

What are the functions of iodine for health and performance? The only known role of iodine in humans is to serve as an element essential to the synthesis of hormones secreted by the thyroid gland, namely tetraiodothyronine (thy- roxine, or T4) and triiodothyronine (T3). T4 and T3 are involved in the metabolism of all cells of the body dur- ing the growth process and in the development of most organs, particularly the brain.40 Iodine is related to ath- letic performance through the action of the thyroid hor- mones, which play a role in protein synthesis in skeletal muscle, energy expenditure, weight control, and body temperature regulation. More research is needed to fully understand the impact of iodine on athletic performance.

goiter A clinical condition resulting from iodine deficiency. Goiter causes enlargement of the thyroid gland and results in an observable enlarge- ment of the lower neck.

Training Table 7.4: Sweet Potato Fries These fries are an excellent side dish for grilled meats and burgers.

• 1 medium sweet potato

• ½ tbsp olive oil

• Ground pepper and garlic salt

• Cooking spray

• Preheat the oven to 450°F. Wash and cut the sweet potato into ¼- or ½-inch wedges. Place the potato wedges in a large plastic bag with the ½ tbsp olive oil. Add ground pepper and garlic salt to taste. Close the bag and shake to mix the potato, oil, and spices thoroughly. Spray a cookie sheet with cooking spray and spread the potato wedges evenly on the sheet. Bake the potatoes for 20 to 30 minutes, stirring every 10 minutes to ensure even browning.

• Serving size: 1 potato (recipe makes one serving)

• Calories: 222 kcals

• Protein: 4 grams

• Carbohydrate: 37 grams

• Fat: 7 grams

Chapter 7 Minerals 201

What is the RDA/AI for molybdenum? The RDA for men and women is 45 micrograms per day.30

What are the functions of molybdenum for health and performance? Molybdenum is an essential trace element needed by vir- tually all life forms. In humans, molybdenum is known to function as a cofactor for three enzymes. Two of the enzymes play a role in serving as antioxidants and detoxifying agents in the body. The third enzyme, sul- fite oxidase, catalyzes a reaction that is necessary for the metabolism of sulfur-containing amino acids, such as cysteine. Only sulfite oxidase is known to be crucial for human health.58

What are the complications of molybdenum deficiency? Health complications or consequences of low molybde- num intake have not been observed in humans when con- suming an adequate diet.30 The only documented case of acquired molybdenum deficiency occurred in a patient with Crohn’s disease on long-term total intravenous nutri- tion that was not supplemented with molybdenum.59 Cur- rent understanding of the essentiality of molybdenum in humans is based largely on the study of individuals with very rare inborn errors of metabolism and therefore offers little in regard to application for sports nutrition.

What are the symptoms of molybdenum toxicity? Molybdenum toxicity is rare. The upper limit has been established at 2000 micrograms per day because large quantities can interfere with copper absorption.30

Which foods are rich in molybdenum? Molybdenum is found mainly in plant products such as cereals, whole grains, and legumes. The molybdenum con- tent of plant foods varies depending upon the soil con- tent in which they are grown.30 Organ meats are the rich- est source of molyb- denum in animal products. Because the methods for ana- lyzing the molybdenum content of foods are not reliable, specific food content information is limited.

What is a suggestion for a molybdenum-rich meal or snack? Breakfast: 2 cups bran flakes with 12 oz skim milk and a banana

Total molybdenum content = ~17 micrograms

Do athletes need molybdenum supplements? Molybdenum supplements are neither needed nor ben- eficial for athletes. Food sources of molybdenum are suf- ficient, and the usual intake of molybdenum is well above the dietary molybdenum requirement.30

Why is selenium important for athletes? Selenium has only recently received recognition in the nutrition community as an essential nutrient. The con- nection between human health and selenium intake was

Figure 7.13 Food sources of iodine. Few foods are rich in iodine; it is found mainly in milk, seafood, and some grain products.

Food for Thought 7.2

Importance of Mineral Intake for Athletes: Trace Minerals

Review the recommendations, food sources, and significance of trace minerals for athletes.

Data from Office of Dietary Supplements, National Institute of Health, 2013. Dietary Supplement Fact Sheet: Iodine. Available at: http://ods.od.nih.gov/ factsheets/Iodine-QuickFacts/.

High: 20% DV or more

Good: 10–19% DV

Cod, cooked Corn grits, enriched, cooked Milk, 2% milkfat Milk, nonfat White bread Tortilla, flour Beef liver, cooked Navy beans, cooked Shrimp, cooked Potato, baked Turkey breast, cooked Whole wheat bread

IODINE

Daily Value = 150 µg RDA = 150 µg (males/females)

Egg, cooked Oatmeal, cooked

99 µg 68 µg 56 µg 51 µg 46 µg 41 µg 36 µg 35 µg 35 µg 34 µg 34 µg 32 µg

85 g (3 oz) 1 cup 240 mL (1 cup) 240 mL (1 cup) 50 g (~2 slices) 55 g 85 g (3 oz) 90 g (~1/2 cup) 85 g (3 oz) 110 g (1 small) 85 g (3 oz) 50 g (~2 slices)

24 µg 16 µg

50 g (1 large) 1 cup

Salt, iodized 1.5 g (1/4 tsp) 600 µg

Exceptionally good sources

202 SECTION 1 The Basics of Sports Nutrition

made in 1979 after scientists discovered that Keshan dis- ease could be prevented by providing children in China with selenium supplements. Since then, selenium has quickly climbed the ranks of nutritional importance to become a member of the highly regarded antioxidant cat- egory of nutrients.

What is the RDA/AI for selenium? The RDA for selenium is 55 micrograms for both men and women.60

What are the functions of selenium for health and performance? Selenium’s role for overall health is closely related to its potential ergogenic effects on athletic perfor- mance. Selenium is a component of many bodily pro- teins, with the selenoproteins being the most notable. Selenocysteine is the selenium form associated with glutathione peroxidase, an antioxidant enzyme that helps to combat free radical damage to cells. Through this breakdown of free radicals, glutathione peroxidase actually helps to spare vitamin E, allowing the vitamin to continue on its free radical scavenger hunt. In other words, selenium and vitamin E work synergistically to quench more free radicals than either nutrient could on its own. Current exercise research has delved into the selenium/antioxidant world, aiming to determine the effects of selenium on exercise-induced free radi- cal formation.

Selenium-associated enzymes have also been linked to proper thyroid and immune function, as well as to the healthy development of fetuses. Selenium’s role in immune function has led to cancer risk reduction claims. In general, selenium research is still in its infancy, with all roles, mechanisms, and health/performance effects still under investigation.

What are the complications of selenium deficiency? Selenium deficiency is rare in the United States and other industrialized nations because of our geographi- cally diverse food supply. The origin of foods is important because the sele- nium concentration in soil can vary dra- matically around the world. If individu- als live in a selenium-deficient area and consume only locally grown foods, a selenium deficiency can result. For example, in areas of China with selenium-poor soil, sele- nium-deficient residents are more susceptible to a form of viral cardiomyopathy called Keshan disease.

Selenium has recently been recognized as an anti- oxidant mineral, raising questions about the effects of

suboptimal intake on cardiovascular parameters and can- cer risk. Although it appears that sele- nium may have a role in these areas, the exact functions, associated mecha- nisms, and antici- pated results of selenium deficiency related to cardiovas- cular disease and cancer are still under investigation.

What are the symptoms of selenium toxicity? The upper limit for selenium has been established at 400 micrograms per day.60 Consumption of selenium in excess of the upper limit can cause brittle hair and nails; if toxic levels continue to be consumed, the loss of hair and nails can occur.

Which foods are rich in selenium? Selenium is mainly found in animal products, with sea- food ranking near the top of the list. Plant foods contain selenium; however, content can vary dramatically based on the selenium concentration of the soil within the region it was grown. Refer to FIGURE 7.14 for the selenium content of specific food sources.

What is a suggestion for a selenium-rich meal or snack? Dinner: Shrimp stir-fry with 3 oz of shrimp, 1 cup of mixed vegetables, and 1 cup of cooked brown rice

Total selenium content = 45 micrograms

Do athletes need selenium supplements? Research on the ergogenic benefits of selenium supple- ments is still in its infancy. Some research has shown that the antioxidant status of athletes participating in intense training diminishes, leading to the proposal that selenium and other antioxidant supplements may be warranted.61,62 However, because it is relatively easy to consume adequate amounts of selenium in a well-bal- anced diet, and because of its toxic effects, selenium sup- plements are not recommended at this time. Once more information is available, these recommendations may change. For a summary of all the minerals’ respective functions, see FIGURE 7.15 .

Are other trace minerals important for athletes? The previous sections have discussed the well-known trace minerals; however, there are a few more that were not discussed. These trace minerals are summarized in TABLES 7.3 and 7.4 .

Gaining the Performance Edge

The trace minerals include iron, zinc, chromium, fluoride, copper, manga- nese, iodine, molybdenum, and sele- nium. Each of these minerals plays a specific and important role in over- all health and athletic performance. Athletes should strive to consume these nutrients from whole foods first, and rely on supplements only when individually indicated.

Food for Thought 7.3

You Are the Nutrition Coach

Apply the concepts from this chapter to several case studies.

Chapter 7 Minerals 203

Figure 7.14 Food sources of selenium. Selenium is found mainly in meats, organ meats, seafood, and grains. Note: The DV for sele- nium is higher than the current RDA of 55 micrograms for males and females age 19 and older. Data from U.S. Department of Agriculture, Agricultural Research Service, 2012. USDA National Nutrient Database for Standard Reference, Release 25. Nutrient Data Laboratory home page. Available at: http://www.ars.usda.gov/ba/bhnrc/ndl.

Figure 7.15 Summary of the functions of minerals. Refer to the specific mineral sections for detailed explanations of each function.

Oysters, cooked Tuna, canned Lobster, cooked Pork, loin, cooked, lean only Shrimp, cooked Beef liver, cooked Spaghetti, cooked Whole-wheat bread Egg, hard cooked Oatmeal, cooked

SELENIUM

Daily Value = 70 µg RDA = 55 µg (males/females)

Rice, brown, cooked Rice, white, enriched, cooked Cheerios cereal Cheese, cottage White bread Grits, corn, enriched, cooked

60.9 µg 44.2 µg 36.3 µg 36.0 µg 33.7 µg 30.7 µg 29.8 µg 18.3 µg 15.4 µg 11.9 µg

85 g (3 oz) 55 g (2 oz) 85 g (3 oz) 85 g (~3 oz) 85 g (3 oz) 85 g (3 oz) 140 g (~1 cup) 50 g (2 slices) 50 g (1 large) 1 cup

13.7 µg 10.5 µg 10.4 µg 9.9 µg 8.7 µg 7.5 µg

140 g (~3/4 cup) 140 g (~3/4 cup) 30 g (1 cup) 110 g (~1/2 cup) 50 g (2 slices) 1 cup

High: 20% DV or more

Good: 10–19% DV

Brazil nuts

Exceptionally good sources

28 g (1 oz) 544 µg

ATP

GERM

Free

Radical

ATP GERM Free

Radical Vitamins

Mineral Functions*

Calcium

Phosphorus

Magnesium

Sodium

Chloride

Potassium

Sulfur

Iron

Zinc

Chromium

Fluoride

Copper

Manganese

Iodine

Molybdenum

Selenium

Energy production

Nervous system function

Blood

Immune system function

Growth and development

Enzyme function

Bone

Antioxidant

Muscle Function

Endocrine function

Cardiovascular Health

204 SECTION 1 The Basics of Sports Nutrition

Table 7.3 Review of Other Trace Minerals

Mineral RDA/AI for adults ages 19 to 50

Functions for health/performance Upper limit Toxicity complications

Arsenic Not determinable No biological function determined for humans; animal data suggest a requirement.

Not determinable No adverse effects shown for organic arsenic. Inorganic arsenic known as a toxic substance.

Boron Not determinable No biological function determined for humans; animal data suggest a requirement.

20 mg per day Animal studies reveal reproductive and developmental effects.

Nickel Not determinable No biological function determined for humans; animal data suggest a requirement.

1.0 mg per day Animal studies have observed decreased body weight gain.

Silicon Not determinable No biological function determined for humans; animal data suggest it contributes to adverse health effects.

Not determinable Naturally occurring silicon in foods and water does not appear to be a requirement.

Vanadium Not determinable No biological function determined for humans. 1.8 mg per day Animal studies have observed renal lesions as a result of high intakes.

Table 7.4 Food Sources for Other Trace Minerals

Mineral Food sources Supplements needed for athletes?

Arsenic Dairy products, meats, fish, grains, and cereals

No. Currently there is no justification for addition of arsenic to the diet.

Boron Fruit-based beverages, potatoes, legumes, milk, avocados, and peanuts

No. Currently there is no justification for addition of boron to the diet.

Nickel Nuts, legumes, cereals, sweeteners, and chocolate powders and candies

No. Currently there is no justification for addition of nickel to the diet.

Silicon Plant-based foods No. Currently there is no justification for addition of silicon to the diet.

Vanadium Mushrooms, shellfish, black pepper, parsley, and dill seed

No. Currently there is no justification for addition of vanadium to the diet.

Chapter 7 Minerals 205

The Box Score Key Points of Chapter

n Minerals are inorganic nutrients that are essential for normal body functioning.

n Minerals are needed in very small quantities rela- tive to other nutrients because they are structurally very stable and they can be repeatedly used in the body without breakdown. Dietary intake of miner- als from foods can lead to a toxic buildup; however, most toxicity is caused by ingesting high-dosage supplements.

n Minerals are classified as either major minerals or trace minerals. Major minerals are those needed by the body in amounts greater than 100 milligrams per day. Trace minerals are those required in daily quan- tities of less than 100 milligrams.

n Calcium, phosphorus, magnesium, sodium, chloride, potassium, and sulfur constitute the major miner- als. The trace minerals include iron, zinc, chromium, fluoride, copper, manganese, iodine, molybdenum, and selenium.

n Calcium is not only required for ensuring healthy, strong bones, but it is also important in blood clot- ting, nerve transmission, and muscle contraction. The AI is approximately 1000 milligrams per day for those 19 to 50 years of age.

n Phosphorus, similar to calcium, is also important for strong bones. It is also an integral part of cell mem- branes and plays a role in enzyme activation. The RDA for phosphorus is 700 milligrams per day, which is easily achieved in the typical American diet.

n Magnesium plays a role in the regulation of blood pressure, is critical for the proper functioning of many cellular enzymes, and is important for bone formation. The RDA for magnesium ranges from 310–420 milligrams per day, and supplementation with higher doses has not shown any ergogenic effects in athletes.

n Sodium and potassium are important for maintain- ing blood pressure, nerve impulse transmission, and muscle contraction. The AIs for sodium and potassium are 1500 and 4700 milligrams per day, respectively. Athletes need to make an effort to curb sodium intake and increase potassium consumption to prevent complications such as increases in blood pressure, muscle weakness, and heart arrhythmias.

n Chloride has roles in the body’s immune system, digestion of food, and nerve transmission. The AI

of 2300 milligrams per day is usually met with diet alone via salted foods.

n Sulfur plays a key role in normal growth and devel- opment; however, it does not have an established RDA or AI. Sulfur is found in a variety of foods, and deficiencies are rare.

n The trace mineral iron plays an essential role in the transport and utilization of oxygen throughout the body. Deficiencies do occur in athletes, resulting in anemia; however, universal use of iron supplemen- tation for all athletes is not warranted.

n Zinc is a trace mineral that serves as a cofactor for various enzymes involved in carbohydrate, protein, and fat metabolism during exercise. It also makes an important contribution to recovery because of its role in protein synthesis and repair of tissues. Fortu- nately, zinc deficiencies are rare in athletes consum- ing adequate total calories.

n Chromium is a trace mineral touted to increase insulin activity and thus enhance glucose uptake and protein assimilation. As a result, it was spec- ulated that chromium supplementation would increase muscle mass and decrease fat mass. Cur- rent research into the effectiveness of chromium supplementation has not supported these claims.

n Fluoride is critical for the mineralization of bones and teeth. Although not directly involved in energy production or metabolism, fluoride is important to athletes given the fact that all sports require a skel- eton and connective tissues that are strong and resilient.

n Copper, iodine, manganese, selenium, and molyb- denum are trace minerals in which deficiencies are very rare. Although they play critical roles related to enzyme activity, hormone function, and/or free radical neutralization, their effects on athletic per- formance are relatively unstudied and/or inconclu- sive. Supplementation of these trace minerals is not warranted.

n Despite the important roles trace minerals play in the body, the small daily requirements are usually met by the typical American diet. As a result, trace mineral supplementation in excess of that provided by diet alone is not recommended and has not been shown to have any ergogenic effects on athletic performance.

Study Questions

1. What role do minerals play in the body? 2. What are the major minerals? What differentiates a

major mineral from a trace mineral?

3. What are some of the common food sources for each of the major minerals?

206 SECTION 1 The Basics of Sports Nutrition

4. Discuss the various conditions that result as a conse- quence of deficiencies in the major minerals.

5. Should athletes take supplements containing large doses of the major minerals? Defend your answer based on the benefits versus the risks.

6. What role does the trace mineral iodine play in the body? What condition results from iodine deficiency? Why is this condition very rare in the United States?

7. Besides iodine, list four other trace minerals, discuss their roles in the body, and give specific foods that serve as good sources for each.

References

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3. Heaney RP, Davies KM, Barger-Lux MJ. Calcium and weight: clinical studies. J Am Coll Nutr. 2002;21(2):152S–155S.

4. Teegarden D. Calcium intake and reduction in weight or fat mass. J Nutr. 2003;133(1):249S–251S.

5. Parikh SJ, Yanovski JA. Calcium intake and adiposity. Am J Clin Nutr. 2003; 77(2):281–287.

6. Zemel MB. Role of calcium and dairy products in energy partitioning and weight management. Am J Clin Nutr. 2004;79(5):907S–912S.

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8. Levenson DI, Bockman RS. A review of calcium prepa- rations. Nutr Rev. 1994;52(7):221–232.

9. Institute of Medicine. Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride. Food and Nutrition Board. Washington, DC: National Acade- mies Press; 1997.

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11. Kreider RB, Miller GW, Williams MH, Somma CT, Nasser T. Effects of phosphate loading on oxygen uptake, ventilatory aerobic threshold and run per- formance. Med Sci Sports Exerc. 1990;22:250–255.

12. Kreider RB, Miller GW, Schenck D, et al. Effects of phosphate loading on metabolic and myocardial responses to maximal and endurance exercise. Int J Sports Nutr. 1992;2:20–47.

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22. Williamson S, Johnson R, Hudkins P, Strate S. Exer- tional cramps: a prospective study of biochemical and anthropometric variables in bicycle riders. Cycling Sci. 1993;15:20.

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25. Cheng SM, Yang LL, Chen SH, Hsu MH, Chen IJ, Cheng FC. Magnesium sulfate enhances exercise performance and manipulates dynamic changes in peripheral glucose utilization. Eur J Appl Physiol. 2010;108:363–369.

26. Brilla LR, Haley TF. Effect of magnesium supplemen- tation on strength training in humans. J Am Coll Nutr. 1992;11(3):326–329.

27. Nielsen FH, Lukaski HC. Update on the relationship between magnesium and exercise. Magnesium Res. 2006;19(3):180–189.

28. Seeling MS. Consequences of magnesium deficiency on the enhancement of stress reactions: preventive and therapeutic implications (a review). J Am Col Nutr. 1994;13:429–446.

Chapter 7 Minerals 207

29. Institute of Medicine. Dietary Reference Intakes for Water, Potassium, Sodium, Chloride and Sulfate. Food and Nutrition Board. Washington, DC: National Academies Press; 2004.

30. Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Man- ganese, Molybdenum, Nickel, Silicon, Vanadium and Zinc. Food and Nutrition Board. Washington, DC: National Acad- emies Press; 2001.

31. World Health Organization. WHO Global Database on Anemia and Iron Deficiency 2000. Available at: http:// www.who.int/vmnis/database/anaemia/anaemia_ data_status_prevalence/en/index.html. Accessed March 2, 2011.

32. Beard J, Tobin B. Iron status and exercise. Am J Clin Nutr. 2000;72(2 suppl): 594S–597S.

33. Constantini NW, Eliakim A, Zigel L, Yaaron M, Falk B. Iron status of highly active adolescents: evidence of depleted iron stores in gymnasts. Int J Sports Nutr Exerc Metabol. 2000;10(1):62–70.

34. Cowell BS, Rosenbloom CA, Skinner R, Summers RH. Policies on screening female athletes for iron defi- ciency in NCAA division I-A institutions. Int J Sports Nutr Exerc Metabol. 2003;13(3):277–285.

35. Malczewska J, Szczepanska B, Stupnicki R, Sendecki W. The assessment of frequency of iron deficiency in athletes from the transferring receptor-ferritin index. Int J Sports Nutr Exerc Metabol. 2001;11(1):42–52.

36. Dubnov G, Constantini NW. Prevalence of iron deple- tion and anemia in top-level basketball players. Int J Sports Nutr Exerc Metabol. 2004;14(1):30–37.

37. Rodriguez NR, DiMarco NM, Langley, S. Position of the American Dietetic Association, Dietitians of Canada, and the American College of Sports Medicine: nutrition and athletic performance. J Am Diet Assoc. 2009;1090(3):509–527.

38. Fallon KE. Utility of hematological and iron- related screening in elite athletes. Clin J Sports Med. 2004;14:145–152.

39. Zoller H, Vogel W. Iron supplementation in athletes— first do no harm. Nutrition. 2004;20:615–619.

40. Speich M, Pineau A, Ballereau F. Minerals, trace elements and related biological variables in ath- letes and during physical activity. Clin Chim Acta. 2001;312(1–2):1–11.

41. Ohno H, Yamashita K, Doi R, Yamamura K, Kondo T, Taniguchi N. Exercise-induced changes in blood zinc and related proteins in humans. J Appl Physiol. 1985;58:1453–1458.

42. Singh A, Evans P, Gallagher KL, Deuster PA. Dietary intakes and biochemical profiles of nutritional status of ultramarathoners. Med Sci Sports Exerc. 1993;25:328–334.

43. Fogelholm GM, Himberg J, Alopaeus K, Gref C, Laakso JT, Mussalo-Rauhamaa H. Dietary and biochemical indices of nutritional status in male athletes and con- trols. J Am Coll Nutr. 1992;11:181–191.

44. Buchman AL, Keen C, Commisso J, et al. The effect of a marathon run on plasma and urine mineral and metal concentrations. J Am Coll Nutr. 1998;17(2):124–127.

45. Anderson RA, Polansky MM, Bryden NA. Strenuous running: acute effects on chromium, copper, zinc, and selected clinical variables in urine and serum of male runners. Biol Trace Element Res. 1984;6:327–336.

46. Van Rij AM, Hall MT, Dohm GL, Bray J, Pories WJ. Change in zinc metabolism following exercise in human subjects. Biol Trace Element Res. 1986;10:99–106.

47. Dressendorfer RH, Sockolov R. Hypozincemia in ath- letes. Phys Sports Med. 1980;8:97–100.

48. Haralambie G. Serum zinc in athletes in training. Int J Sports Med. 1981;2: 136–138.

49. Anderson RA, Polansky MM, Bryden NA, Roginski EE, Patterson KY, Reamer DC. Effect of exercise (running) on serum glucose, insulin, glucagon, and chromium excretion. Diabetes. 1982;31:212–216.

50. Anderson RA, Bryden NA, Polansky MM, Thorp JW. Effects of carbohydrate loading and underwater exer- cise on circulating cortisol, insulin and urinary losses of chromium and zinc. Eur J Appl Physiol. 1991;63:146–150.

51. Walker LS, Bemben MG, Bemben DA, Knehans AW. Chromium picolinate effects on body composition and muscular performance in wrestlers. Med Sci Sports Exerc. 1998;30(12):1730–1737.

52. Vincent JB. The potential value and toxicity of chro- mium picolinate as a nutritional supplement, weight loss agent and muscle development agent. Sports Med. 2003;33(3):213–230.

53. Lukaski HC, Bolonchuk WW, Siders WA, Milne DB. Chromium supplementation and resistance train- ing: effects on body composition, strength and trace element status of men. Am J Clin Nutr. 1996;63:954–965.

54. Stearns DM, Belbruno JJ, Wetterhahn KE. A prediction of chromium (III) accumulation in humans from chro- mium dietary supplements. FASEB J. 1995;9:1650–1657.

55. McGuire S. Fluoride content of bottled water. N Engl J Med. 1989;321(12): 836–837.

56. Gropper SS, Sorrels LM, Blessing D. Copper status of collegiate female athletes involved in different sports. Int J Sports Nutr Exerc Metabol. 2003; 13(3):343–357.

57. Clarkson PM, Thompson HS. Antioxidants: what role do they play in physical activity and health? Am J Clin Nutr. 2000;72(2 suppl):637S–646S.

58. Nielsen FH. Ultratrace minerals. In: Shils M, Olson JA, Shike M, Ross AC, eds. Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins; 1999:283–303.

208 SECTION 1 The Basics of Sports Nutrition

59. Abumrad NN, Schneider AJ, Steel D, Rogers LS. Amino acid intolerance during prolonged total parenteral nutrition reversed by molybdate therapy. Am J Clin Nutr. 1981;34(11):2551–2559.

60. Institute of Medicine. Dietary Reference Intakes for Vitamin C, Vitamin E, Selenium and Carotenoids. Food and Nutrition Board. Washington, DC: National Academies Press; 2000.

61. Bloomer RJ, Goldfarb AH, McKenzie MJ, You T, Nguyen L. Effects of antioxidant therapy in women exposed to eccentric exercise. Int J Sports Nutr Exerc Metabol. 2004;14:377–388.

62. Subudhi AW, Davis SL, Kipp RW, Askew EW. Antiox- idant status and oxidative stress in elite alpine ski racers. Int J Sports Nutr Exerc Metabol. 2001;11: 32–41.

Additional Resources

Chan S, Gerson B, Subramaniam S. The role of copper, molybdenum, selenium, and zinc in nutrition and health. Clin Lab Med. 1998;118(4):673–685.

Dressendorfer RH, Peterson SR, Moss-Lovshin SE, Keen CL. Mineral metabolism in male cyclists during high- intensity endurance training. Int J Sports Nutr Exerc Metabol. 2002;12(1):63–72.

Finstad EW, Newhouse IJ, Lukaski HC, McAuliffee JE, Stewart CR. The effects of magnesium supplementation on exer- cise performance. Med Sci Sports Exerc. 2001;33:493–498.

Golf SW, Happel O, Graef V. Plasma aldosterone, corti- sol and electrolyte concentrations in physical exer- cise after magnesium supplementation. J Clin Biochem. 1984;22:717–721.

Chapter 7 Minerals 209

ut te

rst oc

k / fr

ac ta

l-a n

Key Questions Addressed 1. What’s the big deal about water?

2. What are the consequences of poor water balance?

3. How much fluid do individuals need on a daily basis?

4. What is the role of preexercise hydration?

5. What is the role of hydration during exercise?

6. What is the role of postexercise hydration?

You Are the Nutrition Coach Chad is a collegiate lacrosse player in Arizona. During preseason and in-season training, the team will practice for hours, often in 80- to 90-degree weather. The coach incorporates fluid breaks during practice; however, he allows the athletes to consume only water. The coach believes that sports beverages hinder performance and therefore forbids the athletes to con- sume them. The athletes complain of feeling fatigued, lethargic, and light-headed by the end of practices.

Questions • What are the problems in this scenario?

• What should the athletes do to feel better throughout the duration of their practices?

Water

zz sto

ck /G

et ty

Im ag

es CHAPTER 8

What are the functions of water in the body? As stated earlier, water does not provide the body with energy (i.e., calories), but it is second only to oxygen in regard to its importance for maintaining life (see FIGURE 8.1 ). In addition to providing structural integrity to cells, water serves as the body’s delivery and waste removal medium. Blood plasma distributes nutrients, hormones, immune cells, and oxygen, just to name a few items, to the billions of cells that make up the tissues of our bodies. In addition, the blood carries away from the cells substances such as carbon dioxide, lactic acid, and ammonia that are formed during the breakdown of nutrients for cellular energy.

The watery environment of the body’s tissues serves as a reactive medium. Water is often a product or reactant in many of the chemical reactions that occur in the body. For example, one of the end products of aerobic metabo- lism is water. Water also serves as the solvent for many essential molecules, such as glucose, certain vitamins, minerals, proteins, and enzymes.

Body water also helps in maintaining a stable body temperature. Water has excellent conductive properties and helps move warm temperatures from the core of the body to the periphery. In fact, water conducts heat 26 times faster than air. Body water also serves as the source for sweat that is produced by specialized glands called sweat glands. The sweat is directed to the surface of the skin by ducts leading directly from the sweat glands. Once

on the surface of the skin, the sweat drop is exposed to the air and can evaporate. It is the evaporation of the sweat that actu- ally provides the cooling effect.

sweat glands Specialized glands located in the deep layer of the skin responsible for the production of sweat and its delivery to the surface of the skin for the purpose of evaporative cooling.

What’s the big deal about water? Water is arguably the most essential of all the nutri- ents for athletes despite the fact that it does not provide the body with energy. Death occurs more rapidly in the absence of water than in the absence of any other nutri- ent. Water restriction can result in death in as little as 3 days. Armed with this knowledge, it doesn’t take much imagination to realize the consequences of dehydration on training and/or sport performance.

The phrase “you are what you eat” should be reworded to “you are what you drink.” Roughly 55–60% of the average human’s body weight is water. Two-thirds of body water is found inside the cells and is referred to as intracellular water. Muscle tissue, which is of obvious importance to athletes, is approximately 70% water.

This is just another reason why water is so critical to sport performance. The remaining one-third of body water is found outside of cells and is known as extracel lular water. Most of the extracellular water is found in the spaces between cells, in lymph, and in blood plasma.

Intracellular and extracellular water content vary based on several factors:

• Protein content of tissues: Muscle, composed of a large amount of protein, contains a much greater percentage of water than adipose tissue, which is composed of fats. The percentage of total body water can vary tremendously from a lean, muscu- lar athlete with a low body fat composition to an obese, sedentary individual with a high body fat composition.

• Carbohydrate content of tissues: Glycogen consists of linked glucose molecules and is stored inside cells along with water. For every gram of glycogen, 3 grams of water are stored. The water released from glycogen breakdown during exercise can be useful for prevent- ing dehydration.

• Electrolyte concentration within and outside cells: Intra- cellular and extracellular minerals such as sodium, chloride, potassium, and calcium affect the flux of fluid into and out of cells. Large fluctuations in body water storage can contribute to a variety of health concerns as well as poor physical performance in sports. Balancing daily fluid losses with intake is criti- cal in preventing the ill effects of dehydration, as well as overhydration.

intracellular water Body water that is found inside the cells. Approximately 66% of the total amount of water in the body is located inside the cells.

Cooling

Chemical reactions

Body fluids pH balance

Resistance to temperature change (heat capacity)

Figure 8.1 Functions of water. Water has many critical functions in the body.

extracellular water Body water that is found outside of cells that make up the various tissues of the body. Examples of extracellular wa- ter are saliva, blood plasma, lymph, and any other watery fluids found in the body.

Chapter 8 Water 211

Water also plays a crucial role in maintaining the body’s acid–base balance. It serves as the transport medium for protein buffers such as hemoglobin and plays an indi- rect role in the functioning and formation of the blood’s most potent chemical buffer, sodium bicarbonate. Under resting conditions when energy demands are low, very few

hydrogen ions (i.e., H+) are produced and the body’s pH is slightly alkaline (pH = 7.4). Because of the lower hydrogen ion levels at rest, water combines with CO2 to form carbonic

acid, which in turn dissociates into sodium bicarbonate and hydrogen ions, thus maintaining resting H+ concentra- tions (see FIGURE 8.2 ). Conversely, during intense exercise when energy demand is high many H+ are produced and thus buffered by sodium bicarbonate to form carbonic acid. The carbonic acid then dissociates to water and CO2, which is expelled at the lungs.

Finally, water is critical to the maintenance of blood volume. Adequate blood volume directly affects blood pressure and cardiovascular function. Dehydration, resulting in the loss of as little as 3–5% of body weight, begins to compromise cardiovascular function, which has a direct impact on sport performance, particularly for aer- obic sports.

What are the sources of water? Water is obtained from several different sources. Approxi- mately 80% of daily water needs are supplied in the form of fluids. Less than 20% comes from the water found in fruits, vegetables, and other foods. The remainder is actu- ally formed by the body during normal cellular metabo- lism. Carbohydrates, fats, and proteins are broken down via the aerobic energy system to form carbon dioxide and water. The water formed during aerobic metabolism is known as “metabolic water.” Hydrogen molecules that are part of the chemical structure of carbohydrates, fats, and proteins are basically stripped off and carried to the electron transport chain. The electron transport chain is the last metabolic pathway associated with the aerobic energy system, and it is here that the hydrogen ions are ultimately transferred to an oxygen atom to form H2O. In other words, our bodies are constantly producing meta- bolic water; however, the body does not make enough to satisfy total daily needs.

Is bottled water better than other sources of water? Bottled water costs more than tap water, but that does not mean that it is superior. Water is water no matter where it comes from. The difference most athletes cite between water sources is the taste, which is determined by what

sodium bicarbonate A chemi- cal compound found in the blood that helps maintain the body's normal acid–base balance. Sodium bicarbonate is considered the blood's most potent chemical buffer.

212 SECTION 1 The Basics of Sports Nutrition

Fortifying Your Nutrition Knowledge

Dressing Appropriately for the Temperature How should athletes dress for exercise in the heat? When exercising in the heat, it is critical that the clothing worn be functional, not fashionable. The body relies on four pro- cesses to cool itself: conduction, convection, radiation, and evaporation. Conduction is the transfer of heat from one object to another by direct contact; for example, heat is lost via con- duction when a cold water bottle is placed on the skin of the neck. Convection is heat loss from the body by the passage of air or fluid molecules over the skin of the body; for example, using a fan to circulate air molecules past the body enhances cooling by convection. Radiation is a means of heat loss via electromag- netic waves. Objects that are hotter than their surroundings emit heat waves and thus lose heat. Radiation of heat is how most (~60%) of the body's heat is lost during rest. All three of these mechanisms aid in heat loss as long as the environmen- tal temperatures are below body temperature. Of course, the closer the environment's temperature gets to body tempera- ture, even though it is still below it, the less effective they are at providing cooling. The fourth avenue of heat loss is evapora- tion. It is the process of heat loss via the vaporization of a fluid to a gas, and it is the most important cooling mechanism for the body during exercise. Evaporation of sweat accounts for up to 80% of the body's cooling during exercise or activity. Thus, when thinking about appropriate dress for exercise in the heat, consideration of all of these processes will ensure maximal cool- ing for the body.

When exercising in the heat, clothing should be light col- ored, porous, and constructed of thin material. For example, a cap that is light colored and made of mesh material would be appropriate to wear. It is beneficial to have as much skin exposed to outside air as possible. Some athletes may wet their clothing with water before beginning to exercise. How should athletes dress for exercising in the cold? When dressing for activity in the cold, the four mechanisms of heat loss must still be considered; however, the goal is to dimin- ish their effectiveness so that the body conserves heat. It is best to dress in multiple layers of thin clothing that cover as much skin as possible. The outside layer should be of a dark color and made of wind-breaking material. The innermost layer should be constructed of absorbent material capable of wicking any sweat away from the surface of the skin. The head and ears should be covered, and a balaclava can be used to cover the face.

When dressing for the cold, it is critical to not overdress. Over- dressing will cause excessive sweating, which can soak through all the layers of clothing and thus make a conductive channel for loss of body heat. A simple test to determine the appropri- ate level of dress for the cold is for an athlete to dress and then step out into the elements. If the athlete is immediately com- fortable out in the elements, the athlete is overdressed; if the athlete is slightly chilled and a bit uncomfortable, the level of dress is appropriate. Once exercise has begun, body heat pro- duction will increase and the athlete will no longer feel chilled.

is dissolved in the water. In the case of tap water, the minerals from the ground that leach into the water give it its taste. Each location in the world has its own unique mineral composition, and as a result water can taste very different from location to location. This does not mean that the water itself is more or less effective in hydrating the body; however, it can make a difference in whether athletes drink the water.

Bottled water is usually filtered, and in some instances minerals and/or flavoring have been added back, which enhances only palatability. Of course, savvy marketing would have athletes think that the water is better because it came from natural springs or clear mountain streams. However, athletes should not assume that because the water is bottled it comes from a pristine area. As with food labels, read the water label. Many times the bottled water is coming from the municipal system of a large city, where the water just happens to taste good.

Finally, athletes should not assume that bottled water is safer to drink than tap water. According to the National Resources Defense Council, the FDA’s rules completely exempt 60–70% of the bottled water sold in the United States from the agency’s bottled water standards because the FDA says its rules do not apply to water packaged and sold within the same state. Unfortunately, policing of water regulations within states is underfunded, and one in five states imposes no regulations at all. Even when bottled waters are covered by the FDA’s bottled water standards, those rules are less stringent in many ways than Environmental Protection Agency (EPA) rules that apply to big-city tap water. The take-home message is that athletes should not assume that bottled water is bet- ter than what comes out of the tap. If athletes do not like the taste of their tap water, many different types of in- home water filtration devices can be purchased, includ- ing faucet-mounted filters, pitchers, and even individual

Figure 8.2 The role of water in the sodium bicarbonate buffering system. Water plays a crucial role in maintaining the body's acid–base balance. As depicted, water can either increase or decrease acidity via its relationship to the formation or breakdown of carbonic acid.

H+H +

Metabolic H+

formed at REST

H2O + CO2+ Sodium

Bicarbonate (NaHCO3

–)

Carbonic Acid

(H2CO3)

Metabolic H+

formed during EXERCISE

H2O + CO2+ Sodium

Bicarbonate (NaHCO3

–)

Carbonic Acid

(H2CO3)

water bottles with a filter. These filters will improve the taste of the water and can save the athlete a lot of money.

The exception to this rule pertains to international travel. Each country imposes its own regulations related to water safety. In some instances, bottled water may be safer to consume than tap water. Athletes should inves- tigate the safety of tap water at their destinations before traveling abroad.

What are the ways in which we lose body water? Body water is lost via urination, defecation, sweating, and insensible processes (see FIGURE 8.3 ). Roughly 60% of the body water lost at rest is via formation of urine. However, during exercise in warm environments, sweat formation becomes the primary culprit and can account for up to 90% of water losses. The degree to which sweat formation con- tributes to water loss is dependent on several factors: the environment (temperature, humidity, and wind velocity), the intensity of the exercise (the metabolic demand and thus the amount of heat generated), the duration of the exercise, and the size of the individual. Water is also lost via a process known as insensible perspiration. This is differ-

ent from the process of sweating. Insensi- ble perspiration is when water from within the body actu- ally seeps through the skin to the skin’s sur- face, where it then evaporates into the air. It is labeled as insensible because,

unlike sweat that forms at rates high enough to notice, the water seepage through the skin occurs at a very slow rate, but is ongoing 24 hours a day.

insensible perspiration Loss of water from the body via seepage through tissues and then eventual evaporation into the air. It is labeled as insensible because, unlike sweat- ing, the water loss via seepage through the skin or respiratory pas- sageways occurs relatively slowly and thus goes unnoticed.

Chapter 8 Water 213

Figure 8.3 Typical daily fluid intake and output. To maintain fluid balance, your body regulates its fluid intake and output. Data from U.S. Department of Agriculture, Agricultural Research Service, 2012. USDA National Nutrient Database for Standard Reference, Release 25. Nutrient Data Laboratory home page. Available at: http://www.ars. usda.gov/ba/bhnrc/ndl.

Kidneys (urine)

Skin*

Lungs

Feces**

Food 600–750 mL

450–2,400 mL

250–350 mL

500–1,000 mL

* (Insensible perspiration + sweat production) The volume of perspiration is normally about 100 milliliters per day. In very hot weather or during heavy exercise, a person may lose 1 to 2 liters per hour.

** People with severe diarrhea can lose several liters of water per day in feces.

450–1,900 mL

250–400 mL

100–200 mL

Drink

Metabolic

Water Sources

Water Output

Approximately 15% of the water lost daily is lost by insensible perspiration. Insensible perspiration also includes water lost during breathing. The air breathed into the body is warmed and humidified by the respiratory pas- sageways that direct the incoming air to the lungs. The drier the air or the greater the volume of air breathed, such as during exercise, the greater the loss of body water via this process. Water loss via the respiratory system can be quite significant, particularly in high-altitude sports in cold cli- mates because cold air is very dense and holds little mois- ture, thus making cold air very dry air. Intense exercise that greatly increases breathing rates, in turn, increases water loss from the respiratory passageways. The take-home mes-

sage is that despite the fact that the cli- mate is cold and sweating may not be as great as in warm environments, water intake is still criti- cal to ensure main- tenance of hydration levels. The only way

to maintain hydration on a daily basis is to ensure that daily water intake is equal to daily water loss. If water intake equals water loss, then water balance has been achieved.

What are the consequences of poor water balance? Failing to maintain water balance can have dire conse- quences not only in regard to sport performance, but also in regard to survival. With all environmental conditions being the same, a net loss of body water (i.e., poor water balance) can lead to increases in body temperature com- pared to the hydrated state when performing the same activity (see FIGURE 8.4 ). The combination of impaired ther- moregulation and environmental heat stress can lead to heat-related disorders such as heat cramps, heat exhaus- tion, and heat stroke (see TABLE 8.1 ).

The good news is that heat-related disorders are completely avoidable if commonsense practices regard- ing heat exposure and hydration are followed. The requirements for maintaining water balance are highly variable among individuals based on size, body composi- tion, activity level, and climate, just to mention a few. If daily water intake is less than daily water loss, the body is

in negative balance and dehydration will result if water intake is not increased. The opposite scenario, in which the body is in a positive water bal- ance, is referred to as hyperhydration.

water balance Term used to describe the body's state of hydra- tion. If water intake equals water loss, then water balance has been achieved. If water loss exceeds water intake, then negative water balance results. The converse is positive water balance.

dehydration A condition resulting from a negative water balance (i.e., water loss exceeds water intake).

hyperhydration A condition resulting from a positive water balance (i.e., water intake exceeds water loss).

214 SECTION 1 The Basics of Sports Nutrition

Being slightly hyperhydrated is preferable to being slightly dehydrated in regard to sport performance. Dehy- dration leads to a multitude of physiological function changes that are detrimental to training and performance (see FIGURE 8.5 ). Dehydration leads to loss of blood volume, which, in turn, leads to decreases in the amount of blood the heart can pump to the working muscles. Decreased blood flow to muscles means less oxygen is being deliv- ered, and therefore less work can be performed by the muscles. When the aerobic capabilities of muscle to make energy are diminished because of poor delivery of oxy- gen, the muscles begin to rely more heavily on anaerobic metabolism. The more the body has to rely on anaero- bic metabolism, the quicker lactic acid levels build, the higher the rating of perceived exertion, and the faster fatigue will occur if the athlete does not decrease his or her level of activity. The end result is less-than-optimal sport performance.

Dehydration also leads to extra heat and cardiovas- cular stress during exercise. As little as a 2–3% decrease in body weight caused by dehydration can result in increases in body temperature and heart rate despite the fact that exercise intensity remained the same. The pro- gressive increase in heart rate in the absence of an

Figure 8.4 Effect of dehydration on heart rate and rectal temperature during exercise of the same intensity. Rectal temperature and heart rate both increase with advancing dehydration. Source: Data from McGraw-Hill Companies from Brooks GA, Fahey TD, Baldwin K. Exercise Physiology: Human Bioenergetics and Its Applications. 4th ed. Boston, MA: McGraw-Hill; 2004.

Table 8.1

Heat-Related Disorders

Heat- related disorder

Degree of severity

Signs and symptoms

Corrective actions

Heat cramps Least Muscle cramping Stretch muscle Moderate activity Provide fluids

Heat exhaustion

Moderate Profuse sweating

Cold, clammy skin

Faintness Rapid pulse Hypotension

Cease activity Rest in shade Lie down Consume fluids

Heat stroke Highest Lack of sweat Dry, hot skin Muscle

incoordination Mental confusion Disorientation

Call for medical help Initiate cooling of body

(e.g., fanning, cold towels or ice packs around neck, under arms, and at groin)

Immerse or douse with cold water

100

120

140

160

H ea

rt r

at e

(b ea

ts •

m in

–1 )

Hydrated

Dehydrated

Hydrated

Dehydrated

98.6

100.4

102.2

Exercise duration (min)

0 30 60 90 120

Exercise duration (min)

0 30 60 90 120 R

ec ta

l t em

pe ra

tu re

( °F

)

Chapter 8 Water 215

increase in exercise intensity is known as cardiac drift. Cardiac drift occurs because of decreasing blood volume,

which in turn requires the heart to pump faster to deliver enough blood to the working mus- cle (see Figure 8.5). Athletes must under-

stand that intense exercise in hot, humid environments can result in such rapid fluid losses that increasing fluid intake alone may not be enough to enable the athlete to prevent dehydration. As a result, athletes must be taught that they may also have to modify their intensity (i.e., pace and/or effort) during competition in hot, humid envi- ronments. Failure to do so will lead to progressive dehy- dration that can eventually lead to cardiovascular collapse, severe heat illness (see Table 8.1), or both. Clearly, main- taining hydration before, during, and after training and/ or sport participation is critical.

Is it possible to overhydrate the body? Although rare, it is possible to consume too much water. The resulting condition is known as hyponatremia, more commonly referred to as water intoxication. With the advance of extreme endurance sports, hyponatre-

mia has become a more frequent occur- rence. Hypo means too “low,” na means “sodium,” and emia means “blood”; thus hyponatremia is a condition in which the fluids of the body

cardiac drift A progressive in- crease in heart rate in the absence of an increase in exercise intensity. It is the result of a loss in blood volume.

% Body weight loss

Death

0 1 2

3 4 5

7 8 9

10 11

Thirst Increased thirst, loss of appetite, discomfort Impatience, decreased blood volume Nausea, slowing of physical work Difficulty concentrating, apathy, tingling extremities Increasing body temperature, pulse, and respiration rate Stumbling, headache Dizziness, labored breathing Weakness, mental confusion Muscle spasms, indistinct speech Kidney failure, poor circulation due to decreased blood volume

Figure 8.5 Effects of progressive dehydration.

hyponatremia A rare condi- tion resulting from the dilution of sodium levels in the body. Endur- ance and ultra-endurance athletes who drink copious amounts of water without regard to sodium replacement increase their risk for hyponatremia.

Table 8.2

Indexes of Hydration Status

Condition % Body weight (BW) change*

Urine color** Urine specific gravity

Well-hydrated 1 to –0.9 1 or 2 < 1.010

Minimal dehydration

–1.0 to –2.9 3 or 4 1.010–1.020

Significant dehydration

–3.0 to –4.9 5 or 6 1.021–1.030

Serious dehydration

≤ –5 > 6 > 1.030

* % BW change ([postexercise BW – preexercise BW]/preexercise BW) × 100

** See Figure 8.6.

Reproduced from Casa DJ, Armstrong LE, Hillman DK, et al. National Athletic Trainers’ Association position statement: fluid replacement for athletes. J Athl Train. 2000;35(2):212–224. Reprinted with permission.

become very low in sodium content. Sodium is an impor- tant electrolyte and is critical to normal function of muscle and the nervous sys-

tem. Symptoms of hyponatremia mimic those of some- one who is intoxicated and include muscle weakness, muscle incoordination, disorientation, and eventually seizures, coma and death, if the condition is not recog- nized and treated.

Endurance and ultra-endurance athletes are at great- est risk for hyponatremia because of their repeated expo- sure to long training bouts that result in significant fluid loss via sweat. Because sodium and chloride are the main electrolytes lost in sweat, rehydration without replace- ment of these electrolytes will eventually lead to dilution of their concentrations in the body.1 One way to prevent hyponatremia is to have athletes ingest sports drinks con- taining electrolytes, particularly sodium. In regard to non- endurance athletes, hyponatremia is very rare. As a result, the use of electrolyte sports drinks by nonendurance ath- letes is of lesser importance because of the fact that diet alone in most instances provides enough sodium chloride (i.e., salt) to cover losses in training.

How can hydration status be monitored? Hydration status can be measured in several ways prior to exercise (see TABLE 8.2 ). Each method has pros and cons in regard to the ease of administration and related costs. One easy way to monitor whether water balance is being achieved is to monitor body weight. Daily weight fluctua- tions are caused primarily by changes in water status. As a result, changes in body weight that occur within a 24-hour

water intoxication A condi- tion resulting from the excessive intake of water. The end result can be a clinical condition known as hyponatremia.

216 SECTION 1 The Basics of Sports Nutrition

time frame can give an indication of whether water intake is replenishing daily water loss. For example, if an indi- vidual weighs 120 pounds prior to her workout and 118 pounds after the workout, the weight lost during exercise was a result of water loss. The rule of thumb for rehy- drating is that for every 1 pound of weight lost an athlete should consume 2–3 cups (8 oz = 1 cup) of water. An excel- lent practice for athletes, particularly those in warm cli- mates, is to monitor changes in their pre- and postpractice weights and then follow the rehydrating rule of thumb. If their prepractice weight is not back to the previous day’s prepractice weight, then their attempt at rehydrating needs to be increased to prevent progressive dehydration.

Although monitoring body weight is a quick, easy, and inexpensive hydration assessment method, several potentially confounding physical and mental issues need to be considered. Physically, other factors besides water loss during a training session, such as food intake, the time weight was taken from last meal, bowel movement patterns, and bladder content at the time of weighing, can affect body weight over the course of 24 hours. As a result,

it can be difficult to distinguish which of those factors are contributing to a higher- or lower-than-normal weight, and this can provide confusing or misleading information regarding specific hydration status. Weighing athletes at the same time of day and with an empty bladder can help control for some of these variables and provide a more accurate picture of hydration level.

One mental factor that often is overlooked is the effect of frequent or daily weigh-ins. Requiring an athlete to step on a scale repeatedly in 1 week, especially if in front of other teammates and coaches, can cause the athlete to become excessively focused on weight, which can spiral into distorted eating and body image issues. Because of this risk, other methods of measuring hydration status should be considered for some athletic populations.

One sport that depends heavily on body weight mea- surements is wrestling. Concern has risen in recent years about unhealthy weight loss practices, including severe dehydration, to cut weight. Guidelines have been instituted through the National Collegiate Athletic Association and the National Federation of State High School Associations to establish a minimum weight for each athlete at the begin- ning of the competitive season.3,4 Because it was discovered that wrestlers were arriving at minimum weight testing in a dehydrated state to secure a lower weight minimum, both organizations have included body composition and other hydration tests to be used in conjunction with weigh-ins.

Several other methods of assessing hydration sta- tus are related to urine: color, specific gravity, and vol- ume.5 Urine can be collected in a sample container and compared to a color chart, measured for specific grav- ity with a refractometer, or evaluated on total volume. Comparing urine color to a chart can be quick and easy but also expensive over time because of the cost of collection containers (see FIGURE 8.6 ). Athletes can also subjectively evaluate urine color—typically dark, con- centrated urine with a strong smell indicates dehydra- tion. Using a refractometer is simple; however, there are costs associated with purchasing the equipment and issues of ease of portability. Urine volume can be a good indicator of hydration, but it tends to be cumbersome to collect and measure.

Each athlete or team needs to determine the most accurate, realistic, convenient, and cost-effective method for measuring hydration status prior to exercise. For any sports requiring weight classes, such as wrestling, train- ers are strongly encouraged to measure hydration status in several ways before allowing an athlete to participate in an event. The National Athletic Trainers’ Association (NATA) recommends that athletes should be screened for urine specific gravity and urine color at the time of weigh- ins. The upper end of the acceptable range for hydration status is a urine specific gravity of less than or equal to 1.020 or urine color of less than or equal to 4 (see Table 8.2 and Figure 8.6). Body weight changes during and after exercise are also excellent indicators of fluid dynamics and should be included in hydration assessments.

Chapter 8 Water 217

Fortifying Your Nutrition Knowledge

Teaching Athletes to Self-Monitor Hydration Status Athletes should be well-versed on the following methods for self-monitoring of daily hydration status:

■ Urine color: Urine that is clear or the color of pale lem- onade indicates positive hydration. Urine the color of apple juice or that is bright yellow or amber in color indi- cates dehydration. Athletes should monitor urine color throughout the day, not just before or after practice or competition.

■ Urine volume: Adequately hydrated athletes will need to urinate approximately every 1 to 2 hours during wak- ing hours. Athletes should notice if they have gone sev- eral hours without urinating as a sign that they may be becoming dehydrated. The average daily urine output under normal conditions is approximately 1.5–2.5 liters per day.2 Athletes, however, will consume more fluids, sweat more, and may have greater urine output. It is not practical to measure urine output; therefore, monitoring the number of times athletes urinate is more practical and helpful to determine hydration status.

■ Daily morning weight: Athletes may choose to weigh each morning during high heat, humidity, and intense preseason training. A decrease of more than 1% of body weight or more than 1 pound suggests possible dehydration.

■ Weighing in pre- and postpractice: Athletes should weigh themselves in light clothing before practice and in the same amount of clothing after practice. Be sure to have athletes remove sweaty T-shirts and towel off before the postpractice weight. Replenish with fluids in the amount of 16–24 ounces for every pound of weight lost.

U.S. survey data from the National Health and Nutrition Examination Survey (NHANES) III provide an estimation of the percentage of water required from drinking water and other beverages versus solid food. The results of the sur- vey reveal that fluids provide 81% of total water intake, whereas foods contribute 19%. Based on the total water recommendations, men should be consuming approxi- mately 3 liters of fluid (101 oz or ~13 cups) and women should aim for 2.2 liters of fluid (74 oz or ~9 cups) each day. Athletes may need to modify these fluid recommendations to match their individual requirements based on physical activity, environmental conditions during training/compe- tition, and outdoor climate. In general, daily fluid intake driven by thirst can adequately maintain hydration status.

Another method for estimating fluid needs for the average individual under normal circumstances and in moderate environmental conditions relates total energy intake to fluid requirements. It has been estimated that individuals require approximately 1 milliliter of water for every calorie of energy consumed.7 The average Ameri- can consumes approximately 2000 calories per day, which equates to 2000 milliliters of fluid. Milliliters are converted to ounces by dividing the number of milliliters by 240, because there are 240 milliliters in 8 ounces of fluid (2000 milliliters ÷ 240 = 8.33 cups of fluid per day). Therefore, the commonly prescribed 8 cups (8 oz each) of water per day holds true for the average American.

Determining water needs based on calorie intake can provide a more individualized approach for athletes’ daily water needs. Athletes have varied energy intakes based on weight, energy expenditure, and sport performance goals. As energy needs increase and caloric consumption increases, so does the requirement for fluids. For example, according to the calorie and fluid connection, an athlete

How much fluid do individuals need on a daily basis? Water is the largest constituent of the human body and is critical for maintaining life, general health, and opti- mal athletic performance. Proper daily water intake pre- vents the deleterious effects of dehydration, including metabolic and functional abnormalities. Because water has not been shown to directly prevent chronic diseases, and because of great individual differences in fluid needs based on climate, activity level, and metabolism, an AI has been set for water rather than an RDA.

What are the current recommendations for daily fluid intake? The AI for water, published by the Institute of Medicine, reflects the current research and population survey data. For men and women older than age 19, the recommended intake is 3.7 liters and 2.7 liters of water per day, respec- tively.6 Refer to TABLE 8.3 for the recommendations for younger men and women. These daily quantities reflect total water intake from drinking water as well as from other beverages containing water and from solid foods.

Table 8.3

Dietary Reference Intake Values for Total Water

Gender and age group

AI (L/day) from foods

AI (L/day) from beverages

AI (L/day) total water

Males, 4–8 years 0.5 1.2 1.7

Males, 9–13 years 0.6 1.8 2.4

Males, 14–19 years 0.7 2.6 3.3

Males, > 19 years 0.7 3.0 3.7

Females, 4–8 years 0.5 1.2 1.7

Females, 9–13 years

0.5 1.6 2.1

Females, 14–19 years

0.5 1.8 2.3

Females, > 19 years

0.5 2.2 2.7

Source: Data from Institute of Medicine. Dietary Reference Intakes: Water, Sodium, Chloride, Potassium and Sulfate. Food and Nutrition Board. Washington, DC: National Academies Press; 2004.

Hydrated

Dehydrated

Optimal1

Well hydrated

Dehydrated: You need to drink

more water

Seek medical aid: May indicate blood in

urine or kidney disease

218 SECTION 1 The Basics of Sports Nutrition

Figure 8.6 Urine color comparison. Athletes can compare their urine color to the descriptions of urine color in the chart to deter- mine hydration status. The goal for adequate hydration is clear to pale yellow urine (i.e., urine rating 1 or 2). A urine color rating equal to 5 or 6 indicates significant dehydration. Modified from Geographic Area Coordination Centers. Northwest Inter- agency Coordination Center. “Are You Hydrated?” Retrieved from: http://gacc. nifc.gov/nwcc/content/pdfs/safety/DOD_Urine%20Color%20Test_Poster.pdf.

ratio. For example, humans lose approximately 1 millili- ter of water for every milligram of caffeine consumed.6 One cup (240 milliliters) of brewed coffee contains an average of 80 milligrams of caffeine. Consumption of this product would lead to a loss of approximately 80 milliliters of water, but a gain of 160 milliliters of water. The fluid loss also tends to be transient in nature, and thus doesn’t cause major shifts in fluid balance. There- fore, the Institute of Medicine reports that caffeinated and alcoholic beverages can contribute to an individ- ual’s total water intake. For athletes, these beverages should comprise only a small portion of total fluid intake per day because of the damaging physical and mental effects of excess alcohol consumption and the poten- tially unwanted side effects of large doses of caffeine. However, there appears to be no need to completely eliminate caffeine specifically from the diet. Moderate caffeine intake is unlikely to cause detrimental fluid– electrolyte imbalances, if athletes are eating and drink- ing normally on a daily basis.8

High-protein diets also have the potential to increase water losses. The normal metabolism of protein produces urea. The human body considers urea a toxic chemical that must be excreted as waste through the urine. Indi- viduals who are consuming large quantities of protein daily, in excess of their daily requirements, may be caus- ing the body to excrete more fluid to flush out the urea. More research is needed in this area to confirm the asso- ciation between high protein intakes and fluid losses as well as the establishment of any variance to the current daily fluid recommendations for those choosing a high- protein meal plan.

Many prescribed and over-the-counter medications have a diuretic effect on the body. The extent of the diure- sis depends on the drug dosage and individual response.

who consumes 2500 calories per day would need 2.5 liters of fluid per day, but a different athlete who consumes 5000 calories per day would require twice as much fluid daily. Clearly, 5.0 liters of water is more than the values shown in Table 8.3, but athletes in general usually have greater fluid needs. In fact, during intense training of long duration and in high heat and humidity, even the higher water intake recommendation based on the 1 milliliter per calorie method may be insufficient to maintain water balance. Vigilant assessment of water loss during exercise activities and replacement of these losses at appropriate levels, as described later in this chapter, will help athletes meet their fluid needs for both daily hydration and hydra- tion before, during, and after exercise activities.

Fluid losses can be replenished through drinking water, other beverages containing water, and foods. Water, juices, milk, coffee, tea, and soda all contribute to a person’s daily fluid intake. Water is always a good choice because it is calorie free and inexpensive. Juices and milk contribute not only fluid, but also macronutrients, vitamins, and min- erals. They should be consumed in moderation, however, because they can add a significant amount of total calo- ries to the daily diet. Caffeinated coffee and tea will have a slight diuretic effect; therefore, decaffeinated varieties are preferable. Regular sodas are not recommended because of the large quantity of refined sugars they contain. Diet

sodas are often con- sidered a better option than regu- lar sodas; however, because of the incon- sistent results from research studies on the long-term safety of artificial sweet- ener consumption, diet sodas should be kept to a minimum.

Solid foods also contribute water to an athlete’s total daily fluid intake. Fruits and vegeta- bles contain a large percentage of water,

upward of 70–90%. Meats, dairy products, and grain prod- ucts consist of lower percentages of water; however, per- centages still range from 30–50%. Refer to FIGURE 8.7 for the water content of various foods. Not only do solid foods directly contribute to water consumption, but the metab- olism of foods creates water as a by-product.

Can certain beverages, foods, or medications contribute to fluid losses? Caffeine and alcohol have been shown to have a diuretic effect, causing the body to excrete fluids in urine. How- ever, the consumption versus loss is not necessarily a 1:1

Figure 8.7 Water content of various foods.

W at

er C

on te

nt (

% )

86 80

37 36

15 5

100

Le ttu

O ra

ng e

P ot

at o

C hi

ck en

B ee

H ar

d ch

ee se

B re

B ut

te r

C er

ea l

Chapter 8 Water 219

Gaining the Performance Edge

The hydration needs of an athlete can be estimated using the follow- ing formula: total calories/240 = number of cups of fluid needed each day. For example, the num- ber of 8-oz cups of fluid required by an athlete consuming 3000 cal- ories a day can be estimated as fol- lows: 3000 calories/240 = 12½ cups per day. It is important to remem- ber that fluid losses during exercise must be added to the calculated estimation to cover the hydration needs of athletes.

Athletes should discuss the side effects of any prescrip- tion or over-the-counter drug taken on a routine basis with their physician and adjust their fluid intake accord- ingly. Coaches need to be aware of the dangers of ath- letes taking excessively high doses of diuretics without the supervision of a physician. Typically, wrestlers and other athletes attempting to make a weight cut-off, as well as athletes with eating disorders, are the individuals taking diuretics. Large doses can cause potassium and other electrolyte disturbances, which can lead to muscle weakness and ultimately cardiac problems.

What are some practical guidelines for consuming fluids on a daily basis? The goal of daily fluid consumption is to ensure the main- tenance of optimal health. To achieve this goal, athletes should consider the following hydration guidelines:

• Each athlete should be aware of his or her individual daily fluid needs and consume fluids accordingly.

• Optimal hydration should stimulate urination approximately every 1 to 2 hours.

• Urine that is pale or clear in color typically indicates adequate hydration. Athletes need to realize that vitamin and mineral supplementation can create a yellow tint to urine and therefore the color of urine may or may not be an accurate reflection of hydra- tion status.

• Fluids can be obtained from water, milk, juices, cof- fee, tea, and sports beverages as well as watery foods such as soup, fruits, and vegetables.

• Caffeine should be consumed in moderation. Alcohol consumption should be minimized if not eliminated.

• Athletes should follow a well-balanced diet, includ- ing moderate amounts of protein to avoid diuresis as a result of high-protein diets.

• Athletes and coaches should be aware of the diuretic side effects of any medications taken on a regu- lar basis and adjust daily fluid recommendations accordingly.

What is the role of preexercise hydration? Proper hydration before exercising sets the stage for optimal sport performance. Athletes who avoid fluids intentionally or unintentionally before training sessions or competitive events tend to fatigue quickly, complain of dizziness or faintness, demonstrate a faster rise in core body temperature, have increased heart rates and perceived levels of exertion, and perform subop- timally.9–11 In contrast, drinking excessive amounts of fluid prior to exercise can lead to frequent and disruptive urination and possibly hyponatremia. Athletes need to know the benefits of optimal hydration before exercis- ing, accurate measurements of hydration status, and the current guidelines for the quantity, type, and timing of

fluid ingestion prior to training sessions and competi- tive events.

How much fluid should be consumed before exercise? When establishing a plan for fluid consumption before exercise, consider not only the volume of fluid, but also the timing of ingestion. Generous, but not excessive, amounts of fluids should be consumed in the 24 hours before exercise. Drinking enough fluids to meet daily rec- ommendations will allow an athlete to start an exercise session well hydrated. Fluid intake within the 1 to 2 hours prior to exercise can enhance thermoregulation and lower heart rate during exercise.10,12 The American College of Sports Medicine (ACSM),13 the NATA, and the Academy of Nutrition and Dietetics (AND) all recommend the fol- lowing hydration schedule in the hours immediately prior to exercise:

• Slowly drink approximately 400–600 milliliters (13–20 oz) or the equivalent of about 5–7 milliliters per kilogram of body weight (mL/kg) at least 4 hours prior to exercise.

• If urine is not produced or is dark and highly con- centrated, slowly drink more fluid (e.g., ~3–5 mL/kg) about 2 hours before exercise.

• Drink 200–300 milliliters (7–10 oz) in the 10 to 20 min- utes prior to exercise. These volumes of fluid will ensure that athletes are

properly hydrated while allowing the kidneys to regulate total body fluid.

What types of fluids should be consumed? Athletes can choose from a variety of fluids in the hours leading up to a training session or competition, includ- ing water, juices, milk, coffee, tea, sports drinks, sodas, and beverages containing glycerol (see FIGURE 8.8 ). Each

beverage has bene- fits and drawbacks; therefore, it is critical that athletes experi- ment with the dif- ferent choices prior to actual practice or competition to deter- mine their prefer- ence and individual

tolerance. Water is an appropriate choice, especially if accompanied by a substantial snack or meal. Solid food can provide carbohydrates and electrolytes before exer- cise whereas water provides fluid without further increas- ing the concentration or osmolarity of the stomach and intestinal contents. Water is also inexpensive and easy to obtain.

Juices, specifically 100% juices, provide fluid, carbo- hydrates, and electrolytes, which are all beneficial prior to exercise, but not without consequences for some

osmolarity Similar to osmolality, it is an indicator of the concentra- tion of dissolved particles per liter of a solvent (mOsm/L). The higher the osmolarity, the greater the tendency to attract water rather than be absorbed.

220 SECTION 1 The Basics of Sports Nutrition

athletes. Carbohydrates in juice can help top off glyco- gen stores for use during exercise. Because juice is a liq- uid source of carbohydrates, it is digested and absorbed more quickly than are solid foods, making for a speedy delivery of nutrients to the muscles. Potassium, which is found in both fruit and vegetable juices, as well as sodium, found mainly in vegetable juices, are electro- lytes that are lost in sweat and therefore beneficial to consume prior to exercise. Seemingly an ideal choice, some athletes swear by juice before training and compe- titions, whereas others find juices disagreeable to their gastrointestinal systems immediately prior to exercise. The high fructose content of full-strength juices, if con- sumed immediately before exercise (or within 15 to 30 minutes) may delay gastric emptying, causing gastroin- testinal upset in some athletes. Individual preference and tolerance should guide the choice of whether to include juice in the preexercise hydration plan.

Milk provides another seemingly ideal beverage to the lineup of hydration choices. Milk helps athletes meet car- bohydrate and protein requirements prior to exercise, in addition to providing fluid. A little protein in the preexer- cise meal or snack slows the release of nutrients into the

Figure 8.8 Variety of beverages for daily hydration. All beverages consumed count toward daily hydration needs. Limit the use of sodas and other carbonated beverages, which may decrease the effectiveness of overall hydration and nutri- tion status.

bloodstream and thereby allows for a more even supply of energy to the muscles during exercise. Therefore, milk is an excellent preexercise fluid choice; however, many athletes find it difficult to digest, causing stomach upset, bloating, or diarrhea prior to training or competitions. Obviously these effects are undesirable, so milk consump- tion prior to exercise should be based on individual pref- erence and tolerance.

Coffee and tea are often used as a precompetition beverage because of the claims that caffeine enhances endurance performance. The general consensus in the research is that caffeine does provide an ergogenic ben-

efit by improving endurance time to exhaustion in pro- longed events.14,15 Some of the con- troversy that exists surrounding caf-

feine is the balance between its ergogenic benefits and its diuretic effects. However, as mentioned earlier in this chapter, the diuretic effects of caffeine do not completely negate the fluid contribution of these beverages. There- fore, coffee and tea do count toward fluid goals prior to exercise. The deciding factor on inclusion of coffee or tea before exercise is an athlete’s individual tolerance and familiarity with the effects of caffeine. For those who are accustomed to caffeine on a daily basis, coffee or tea should be consumed to avoid headaches or lethargy caused by sudden caffeine withdrawal. For those who do not consume caffeine regularly, coffee and tea should probably be avoided because of the potential side effects of nervousness, tremors, and gastrointestinal distress.

Sports drinks are frequently used by athletes prior to training sessions and competitions. Sports drinks are specifically formulated as a fluid replacement bever- age for use during exercise. Athletes should therefore reserve the consumption of these drinks mainly for training sessions and competitions and not necessar- ily as a refreshment beverage during the day or in the hours leading up to exercise. A small amount of a sports beverage can be appropriately used immediately prior to exercise, with the intention of supplying a small amount of carbohydrates, sodium, and fluids for the initiation of exercise. However, the focus of preexercise fluids should be on more nutritionally concentrated beverages. An additional concern is that, for those embarking on long- duration activities, sports drinks should be consumed during the activity in copious amounts. If sports drinks are consumed before exercise, there is the possibility that the athlete will tire of the flavor of the sports drink before the end of the endurance training session, poten- tially lowering overall fluid intake and possibly affecting performance.

Sodas are not appropriate for consumption prior to exercise. In general, sodas should be minimized in an ath- lete’s diet because of their large contribution of refined

Chapter 8 Water 221

Gaining the Performance Edge

Water, juice, and milk are excellent choices for preexercise hydration.

sugars. Besides fluid and simple sugars, sodas are devoid of vitamins and minerals and thus do not have nutri- tional value. The carbonation in soft drinks tends to cause individuals to drink less because of a feeling of fullness, potentially leading to dehydration at the initiation of exercise. Sodas should not be consumed prior to exercise and in general should be consumed only occasionally.

Methods to enhance preexercise hydration by supersaturating the body with water have been inves- tigated.16–19 One such method involves consuming flu- ids containing glycerol. Unfortunately, limitations in the experimental designs of many of these studies make it difficult to assess the true efficacy of hyperhydration using glycerol.20 Some studies have revealed a thermo- regulatory benefit, whereas others have shown no effect. However, it appears that even in cases where glycerol intake has been shown to be positive, the benefits have been somewhat negated when hydration status was maintained during exercise.20 Therefore, at this time

there is not enough evidence to endorse the use of glycerol- containing bever- ages before exercise. It should also be noted that the side effects of glycerol ingestion include nausea, headaches, and gastrointesti- nal distress—all of

which are undesirable and unfavorable conditions for optimal athletic performance.

What are practical guidelines for consuming fluids before exercise? The goal of fluid consumption before exercise is to ensure that athletes begin training sessions and com- petitive events hydrated and fueled to perform at their best and maintain health. To achieve these goals, ath- letes and coaches should consider the following hydra- tion factors:

• Drink according to established preexercise hydration guide- lines. Consuming adequate fluids prior to exercise is critical to performance. However, more is not neces- sarily better.

• Athletes and coaches should determine a method for assessing hydration status prior to training sessions and competitions to avoid the adverse effects of dehydration. Urine color, concentration, and odor, as well as body weight, are the most commonly used methods for assessment.

• Water, juices, and milk are excellent choices for preex- ercise hydration and can easily be included in the pre- exercise meal or snack. Caffeinated coffee and tea should be consumed in moderation. Sodas should be avoided.

What is the role of hydration during exercise? The goals of hydration during exercise are to maintain plasma volume and electrolyte balance. Through optimal hydration, athletes can avoid abnormal increases in heart rate and core temperature that can potentially lead to health issues, as well as premature fatigue that will zap performance. Both dehydration (insufficient fluids) and water intoxication (excessive fluids) can negatively affect performance.

A water loss of merely 2–3% of total body weight can decrease performance by reducing cardiac output and increasing an athlete’s risk for heat illnesses.8 Fluid replacement sustains the process of sweating, which cools the body through evaporation. If fluid replacement is suboptimal, blood flow to the skin is decreased, which impairs heat dissipation and elevates body core tem- perature. Losing 2–3% of total body weight is very com- mon and can happen relatively quickly to athletes during training and competitions. Athletes should note that fluid replacement means consuming fluids—not pouring fluids over their heads. Pouring a cold cup of water or ice over the body can provide an immediate sense of relief from the heat but does not elicit the same benefit as consum- ing the fluids. The most effective way to keep body tem- perature in check and enhance performance is to actually ingest the cold fluids.

What is the magnitude of water and electrolyte losses during exercise? Water and electrolyte losses during exercise can vary greatly depending on several factors, including body size, exercise intensity, ambient temperature, humidity, cloth- ing choices, and acclimation.21 For slow-paced, low-inten- sity efforts conducted in low to moderate temperatures, fluid losses might not exceed 500 milliliters per hour (~16–20 oz).22 In hot and humid environments, some ath- letes can lose up to 2–3 liters of water per hour (~68–102 oz). Considering the size of a 2-liter bottle, consuming upward of one and a half of those bottles during 1 hour of exercise can be daunting! However, each athlete’s needs are differ- ent, and therefore individual sweat losses should be calcu- lated and hydration protocols developed to replace fluids at a similar rate. Electrolytes lost in sweat include mainly

sodium, some potas- sium, and small amounts of calcium. Sodium losses have been estimated at 50 mmol per liter of sweat, or 1 gram per liter, during exercise, with a range of 20–80 mmol per liter (400– 1600 milligrams per liter). Potassium

222 SECTION 1 The Basics of Sports Nutrition

Gaining the Performance Edge

Athletes cannot “train” their bodies to increase performance when in a dehydrated state. Proper hydra- tion protocols should be used in all practices and competitions to ensure optimal health and sport performance.

Gaining the Performance Edge

An athlete can drink a variety of flu- ids prior to competition. However, it is important to experiment with the various drinks to determine taste preference and tolerance before actually using them prior to competition.

losses are typically 4–8 mmol per liter (76–152 milligrams per liter) during exercise.23 For short-duration activities, normal daily intake of electrolytes may be adequate to replenish losses in sweat. For athletes training and com- peting for longer durations, at higher intensities, or in hot, humid environments, electrolyte replacement during exercise will be critical for sport performance and preven- tion of hyponatremia.

As mentioned, individual sweat rates vary dramati- cally. To prevent dehydration, while also avoiding water intoxication, athletes need to know the current water and electrolyte intake recommendations for during exercise, their individual sweat rates, and how to translate the information into a fluid plan for training sessions and competitions.

How much fluid should be consumed during exercise? Many national organizations, including the ACSM, NATA, and AND, have issued position statements regarding their recommendations on the ideal quantity of fluid to ingest during exercise for health and peak performance.1,5,13,24 The consensus is that athletes should aim for matching their sweat and urine output with fluid consumption to maintain hydration at less than a 2% reduction in body weight. For most individuals, consuming approximately 200–300 milliliters, or 7–10 fluid ounces, every 10 to 20 minutes during exercise will achieve this goal. However, this recommendation must be confirmed by calculating individual sweat losses through a “sweat trial” to ensure proper hydration based on the factors that contribute to individual variability.

Several studies have revealed no change in perfor- mance with varying volumes of fluid ingested during cycling lasting less than 60 minutes in a neutral envi- ronment.25,26 Although consuming fluids may not have a huge impact on short-duration exercise, it does have a large impact on long-duration exercise (~60 minutes), especially in hot, humid environments.2,27,28 Any ath- lete engaging in exercise lasting longer than an hour should measure his or her sweat rate and implement a hydration plan.

How can an athlete calculate his or her individual sweat rate? Athletes can estimate their individual sweat rate by gath- ering information from a sweat trial. After collecting the data from the trial, the athlete will be able to estimate his or her individual fluid needs per hour through a series of short calculations. Sweat trials should be performed multiple times during training to provide the most accu- rate estimation of the quantity of fluid needed on com- petition day, enabling the athlete to perform at his or her best. Sweat trials should be conducted in several different environments to gain as much information as possible so that there are no surprises or guesses on competition day. Differences should be compared between indoor

and outdoor work- outs, summer and winter training ses- sions, and easy and hard effort days. The data to collect during a sweat trial include the following:

• Body weight (BW), in pounds, before exercise.

• BW after exer- cise (without wearing sweaty clothes).

• Volume of fluid consumed (in ounces) during the workout.

• Urine output during exercise. • Total workout/competition time (in hours).5

Most of these measurements can be collected easily, with the exception of urine output. To make the calcu- lation more feasible, athletes should exercise for 1 to 2 hours without urinating, thus negating the need for the urine output data. After collecting the other pieces of data indicated, the sweat rate can be calculated using the fol- lowing steps: 1. Determine body weight lost during exercise. By subtract-

ing the total body weight after exercise from the total body weight before exercise, an athlete can determine the amount of water lost, expressed in pounds:

BW before exercise – BW after exercise = pounds of water weight lost

2. Determine the fluid equivalent, in ounces, of the total weight lost during exercise. Every pound of body weight lost during exercise equals approximately 2–3 cups or 16–24 ounces of fluid (1 cup = 8 oz).5 The weight loss that occurs during exercise can translate into the number of ounces of fluid the athlete should have consumed, in addition to the fluid actually consumed during the training session or competition, to main- tain fluid balance. To determine the number of ounces of fluid lost during exercise, multiply the pounds of water weight lost by 16–24 ounces:

pounds of water weight lost during exercise × 16–24 oz = number of ounces of

additional fluid that should have been consumed to maintain fluid balance during the

exercise session

3. Determine the actual fluid needs of the athlete during an identical workout. Add the quantity of fluid consumed during the workout to the fluid equivalent of the weight lost during exercise to determine the total actual fluid needs of the athlete:

ounces of fluid consumed + ounces of additional fluid needed to establish

fluid balance = total fluid needs

Chapter 8 Water 223

Gaining the Performance Edge

Although consuming 200–300 mil- liliters (7–10 oz) of fluid about every 15 minutes will help maintain hydration during exercise for most athletes, sweat trials should be per- formed to learn individual hydration needs.

4. Determine the number of fluid ounces needed per hour of exercise. For practical purposes, divide the total fluid needs by the duration of the sweat trial, in hours. This final calculation will provide the athlete with an esti- mation of his or her hourly fluid needs, which can then be used to plan accordingly for training sessions, and ultimately for competitions of varying lengths.

total fluid needs/total workout time in hours = fluid ounces per hour of exercise

For example, Alex weighs in before tennis practice at 145 pounds. After 2 hours of playing tennis outdoors on a mild summer day, he weighs in at 143 pounds. Dur- ing his practice, Alex consumed 20 ounces of fluid. What are Alex’s total fluid needs per hour? Following the steps listed previously: 1. Weight loss = 145 lb – 143 lb = 2 lb of water weight loss 2. Additional fluid needed = 2 lb × 16–24 oz = 32–48 oz

of additional fluid that should have been consumed to maintain fluid balance dur- ing the practice session

3. Total fluid needs = 20 oz + 32–48 oz = 52–68 oz

4. Fluid needs per hour = 52–68 oz/2 hr of prac- tice = 26–34 oz/hr From this sweat

trial, Alex would estimate his total fluid needs per hour of training or com- petition to be 26–34 ounces. Therefore, he can plan accordingly for his next practice and bring two 20-ounce water bottles filled with a sports drink.

How does the volume of fluid ingested during exercise affect gastric emptying and intestinal absorption? The goal of determining individual sweat rates is to estab- lish a fluid plan that would closely match fluid intake with fluid losses. This state of fluid balance, or euhydration, is not always possible for athletes to achieve. In some cases, athletes’ sweat rates exceed maximal gastric emptying rates, which, in turn, limit the intestinal absorption of flu- ids. For these athletes, fluid recommendations are set at a volume that matches sweat losses as closely as possible without exceeding gastric emptying rates, thus avoiding stomach cramping and bloating. Using a carbohydrate-con- taining sports bever- age during exercise

Gaining the Performance Edge

An athlete should not gain weight during an exercise session. Weight gain indicates overhydra- tion and can increase the risk for hyponatremia.

Food for Thought 8.1

Determine Your Fluid Needs During Exercise

Perform your own sweat trial to determine your fluid needs.

By increasing the volume of fluid ingested, athletes will not only more closely match their fluid losses, thus preventing the detrimental effects of dehydration, but also will actually facilitate euhydration by stimulating gastric emptying. Larger volumes in the stomach stimu- late the release of fluids into the intestines, leading to a faster delivery of fluids from ingestion to absorption during exercise. If an athlete becomes dehydrated by as little as 2–3% body weight, gastric emptying rates begin to decline, leading to dehydration and oftentimes to stom- ach discomfort.29

How does heat acclimatization affect hydration requirements? Physiological changes occur as an athlete adjusts to warmer environments during exercise. Adjustments are made for both short- and long-term exposure to heat. An example of a short-term exposure scenario is when athletes are forced to train indoors for several days because of icy winter conditions or heavy snowfall. In

can enhance absorptive capacity. The section entitled “How much and what types of carbohydrates should be included in a fluid replacement beverage?” later in the chapter describes this in more detail.

However, a majority of athletes are consuming fluids at a rate and volume much lower than their maximal gas- tric emptying rate. Many athletes consume less than 500 milliliters of fluid per hour during training or competi- tion. For most individuals, gastric emptying rates of 1 liter or more per hour are possible.21 Therefore, athletes are not reaching their hydration potentials and would benefit from increasing fluid intake during exercise.

euhydration A state of fluid bal- ance in which water loss has been replaced by adequate water intake.

224 SECTION 1 The Basics of Sports Nutrition

this scenario, the indoor temperature and humidity are much higher than the athletes are accustomed to. As a result, they sweat more than usual and thus require a short-term adjustment in their hydration requirements. Once the athletes return to the colder outdoor environ- ment, water requirements quickly return to their previous outdoor training levels. An example of a long-term situ- ation occurs with the change in seasons. As the weather changes from the cool temperatures of spring to the hot, humid conditions of summer, athletes’ sweat rates will be altered. Sweat rates will increase initially for 10 to 14 days. After approximately 2 weeks, an athlete’s sweat rate should be reassessed and the hydration plan modified accordingly.

Athletes’ hydration status should be monitored closely during acclimatization. Typically, athletes will not replace all lost fluids voluntarily in the heat. As heat accli- matization progresses, voluntary intake usually increases to more closely match losses.30 One study has reported an opposite trend in fluid intake.31 Five untrained, unaccli- mated women performed 3 days of exercise in the heat over a period of 6 weeks. The researchers found that fluid intake actually decreased over time. This study had sev- eral methodological pitfalls, however, including the lack of sweat volume measurements to compare to intake to evaluate fluid balance. The study did confirm previous findings that thirst may not always drive an athlete to drink sufficient amounts of fluids, and thus the recom- mendation for monitoring hydration status during heat acclimation.

How does altitude affect hydration requirements? Exposure to high altitude increases the risk for athletes becoming dehydrated. Physiologically, several issues can affect the hydration status of athletes training or com- peting at higher altitudes, in particular altitudes above 1.6 kilometers (5280 feet). First, temperatures tend to become progressively colder with increasing altitude (1.8°F for every 500 feet), and colder air is drier air. As altitude increases above 5280 feet, there is less air pres- sure driving oxygen into the blood. As a result, the body adjusts to the decreased oxygen availability by noticeably increasing breathing rate. The increased volume of dry air coursing through the respiratory passageways, even at rest, leads to increased water loss as the air is humidi- fied on its way to the lungs. When taken in combination, 24-hour exposure to colder, drier air leads to a reduction of body water via dramatic increases in insensible water loss through the skin and respiratory tract. As a result, dehydration can result independent of whether the ath- lete is training or not. During training, sweat losses are added to the increased water loss via insensible avenues to make fluid turnover even greater. Therefore, athletes need to be particularly conscious about increasing fluid intake at higher altitudes and monitoring urine color and/or body weight fluctuations to help maintain their water balance.

What types of fluids should be consumed during exercise? The type of fluid consumed during exercise can have a major impact on the athlete’s hydration status. The inclusion of macronutrients, vitamins, and minerals can supply the dietary components to enhance endurance performance and/or muscle building. The temperature of a beverage can affect palatability and digestibility, affect- ing the volume of fluid an athlete ingests and absorbs. These components and characteristics of fluid replace- ment beverages have been recognized, studied, and inte- grated into what most athletes know of as “sports drinks.”

How much and what types of carbohydrates should be included in a fluid replacement beverage? Exogenous carbohydrates are extremely beneficial during exercise, especially if the activity is of high intensity or long duration (> 45 minutes). In terms of fluids, a carbo- hydrate-containing beverage has been shown to increase athletic performance versus consuming water alone.28,32,33 It is recommended that athletes consume approximately 30–60 grams of carbohydrates per hour during exercise to maintain energy and power output while preventing gas- trointestinal upset. Sixty grams of carbohydrate per hour equates to approximately 1 liter of a 6–8% carbohydrate drink. Consuming beverages supplying greater than an 8% solution will increase the ingestion of carbohydrates; however, it will also decrease the gastric emptying and intestinal absorption rates.29,34,35 Higher concentrations in the intestines can cause a reverse osmotic effect, pull- ing fluids into the intestinal lumen, potentially leading to bloating, cramping, and diarrhea. There- fore, fluids with a higher concentration of carbohydrates, such as fruit juices, sodas, and some sports beverages, are not recommended as the sole beverage during exercise.5 These fluids can be used appropriately in small amounts during ultra-endurance events when flavor fatigue is of concern.

The carbohydrate concentration, or % carbohydrate, can be determined by looking at the Nutrition or Supple- ment Facts label on a product. Look for the number of grams of carbohydrates in 240 milliliters, or 8 ounces, of the product. To determine the carbohydrate concentra- tion, divide the grams of carbohydrates by 240 milliliters, and then multiply the result by 100:

(grams of carbohydrates/240 mL) × 100 = % carbohydrate solution

For example, a sports beverage may have 15 grams of carbohydrates in one 8-ounce serving. By using the

Gaining the Performance Edge

Ingesting sports drinks contain- ing a 6–8% carbohydrate concen- tration can enhance performance during long-duration (> 45 minutes) exercise.

Chapter 8 Water 225

preceding calculation, it is determined that the sports beverage is a 6% carbohydrate solution:

(15 g of carbohydrates/240 mL) × 100 = 6% carbohydrate solution

Conversely, a fruit juice might have 35 grams of car- bohydrates in one 8-ounce serving. The fruit juice is a 15% carbohydrate solution:

(35 g of carbohydrates/240 mL) × 100 = 15% carbohydrate solution

By using this calculation, athletes can evaluate the appropriateness of new or existing products on the mar- ket for use during training sessions or competitions.

The type of carbohydrates in a fluid replacement bev- erage is also of importance. Glucose, sucrose, and glucose polymers are appropriate types of carbohydrates that digest well for most individuals and are absorbed readily through the intestines. Sports drinks are typically com- posed of a combination of these sugars. The absorption of carbohydrates is actually maximized when several forms of carbohydrates are used simultaneously, which is the reason why glucose, sucrose, and glucose polymers are included in one product.36–38 Sources of fructose, such as fruit juice, should be limited because fructose has been shown to increase gastrointestinal distress when con- sumed during exercise.36,39 Athletes should note that fruc- tose is sometimes included in small amounts in sports beverages to increase the palatability of the beverage and possibly enhance gastric emptying. A few studies have shown gastric emptying to increase when a beverage con- tains both glucose and fructose, versus glucose alone.40 In general, the small amounts of fructose added to some sports beverages can be tolerated without consequence. Each athlete should determine his or her individual pref- erences and tolerances to evaluate the usage of products that contain fructose.

Taste can affect the amount of fluid consumed during exercise. A flavored beverage has been found to encour- age higher fluid consumption during exercise than plain water.41–43 Some athletes have specific flavor preferences and may consume less total fluid if they are presented with beverages in flavors they dislike. If a team or coach- ing staff supplies flavored sports drinks to players, pro- viding several different flavors may be helpful to meet specific player preferences. Athletes should be encour- aged to try different flavors during their sport activity practices and use the most palatable flavors during com- petition and training.

Exercise intensity and environmental conditions also dictate what is considered the ideal carbohydrate con- centration of a fluid replacement beverage. As the need for fluids during exercise increases, the ideal level of car- bohydrate concentration decreases. For example, in hot, humid environments where sweat rates are high and therefore fluid requirements are great, the level of carbo- hydrates in a replacement beverage should be below 7% to

optimize the rate at which carbohydrates are digested and absorbed. When con- ditions are mild and the exercise inten- sity is low, carbohy- drate concentrations of greater than 7% may be tolerated.5 Once again, individual variances will ultimately determine the ideal level of carbohydrate con- centration and thus fluid choices.

How much and what types of electrolytes should be included in a fluid replacement beverage? Sweat is composed mainly of water, along with various electrolytes, such as sodium, chloride, potassium, mag- nesium, and calcium. However, the concentration of electrolytes in sweat can vary greatly based on the rate of sweating, the state of training, and the state of heat acclimatization. Generally speaking, the better the state of conditioning and the more acclimatized the athlete is to hot, humid environments, the lower the concentration of electrolytes found in the sweat. However, considering that sweat rates can be upward of 2–3 liters per hour, the loss of sodium and other electrolytes can be significant. To maintain proper bodily function as well as peak per- formance, drinks containing electrolytes are appropriate for consumption during exercise, especially prolonged endurance activities. The main electrolytes lost in sweat are sodium and chloride. For exercise durations less than 3 to 4 hours in length, sodium and chloride replacement does not appear to be physiologically necessary. How- ever, even for short-duration activities, the presence of sodium in a beverage provides an extra bonus in the quest for optimal hydration—sodium typically makes bever- ages more palatable and stimulates the drive to drink. Therefore, even though the depletion of sodium during short-duration activities does not necessitate concurrent replacement, it can motivate athletes to drink more fluids and thus optimize hydration levels.

In several situations sodium and chloride consump- tion during exercise is critical. For athletes engaging in exercise sessions lasting longer than 4 hours, the gradual loss of sodium in sweat over time can lead to depletion and low blood sodium concentrations. Also, within the initial days of heat acclimatization, athletes will lose a larger percentage of sodium in sweat and thus require sodium replacement. In addition to consuming sodium during exercise, athletes acclimatizing to the heat should also consider a temporary increase in their daily intake of sodium, possibly as high as 4–10 grams of sodium per day.44 This level can be easily consumed by eating salty foods and adding a small amount of table salt to foods during meals. Finally, individuals who are restricting sodium intake or who have not consumed a well-bal- anced meal prior to exercise should consider choosing a

Gaining the Performance Edge

Having athletes drink flavored bev- erages of their liking during exer- cise may encourage higher fluid consumption.

226 SECTION 1 The Basics of Sports Nutrition

beverage containing sodium during exercise. Therefore, under these conditions, the NATA has recommended add- ing sodium to fluid replacement beverages in quantities of 0.3–0.7 grams per liter. For most athletes the sodium content of sports beverages is sufficient to meet their needs during exercise. However, in some cases additional salt tablets may be indicated.

Other minerals in sweat, though present in small quantities, include potassium, magnesium, calcium, cop- per, iron, and zinc. These minerals are not universally found in sports beverages but can be found in other sports performance products. Most sports beverages contain a small amount of potassium, which will meet the needs of most athletes during exercise. Potassium tablets should not be taken—excessive amounts of potassium can dis- rupt the electrical rhythm of the heart. Athletes can easily, and inexpensively, increase their daily food intake of these minerals to compensate for any losses in sweat.

If electrolytes lost in sweat are not replaced, prob- lems can occur. An electrolyte deficiency can occur after one bout of long-duration exercise and/or excessive sweating or from a low daily intake of electrolytes cou- pled with consistent depletion of electrolytes through regular physical activity. One of the most common symp- toms of electrolyte deficiencies is muscle cramping. Mus- cle cramps are uncomfortable, distracting, and can halt athletes in their tracks, thus affecting sport performance. In some cases, an electrolyte deficiency not only affects athletic performance but also endangers health. One of the increasingly common health issues associated with electrolyte deficiency is exercise-induced hyponatremia.

Hyponatremia is a disorder of fluid-electrolyte bal- ance that results in abnormally low sodium concentra- tions (> 130–135 mmol/L) in the blood, typically occurring during endurance duration activities lasting longer than 4 hours. If sustained, hyponatremia can lead to a vari- ety of neurological dysfunctions that, left untreated, can escalate into seizures, coma, and/or death. The signs and symptoms of hyponatremia include headache, nausea, dizziness, vomiting, or seizures. Hyponatremia can be caused by several factors:

• Drinking too much prior to a workout or event • Following a salt-free or very low-salt diet • Consuming fluid in excess of individual sweat losses • Drinking only water, versus a sports beverage con-

taining sodium, during long-duration exercise • Exercising for longer than 4 hours • Taking diuretic medications, typically prescribed for

hypertension • Taking NSAIDs (nonsteroidal anti-inflammatory

drugs) such as Advil or Aleve before or during exercise By following the preexercise hydration guidelines,

discovering individual sweat rates, relying on mainly sports beverages during long-duration exercise, and eat- ing sodium in pre- and postexercise meals, a majority of hyponatremia cases can be averted. Special precautions need to be taken for athletes participating in marathons,

Ironman distance triathlons, and other ultra-endurance events.

Does the osmolality of the fluid consumed during exercise make a difference? The effects of osmolality on both gastric emptying and intestinal absorption have been studied. The osmolality of a beverage depends mainly on the carbo- hydrate and electro- lyte content of a product. In general, as osmolality increases, gastric emptying decreases. In recent years, to decrease the osmolality of their products, sports drink manufacturers have started using glucose polymers or maltodextrins, which have less of an effect on osmolality than simple sug- ars do. Although important, the osmolality of beverages seems to be secondary to other factors in regard to gastric emptying. Gisolfi et al.45 found that beverages ranging as high as 400 mOsm/kg did not inhibit gastric emptying. Therefore, the osmolality of sports beverages does not appear to be as influential as the volume and calorie con- tent of fluids for gastric emptying.

However, the osmolality of sports beverages has been shown to greatly affect the intestinal absorption of fluids. Some research has shown that solutions that are hypertonic to plasma (<280 mOsm/kg) stimulate less fluid absorption through the intestines and actually draw water into the intestinal lumen, potentially lead- ing to dehydration and intestinal cramping.46 Hypotonic and isotonic solutions (<280 mOsm/kg) have been sug- gested to enhance fluid absorption through the intes- tinal wall, facilitating hydration.19,47 However, some studies have challenged the notion of an upper limit of 280 mOsm/kg for optimal intestinal absorption.45 More research is needed in this area to determine an ideal osmolality for intestinal absorption at varying levels of exercise intensities. For now, a general recommendation, attempting to optimize both gastric emptying and intesti- nal absorption, is to choose a fluid replacement beverage with an osmolality close to 280 mOsm/kg. The amount and type of carbohydrates in a beverage have the great- est effect on osmolality; therefore, continuing to use com- mercially prepared sports drinks of less than or equal to a 6–8% solution (14–18 grams carbohydrates per 8 fluid ounces) is still the best recommendation.

Does the temperature of fluids consumed during exercise matter? The temperature of fluids consumed during exer- cise can either encourage or discourage consump- tion. Most athletes prefer a cool beverage, claiming the

osmolality An indicator of the concentration of dissolved particles per kilogram of solvent (mOsm/kg). Osmolality affects the movement of water across mem- branes when the concentrations on either side of the membrane are different. A beverage with a high osmolality tends to draw wa- ter to it rather than be absorbed.

Chapter 8 Water 227

lower temperatures make the fluid more appealing and refreshing. Individ- ual preferences vary; however, beverages at 50–59°F are typi- cally recommended.5

Should protein be included in fluid replacement beverages? The inclusion of protein in carbohydrate–electrolyte replacement beverages has recently been explored. The theory is that consuming protein during exercise will increase the body’s insulin response to ingested nutri- ents during exercise, thus sparing glycogen stored in the muscle and liver, and, in turn, enhancing endurance per- formance. In several studies, the addition of protein to a carbohydrate beverage enhanced the insulin response postexercise.48–50 It has therefore been theorized that add- ing protein to a beverage during exercise would have the same effect. However, the results from studies performed during exercise have been inconsistent, with some researchers reporting increased performance without an enhanced insulin response.51 Therefore, an ergogenic effect may be caused by a mechanism other than insulin. More research is needed in this area to define the advan- tages of a protein–carbohydrate–electrolyte beverage over a traditional sports drink, as well as the ideal quantity of protein to consume through a beverage during exercise. For a summary of factors affecting fluid consumption and absorption during exercise, refer to TABLE 8.4 .

Why are commercial sports beverages beneficial for athletes? In the 1960s, the University of Florida Gators were frus- trated by the performance of their football team. The players were strong in the first half of a game but faded quickly near the end of the third and beginning of the fourth quarters because of dehydration. Dr. Robert Cade and Dr. Dana Shires developed a beverage that replaced the nutrients lost during exercise and heavy sweating, specifically carbohydrates and electrolytes. Cade and Shires’s beverage became known as Gatorade—the orig- inal sports beverage. After drinking this new beverage, the athletes felt rejuvenated and therefore played strong throughout their games. The Gators had a record of 7–4 in their first year of drinking Gatorade in 1965 and then improved to a 9–2 record in 1966. Opponents were flab- bergasted and intrigued. As the Gators went on to win the Orange Bowl for the first time in their history, the ath- letes swore that drinking Gatorade was the reason they felt stronger for longer. Although its introduction was not monitored through a controlled study, Gatorade is now one of the most well-researched products in the sports nutrition arena. However, the “ideal” sports beverage for

Gaining the Performance Edge

During exercise, drinking chilled fluids is refreshing and may encour- age greater fluid consumption.

Table 8.4 Factors Affecting Fluid Consumption and Absorption During Exercise

Factor Recommendation Additional considerations

Amount of carbohydrate

Approximately 30-60 g of carbohydrates/hour

Helps provide energy during exercise

Carbohydrate concentration

6–8% carbohydrate solution is the best for beverages used during exercise.

> 8% solution can cause delayed gastric emptying and gastric upset.

Type of carbohydrate

Glucose, sucrose, and glucose polymers

High levels of fructose in sports drinks may cause delayed gastric emptying and gastric upset.

Flavor Flavored beverages increase fluid intake during exercise versus plain water or unflavored sports beverages.

Athletes have varied flavor preferences and should taste test a variety of flavors to find a favorite.

Exercise intensity

8% or lower carbohydrate solution is best tolerated at higher exercise intensity levels.

Either sports drinks or water can be used during high-intensity exercise.

Environmental conditions

High heat and humidity increase fluid needs; 8% or lower carbohydrate solution is best tolerated in these conditions.

More frequent hydration breaks during exercise and competition are needed.

Electrolytes 0.3–0.7 g sodium per liter of fluid consumed

Other electrolytes such as potassium, magnesium, or calcium may be added in small amounts.

Osmolality ~280 mOsm/kg As osmolality increases, intestinal absorption tends to decrease.

Temperature of the beverage

Cool is best, typically between 50°F and 59°F is best tolerated.

Individual preferences will vary.

Protein No recommendations at this time for the inclusion of protein in sports beverages

More research is needed to fully evaluate the need for protein during exercise.

all durations, intensities, and types of sports has not been defined or formulated. To learn more about Gatorade and research on sports beverages, consult the website of the Gatorade Sports Science Institute at www.gssiweb.com.

Gatorade currently has many competitors in the sports beverage market, with formulas varying slightly from product to product. The commonality among most sports beverages is the inclusion of fluid, carbohydrates, and electrolytes. The profile of electrolytes, vitamins, and carbohydrate sources as well as the quantity of each of these nutrients create a majority of the differences. Formulas also vary by flavor, sweetness, carbonation, and viscosity in attempts to cater to varying personal

228 SECTION 1 The Basics of Sports Nutrition

preferences. The “optimal” formulation of a sports bever- age has not necessarily been proven through comparison research; therefore, individual preferences are a major determinant of consumption and thus success with a sports beverage. Overall, the benefit of sports beverages versus water is the inclusion of carbohydrates for sustain- ing energy levels and electrolytes to prevent conditions such as hyponatremia.

Athletes need to look closely at the Nutrition Facts or Supplement Facts label on beverages to evaluate the type and quantity of carbohydrates, electrolytes, and other nutrients contained in the beverage to determine the appropriateness for their individual sport, the dura- tion of their activities, and individual preferences. The fol- lowing are some items to look for when reading sports beverage labels:

• Type of carbohydrate: Each formula is slightly differ- ent. Look for glucose, sucrose, or glucose polymers listed on the ingredients label. Some brands pro- mote their product as a source of “complex carbo- hydrates,” claiming to sustain energy longer. Most of these products use glucose polymers as the carbo- hydrate source; these are strings of linked glucose molecules versus a single or “simple” carbohydrate. These products can certainly be beneficial in enhanc- ing performance because they provide carbohydrates, but they may or may not necessarily be more effec- tive than other sports beverages that include a mix of carbohydrate sources. In general, avoid products that contain solely or mainly fructose as the source of car- bohydrates. “Natural” sports beverages often contain fructose because fruit juice is used as the sweetening agent versus other sugars. Some athletes may be able to consume fructose without adverse side effects of stomach and intestinal upset and cramping; however, it is better to be safe than sorry and make it a rule to watch out for fructose.

• Artificial sweeteners: Some brands of sports beverages include artificial sweeteners. The artificial sweeten- ers are added to enhance the flavor and palatability of the beverage while keeping the carbohydrate concen- tration within the guidelines of 6–8%. How- ever, if an athlete is consuming large quanti- ties of fluid dur- ing workouts or c o m p e t i t i o n s to match sweat losses, the ath- lete’s intake of artificial sweeteners can rise dramat- ically with these products. Some athletes experience adverse side effects or possibly allergic reactions to artificial sweeteners. Therefore, products containing artificial sweeteners such as aspartame, saccharin,

and acesulfame potassium are not recommended. Look for these sweeteners in the ingredient listing on the label.

• Stimulants such as caffeine or herbal products: Bever- ages labeled as “energy” drinks are often marketed for use during exercise. These drinks often contain caffeine and/or a variety of herbal stimulants, such as guarana, as their major source of “energy.” Sugar can be included but is often in concentrations above the recommended 6–8%. Other formulas are sweet- ened by artificial sweeteners, which provide no car- bohydrates. In general, these energy drinks should be avoided during exercise. Look for kola nut, guarana, caffeine, and artificial sweeteners in the ingredients listing.

• High doses of vitamins and minerals: To make their for- mula different, some beverages contain a variety of B vitamins, antioxidant vitamins, or minerals. Sodium, chloride, and potassium are the minerals that are beneficial to include in a sports drink and should be included in sufficient quantities. However, other vitamins or minerals can cause gastrointestinal dis- tress, especially when the beverage is consumed in large quantities to match sweat rates. Look on the Supplement Facts label for the %DV for each vita- min and mineral in one serving of the product. Mul- tiply the percentage by the number of servings that will be consumed in one exercise session. If the total amount consumed—for nutrients other than carbo- hydrates, sodium, or potassium—is reaching 200% or more, then reconsider using the product. For exam- ple, magnesium is promoted as a mineral that can help prevent cramping. For athletes consuming a well-balanced diet, sufficient daily magnesium can be helpful for the prevention of muscle cramps. How- ever, if an athlete who suffers from muscle cramp- ing chooses a sports beverage containing significant amounts of magnesium, problems can result. Assum- ing the athlete will need to drink 4 to 8 servings of the sports beverage (assuming an 8 oz serving, with the athlete requiring 32–64 oz for a practice lasting 1 to 2 hours), the total magnesium consumed may exceed the RDA by several times, possibly resulting in gastrointestinal upset and diarrhea—a side effect of excessive intake of magnesium. Therefore, look for the electrolyte basics in a sports beverage—sodium, chloride, and potassium—and avoid products con- taining large quantities (> 10–20% DV in one serving) of other vitamins or minerals.

• Carbonation: The vast majority of commercial sports beverages are not carbonated. However, athletes should check the label and avoid carbonated bever- ages before, during, and immediately after exercise. The effervescent bubbles in these beverages take up space in the stomach, causing a full or bloated feel- ing. This will decrease the amount of fluid consumed because there is a false sense of fullness. Athletes

Gaining the Performance Edge

During exercise, consuming sports beverages containing 6–8% car- bohydrate can help sustain perfor- mance; however, be cautious using drinks containing fructose, artificial sweeteners, and/or stimulants.

Chapter 8 Water 229

should limit carbonated beverages as part of their reg- ular fluid intake during the day for the same reason.

• Specialty formulas: Sports beverage producers may have an entire line of hydration products. Typically the products will fall into several categories: preexer- cise, during physical activity, ultra-endurance events, and recovery beverages. The preexercise beverages are generally higher in carbohydrates to help athletes maximize glycogen stores before a training session or competition. These beverages may not be necessary; well-balanced meals and fluids from water, milk, and juice are sufficient for providing carbohydrates and fluids prior to activity. Formulas for during activity focus on carbohydrates and electrolytes. Follow the previously mentioned guidelines when reviewing these products. The endurance formulas are typically higher in sodium and other electrolytes. These bever- ages can be useful and appropriate for exercise last- ing longer than 4 hours. Evaluate each product for the appropriateness of the types of carbohydrates and quantities of various vitamins and minerals. Recovery beverages generally contain carbohydrates, protein, and antioxidant vitamins and minerals. These beverages can be useful for sit- uations when athletes do not have immediate access to food after exercise. However, if food and beverages are easily accessible, then recovery beverages may not be necessary. For a comparison of sports beverages commonly used during exercise, refer to TABLE 8.5 .

What are some practical guidelines for consuming fluids during exercise? The goal of fluid consumption during exercise is to keep athletes hydrated so that they can perform at their best and maintain health. To achieve these goals, athletes and coaches should consider the following hydration factors:

• Fluids should be readily available. Athletes need to take personal responsibility for having fluids on hand at all times during training sessions and competitions. Athletes should have plenty of water bottles to keep in gym bags, in lockers, at home, and in training rooms. Measured water bottles can also help athletes determine whether they are meeting their hydration needs.

• Fluids should taste good based on personal preference. If the beverage does not taste good to an athlete, he or she will not drink it. Therefore, allow athletes to

Gaining the Performance Edge

During exercise, sports drinks con- taining small amounts of sodium, potassium, and chloride can help sustain performance; however, avoid drinks containing large quan- tities (> 10% DV) of other vitamins and minerals.

Fortifying Your Nutrition Knowledge

Determine Don's Hydration Needs Don, an Ironman triathlete, performed a sweat trial to deter- mine his fluid needs per hour. He cycled 50 miles at a 20 mph pace, and then ran 10 miles at a 9-minute-per-mile pace. During the workout, he drank four 24-ounce bottles of a sports bev- erage on the bike, and then drank another 24 ounces of water during the run. He lost 6 pounds during his workout.

What are Don's fluid needs?

Answer:

■ Determine body weight lost during exercise. Don lost 6 pounds during his exercise session.

■ Determine the fluid equivalent, in ounces, of the total weight lost during exercise. Don lost 6 pounds, so 6 lb × 16–24 oz/lb = 96–144 oz.

■ Determine the actual fluid needs of the athlete during an identical workout. Don consumed 96 ounces on the bike (4 × 24 oz/bottle) plus 24 ounces on the run, for a total of 120 ounces. Adding the fluid consumed during exer- cise to the fluid equivalent of body weight lost during exercise equals 216–264 oz (120 + [96–144]).

■ Determine the number of fluid ounces needed per hour of exercise. Don's total fluid needs are 216–264 oz. Because he was on the bike for 2.5 hours (50 miles ÷ 20 mph = 2.5 hr) and 1.5 hours on the run (10 miles × 9 min/mile pace = 90 min = 1.5 hr), the total exercise time was 4 hours. Dividing the total fluid needs by the total exercise time equals 54–66 oz/hr ([216–264 oz] ÷ 4 hr).

Don is a “big sweater,” losing 54–66 ounces of sweat per hour of exercise. This volume of fluid can be challenging to consume while exercising. Currently, Don is only consuming 30 ounces of fluid per hour (120 oz consumed ÷ 4 hours of exercise = 30 oz/hour). Therefore, Don can start to gradually increase the vol- ume of fluid he ingests each hour during exercise, approaching 54–66 ounces per hour, monitoring for any gastric and/or intes- tinal discomfort. He may or may not reach the ultimate goal; however, he can strive for it. To maximize the fluid retained, he should focus on the inclusion of sports beverages versus solely water.

choose their fluid replacement beverage, within the guidelines stated in this chapter.

• Coaches should allow for regular refreshment breaks dur- ing training and competitions. Not only should fluids be on-site and available, but regular breaks should be taken in order for consumption to occur. Breaks will depend on the nature of the sport, such as timeouts in basketball or in between sets in swimming.

• Consumption of fluids should begin early in an exercise session. It takes approximately 10 to 20 minutes for ingested fluids to reach the bloodstream; by initiat- ing the consumption of fluid replacement beverages

230 SECTION 1 The Basics of Sports Nutrition

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Chapter 8 Water 231

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232 SECTION 1 The Basics of Sports Nutrition

early in a training session, athletes can stay ahead of the game in hydration. By consuming fluids gradu- ally during practices and competitions, athletes not only will maintain euhydration to a greater degree, but also will generally tolerate fluids better than in bolus feedings.

• Use sports beverages for sessions lasting longer than 60 to 90 minutes. As the duration of exercise increases, the need for carbohydrate and electrolyte replacement during exercise also escalates. Drinking solely water during long-duration exercise can increase the risk of hyponatremia because of the lack of electrolyte consumption. It should be noted that sports bever- ages may also enhance performance during slightly shorter duration activities (i.e., 45 to 60 minutes) if they are of high intensity.

• Consider “hydration training” equal to “physical training” for competition. Athletes must practice their hydra- tion protocol during training to minimize the risk of gastric and intestinal discomfort dur- ing competitions caused by unfa- miliar condi- tions. Hydration training should be considered as seriously as physical training.

What is the role of postexercise hydration? After exercise, the body is thirsty and hungry for replen- ishment. Replacing water, as well as electrolytes and car- bohydrates lost during exercise, as quickly as possible aids in the recovery of a variety of body processes, including cardiovascular, thermoregulatory, and metabolic activi- ties. Unfortunately, many athletes fail to drink enough to fully restore euhydration and replenish their glycogen and electrolyte stores. Athletes need to be educated on the importance of proper hydration after exercise, current guidelines, and practical tips and hints to put the recom- mendations into practice.

How much fluid should be consumed? Ideally, athletes will estimate their sweat losses and then aim to match sweat losses with fluid intake during exer- cise. However, this situation rarely exists, and therefore lost fluids need to be replaced after training sessions or competitions. If pre- and postexercise weight measure- ments were taken, then the rehydration volume can be calculated. Sweat losses should be matched 100–150% because the kidneys continually produce urine, thus increasing total water excretion.52 Therefore, for every pound that is lost during exercise, approximately 16–24

ounces of fluid should be consumed. Fluids should be consumed as soon as possible to accelerate recovery, especially if athletes are performing multiple workouts in one day.

Regardless of whether body weight was measured, athletes should begin hydrating immediately, drinking slowly and consistently. Typically, athletes are encouraged to drink until their urine returns to a clear or pale color. If so, then it is estimated that the athlete will be within 1% of his or her baseline body weight.53 However, the notion of urine color providing an accurate measure of hydration status has been questioned by some researchers. Kovacs et al.54 found that urine color, specific electrical conduc- tance, and osmolality were all poor indicators of hydra- tion status in the 6 hours postexercise. More research is needed in this area to fully define the ideal measures of hydration postexercise.

Athletes should be cautioned to avoid drinking very large quantities of water in a short period of time imme- diately following exercise because this can potentially lead to delayed rehydration or, more seriously, hypona- tremia. Large quantities of water are absorbed readily into the bloodstream. The rapid influx of water dilutes the concentration of sodium, causing a decreased plasma osmolality. The body responds to the lower osmolality by increasing urine production and blunting the normal sodium-dependent stimulation of the thirst mechanism. If plain water continues to be consumed, sodium con- centrations will con- tinue to plummet, and hyponatremia ensues. Postexercise beverages ideally should contain car- bohydrates and elec- trolytes to replenish stores as well as to assist in optimizing rehydration. Therefore, beverages such as fruit and veg- etable juices, milk, soups, or sports drinks should be con- sumed in addition to water after exercise.

What types of fluids should be consumed? Many athletes’ rehydration plans consist of guzzling down plain water. Although water will supply fluid to the body, it may not be the ideal beverage for postexercise replenishment. By consuming carbohydrates and sodium along with water, euhydration, muscle glycogen, and elec- trolyte balance can be restored more readily.

As mentioned previously, most athletes do not drink enough fluids voluntarily. Therefore, any method of encouraging fluid consumption after exercise will be ben- eficial. Part of the concern with consuming only water is that it generally does not stimulate the drive to drink and also can increase urine output, causing both decreased intake and increased losses. The presence of carbohy- drates and sodium in either a postexercise beverage or a

Food for Thought 8.2

Importance of Water Intake for Athletes

Review information on types of fluids, intake and output quanti- ties, and other pertinent hydration information.

Gaining the Performance Edge

For every pound that is lost during exercise, 16 to 24 ounces of water should be consumed. Fluids should be consumed as soon as possible to accelerate recovery.

Chapter 8 Water 233

meal consumed concurrently with water can remedy the situation. Sodium will enhance fluid retention and the drive to drink.52,55 Carbohydrates can increase the rate of intestinal absorption of both water and sodium.56–58 Because sodium is lost in sweat and carbohydrate stores are depleted during exercise, it is beneficial to consume these nutrients not only for rehydration purposes, but also for electrolyte and glycogen replenishment.

Potassium, another electrolyte lost in sweat, can eas- ily be replaced by consuming whole foods and juices after exercise. In a 2-hour workout session, an average athlete will lose approximately 180 milligrams of potassium. One banana contains ~500 milligrams—more than twice what is lost in 2 hours of exercise. A vari- ety of whole fruits and vegetables and their juices are rich sources of potassium and are ideal to con- sume after exercise. Refer to TABLE 8.6 for a summary of the daily and exercise- specific fluid recom- mendations for athletes.

Are supplements beneficial after exercise? Many fluid replacement products are marketed to ath- letes to help facilitate hydration while also replacing electrolytes and glycogen stores after exercise. Before reaching for one of these products, athletes should con- sider the following:

• How filling is the product? Many of the products come in a powdered form that is mixed with 8–24 ounces of plain water. If an athlete loses 2 pounds during a workout (the equivalent of 32–48 fluid ounces), but only drinks 8–24 ounces, then he or she is falling short on water replenishment. Recovery products typically contain 120–320 calories and thus can be filling, caus- ing an athlete to voluntarily stop drinking. Although added carbohydrates, sodium, and other nutrients are important to have immediately following exercise, if they prevent an athlete from also consuming the

Gaining the Performance Edge

Athletes should consider consum- ing drinks containing carbohydrates and sodium for rehydration after training to help speed replenish- ment of fluid and energy reserves as well as replace sodium lost as a result of sweating.

Table 8.6 Daily and Exercise-Specific Fluid Recommendations for Athletes

Daily recommendation 2–4 hours prior to exercise

10–20 minutes prior to exercise

During exercise After exercise

Amount AI = 3.7 L/day (males); 2.7 L/day (females) 1 mL/calorie consumed

13–20 oz 7–10 oz 7–10 oz every 10 to 20 minutes

16–24 oz per pound of body weight lost, consumed within 2 hours

Type of Beverage Water, 100% juices, milk, or other beverages

Water or sports drink; juices or milk if tolerated

Water or sports drink Sports drink preferable or water

Water, sports drink, juices, milk, or other beverages

fluid he or she needs, then the supplement should be avoided. If the product tastes good and therefore the athlete drinks more, then the supplement may be beneficial.

• How much carbohydrate and sodium are present in the supplement? As mentioned previously, carbohydrates and sodium are beneficial for replenishment and rehydration. However, some products fall short of the recommended doses of each of these nutrients, potentially hindering recovery if no other food or fluid is consumed. Athletes should consume carbohy- drates at a rate of 1.0–1.5 grams per kilogram of body weight every 2 hours for 6 hours postexercise. For every liter of fluid lost in sweat (1 L = 34 oz = ~1.5–2 lb of weight loss), 300–700 milligrams of sodium should be consumed after exercise. Based on body weight and sweat losses, athletes should examine the Sup- plement Facts label on the supplement to determine whether it contains sufficient quantities of carbohy- drates and sodium, in addition to fluid.

234 SECTION 1 The Basics of Sports Nutrition

• How expensive is the product? Supplements can cost a fortune! Water, juices, and soups as well as sodium- and carbohydrate-rich foods can deliver equal nutri- tion, often at a much lower price. However, some athletes prefer using the recovery drink supplements because they require little to no preparation, may not require refrigeration, and can taste good. Athletes should weigh the pros and cons of using a supple- ment versus “real” food to determine whether it is worth the cost.

• Are there a lot of “extras” in the supplement? Some sup- plements can pack a huge dose of one or several vitamins and minerals in one serving of the product. Keep in mind that the recovery drink is only one item consumed throughout the day. If the supplement, in addition to other foods and beverages, provides mega-doses of nutrients, toxic levels may be reached over time. Look closely at the Supplement Facts label to ensure that none of the nutrients are supplied in doses above 100% DV.

What are some practical guidelines for consuming fluids after exercise? The goal of fluid consumption after exercise is to restore the body to euhydration status in preparation for the next training or competitive session. To achieve this goal, ath- letes and coaches should consider the following:

• Rehydration should begin as soon as possible. Athletes need to begin drinking water and other fluids within 2 hours of the cessation of activity, but preferably immediately following exercise. Encourage athletes who tend to avoid intake of fluids altogether after exercise to sip on fluids gradually until their stomach is ready to handle more volume.

• Beverages and/or foods consumed after exercise should contain carbohydrates and sodium. The addition of these

nutrients facilitates fluid absorption and retention while also replacing nutrients lost during exercise. Examples of salty, carbohydrate-rich beverages and foods include vegetable juices, soups, cheeses, lun- cheon meats, pizza, pretzels, and condiments (such as mustard, ketchup, barbeque sauce, and steak sauce) on sandwiches and burgers.

• Plan ahead. Often, athletes will not refuel and rehy- drate properly after exercise as a result of lim- ited access to refreshments. Athletes need to take responsibility for ensuring that fluids and foods will be available immediately after exercise to begin the replenishment process. Planning options include packing items before heading to the gym or playing field, purchasing fluids and foods at a nearby grocery or convenience store, and returning home quickly and drinking/eating as soon as possible.

• Plan for easy-to-prepare snacks and meals. After hard workouts and competitions, athletes are fatigued and can lack the motivation to prepare a snack or meal in a timely fashion. Athletes should develop a rehydra- tion plan that is easy to follow and easily accessible.

• Use supplements wisely and sparingly. Supplements can have a place in an athlete’s rehydration plan, if used intelli- gently. Reserve supplement use for times when other beverages and foods are not available. Read Supple- ment Facts labels and look for adequate quantities of carbohydrates and sodium and moderate quanti- ties of other vitamins, minerals, and nutrients.

Food for Thought 8.3

You Are the Nutrition Coach

Apply the concepts from this chapter to several case studies.

Chapter 8 Water 235

The Box Score Key Points of Chapter

n Water is arguably the most essential of all the nutri- ents despite the fact that it does not provide the body with energy. Two-thirds of the body’s water is found inside the cells and is referred to as intra- cellular water. Muscle tissue, which is of obvious importance to athletes, is 70% water. The remain- ing one-third of the body’s water is found outside of cells and is known as extracellular water. Most of the extracellular water is found in the spaces between cells, in lymph, and in blood plasma.

n Water provides structural integrity to cells, serves as the body’s delivery and waste removal medium, aids in thermoregulation, helps in the regulation of acid–base balance, and is critical to the maintenance of blood volume. All of these functions have a direct impact on not only athletic performance but also survival. Dehydration resulting in weight loss of as little as 2–3% of body weight begins to compromise cardiovascular function, which has a direct impact on sport performance.

n Approximately 80% of our daily water needs is sup- plied in the form of fluids. The remainder (20%) comes from water found in fruits, vegetables, other foods, and metabolic water.

n Water is lost via insensible perspiration, urine, feces, and sweat. The amount lost via sweat is highly vari- able depending on the environmental conditions as well as the intensity and duration of the exercise training or sport activity. Balancing water intake with water loss is critical for optimal performance, particularly during long-duration activities.

n One easy way to determine the achievement of water balance is to monitor body weight. Daily weight fluctuations are caused primarily by changes in water status.

n Although rare, it is possible to drink too much water, which can result in what is known as “water intoxication.” Water intoxication leads to very low

blood sodium levels (i.e., hyponatremia), thereby causing muscle weakness, disorientation, and/or coma. Endurance and ultra-endurance athletes are at greatest risk for hyponatremia because of their repeated exposure to long training bouts in which water intake is very high and/or sodium intake inadequate.

n For men and women 19 years and older, the recom- mended intake for water is 3.7 liters and 2.7 liters per day, respectively. These daily quantities reflect total water intake from drinking water as well as from other beverages containing water and from solid foods.

n Proper hydration before exercising sets the stage for optimal sports performance. Generous, but not excessive, amounts of fluids should be consumed in the 24 hours before exercise. Drinking enough flu- ids to meet the daily recommendations will allow an athlete to start an exercise session well hydrated. Drinking approximately 13–20 ounces of fluid 2 to 4 hours prior to competition and 7–10 ounces of fluid 10 to 20 minutes prior will ensure that athletes are properly hydrated.

n The goals of hydration during exercise are to main- tain plasma volume and electrolyte balance. Water and electrolyte losses during exercise can vary greatly depending on several factors, including body size, exercise intensity, ambient temperature, humidity, clothing choices, and acclimation. For most individuals, consuming approximately 200–300 milliliters, or 7–10 fluid ounces, every 10 to 20 min- utes during exercise will achieve this goal.

n Replacing water, as well as electrolytes and carbo- hydrates, should begin as quickly as possible after exercise. For every pound that is lost during exercise, 16 to 24 ounces of water or replacement beverage should be consumed.

Study Questions

1. Discuss why the statement “you are what you drink” is appropriate in regard to water’s role as a nutrient.

2. What is “water balance”? Which condition, a positive balance or a negative balance, poses the greatest risk to athletes? Defend your answer.

3. Explain why the statement “bottled water is a bet- ter source of fluid than tap water” is not necessarily accurate.

4. An athlete concerned about drinking municipal water because of the impurities comes to you to find out where she can buy distilled water. What do you tell

the athlete? In other words, what are some of the pros and cons of drinking distilled water?

5. What is the difference between sweat and insensible perspiration? Which is a greater avenue of fluid loss in the athlete?

6. As a sports nutritionist, how can you determine whether your athletes are hydrating well enough dur- ing daily training sessions? If they are not taking in enough fluid during training, how do you know how much to tell them to drink to rehydrate before the next practice?

236 SECTION 1 The Basics of Sports Nutrition

7. What is the AI for daily fluid intake? What are the body’s sources for fluids throughout the day?

8. How much and what types of beverages can be consumed in the hours and minutes leading up to competition? Discuss why fluid intake prior to com- petition is advantageous.

9. What is a “sweat trial”? What data need to be col- lected when performing a sweat trial? What are the potential risks associated with not performing a sweat trial on an athlete?

10. What factors can affect how quickly the intestines absorb fluids during training or sport performance?

11. What is hyponatremia? Under what conditions and in which sports might it pose the greatest risk?

12. As a sports nutritionist, what practical guidelines would you give your athletes to help ensure adequate hydration during competition?

13. After competition or training, rehydration is very important. What are the pros and cons of drinking just plain water during recovery?

References

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36. Hoswill CA. Effective fluid replacement. Int J Sports Nutr. 1998;8:175–195.

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and fluid balance in exercising, trained, heat-acclima- tized boys. J Appl Physiol. 86:78–87.

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45. Gisolfi CV, Summers RW, Lambert GP, Xia T. Effect of beverage osmolality on intestinal fluid absorption during exercise. J Appl Physiol. 1998;85(5):1941–1948.

46. Maughan RJ, Noakes TD. Fluid replacement and exer- cise stress: a brief review of studies on fluid replace- ment and some guidelines for athletes. Sports Med. 1991;12:16–31.

47. Wapnir RA, Lifshitz F. Osmolality and solute con- centration: their relationship with an oral hydration solution effectiveness; an experimental assessment. Pediatr Res. 1985;19:894–898.

48. Spiller GA, Jensen CD, Pattison TS, Chick CS, Whit- tam JH, Scala J. Effect of protein dose on serum glu- cose and insulin response to sugars. Am J Clin Nutr. 1987;46:474–480.

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50. Zawadzki KM, Yaspelkis BB, Ivy JL. Carbohydrate-pro- tein supplement increase the rate of muscle glycogen storage post-exercise. J Appl Physiol. 1992;72:1854–1859.

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238 SECTION 1 The Basics of Sports Nutrition

Key Questions Addressed 1. What is an ergogenic aid?

2. What are dietary supplements?

3. Where can information on nutritional ergogenic aids be found?

4. What tools are available to research information on ergogenic aids?

5. What is doping?

6. What are some of the commonly encountered doping substances?

7. What types of dietary supplements and nutritional ergogenics are commonly used by endurance athletes, strength/power athletes, and team sport athletes?

You Are the Nutrition Coach Jason, a 16-year-old high school track athlete, has set a goal to improve his 100- and 200-meter sprint times. He has seen the muscle development evident in elite sprinters and therefore des- perately wants to increase his muscle mass, strength, and power. After talking about training regimens, daily nutrition, and supplementation with numerous other athletes at track meets, he has decided to begin taking several supplements to help him reach his goals. His mother is very conscientious about preparing a nourishing supper; however, Jason prepares his own breakfast and lunch, which he admits typically do not consist of quality food choices. Cur- rently he is resistance training two to three times per week and taking the following supple- ments: “mega” multivitamin/mineral supplement, boron, ornithine and arginine, chromium picolinate, and whey protein.

Question • What would you suggest to Jason to help him achieve his personal goal of increasing muscle

mass to become a stronger, more powerful athlete?

Nutritional Ergogenics

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CHAPTER 9

running and swim suits decrease wind resistance or drag in the water and thus improve race performance. These are just a few of the innovations in equipment that are designed to improve performance.

Negative thoughts or doubts, lack of mental focus, and physical or emotional inhibitions can all be the nem- esis of an athlete. This is where psychological ergogenic aids come into play. Sports psychologists meet with ath- letes to help them learn mental strategies for overcom- ing fears and to improve concentration. Visualization is a common psychological ergogenic aid used by athletes. The athlete develops a mental picture of him- or herself performing what he or she is about to do physically. It is not unusual to see divers or gymnasts prior to their competitions with their eyes closed and subtly moving their bodies as they mentally perform a dive or gymnas- tic routine.

Pharmacological ergogenic aids fall into the category of medicines or drugs. They are chemical substances that were originally designed to treat disease but now are used by healthy athletes with the sole intent of enhanc- ing performance or physical prowess. For example, amphetamines, painkillers, anabolic steroids, and other synthesized hormones fall under this category of phar- macological ergogenic aids. This category of ergogenic aids is arguably the most dangerous and controversial because misuse can result in serious physical complica- tions or death. Consequently, many of the pharmacolog- ical ergogenic aids are banned by sports organizations worldwide.

The main focus of this chapter will be on nutritional ergogenics. Nutritional ergogenic aids are foods, supple- ments, special diets, and dietary practices that are used by athletes to improve performance. Although for centu- ries the Chinese have practiced ingesting natural foods or compounds for medicinal and spiritual reasons, it is the

What is an ergogenic aid? The derivation of the word ergogenic gives an indication of its meaning: Ergo, which is derived from the Greek word ergon, refers to work; genic is derived from genman, which means to generate or produce. Thus, an ergogenic

aid is anything that enhances a person’s ability to perform work or, in the case of athletics, to per- form better. The ulti-

mate goal of using ergogenic aids is to gain a competitive edge over the opponent.

Ergogenic aids can take many different forms: physi- ological, biomechanical, psychological, pharmacological, and nutritional (see TABLE 9.1 ). Physiological ergogenic aids enhance the functioning of the body’s various systems. It is interesting to note that the most often used physi- ological ergogenic aid is not even thought of as one—it is exercise training. Making a muscle bigger and stronger through strength training improves its ability to gener- ate force and thus enables the athlete to run faster and jump higher. Endurance training causes adaptations by the body that result in greater blood volume, more blood vessels, and a larger, stronger heart. The end result is an enhanced cardiovascular system capable of delivering more blood to working muscles so that faster race paces or longer distances can be maintained.

Biomechanical ergogenic aids enable the athlete to perform better by providing a mechanical advantage. Big- ger yet lighter tennis rackets and golf clubs enable ath- letes to hit balls with less error and more speed. Improved ice skates in which the blade stays on the surface of the ice longer enable speed skaters to provide more thrust and therefore achieve greater speeds. Specially designed

Table 9.1

Types of Ergogenic Aids

Type of ergogenic aid Description Examples Nutritional Any supplement, food product, or dietary manipulation

that enhances work capacity or athletic performance Carbohydrate loading, creatine phosphate, amino acid

supplementation, vitamin supplementation, glucose polymer drinks, sports gels, carbohydrate-loading drinks, liquid meals

Physiological Any practice or substance that enhances the functioning of the body’s various systems (e.g., cardiovascular, muscular) and thus improves athletic performance

Bicarbonate buffering, any type of physical training (e.g., endurance, strength, plyometric), blood doping via transfusions, the practice of warming up

Psychological Any practice or treatment that changes mental state and thereby enhances sport performance

Visualization, sessions with a sport psychologist, hypnosis, pep talks, relaxation techniques

Biomechanical Any device, piece of equipment, or external product that can be used to improve athletic performance during practice or competition

Weight belts, knee wraps, oversize tennis rackets and golf clubs, clap skates, body suits (swimming/track), corked bats

Pharmacological Any substance or compound classified as a drug or hormonal agent that is used to improve work output and/or sport performance

Hormones (e.g., growth hormone, erythropoietin, anabolic androgenic steroids), amphetamines, caffeine, beta- blockers, ephedrine

ergogenic aid Anything that enhances a person’s ability to perform work, or in the case of ath- letics, to perform better in sport.

240 SECTION 1 The Basics of Sports Nutrition

42% to over 53% of U.S. adults, with women using supple- ments more than men.2 However, another study notes that the NHANES statistics on usage are low and that actual consumer usage ranges from 64 to 69%.3 Regardless, the manufacture and supply of dietary supplements in the United States is a multibillion-dollar industry.

Supplement use among athletes makes up a large percentage of total supplement sales. Forty to 70% of all athletes report using supplements, with some individual sports reporting usages of up to 88%.4,5 The sports nutri- tion product market (including sports bars, drinks, and other supplements) generated more than $25.7 billion in sales according to a 2011 report by the Nutrition Business Journal. In a study of NCAA athletes at a Division I univer- sity, Froiland et al. reported that 23% of the surveyed ath- letes regularly (at least five times per week) took a dietary supplement.6 Thirty-nine percent reported they currently were not taking any supplement; however, all but 6% of the athletes reported using a wide variety of calorie or fluid replacement products. Almost 73% of the athletes reported using sports/energy drinks (e.g., Gatorade, PowerAde, All Sport, Red Bull), and 61.4% reported using calorie replacers (e.g., Boost, Slim-Fast–type products) and bars (e.g., Per- sonal Edge, PowerBar). Forty-seven percent reported taking a multivitamin. Supplement manufacturers are constantly developing new products and targeting athletes in their marketing strategies, because athletes are focused on any- thing that may be able to improve their sport performance.

Why do athletes use dietary supplements? Athletes are always looking for an edge over their com- petitors. Often they turn to dietary supplements that they feel may give them that edge. However, there is no sub- stitute for an appropriately planned training regimen and nutrition schedule. Athletes need to be aware of the safety, efficacy, actions, and laws regarding dietary supplements.

Athletes consume supplements for a variety of reasons. The leading reasons for supplement use include health maintenance, faster exercise recovery, increased

ancient Greeks who have been touted as the first to use nutritional ergogenics to gain the “competitive” edge in sports. Today, the sale of substances that fall into the cat- egory of nutritional ergogenic aids is a multibillion-dollar industry. This chapter will provide a general overview of ergogenic aids and the resources available to sport nutri- tion professionals for evaluating dietary supplements. It is not intended to be a thorough review of current research on specific products and practices.

What are dietary supplements? A dietary supplement, as defined by the Dietary Supple- ment Health and Education Act (DSHEA) of 1994,1 is a product (other than tobacco) intended to supplement the diet that contains one or more of the following dietary ingredients:

• Vitamin • Mineral • Herb or other botanical • Amino acid • Dietary substance to supplement the diet by increas-

ing the total dietary intake • Concentrate, metabolite, constituent, extract, or a

combination of any of the above ingredients Dietary supplements are not intended to be used as a

food or as a sole item of a meal or diet, and these products must be labeled as a dietary supplement. DSHEA broad- ened the regulatory definition of dietary supplements and altered the federal government’s oversight of supplement products. Under DSHEA, the supplement manufacturer

is responsible for the safety of the product. However, the supple- ment manufacturer is not required to test its product for safety, nor does it have to prove that the sup- plement does what it claims to do.

Since DSHEA, there has been increased consumer interest in, and use and availabil- ity of a wide vari- ety of supplements. Based on data from the National Health and Nutrition Exam- ination Surveys (NHANES), from 1994 to 2006 the use of dietary supplements has increased from

dietary supplement A product (other than tobacco) that is not intended to be used as a food or a sole item of a meal or diet. To be considered a dietary supplement, the product must contain one or more of the following dietary ingredients: vitamin, mineral, herb or other botanical, amino acid, dietary substance to supplement the diet by increasing the total dietary intake, or a concentrate, metabolite, constituent, extract, or combination of any of these ingredients.

Dietary Supplement Health and Education Act (DSHEA) A legislative act passed in 1994 to help regulate the dietary supple- ment industry. DSHEA broadened the regulatory definition of dietary supplements and altered the federal government’s oversight of supplement products.

Chapter 9 Nutritional Ergogenics 241

Fortifying Your Nutrition Knowledge

Removal of Ephedra from the U.S. Market On February 11, 2004, the FDA issued a final ruling that banned the sale of ephedra-containing supplements in the United States.7 The effective date of the ban was April 12, 2004, giving supplement makers 2 months to pull their supplements con- taining ephedra or ephedrine alkaloids off the market. The term ephedrine alkaloids was used by the FDA in the Federal Register final ruling because it is these alkaloids that produce the effects that necessitated the banning of the supplement. The common commercial name used for these ephedrine alkaloids is ephe- dra. This action banning ephedra was the first time the FDA had taken a formal action to halt the sale of a dietary supplement ingredient since the passage of DSHEA in 1994.8 The final ruling

energy, increased muscle mass, and improved strength.5,6 Male athletes tend to choose protein and weight gain prod- ucts, creatine, and other supplements promoted to help an athlete gain muscle mass and burn fat. Conversely, female athletes are more likely to consume vitamin and min- eral supplements, weight loss supplements, and energy enhancers. Some of these supplements may be helpful and even necessary for athletes. For example, calcium and iron dietary supplements may eliminate deficiencies, particu- larly in females or in athletes who tend to eat fewer calories than their energy demands. In most cases, however, sup- plements are consumed in the hope of enhancing perfor- mance, regardless of the safety or efficacy of the product.

What are the regulations governing dietary supplements? Supplements are not drugs. Drugs are intended to cure, treat, or prevent disease. Drugs must undergo extensive studies of safety and effectiveness, drug interactions, and dosing effects and must have formal FDA approval prior to marketing the product. In contrast, dietary supplements do not have to undergo any studies on safety or efficacy prior to entering the market. Supplements are also not food additives, which require testing prior to entering the food marketplace. Dietary supplements containing any

Figure 9.1 Supplement Facts panel. Similar to the Nutrition Facts panel on food labels, the Supplement Facts panel required on dietary supplement labels shows the product composition.

Supplement Facts

* The % Daily Value (DV) tells you how much a nutrient in a serving of food contributes to a daily diet. 2,000 calories a day is used for general nutrition advice.

Amount per serving

12 servings per container

Total Fat 2g Saturated Fat 1g Trans Fat 0g

Sodium 50mg Total Carbohydrate 0g

Dietary Fiber 0g Total Sugars 0g

Includes 0g Added Sugars Protein 30g

2% Cholesterol 0mg 0%

3% 5%

% Daily Value*

0% 0%

Vitamin D 0mcg 0% Calcium 130mg 10% Iron 0mg 0% Potassium 100mg 6%

Serving size 1 Scoop (22g)

Calories 138

new ingredients do not require testing. The manufacturer gathers and interprets safety and efficacy information and then must submit the product and safety informa- tion to the FDA 75 days prior to marketing the product. After the 75-day waiting period, the supplement can be placed on the market. However, the FDA does not approve the new ingredient. New supplements that do not contain any new ingredients do not have to submit anything to the FDA prior to marketing the product.

Since 1999, DSHEA has required all supplements to be labeled with all of the product’s ingredients and a Sup- plement Facts panel. The label is very similar in appear- ance to the Nutrition Facts panel on food labels. FIGURE 9.1 shows a Supplement Facts panel and ingredient list.

Supplement manufacturers cannot make claims that the product can cure or relieve specific health conditions or diseases. They also cannot claim the supplement has pharmacological uses, because these claims would then categorize the supplement as a drug, requiring FDA approval. However, similar to food labeling, supplement manufacturers can make structure/function, nutrient content, and health claims. The structure/function, nutri- ent content, and health claims allowed on dietary supple- ment labels are similar to the food-labeling claims with one big distinction: Food labels are regulated by the FDA and dietary supplement labels are not.

Regulations limit the claims allowed on supplement labels. However, the FDA does not regularly monitor these

242 SECTION 1 The Basics of Sports Nutrition

was made after an extensive review of the reports of adverse events, a review of scientific literature on the pharmacology of ephedrine and ephedrine alkaloids, and peer-reviewed scien- tific literature on the effects of ephedrine alkaloids.

The ephedrine alkaloids, including, among others, ephed- rine, pseudoephedrine, norephedrine, methylephedrine, norpseudoephedrine, and methylpseudoephedrine, are chemi- cal stimulants that occur naturally in some botanicals (plants) but can also be derived synthetically. Ma huang, ephedra, Chi- nese ephedra, and epitonin are several names used for botani- cal ingredients that are sources of ephedrine alkaloids. These dietary supplements were used primarily as appetite sup- pressants and energy boosters for weight loss or stimulants to enhance athletic performance.9,10 However, a multitude of adverse side effects leading to reported heart attacks, strokes, seizures, and death led to the banning of ephedrine alkaloid supplements.

Athletes should be aware that companies are still attempting to sell supplements containing ephedrine alkaloids. One of the more recent supplements, EphBurn 25, produced by Brand New Energy, was pulled from shelves by the FDA in August 2012. In addition, “ephedra-free” energy products are now flooding the marketplace. However, these new “ephedra-free” products often contain stimulant botanical ingredients such as bitter orange (contains synephrine), high amounts of caffeine, kola nut, guarana, and green tea extracts. Safety concerns regarding these stimulant-containing products persist. Athletes need to continue to be aware of the safety and efficacy issues of stim- ulant-containing supplements.

claims. The volume of supplements currently on the mar- ket, along with the volume of new ones constantly enter- ing the market, prohibit close monitoring of these claims. The following is an explanation of allowable claims on dietary supplement labels:

• Nutrient content claims: Claims on the labels of foods or dietary supplements that characterize the level of a nutrient in that food or supplement can be made if they are in accordance with FDA-authorized regula- tions. For example, a dietary supplement that states it is a “good source of calcium” must contain at least 10–20% of the Daily Value for calcium.

• Health claims: Health claims are allowed only if scien- tific evidence or statements from recognized scien- tific authorities are reviewed by the FDA and meet the standards set for the health claim. This also is similar to making health claims on food labels. For example, a vitamin/mineral supplement that contains 100% of the RDA for folic acid could state a health claim regarding the benefit of folic acid taken during preg- nancy in the prevention of neural-tube defects.

• Structure/function claims: These claims are not autho- rized or reviewed by the FDA. Claims about how a sup- plement affects a function in the body or a structure of the body can be made based on the manufacturer’s review and interpretation of the scientific literature. Structure/function claims on labels must be accom- panied by a disclaimer such as the following: “This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease” (see FIGURE 9.2 ). Claims such as “glucosamine may strengthen joints” are allowed when accompanied by the disclaimer, but the statement “glucosamine cures arthritis” is not allowed. The manufacturer of

Figure 9.2 Examples of supplement labels with health and structure/function claims.

Structure/Function Claim

Calcium Supplement Regular exercise and a healthy diet

with enough calcium helps adolescent and young adult women maintain good bone health and may reduce the risk of osteoporosis later in life.

Health Claims

Folic Acid Supplement Healthful diets with adequate

folate may reduce a woman’s risk of having a child with a brain or

spinal cord defect.

Whey Protein Builds muscle mass,

reduces muscle fatigue, enhances strength.

This statement has not been evaluated by the

Food and Drug Administration. This

product is not intended to diagnose, treat, cure,

or prevent disease.

a supplement that makes a structure/function claim on the label must notify the FDA no later than 30 days after marketing the product. These structure/func- tion claims on supplement labels fall under a differ- ent jurisdiction within FDA than the approved health claims statements allowed on food labels. The food label claims are preapproved by the FDA, and only certain claims can be made by law. It is the structure/function claims that frequently

sound too good to be true and often hook athletes into believing they need a particular supplement to gain an edge over the competition. Many sport supplements place structure/function claims on their labels to entice ath- letes to buy their products.

In addition, DSHEA states that the supplement label must list all ingredients, including the active ingredients.

However, product testing and regula- tion are not required as part of DSHEA before a supplement is marketed or while on the market. The manufacturer is responsible for the labeling and safety of the product; how- ever, because com- panies do not have to prove their prod- ucts’ safety, efficacy, or accuracy of ingre- dients before hitting the market, the prod- uct could contain

Chapter 9 Nutritional Ergogenics 243

Gaining the Performance Edge

Nutritional supplements do not require FDA approval, nor do they go through the same rigorous test- ing and scientific approval process as pharmaceutical drugs. Athletes need to be aware of the possibility that supplements may (1) contain a banned substance and (2) pose a health risk if consumed in con- junction with other supplements or medications. Athletes should weigh the benefits versus the risks and costs when deciding whether to take a supplement.

any or none of the ingredients listed. Some supplements could contain ingredients that are not listed on the label as well. This can be important for athletes in sports that perform drug testing. Athletes have had winning perfor- mances challenged and awards withdrawn because of inadvertent consumption of a seemingly benign dietary supplement that contained a banned substance. Ath- letes must understand that manufacturers can mislead consumers by omitting ingredients on the label, putting ingredients on the label that are not actually in the prod- uct, or falsely claiming a structure/function application and, because of poor regulatory oversight, may never have had action taken against them.

The Federal Trade Commission (FTC) regulates the advertising of dietary supplements. It is the responsibility of the FTC to ensure truth in advertising on supplement labels, in print advertising, and in commercials. The mis-

sion of the FTC is to prevent unfair com- petition and to pro- tect consumers from unfair or deceptive practices in the mar- ketplace. The agency encourages self- monitoring by the supplement industry and intervenes when

deceptive or unsafe advertising occurs. Advertisements that make false claims or fail to use appropriate structure or function disclaimer statements are subject to action by the FTC. The FTC can take action against the manufac- turer for providing false or misleading claims or if the product claims safety in the absence of evidence of safety. For example, over the past few years the FTC has sent let- ters to various weight-loss supplement makers requesting they discontinue claims about fantastic amounts of weight loss or misleading information about the scientific research behind specific weight-loss claims.

A few of the common marketing ploys manufacturers use to entice athletes to purchase their products include:

• Product is endorsed by a well-known professional athlete.

• Testimonials from other supplement users claiming amazing results. These spokespeople are often very fit and athletic looking, adding to the mystique and “credibility” of the product.

• Claiming “scientific research,” but studies are not published in scientific journals or only unpublished research is cited.

• False label or health claims. If the FTC learns of these claims and finds them to be false, the FTC can take action against the supplement manufacturer. Many supplements are marketed to athletes as fat

burners, muscle builders, and energy enhancers. Some of these products are effective, but others are not. For exam- ple, creatine has shown promise as a muscle-building sport

Federal Trade Commission (FTC) A government agency whose mission is to ensure truth in advertising on supplement labels, in print advertising, and in commercials, thereby preventing unfair competition and protecting consumers from unfair or decep- tive practices in the marketplace.

supplement. Many controlled studies have been performed on creatine’s effects on weight gain and increased muscle mass and have been published in peer-reviewed scientific journals. Sports drinks containing electrolytes and carbo- hydrates have significant scientific backing for ergogenic effects on endurance training. Although these two exam- ples have been well researched, the majority of sports ergo- genic supplements that arrive on the market each year do so with minimal or no testing at all. Some supplements have had minimal testing on animals or in vitro but no human testing. Still others take already published research and misapply it to new supplements. These loose applica- tions may include scientific-sounding jargon that promises quick results with minimal or no side effects.

Are some supplements better or safer than others? Differences in plant species, growing practices, soil con- tent, harvesting, the part of the plant used (i.e., leaf, seed, stem, or fruit), and storage practices all can influence the content of a dietary supplement and therefore the effect of the product on the consumer. Because supplements do not require proof of testing and the contents of a product are not always consistent,4 two bottles of an identically

packaged supple- ment made by the same manufacturer can vary greatly and thus alter the effect on the body. This can happen if a differ- ent plant species is used, if the supplier provides a different plant product with or without the manu- facturer’s knowledge, or if the manufac- turer does not use quality control mea- sures during the pro-

duction of the supplement.11,12 Some manufacturers voluntarily use quality control measures, however, and can verify the content of their products.

Good manufacturing practices (GMPs) for pharma- ceuticals have been in place for many years and are

administered by the FDA. GMPs mean that the drug was manufactured and p a ck ag e d w i t h established quality control measures. This includes con- trols in personnel, facilities design and

good manufacturing practices (GMPs) A set of quality control measures adopted by the United States Pharmacopeia that establish- es guidelines for personnel, facilities design and cleanliness, equipment, testing, storage, production and process controls, yield, packaging, and shipping of products.

244 SECTION 1 The Basics of Sports Nutrition

Gaining the Performance Edge

“Buyer beware” is the best adage for athletes when it comes to dietary supplements. Many manufacturers of dietary supplements target their products to athletes and use lan- guage with just a hint of scientific lingo to entice athletes to buy their product. These supplements may indeed contain the ingredients on the label, but those ingredients may not provide the enhanced athletic performance that the label claims.

cleanliness, equipment, testing, storage, production and process controls, yield, packaging, and shipping. Essen- tially, all areas from the supply of ingredients used to the actual manufacturing and packaging, labeling, and dis- tribution of pharmaceuticals must follow established good manufacturing practices.

GMP guidelines are currently being developed to help ensure that safety and quality control measures are used during the production of dietary supplements. Many supplements are prepared in quality-controlled environ- ments where contamination from other substances is not likely. However, other supplement makers may use poor manufacturing practices; use the same equipment to pre- pare or package different products, which can lead to con- tamination of supplements; and do not use quality control measures for ingredients, storage, and packaging.13,14

Standards published by the The United States Phar- macopeial Convention (USP) and others provide a set of guidelines for the quality, purity, manufacturing practices,

and ingredients in supplement prod- ucts. The oldest certi- fication program is conducted by the USP. The organiza- tion has been in exis- tence since 1820 and

is a nonprofit entity dedicated to setting public standards for the quality of healthcare products. In 2003, the USP developed a program to verify the quality standards it publishes for dietary supplements. The USP verification mark and those of other certification programs can only be used on supplements that have been through an exten- sive verification process. Some examples of these can be seen in FIGURE 9.3 . To obtain a verification seal, the supple- ment must be made using good manufacturing practices and pass verification tests for ingredients listed on the label, amounts listed, presence of contaminants (some of

United States Pharmacopeial Convention (USP) A nonprofit organization that establishes and verifies standards for the quality, purity, manufacturing practices, and ingredients in supplement products.

Figure 9.3 Verification seals of respected U.S. supplement certification programs. Courtesy of AEGIS; Courtesy of BSCG; Courtesy of ConsumerLab.com; Courtesy of NSF; Courtesy of USP: Registered trademark of U.S. Pharmacopeial Convention. Used with permission.

which may be banned), and supplement break down and release of ingredients in the body. While the USP, National Nutritional Foods Association (NNFA), and ConsumerLab. com (CL) seals verify product quality and purity, Banned Substances Control Group (BSCG), Informed Choice, Aegis, and NSF seals also indicate the product is free of any banned ingredients that could affect the eligibility of competitive athletes.

Manufacturers voluntarily choose to go through the certification process to test and verify their dietary sup- plements. Athletes who purchase dietary supplements should look for the verification seals of these certifying organizations on the product label (see Figure 9.3). Doing so helps to insure that they are getting a higher-quality product than supplements sold without a seal. Addition- ally, three of the agencies also test for banned substances.

Choosing a supplement manufactured by a well-known company may provide for a better product. The manufac- turing and labeling used by larger, established companies will likely have better standards, such as an accurate listing of all the ingredients in the product and the dosage levels of all active ingredients. Some pharmaceutical manufac- turers also make dietary supplements. The standards in place that these companies must use to have their drugs approved may also be used when they develop dietary sup- plements. Although it is not guaranteed that supplement makers that also make pharmaceuticals will have better- quality dietary supplements, it is one more thing athletes can look for when making supplement choices.

There is no question that some dietary supplements, especially certain vitamins and minerals, offer potential health benefits. However, most dietary supplements mar- keted to athletes for increased sport performance have not had vast amounts of scientific research to back the products’ claims. Athletes also need to realize that the supplements they are taking, knowingly or unknowingly, may contain banned substances that can have serious ethical and physical consequences.

Chapter 9 Nutritional Ergogenics 245

Where can information on nutritional ergogenic aids be found? TABLE 9.2 provides a listing of several different resources that supply information on dietary supplements. Some of the Internet sources provide information about banned sub- stances, and others are designed to help consumers make informed choices about supplement use. Athletes in sports in which drug testing is likely should be aware that many dietary supplements that do not carry verification seals could contain banned substances, even if the label does not list the ingredient. Using the list of resources will help athletes make informed choices about which supplements to use, appropriate supplement doses, potential side effects, and purported benefits of taking dietary supplements.

The best sports nutrition professionals are well versed in the vast array of dietary supplements that athletes com- monly use. Athletic trainers working predominantly with strength athletes should become very familiar with the supplements marketed toward muscle gain and fat loss. Similarly, nutrition professionals working with female ath- letes will find it helpful to become familiar with common weight loss, energy, fat burning, and vitamin/mineral sup- plements. Athletes appreciate being educated about the pros and cons of using supplements, including the risks of positive drug testing and the cost of these supplements. Well-balanced nutrition is often much less expensive than consuming dietary supplements regularly. Sports nutri- tion professionals should not advocate a universal “sup- plements should never be taken” policy. Those who do

will often lose cred- ibility with athletes. Certain dietary sup- plements may have significant benefits for some athletes. Sports nutrition pro- fessionals should work with athletes to help them make informed decisions about supplement

use by helping them understand the safety, efficacy, and economics of taking dietary supplements for improved sport performance.

What tools are available to research information on ergogenic aids? New dietary products and supplements are appearing on store shelves faster than research can keep up. As noted earlier, most of these nutritional products have not been tested for effectiveness or safety. Unless the manufac- turer sponsors placebo-controlled studies, which is very rare, or the ergogenic aid garners the attention of sports organizations or the FDA, experimental testing is unlikely. As a result, ineffective products continue to sell until

Table 9.2

Dietary Supplements Resources

Source Location Information Websites

ConsumerLab.com www.consumerlab. com

Product reviews of many supplements, sports bars, and sports drinks

FDA Center for Food Safety and Applied Nutrition

http://www.fda.gov/ forconsumers/ consumerupdates/ ucm153239.htm

Consumer information on legislation, safety alerts, recalled products, etc. dealing with dietary supplements

Food and Nutrition Information Center

http://fnic.nal. usda.gov/ dietary-supplements

Credible information on dietary supplements, herbs, and botanicals; can search for specific supplements

Human Performance Resource Center

http://hprc-online. org/dietary- supplements

A website dedicated to providing evidence- based information and key resources to help warfighters optimize their performance

Informed Choice www.informed-choice. org

A quality assurance program for sports nutrition products; logo indicates that the product has been tested for banned substances.

International Bibliographic Information on Dietary Supplements (IBIDS) Database

http://ods.od.nih.gov/ Heath_Information/ IBIDS.aspx

Can search for information on specific supplements and supplement safety and locate research articles

MedWatch www.fda.gov/Safety/ MedWatch/ HowToReport/ ucm053074.htm

Consumers or medical professionals can report adverse events suspected to be related to supplement use.

National Center for Complementary and Alternative Medicine

http://nccam.nih.gov Information on various dietary supplements and other alternative medicines

National Collegiate Athletics Association

www.ncaa.org/ health-and-safety/ policy/drug-testing

Lists of NCAA-banned substances and information about drug-testing policies

National Institutes of Health: Dietary Supplement Label Database

www.dsld.nlm.nih. gov/dsld

Provides researchers and scientists information on the full label contents from dietary supplement products marketed in the United States

National Institutes of Health: Office of Dietary Supplements

https://ods.od.nih. gov/

Dietary supplements fact sheets and health information related to supplements

(continues)

246 SECTION 1 The Basics of Sports Nutrition

Gaining the Performance Edge

Sports nutrition professionals work- ing with athletes need to determine what, if any, supplements are being taken. This inquiry should include current and past dietary supple- ment use and why the athletes are taking the supplements.

word of mouth from one user to another eventually kills the demand. Unfortunately, that can take years. In the meantime, bogus products continue to defraud athletes and the general public.

Sports nutrition professionals must be aware of the various research tools available to help them gain as much information as possible, when available, on nutri- tional products. Sports nutrition professionals are often the first line of defense in protecting athletes and the public from ineffective and potentially unsafe nutri- tion products. Learning as much as possible about the product and its ingredients is vital so that the sports nutrition professional can educate athletes about the product. Many times, merely instructing someone not to use a product is not an effective deterrent. However,

Table 9.2

Dietary Supplements Resources

Source Location Information Natural Medicines

Comprehensive Database

http://naturaldatabase. therapeuticresearch. com/ home.aspx?cs= CEPDA&s=ND

Reliable information on natural medicines and herbal and nonherbal supplements

NSF International http://www.nsf. org/services/ by-industry/dietary- supplements/

An independent nonprofit organization committed to making the world safer; provides consumers with information on foods and supplements

PubMed www.ncbi.nlm.nih. gov/pubmed

A free service of the U.S. National Library of Medicine that enables searches on life science topics such as nutritional ergogenic aids and dietary supplements

Supplements Watch www. supplementswatch. com

Scientific reviews of research related to supplements; provides a rating system for any supplements it has reviewed and comprehensive and up-to-date information concerning dietary supplements

United States Anti- Doping Agency

www.usada.org Lists of banned ergogenic aids and supplement information for athletes and the public

United States Pharmacopeia

www.usp.org/ USPVerified

Lists of dietary supplements that have the USP- verified seal; provides information on selecting supplements

World Anti-Doping Agency

www.wada-ama.org Lists of banned ergogenic aids and other information for athletes and the public

explaining in layperson’s terms what the product contains and what is known about the main ingredients, and offer- ing supportive research evidence, will provide logic for the recommendation.

When investigating a dietary supplement, the anti- doping agencies should be consulted. The World Anti- Doping Agency (WADA) and the United States Anti-Doping Agency (USADA) were created in 1999 with the sole intent

of educating athletes about supplements and other ergogenic aids. Their websites (found in Table 9.2) provide a wealth of information on banned substances, the latest informa- tion releases on vari- ous aids, and contact information for questions.

One of the best ways to determine whether any peer- reviewed research has been conducted

on a specific product is to use the Internet to log into the library site of an area university or college. University libraries often provide access to several research journal databases that will allow individuals to search for a spe-

cific product or ingre- dients. Some of the more common data- bases that include journals covering research in the area of sports nutrition are MEDLINE/PubMed, CINAHL, and Sport- Discus. If nothing can be found using the research databases, then using a database covering the popular media, magazines, journals, and news- letters may provide an informational arti- cle on the product. Often an expert will be cited, or unpub- lished studies involv- ing the product will be mentioned. Usu- ally a quick search on Google can provide contact information

United States Anti-Doping Agency (USADA) A national- level nongovernmental organiza- tion that serves as an extension of the World Anti-Doping Agency. Its mission is to educate athletes about doping, reinforce the ideal of fair play, and sanction those who cheat.

World Anti-Doping Agency (WADA) An international, non- governmental organization whose mission is to foster a doping-free culture in sports. WADA was es- tablished in 1999 and is headquar- tered in Montreal, Canada.

MEDLINE/PubMed The U.S. National Library of Medicine’s premier bibliographic database that provides information from the following fields: medicine, nursing, dentistry, veterinary medicine, al- lied health, and preclinical sciences.

CINAHL The acronym used for the Cumulative Index to Nursing & Allied Health, which is a reference database that provides authorita- tive coverage of the literature re- lated to nursing and allied health.

SportDiscus A reference data- base of citations, books, confer- ence proceedings, dissertations, reports, monographs, journals, magazines, and newsletters cover- ing information in the following areas: sports medicine, exercise physiology, biomechanics, psychol- ogy, training techniques, coaching, physical education, physical fitness, active living, recreation, history, facilities, and equipment.

(continued)

Chapter 9 Nutritional Ergogenics 247

What is doping? Doping is the practice of enhancing performance through the use of foreign substances or other artificial means. According to WADA, the word doping was originally derived

from the Dutch word dop, which was the name of an alcoholic drink made from grape skins. The drink was used by Zulu

warriors to enhance their physical prowess in battle. How- ever, it was not until the turn of the 20th century that the word doping began to be used regularly and referred to the drugging of racehorses. Doping has become an epidemic in sports and presents risks not only to the health of athletes, but also to the basic tenet of fair play in competition.

Athletes, and the general public, must understand that DSHEA significantly reduced the regulation of sup- plements and broadened the category to include herbals and botanical products. In short, according to DSHEA, the FDA has the power to oversee the supplement industry but cannot investigate a supplement unless a safety prob- lem has been reported. The bottom line is that the vast majority of supplements sold to the general public have not been tested for effectiveness or safety.

Despite this fact, the sale of dietary supplements is a multibillion-dollar industry. Sports nutrition profession- als and the athletes they counsel must be knowledgeable about the ingredients found in any dietary supplements because they may contain substances banned by the International Olympic Committee (IOC) and other gov- erning sports organizations (see TABLE 9.3 ). Failure to pay attention to supplement ingredients could lead to posi- tive testing for doping and implementation of associated punitive sanctioning.

doping The practice of enhanc- ing performance through the use of foreign substances or other artificial means.

for the experts or investigators mentioned in the article. An email or phone call to these contacts can be a goldmine of information.

The websites of other professional organizations can also be consulted, such as the American College of Sports Medicine (www.acsm.org); National Strength and Conditioning Asso- ciation (www.nsca. com); Sports, Car- diovascular, and Wellness Nutrition (SCAN; www.scan- dpg.org); and Inter- national Society of Sports Nutrition (www.sportsnutritionsociety.org). Occasionally, informa- tion in the form of position statements, pronouncements, or press releases can be found on specific nutritional ergogenics.

248 SECTION 1 The Basics of Sports Nutrition

Food for Thought 9.1

Researching Nutritional Ergo- genic Aids

Go through the steps for evaluat- ing a nutritional ergogenic aid.

Fortifying Your Nutrition Knowledge

Instructions for Evaluating Nutritional Ergogenic Aids Athletes should consider the following before using a dietary supplement:

■ Does the product contain a banned substance? Look on the ingredient list to determine what substances the prod- uct contains. Use information from Table 9.2 and consult the WADA or USADA websites for the most up-to-date information on banned substances. If the ingredient list is not provided or the company producing the supple- ment is not well known, then further investigation into the supplement’s ingredients is necessary. Search the Internet for information on the company and its prod- ucts. Sometimes basic searches can provide more infor- mation on the company and its products, which, in turn, allows for more in-depth investigation. Visit the websites listed in Table 9.2 and use their site-specific search func- tion to see if information about the company and/or its products have been posted. It is important for athletes to understand that ignorance is not a defense if they are caught taking a banned substance.

■ Is there scientific research that supports the reported claims? If the supplement does not contain any banned substances, then the next step is to determine whether the supplement has been shown to have a beneficial effect. Unfortunately, many times the supplement is just a gimmick packaged with a great advertising message. The old adage, “If it sounds too good to be true, it prob- ably is” certainly holds here. Testimonials by famous ath- letes or bulked-up and fit-appearing athletes should not take the place of searching for actual research on the safety and efficacy of the supplement. Athletes should be responsible and consult a credible source of

information (i.e., a registered dietitian) and/or perform a search of the peer-reviewed research literature using a database such as PubMed (see Table 9.2) so that they can make sound decisions regarding supplementation.

■ Is the supplement safe? The benefit-to-risk ratio must always be evaluated for any supplement. Although the scientific research found by performing a Web search may provide some insight, it is also important to visit the sites of the U.S. Pharmacopeia, ConsumerLab.com, Informed Choice, and others listed in Table 9.2 for any potential safety concerns.

■ How much does the supplement cost? Decisions should consider cost versus proposed benefit. Web searches for the specific product can often yield the market price of the product and enable purchase at the best price. If the benefit appears to be proven and the athlete can afford the product, then purchase may be worthwhile. How- ever, athletes should keep in mind that supplements are typically more expensive than whole foods.

Table 9.3

World Anti-Doping Code: 2016 Prohibited Substances List

Prohibited substance category Specific substances Actions S0: Non-Approved

Substances Any pharmacological substance that is not addressed by any of the subsequent sections

of the List and with no current approval by an governmental regulatory health authority for human therapeutic use (e.g., drugs under pre-clinical or clinical development or discontinued, designer drugs, substances approved only for veterinary use) is prohibited at all times.

S1: Anabolic Agents* Exogenous anabolic androgenic steroids: 1-androstenediol, 1-androstenedione, 1-testosterone, 4-hydroxytestosterone, 19-norandrostenedione, bolandiol, bolasterone, boldenone, boldione, calusterone, clostebol, danazol, dehydrochloromethyltestosterone, desoxymethyltesterone, drostanolone, ethylestrenol, fluoxymesterone, formebolone, furazabol, gestrinone, mestanolone, mesterolone, methandienone, metenolone, methandriol, methasterone, methyldienolone, methyl-1-testosterone, methylnortestosterone, methyltestosterone, metribolone, mibolerone, nandrolone, norboletone, norclostebol, norethandrolone, oxabolone, oxandrolone, oxymesterone, oxymetholone, prostanozol, quinbolone, stanozolol, stenbolone, tetrahydrogestrinone, trenbolone and other substances with similar chemical structure or similar biological effects.

Endogenous anabolic androgenic steroids when administered exogenously: androstenediol, androstenedione, dihydrotestosterone, prasterone (dehydroepiandrosterone [DHEA]), testosterone and their metabolites and isomers.

Other anabolic agents: including but not limited to clenbuterol, selective androgen receptor modulators (SARMs), tibolone, zeranol, zilpaterol.

Mimic actions of testosterone; build tissue, especially muscle; enhance recovery.

S2: Peptide hormones, growth factors, and related substances*

Erythropoietin-receptor agonists: erythropoiesis-stimulating agents (e.g., darbepoetin (dEPO), erythropoietins (EPO), EPO-Fc, EPO-mimetic peptides), non-erythropoietic EPO- receptor agonists (e.g., ARA-290, asialo EPO, carbamylated EPO).

Hypoxia-Inducible Factor (HIF) stabilizers (e.g., cobalt, FG-4592) and activators (e.g., argon, xenon).

Chorionic gonadotrophin and luteinizing hormone and their releasing factors: buserelin, gonadorelin, and leuproelin, in males.

Corticotrophines and their releasing factors: corticorelin. Growth hormone and its releasing factors: methoxy polyethylene glycol-epoetin beta

(CERA), and peginesatide (hematide); chorionic gonadotrophin (CG) and luteinizing hormone (LH) in males, corticotrophins, growth hormone (GH), platelet-derived growth factor (PDGF).

Additional prohibited growth factors: fibroblast growth factors (FGFs), hepatocyte growth factor (HGF), insulin-like growth factor (IGF-1), mechano growth factors (MGFs), platelet- derived growth factor (PDGF), vascular-endothelial growth factor (VEGF) and any other growth factor affecting muscle, tendon, or ligament protein synthesis/degradation, vascularization, energy utilization, regenerative capacity or fiber-type switching.

Enhance actions of existing hormones by increasing concentrations in the body.

S3: Beta-2 agonists* All beta-2 agonists, including all optical isomers, are prohibited except inhaled salbutamol, inhaled formoterol, and inhaled salmeterol when taken in accordance with the manufacturer's recommended therapeutic regimen.

Block binding of sympathetic hormones, thus producing a calming effect.

S4: Hormone and metabolic modulators*

Aromatase inhibitors including, but not limited to: 4-androstene-3,6,17-trione (6-oxo), aminogluthetimide, anastrozole, 1,4,6-androstatriene-3,17-dione (ATD), exemestane, formestane, letrozole, and testolactone.

Selective estrogen receptor modulators (SERMs) including, but not limited to: raloxifene, tamoxifen, and toremifene.

Other anti-estrogenic substances including, but not limited to: clomiphene, cyclofenil, and fulvestrant.

Agents modifying myostatin functions including, but not limited to: myostatin inhibitors. Metabolic modulators: activators of the AMP-activated protein kinase (e.g., AICAR,

peroxisome proliferator–activated receptor agonists), insulins and insulin mimetics, meldonium, trimetazidine.

Block conversion of testosterone to estrogen plus diminish effects of estrogen in the body.

(continues)

Chapter 9 Nutritional Ergogenics 249

Table 9.3

World Anti-Doping Code: 2016 Prohibited Substances List

Prohibited substance category Specific substances Actions S5: Diuretics and other

masking agents* Diuretics and masking agents including, but not limited to: desmopressin, probenecid,

plasma expanders (e.g., glycerol; intravenous administration of albumin, dextran, hydroxyethyl starch, and mannitol), acetazolamide, amiloride, bumetanide, canrenone, chlorthalidone, etacrynic acid, furosemide, indapamide, metolazone, spironolactone, thiazides (e.g., bendroflumethiazide, chlorothiazide, hydrochlorothiazide), triamterene, vaptans and other substances with a similar chemical structure or similar biological effects (except drosperinone, pamabrom, and ophthalmic use of carbonic anhydrase inhibitors (e.g. dorzolamide and brinzolamide).

Impair excretion or change blood or urine measures to conceal use of other substances.

S6: Stimulants** Non-specific stimulants: adrafinil, amphepramone, amphetamine, amphetaminil, amiphenazole, benfluorex, benzylpiperazine, bromantan, clobenzorex, cocaine, cropropamide, crotetamide, fencamine, fenetylline, fenfluramine, fenproporex, fonturacetam, furfenorex, mefenorex, mephentermine, mesocarb, methamphetamine (d-), p-methamphetamine, modafinil, norfenfluramine, phendimetrazine, phentermine, prenylamine, prolintane.

Specified stimulants including but not limited to: benzphetamine, cathine, dimethylamphetamine, ephedrine, epinephrine, etamivan, etilamphetamine, etilefrine, famprofazone, fenbutrazate, fencamfamin, heptaminol, hydroxyamphetamine, isometheptene, levmethamfetamine, meclofenoxate, methylenedioxymethamphetamine, methylephedrine, methylphenidate, nikethamide, norfenefrine, octopamine, oxilofrine, pemoline, pentetrazol, phenethylamine and its derivatives, phenmetrazine, phenpromethamine, propylhexedrine, pseudoephedrine, selegiline, sibutramine, strychnine, tuaminoheptane, and other substances with similar chemical structure or similar biological effects.

Stimulate the sympathetic nervous system: enhance mental alertness, increase concentration, decrease mental fatigue, delay onset of physical fatigue.

S7: Narcotics** Buprenorphine, dextromoramide, diamorphine (heroin), fentanyl and its derivatives, hydromorphone, methadone, morphine, oxycodone, oxymorphone, pentazocine, pethidine.

Mask perception of pain and exertion.

S8: Cannabinoids** Natural (e.g., cannabis, hashish, marijuana or synthetic delta 9-tetrahydrocannabinol) and cannabimimetics (e.g., “Spice,” JWH018, JWH073, and HU-210).

Acts on central nervous system; mode of action not clearly understood.

S9: Glucocorticoids** All glucocorticosteroids are prohibited when administered by oral, intravenous, intramuscular, or rectal routes.

Delay fatigue via increased fat mobilization and utilization.

P1: Alcohol** (prohibited in air sports, archery, automobile, powerboating)

Ethanol. Acts on central nervous system as a depressant, masks perception of pain and other senses.

P2: Beta-blockers** (prohibited in archery, automobile, billiards, darts, golf, shooting, skiing/snowboarding, underwater sports)

Beta-blockers include, but are not limited to: acebutolol, alprenolol, atenolol, betaxolol, bisoprolol, bunolol, carteolol, carvedilol, celiprolol, esmolol, labetalol, levobunolol, metipranolol, metoprolol, nadolol, oxprenolol, pindolol, propranolol, sotalol, and timolol.

Mute the effects of the sympathetic hormones and thereby decrease heart rate.

* Prohibited from use at all times. ** Prohibited from use only during competition.

Data from World Anti-Doping Agency, 2016. The World Anti-Doping Code - The 2016 Prohibited List, International Standard. World Anti-Doping Agency website. Available at: https://www.wada-ama.org.TSN

An additional concern for athletes centers on the purity of the dietary supplement and the possibility of inadvertent doping. Inadvertent doping results when an ath- lete is taking a dietary supplement that, unbeknownst to him or her, can result in a

positive test for doping. Inadvertent doping can occur in the following ways:

• The ingredient was listed on the food label but the athlete did not know it was on the banned list or that the ingredient could cause a positive test.

• The supplement label lists all of the ingredients, but the names given are not recognized as being related to banned substances. For example, ma huang herbal products may be listed on the ingredients list,

inadvertent doping A situation resulting from an athlete ingesting a dietary supplement that unbe- knownst to him or her can result in a positive test for a banned substance.

(continued)

250 SECTION 1 The Basics of Sports Nutrition

but athletes may not know that it contains ephedrine, which is banned.

• The supplement manufacturer may not declare a banned substance in its ingredient list. In some cases the ingredient may be included but deliberately not listed, or the banned substance was added inadver- tently by the manufacturer as a by-product of other ingredients or via contamination in the production process. Although the FDA has established guidelines for good

manufacturing practices and accurate labeling of supple- ments, there has been little enforcement. A review on inadvertent doping reported that 7 to 15% of the various supplements tested were contaminated or mislabeled.4 Several studies have revealed evidence of deceptive and inaccurate labeling practices.11–14 In short, this means that the quality control of supplement manufacturing needs improvement and that inadvertent doping may be a real issue for athletes.

Inadvertent doping does not exempt athletes from punishment and embarrassment if they test positive for a banned substance. Sports nutrition professionals must be knowledgeable about not only the list of banned sub- stances, but also herbal substances that are related to or may be converted to banned substances within the body.

What are some of the commonly encountered doping substances? Doping substances used by athletes range from natural herbals to chemically engineered compounds and lit- erally are too numerous for discussion within the con- fines of this chapter. A visit to the local nutrition/health food store will quickly leave a lasting impression of the number of dietary supplements available to athletes. A discussion of each nutritional ergogenic is beyond the scope of this chapter, so rather than being discussed individually, the substances will be divided into func- tional groups as delineated by Antonio and Stout.15 In the following sections each group is briefly discussed, and the more commonly encountered supplements within each group are listed in Tables 9.4 to 9.10. In the tables, the “Claimed Actions” column describes the touted benefits of the nutritional aid. These are merely claims from manufacturers or proposed actions, not the actual results of research. The “Human Research” col- umn indicates whether any human studies have been done and published on the product. A “yes” in this col- umn does not mean the product works, it merely means published human studies using the product exist. The “Potential” column gives an indication as to whether the nutritional aid has some merit for use based on findings from currently available research data. The “Comments/ Concerns” column provides other pertinent information on the nutritional aid. The following functional groups of nutritional ergogenics are covered:

• Anabolics • Prohormones and hormone releasers • Fat reducers • Anticatabolics • Vitamins and minerals

Which nutritional ergogenic aids are commonly used as anabolic agents, prohormones, and hormone releasers? An anabolic agent is a substance that enhances the body’s ability to build tissue. In regard to sports, anabolic agents are typically those that lead to an increase in muscle mass by promoting protein synthesis (see

TABLE 9.4 ). The word anabolic is usually associated with ana- bolic steroids, which technically are syn- thetic hormones that play a similar role to that of testosterone. Because anabolic steroids are syn- thetic hormones and are not considered dietary supplements, they will not be cov- ered in this chapter. However, several compounds classi- fied as dietary sup- plements are touted as increasing the

body’s levels of anabolic hormones. These supplements are known as prohormones and hormone releasers.

Prohormones are precursor substances that can be readily converted to biologically active hormones by the body. Marketers of prohormones promote their products based on the theory that the fewer the enzymatic steps the prohormone has to go through to become biologically active (i.e., the closer in structure it is to the “real thing”), the greater its effectiveness as an ergogenic aid. Although this is not the case, millions of dollars have been spent on substances touted to be close relatives to actual hor- mones in the body. Androstenedione, commonly referred to as “andro,” is probably the most well known of the pro- hormones and requires only one enzymatic step to be converted to testosterone.

Unlike prohormones, which are converted by the body into the targeted hormone, hormone releasers are substances that stimulate an increased quantity or frequency of release of the specific hormone within the body, thus increasing physiologic levels. Clonidine is one such hormone releaser that has been touted to increase growth hormone levels in the body. Some of the more commonly encountered nutritional ergogenics

anabolic agent A substance that enhances the body’s ability to build tissue. In regard to sports, anabolic agents are typically those that lead to an increase in muscle mass by promoting protein synthesis.

prohormone A molecule or substance that can be readily converted to a biologically active hormone.

hormone releaser A substance or substances that stimulate an increased quantity and/or frequency of release of hormones within the body.

Chapter 9 Nutritional Ergogenics 251

classified as anabolic agents, prohormones, or hormone releasers are the following:

• Androstenedione (andro) • Beta-hydroxy-beta-methylbutyrate (HMB) • Boron • Clonidine

• Conjugated linoleic acid (CLA) • Creatine monohydrate (creatine) • Vanadium (vanadyl sulfate)

These substances, as well as other frequently encountered anabolic, prohormone, or hormone releaser supplements, are summarized in Table 9.4 and TABLE 9.5 .

Table 9.4

Anabolic Nutritional Ergogenics

Supplements (other names)

Claimed actions Human research

Potential Comments/Concerns

Beta-hydroxy-beta- methyl-butyrate (HMB)

Prevents protein breakdown and enhances synthesis; increases strength; improves body composition

Yes Moderate- high

Long-term effects unknown; benefits appear to decline with continued use.

Chromium picolinate Enhances action of insulin; increases muscle mass

Yes Low Sufficient amounts can be consumed in the daily diet

Conjugated linoleic acid (CLA)

Increases response to tissue growth factors, hormones, and cell messengers; increases muscle mass

Yes Low Animal studies suggest it is safe; long- term effects unknown

Creatine monohydrate Increases anaerobic output (strength/power) in events lasting 6 seconds to 4 minutes

Yes Moderate- high

Long-term effects (> 5 years) still unknown

Octacosanol Improves neural functioning, thus increasing ability to utilize muscle and intensify training

Yes Low Has been used in foods since 1950; appears safe

Protein powder/bars Increases strength, aids in muscle growth and development

Yes Low-moderate Effective only for athletes who are protein deficient; watch for other added ingredients

Vanadyl sulfate Enhances/mimics effects of growth factors in muscle

Yes Low Animal studies demonstrate severe side effects; human effects less clear

Table 9.5

Prohormones and Hormone Releasers

Supplements (other names) Claimed actions Human research

Potential Comments/Concerns

Andro supplements (androstenedione, androstenediol, 19-nor-4-androstenedione; 19-nor-4-androstenediol)

Increases testosterone levels Yes Low May decrease muscle mass and increase estradiol levels

Arginine and ornithine supplementation

Increases growth hormone production

Yes Low No research supports that amino acids increase growth hormone levels.

Boron Increases plasma testosterone Yes Low No research support for effectiveness; can be toxic

Clonidine Increases growth hormone production

Yes Low No research supporting claims

Dehydroepiandrosterone (DHEA) Increases testosterone levels; decreases fat; builds muscle

Yes Low-moderate Research does not support claims; may decrease HDL levels and insulin sensitivity; female athletes may experience increases in androgen levels.

Tribulus terrestris Increases body’s production of testosterone

Yes Low Promoted as safe alternative to steroids; can be toxic

252 SECTION 1 The Basics of Sports Nutrition

Which nutritional ergogenic aids are commonly used as anticatabolics? Anticatabolics are nutritional compounds that decrease the breakdown of body tissues. Body tissues, and in par- ticular proteins, are in a constant state of turnover, so the idea behind anticatabolics is to slow protein degradation.

If protein degrada- tion is decreased and protein synthesis is maintained, the end result would be an accumulation of pro- tein (in the case of athletes, increased muscle mass). Body

builders, power lifters, Olympic weight lifters, and throw- ing athletes in field events all could potentially benefit from anticatabolics. Anticatabolic dietary supplements include:

• Alpha-ketoglutarate • Branched chain amino acids • Casein protein • Glutamine • Leucine • Whey protein

These anticatabolics are summarized in TABLE 9.7 .

anticatabolic A nutritional com- pound that slows the breakdown processes in the body (catabolism), thus tilting the metabolic balance toward increased tissue building (anabolism).

Which nutritional ergogenic aids are commonly used to reduce fat mass? At first glance, one may wonder how a compound that decreases body fat would be considered an ergogenic aid. However, for some athletes, fat is considered dead weight, and therefore supplements that lead to decreases in body fat could enhance performance by making the athlete lighter. Some of these nutritional agents increase the body’s ability to mobilize and utilize fats for energy. Others decrease appetite, which lowers daily caloric intake and causes the body to turn to fat stores for energy, while still others block the absorption of ingested fats. Regardless of the mode of action, this category of dietary supplements is sought after by endurance athletes, athletes in appearance sports, athletes participating in weight-tiered sports, and the general public. Some of the more commonly encoun- tered fat-reduction nutritional aids are as follows:

• Caffeine • Chitosan • Chromium • Dehydroepiandrosterone (DHEA) • Ephedrine • L-carnitine • Yohimbe

Refer to TABLE 9.6 for a summary of these dietary supplements.

Table 9.6

Fat Reducers

Supplements (other names)

Claimed actions Human research

Potential Comments/Concerns

Caffeine Stimulates central nervous system; increases lipolysis

Yes Moderate-high Elevates blood pressure and heart rate; can cause loose bowels and gastric upset

Chitosan Decreases amount of dietary fat absorbed across intestinal lining during digestion

Limited Moderate Can cause diarrhea; decreases absorption of fat-soluble vitamins

Chromium Enhances the actions of insulin; increases muscle mass, thus increasing metabolic rate

Yes Low Kidney failure and muscle wasting have been reported at high doses

Dehydroepiandrosterone (DHEA)

Increases testosterone levels and thus muscle mass, which increases metabolic rate

Yes Low In women, can increase testosterone level and increase risk for heart disease

Ephedrine Increases lipolysis and resting metabolic rate; suppresses hunger

Yes High No longer sold over the counter because of reported adverse side effects

L-carnitine Assists in transfer of fats into the mitochondria, thereby increasing fat oxidation

No Low Appears to be safe but lack of research support raises questions about use; avoid D-carnitine supplements, because they may be toxic.

Yohimbe Blocks receptors that inhibit lipolysis, thereby increasing fat loss

Yes High Side effects include anxiety, nausea, and tremors; purity of supplements is a concern.

Chapter 9 Nutritional Ergogenics 253

Which vitamins and minerals are commonly used as nutritional ergogenic aids? The micronutrients (i.e., vitamins and minerals) serve key roles in body functions critical to sport performance and thus supplement manufacturers have had little trouble sell- ing their products by touting their potential benefits. How- ever, because the body can reuse vitamins and minerals as they serve in their various roles, our physiologic need for daily intake is very small. This is the reason vitamins and minerals are classified as “micronutrients.” The majority of research investigating vitamins and minerals indicates that unless the athlete is deficient, supplementation beyond the RDA has no effect on sport performance. In other words, under most circumstances, the small daily requirement for vitamins and minerals is usually more than met by a well- balanced diet. Just to make sure that adequate intakes are met, many sports nutrition professionals recommend tak- ing a good quality multivitamin/mineral as an “insurance policy,” but warn that megadosing on any one vitamin or mineral in hopes of an ergogenic effect is neither warranted nor recommended. For a summary of vitamin and mineral requirements, see Chapters 6 and 7.

What types of dietary supplements and nutritional ergogenics are commonly used by endurance athletes, strength/power athletes, and team sport athletes? Athletes are keenly attuned to the physical, nutritional, and energetic requirements necessary for optimal per- formance in their sport. Many athletes self-identify areas

Table 9.7

Anticatabolic Nutritional Ergogenic Aids

Supplements (other names)

Claimed actions Human research

Potential Comments/Concerns

Alpha-ketoglutarate Spares glutamine, thus sparing muscle tissue, which is the biggest source of glutamine

Yes Moderate- high

Long-term safety is unknown, but limited evidence indicates it is well tolerated.

Branched chain amino acids (BCAAs)

Increases availability of valine, leucine, and isoleucine for various functions, thereby sparing muscle tissue, which is the usual source

Yes Moderate- high

Appears to be safe

Casein protein Source of essential amino acids, which decreases muscle protein degradation and stimulates protein synthesis

Yes Moderate- high

Potential for allergic reactions but rare; can increase cholesterol levels

Glutamine Increases availability of glutamine, which is used in energy metabolism in the kidneys, gut, liver, and cells of the immune system, thus sparing muscle

Yes High High doses are required but seems to be safe; long-term effects unknown

Leucine Spares muscle by increasing availability of leucine, which is used by various tissues for energy

Yes Moderate Appears to be safe

Whey protein Source of essential amino acids, which decreases muscle protein degradation and stimulates protein synthesis

Yes High Potential for allergic reactions, but rare; no serious side effects reported even with high doses

that they believe to be weak and then seek products that will address their shortcomings. Shrewd marketers take advantage by using key words or phrases (e.g., “increased power,” “improved endurance”) that draw attention to their product and entice the athlete to “give the product a go.” The following paragraphs identify some of the dietary sup- plements and nutritional ergogenics used by various types of athletes in hopes of enhancing their sport performance.

Because of the nature of endurance sports, any sup- plement promoting an enhancement of energy, muscu- lar endurance, cardiorespiratory capacity, or recovery between workouts, as well as decreased body fat, has great appeal to the endurance athlete. TABLE 9.8 lists a variety of products commonly used by endurance ath- letes. The list ranges from supplements that are highly effective and researched (e.g., sports beverages) to those that appear to be minimally effective and not well docu- mented (e.g., L-carnitine). An athlete’s individual decision to experiment with a particular supplement should occur only after careful consideration of the potential benefits and risks.

Strength/power athletes are attracted to supple- ments or ergogenic aids promoting an enhancement of strength, power, anaerobic metabolism, and muscle mass.

TABLE 9.9 lists a variety of ergogenic aids commonly used by strength/power athletes. The list ranges from ergogenic aids that are highly effective but also possess severe side effects (e.g., steroids) to those that are minimally effective and relatively safe (e.g., chromium). Some of these supple- ments are illegal and/or banned by sports agencies and should obviously be avoided. Others may offer potential benefits but should be evaluated on an individual basis.

254 SECTION 1 The Basics of Sports Nutrition

Table 9.8

Common Nutritional Ergogenics Used by Endurance Athletes

Supplements (other names)

Claimed action Human research

Potential Banned Comments/Concerns

Beet root Improves blood flow throughout body and thus enhances endurance performance

Yes Moderate No Limited research available and side effects of long-term use unknown

Branched chain amino acids (BCAAs)

Essential amino acids that are touted to enhance endurance performance

Yes Low No BCAAs are supplied by whole foods, which also provide other nutrients.

Caffeine (kola nut, guarana)

Enhances performance by increasing serum FFA/use of muscle triglycerides, sparing muscle glycogen

Yes Moderate No Elevates heart rate and blood pressure; can cause irritability, nervousness and gastrointestinal distress

Coenzyme Q10 (ubiquinone or CoQ10)

Enhances function of electron transport chain; increases endurance performance

Yes Low for athletes No Potential for cell damage when consumed in large amounts and exercising intensely

Energy bars Provides energy for prolonged endurance performance

Yes High No Should not be used as a meal replacement

Energy gels Quick supply of carbohydrates during endurance exercise

Yes High No Consume with 8–12 oz of fluid; may be better tolerated taken in small amounts

Ginseng Increases stamina; ability to adapt to training stressors; enhances immune function

Yes Low No Ginseng content in supplements can vary greatly; may increase blood pressure

Glycerol Energy source during exercise; promotes hyperhydration status before endurance exercise

Yes Low-moderate Yes USOC/IOC bans use; may cause gastrointestinal upset and cramping

L-carnitine Fat transporter within cells; increases endurance performance

Yes Low No Avoid D-carnitine supplements, because they may be toxic and can deplete L-carnitine.

Medium-chain triglycerides (MCTs)

Quickly metabolize fatty acids that spare glycogen and thus delay fatigue

Yes Low No May cause gastrointestinal upset and cramping

Multivitamin/mineral Supply essential vitamins and minerals to endurance athletes for optimal health and performance

Yes Moderate No Look for supplements containing no more than 100–200% of the Daily Value.

Pyruvate Accelerates Krebs cycle; enhances use of glucose; greater fat loss; increases glycogen storage

Yes Low-moderate No Limited research available on ergogenic effects and side effects of long-term use

Sodium bicarbonate Buffers lactic acid, thereby delaying the onset of fatigue

Yes Low No May cause nausea, diarrhea, irritability, and/or muscle spasms

Sodium/electrolyte tablets

Prevents hyponatremia by supplying sodium during exercise and other electrolytes as buffers

Yes High No Avoid supplements using mainly sodium bicarbonate; can cause diarrhea/cramping

Sports beverages Enhances endurance performance and delays fatigue by supplying fluid, carbohydrates, and electrolytes

Yes High No Practice during training to avoid gastrointestinal distress during competitions

Many nutritional ergogenics used by team sport ath- letes overlap those of the endurance and/or strength/ power athletes. In other words, each athlete uses supple- ments that he or she feels will help meet the physical or energy requirements of the position the athlete plays. For example, the typical power, contact team sport ath- letes are likely to take the same supplements as strength/

power athletes, namely those designed to increase mus- cle mass, improve speed, or enhance strength. Baseball, hockey, football, and basketball players commonly report using creatine. They also are more likely to try hormone releasers, prohormones, and/or anabolic steroids. Volley- ball, soccer, and field hockey athletes tend to seek out dif- ferent supplements. These athletes are more interested in

Chapter 9 Nutritional Ergogenics 255

maintaining or losing weight, keeping energy levels high, and taking supplements that will not increase weight but will increase power. The nature of their sport is less dependent on size and brute strength and more depen- dent on agility, quickness, and muscular endurance. Sup- plements that team sport athletes often report using are listed in TABLE 9.10 .

Energy drinks are another example of a nutritional ergogenic that is being used across a wide spectrum of sports before, during, and after exercise. Although the terms are sometimes used interchangeably, “energy drinks” and “sports drinks” are not synonymous. Sports drinks are a category of well-researched prod- ucts that deliver fluid, carbohydrates, and electrolytes to athletes during exercise. Energy drinks will typically

also contain these components; however, they differ from sports drinks due to their higher sugar and B-vitamin content, carbonation, and inclusion of caffeine and other stimulants (e.g., guarana, taurine, and glucuronolactone). These unique char- acteristics are caus- ing growing concern about the safety of these products. Athletes who con- sume energy drinks, especially in large quantities, are at an increased risk for weight gain, gas- trointestinal distress, and, most important, cardiac inci- dents. TABLE 9.11 summarizes the ingredients present in

Table 9.9

Common Nutritional Ergogenics Used by Strength/Power Athletes

Supplements (other names)

Claimed action Human research

Potential Banned Comments/Concerns

Anabolic androgenic steroids

Increases muscle mass and strength Yes High Yes Harmful side effects: abnormal growth, liver and heart disease, stroke, and aggression

Beta-alanine Intramuscular calcium transport and pH buffering

Yes Moderate- high

No Seems to be most applicable to high-intensity activities involving anaerobic glycolysis

Beta-hydroxy-beta- methyl butyrate (HMB)

Prevents protein breakdown and enhances synthesis; increases strength; improves body composition

Yes Moderate- high

No Long-term effects unknown; benefits appear to decline with continued use

Caffeine Stimulates sympathetic nervous system, enhances alertness and muscle excitability

Yes Moderate No Can cause irritability, nervousness, and gastrointestinal distress

Chromium Increases muscle mass; decreases fat mass; improves blood glucose and lipid levels

Yes Low No Sufficient amounts can be consumed in the daily diet

Conjugated linoleic acid (CLA)

Increases production of growth hormone; weight loss; fat loss; increases muscle mass

Some Low No Most research showing benefits was conducted on animals; watch for gastric/intestinal distress

Creatine monohydrate Increases anaerobic output (strength/ power) in events lasting 6 seconds to 4 minutes

Yes Moderate- high

No Long-term effects (> 5 years) still unknown

Human growth hormone

Increases muscle mass, strength, and power; decreases fat mass

Yes High Yes Causes pathological enlargement of organs and increases risk of chronic disease

Medium-chain triglycerides (MCTs)

Increases energy and muscle mass; decreases fat mass

Yes Low No Side effects often include intestinal cramping and diarrhea.

Multivitamin/mineral Supplies essential vitamins and minerals to athletes for optimal health and performance

Yes Moderate No Look for supplements containing no more than 100–200% of the Daily Value.

Nitric oxide boosters Increases nitric oxide levels in body, thus improving blood flow; aids in muscle growth

Yes Moderate No Results preliminary and equivocal; long-term risks unknown

Protein powder/bars Increases strength; aids in muscle growth and development

Yes Low- moderate

No Effective only for athletes who are protein deficient; watch for other added ingredients

256 SECTION 1 The Basics of Sports Nutrition

Food for Thought 9.2

You Are the Nutrition Coach

Apply the concepts from this chapter to several case studies.

Table 9.10

Common Nutritional Ergogenics Used by Team Sport Athletes

Supplements (other names)

Claimed action Human research

Potential Banned Comments/Concerns

Androstenedione Increases testosterone; increases muscle mass, strength, and power

Yes Low Yes Research does not support claims; may increase estrogens in body

Beta-hydroxy-beta- methyl-butyrate (HMB)

Anticatabolic; spares muscle mass; increases muscle mass and strength

Yes Moderate-high No Possible effect in the untrained; benefits appear to decline with continued use

Branched chain amino acids (BCAAs)

Increases muscle endurance; serves as an anticatabolic

Yes Moderate No No consistent support of endurance effects but some potential as an anticatabolic

Caffeine Boosts metabolism; increases free fatty acid levels in blood; enhances endurance performance

Yes High No Can cause gastric upset and nervous irritability

Creatine monohydrate

Increases anaerobic power; increases strength

Yes High No Research supports claims. May cause diarrhea; long-term effects unknown

Dehydroepi andro- sterone (DHEA)

Prohormone; increases testosterone levels; decreases fat; builds muscle mass, strength, and power

Yes Low-moderate Yes Research does not support claims in young trained athletes; female athletes may experience increased androgen levels and decreased HDL levels and insulin sensitivity

Ephedrine (ma huang/ephedra)

Increases metabolism; suppresses hunger; decreases body fat

Yes High Yes No longer sold over the counter due to reported adverse side effects

Inosine Enhances ATP levels, thereby increasing anaerobic power

Yes Low No Supplementation can elevate uric acid levels and thus cause gout

Ornithine and arginine

Increase release of growth hormone; increase muscle mass

Yes Low No No research supports that amino acids increase growth hormone levels

Table 9.11

Common Energy Drinks

Product (container size)

Sugar (g)

Calories Caffeine (mg)

Sodium (mg)

Carbon- ation

Thiamin (%DV)

Niacin (%DV)

Pantothenic Acid (%DV)

Vitamin B6 (%DV)

Vitamin B12

(%DV)

Riboflavin (%DV)

AMP Energy Original (473 mL)

58 220 142 140 Yes — 20 20 20 20 40

Five (5)-Hour Energy (57 mL)

0 4 157 18 No — 150 — 2000 8333 —

Full Throttle (473 mL)

58 220 200 160 Yes — 200 50 200 200

Jolt (705 mL) 88 353 280 88 Yes — 6 6 200 — —

Monster (473 mL) 54 200 240 360 Yes — 200 — 200 200 200

NOS Energy Drink Original (473 mL)

53 210 160 410 Yes — — — 200 200 —

Red Bull (250 mL) 27 110 80 200 Yes — 100 50 250 80 —

Rock Star (473 mL) 62 260 240 110 Yes — 200 200 200 200 —

Chapter 9 Nutritional Ergogenics 257

many popular products. Currently, energy drinks are not recommended for any athlete, at any time.

Regardless of the demands of a particular sport, there are nutritional ergogenic aids available that claim to enhance performance. Although some supplements/ nutritional ergogenics do have potential, it must be understood that research evidence on most is far from

conclusive. In addition, even fewer nutritional aids have been evaluated in regard to long-term use and associated side effects. Nutrition professionals need to be able to pro- vide athletes with up-to-date information so that they can make educated decisions regarding the use of nutri- tional ergogenics based on grounded information and not on manufacturers’ claims.

258 SECTION 1 The Basics of Sports Nutrition

The Box Score Key Points of Chapter

n An ergogenic aid is anything that enhances a per- son’s ability to perform work. Ergogenic aids can take many different forms: physiological, biome- chanical, psychological, pharmacological, and nutritional.

n According to DSHEA, to be categorized as a dietary supplement, a substance should not be intended to be used as a food or sole item of a meal and must contain one or more of the following dietary ingre- dients: vitamin, mineral, herb or other botanical, amino acid, dietary substance to supplement the diet, or concentrate, metabolite, constituent, extract, or combination of any of the above ingredients.

n Dietary supplements do not require FDA approval and do not go through the same rigorous testing and scientific approval process as pharmaceutical drugs. Athletes need to be aware of the possibility that the supplement they take could contain a banned sub- stance or could pose a health risk if consumed in conjunction with other supplements or medications.

n Good manufacturing practice guidelines are being developed to help ensure that safety and quality control measures are used during the production of dietary supplements. However, supplement mak- ers are not required to follow these practices. As a result, athletes should purchase products displaying the verification seals of one of the US supplement certification programs, all of which ensure prod- uct quality and some which also test for banned substances.

n One of the best ways to determine whether any peer-reviewed research has been conducted on a nutritional ergogenic aid is to log into a university or college library website and search one of several literature databases. Some of the more common

databases that include journals covering research in the areas of sport nutrition are MEDLINE/PubMed, CINAHL, and SportDiscus.

n Other excellent sources of information are the World Anti-Doping Agency (WADA) and the United States Anti-Doping Agency (USADA), which provide a wealth of information on banned substances, the latest information releases on various nutritional aids, and contact information for questions.

n Doping is the practice of enhancing performance through the use of foreign substances or other arti- ficial means. Doping is banned in most sport com- petitions. Unfortunately, doping has become an epidemic in sports, which presents risks not only to the health of athletes, but also to the basic tenet of fair play in competition.

n Endurance athletes should fully evaluate any sup- plement before purchasing and ingesting it. Some products are well researched and highly benefi- cial, whereas others are expensive, ineffective, and potentially harmful.

n Numerous nutritional ergogenic aids are being used by strength and power athletes. Unfortunately, few of these products have been proven to be effective, and most that have are banned from use by sports organizations.

n Use of nutritional ergogenic aids in team sports is as varied as the physical demands of the different posi- tions. Nutritional ergogenic aids that boost muscle building, enhance strength/power, and delay fatigue are prevalent. Athletes must be educated as to the risks and benefits of each as well as to whether their use is banned. Failure to do so can have ramifica- tions affecting the entire team.

Study Questions

1. Define ergogenic aid and discuss the various types of ergogenic aids. What are some examples of each type?

2. What does the acronym DSHEA stand for? What are the ramifications of DSHEA in regard to the use and safety of certain ergogenic aids?

3. What tools does a sports nutrition professional have available to research information about old or new nutritional supplements and other ergogenic aids?

4. Discuss why the statement “buyer beware” is appropriate, particularly for athletes.

5. What roles do the FDA and FTC have in regard to dealing with dietary supplements?

6. List four nutritional ergogenics that might be encoun- tered when working with endurance athletes.

7. List two nutritional ergogenic aid categories that strength athletes are likely to use or to have ques- tions about.

8. Identify one common nutritional ergogenic used by team sport athletes. Discuss the need for and effectiveness of this type of supplement for team sport and other athletes.

Chapter 9 Nutritional Ergogenics 259

9. What is the difference between nutritional sup- plements that are classified as anabolic versus anticatabolic?

10. What is the placebo-controlled study, and why is it important that research involving ergogenic aids con- trols for it?

11. Define doping. What world organization was formed in 1999 to prevent it?

12. What is CINAHL, and how might a sports nutrition professional use it?

13. An athlete asks you about a nutritional supplement with which you are not familiar. How would you research the supplement to become well versed in its purported actions, side effects, legality for sport, and so on?

References

1. 103rd Congress. Public Law 103-417. Dietary Supple- ments Health and Education Act of 1994.

2. Gahche J, Bailey R, Burt V, Hughes J, Yetley E, Dwyer J, Picciano MF, McDowell M, Sempos C. Dietary sup- plement use among U.S. adults has increased since NHANES III (1988–1994). NCHS data brief, no 61. Hyattsville, MD: National Center for Health Statis- tics. 2011.

3. Dickinson A, Blatman J, El-Dash N, Franco JC. Con- sumer usage and reasons for using dietary supple- ments: report of a series of surveys. J Am Coll Nutr. 2014;33(2):176–182.

4. Outram S, Stewart B. Doping through supplement use: a review of the available empirical data. Int J Sport Nutr Exer Metab. 2015;25:54–59.

5. Lun V, Erdman KA, Fung TS, Reimer RA. Dietary supple- mentation practices in Canadian high-performance athletes. Int J Sport Nutr Exer Metab. 2012;22:31–37.

6. Froiland K, Koszewski W, Hingst J, Kopecky L. Nutri- tional supplement use among college athletes and their sources of information. Int J Sport Nutr Exerc Metabol. 2004;14(1):104–120.

7. Food and Drug Administration. Final rule declaring dietary supplements containing ephedrine alkaloids adulterated because they present an unreasonable risk. Federal Register. 2004;69:6787–6854.

8. Rados C. Ephedra ban: no shortage of reasons. FDA Consum Mag. 2004;38(2):6–7.

9. Agency for Healthcare Research and Quality. Ephe- dra and ephedrine for weight loss and athletic per- formance enhancement: clinical efficacy and side effects. File inventory, Evidence Report/Technol- ogy Assessment Number 76; AHRQ Publication No. 03-E022; 2003.

10. Soni MG, Carabin IG, Griffiths JC, Burdock GA. Safety of ephedra: lessons learned. Toxicol Lett. 2004;150:97–110.

11. Maughan RJ. Contamination of dietary supple- ments and positive drug tests in sport. J Sports Sci. 2005;23(9):883–889.

12. Geyer H, Parr MK, Koehler K, Mareck U, Schanzer W, Thevis M. Nutritional supplements cross-contami- nated and faked with doping substances. J Mass Spec- trom. 2008;43(7):892–902.

13. Judkins C, Hall D, Hoffman K. Investigation into sup- plement contamination levels in the US market. 2007. Available at: http://pop.supplementsafetynow. org/files/pdfs/HFL-supplement-research-report.pdf. Accessed November 13, 2015.

14. Geyer H, Braun H, Burke LM, Stear SJ, Castell LM. A–Z of nutritional supplements: dietary supplements, sports nutrition foods and ergogenic aids for health and per- formance—Part 22. Br J Sports Med. 2011;45(9):752–754.

15. Antonio J, Stout JR. Sports Supplements. Philadelphia, PA: Lippincott Williams & Wilkins; 2001.

260 SECTION 1 The Basics of Sports Nutrition

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The Practical Application of Sports Nutrition This section provides an overview of the implementation of sports nutrition guidelines as they apply to nutritional consultation; weight management; endurance, strength/power and team sport athletes; and special populations. The final chapter includes a discussion of how to become a sports dietitian and potential job opportunities.

Chapter 10 Nutrition Consultation with Athletes

Chapter 11 Weight Management

Chapter 12 Endurance and Ultra-Endurance Athletes

Chapter 13 Strength/Power Athletes

Chapter 14 Team Sport Athletes

Chapter 15 Special Populations

Chapter 16 Jobs in Sports Nutrition

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Key Questions Addressed 1. Why is nutrition consultation and communication with athletes important?

2. How much do athletes know about sports nutrition?

3. Who provides nutrition assessment and education to athletes?

4. How does the consultation process with athletes begin?

5. What is a diet history?

6. How are food records analyzed?

7. What are the steps for the initial consultation with the athlete?

8. What are the steps for a follow-up consultation with the athlete?

9. What should walk-in or short sessions with athletes involve?

10. Are there any concerns about the confidentiality of the health, nutrition, and exercise information provided by the athlete?

You Are the Nutrition Coach Jennifer is a freshman and plays shortstop on her college softball team. Her coach thinks that she has the skill to be a starter her sophomore year. She is thin and has a hard time hitting home runs, despite consistently hitting over .325 for the past three seasons of play in high school. Her coach feels that if she were to gain some muscle mass and strength, her home-run hitting would improve, thus securing the starting position next year. Jennifer agrees but is also concerned about gaining too much weight. She decides to consult with the sports dietitian at her college to develop a plan to gain muscle mass and a small amount of weight.

Questions • What information would you like to have Jennifer bring to the first consultation session?

• How do you determine whether Jennifer is ready to make the changes in dietary intake needed to produce weight gain?

• What type of follow-up and continued nutrition consultation would you recommend for Jennifer?

Nutrition Consultation with Athletes

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Why is nutrition consultation and communication with athletes important? Athletes need coaches to help them train to succeed in their sport. They need athletic trainers to help them pre- vent and rehabilitate injuries that may occur during sport activities. Athletes are not expected to know how to pre- vent injuries or train appropriately on their own. However, it is often assumed that athletes know about nutrition and know how to eat for improved sport performance. Simi- lar to working with a coach or trainer to improve sport- specific skills, gaining education or seeking consultation about nutrition can help improve athletes’ sport perfor- mance. Unfortunately, many athletes have had limited nutrition education, gaining no further knowledge than the information presented during K–12 classes. Some ath- letes are fortunate enough to have coaches or parents who are knowledgeable about good nutrition and how it affects sport performance. Often, access to a sports dieti- tian with expertise specifically in sports nutrition is lim- ited. However, for all athletes, acquiring the knowledge and skills that support good nutrition behaviors can help individuals meet their sport-specific goals.

The role of sports nutrition in improving sport perfor- mance has been well documented. The well-hydrated and well-nourished athlete who pays attention to dietary intake before, during, and after workouts/competitions can gain a competitive edge over opponents. Therefore, empowering athletes with nutrition education is essential to any indi- vidual or team athlete. Educational opportunities can be provided in team sessions, in individual consultations, on the playing field, and by giving athletes information about credible sports nutrition resources. Written educational materials designed specifically for a particular sports team or athlete can be valuable resources initially and for future reference. Communicating messages appropriately that meet the athlete’s needs, goals, and lifestyle will help the athlete be successful in making dietary changes. Regard- less of the format of the communication, it is important that athletes receive accurate and timely nutrition infor- mation to improve their sport performance.

This chapter reviews why athletes need nutrition education, who should provide nutrition assessments and educational sessions, common information-gather- ing methods, consultation, and sport-specific nutrition planning. Information about and examples of nutrition analysis, the recording of dietary history, how to provide successful individual consultations, and how to develop interviewing skills are provided. An example consultation using an athlete case study near the end of the chapter can help the learner piece all of the communication con- cepts together.

How much do athletes know about sports nutrition? Athletes who train, compete, and socialize together often obtain their nutrition information from each other. They also get nutrition information from coaches, trainers, and college courses. However, many athletes lack accurate and up-to-date knowledge of the nutrition practices that can enhance sport performance. Most athletes are aware of general nutrition concepts for overall health, but struggle with sport nutrition specifics.

A study conducted by Jonnalagadda et al.1 on the dietary practices, nutrition education, and attitudes of freshman football players at an NCAA Division I school reported the following:

• Sixty-one percent of these athletes believed that pro- tein is the main source of energy for working muscles.

• Seventy-one percent disagreed that sports drinks are better than water for replacing fluid losses.

• Sixty-five percent believed that vitamin and mineral supplements increased energy levels. Another study of 330 athletes in various sports in

Division I schools found that athletes had poor knowl- edge of the recommended percentage of total calories for the macronutrients.2 Only 29% identified the correct car- bohydrate intake, 11.8% the correct fat intake, and just 3% knew the correct protein intake. A more recent study of the dietary practices of NCAA Division I football play- ers indicated that nutritional knowledge is still poor.3 In regard to hydration, Nichols et al. reported that athletes had adequate general knowledge but lacked information on appropriate behaviors for consuming sports drinks.4

The study of 330 Division I athletes also surveyed ath- letes to determine whether and where athletes received sports nutrition information.2 They found that 55% had received nutrition information or counseling in their col- lege careers (60% of the women and 49.5% of the men). Most of the information was distributed by the strength and conditioning coaches (21.9%), athletic trainers (19.0%), or university classes (12.5%), and 10% of the education was provided by dietitians. Similarly, Burns et al. report that athletes in several different sports at eight NCAA Division I universities received their nutrition information primar- ily from athletic trainers (39.8%) and strength coaches © iofoto/Shutterstock, Inc.

264 SECTION 2 The Practical Application of Sports Nutrition

(23.7%).5 Coaches, athletic trainers, dietitians, and others working closely with athletes all should work together to provide accurate nutrition information to athletes.

A study of a Division I hockey team revealed that many hockey players obtain their information from their peers.6 In this study, the freshman players observed the dietary intake of and comments from the older players on the team and subsequently modeled their eating style after these more experienced players. Fortunately, the older players in this study chose lower-fat, more nutri- ent-dense foods. Even though these older players did not have formal nutrition education, they passed healthful eating and nutrition information on to the younger play- ers. This modeling behavior worked well in this instance because the older players made food choices that bene- fited their health and sport performance. However, if mis- information is passed along by more senior members of the team, the entire team could be making food choices that are not optimal for sport performance. Some form of traditional education about sports nutrition practices led by knowledgeable staff, followed with peer team support and well-respected role models, will help provide accu- rate information to sports teams and individual athletes.

Who provides nutrition assessment and education to athletes? Athletes can benefit from nutrition education from a vari- ety of sports professionals. Coaches have a significant influence on athletes and can affect their knowledge of nutrition and encourage healthy nutrition behaviors. Ath- letic trainers often have the most contact with athletes, especially an athlete who is injured or needs regular tap- ing, ice, or other daily treatments pre- and postpractice. Strength and conditioning coaches also have regular con- tact with athletes and work with them to improve sport performance with proper training regimens. Registered and licensed dietitians (RDs and LDs) can provide an in- depth assessment of an athlete’s current nutrition status; calculate specific calorie, macronutrient, and micronu- trient goals; aid in meal planning/cooking tips; generate proper hydration schedules; and address specific health- related nutrition questions/concerns, thus making RDs and LDs valuable resources for athletes. The involvement of an RD or LD is also essential to the athlete with medical complications such as diabetes, anemia, weight control issues, or an eating disorder.

All of these professionals can and should provide basic nutrition information to athletes; however, the extent to which information and recommendations are disseminated will vary based on each person’s qualifi- cations. Coaches, athletic trainers, and strength/condi- tioning coaches typically have a high credibility rating with athletes, making them valuable nutrition educa- tors for players. However, most coaches, athletic trainers, and strength/conditioning coaches do not have a college

degree in dietetics or nutrition certifications and there- fore are qualified to educate athletes only on information that is considered “public domain.” There is a plethora of public domain information available that is provided by government agencies and research organizations geared for sports professionals working on improving the nutri- tion status of athletes. Examples of public domain infor- mation include the following:

• MyPlate food guidance system—both print and online information

• Dietary Guidelines for Americans • Information in position papers published by major

nutrition and sport organizations such as the Ameri- can College of Sports Medicine, the National Athletic Trainers Association, and the Academy of Nutrition and Dietetics

• Nutrition information found in textbooks and scien- tific peer-reviewed journals

• Food and nutrition information found on product labels, websites, and printed brochures The key for any individual working with athletes,

regardless of licensure and registration, is to provide nutrition education to athletes using accurate, scientif- ically based information. Without a license, individuals can cross legal and ethical boundaries when providing medical nutrition therapy. Forty-six states currently have statutory provisions regarding professional regulation of dietitians and/or nutritionists.7 The number of states that have licensure laws will change as new legislation is passed at the state level. These laws provide legal defi- nitions of what type of nutrition assessment and edu- cation can be conducted by non-licensed professionals and what cannot be provided unless the individual is licensed. Most licensure laws for dietitians are similar to other allied health professionals, such as athletic trainers, physical therapists, pharmacists, and nurses. The purpose of licensure is to help the public find qualified and trained professionals who have completed minimum education requirements, maintain their education in a timely man- ner, and have passed an exam that verifies a high level of knowledge and proficiency in their profession. Licensure protects the public against fraudulent practices and also allows the state to have regulatory authority over these professions.

In states where licensure is mandated for dieti- tians, the term dietitian or nutritionist may be licensed. That means that only a registered dietitian who meets the qualifications set by the state to obtain a license can use the term dietitian or nutritionist in his or her title or practice. The states also legislate what types of assess- ments or education can be offered by licensed dieti- tians only. In most cases, licensed, registered dietitians are the only professionals allowed to provide nutrition assessments and medical nutrition therapy to individu- als. This means that licensed and registered dietitians are the only professionals allowed to provide athletes with a full assessment of their dietary intake, medical

Chapter 10 Nutrition Consultation with Athletes 265

nutrition needs, and individual recommendations based on those assessments. When athletes need this type of assessment, licensed and registered dietitians should be consulted.

In this chapter, the majority of information related to nutrition consultations with athletes is provided as exam- ples of a registered and/or licensed dietitian performing the assessment. Certainly many additional sports profes- sionals will consult with athletes about their nutrition needs and provide some education regarding nutrition and sport performance. The information in this chapter will be valuable for individuals interested in obtaining the registered dietitian (RD) credential as well as for other professionals working with athletes in primary roles that are not in the nutrition field but relate to the overall health and physical performance of athletes.

How does the consultation process with athletes begin? Ideally, the athlete will document his or her personal health history and dietary intake information prior to the first nutrition education session. The information gathered should include basic demographics, including contact information, a health history questionnaire, a list of current medications and supplements, a food record, and a training or exercise log. If this information is col- lected and reviewed prior to the first visit, it can be evalu- ated more thoroughly, and specific suggestions could be generated during the first visit with the athlete. Each of these pieces of information adds value to the assessment and consultation process; collectively, they provide sports nutrition professionals with the information needed to develop a sound nutrition plan for the athlete.

What is a diet history? A diet history is the most comprehensive form of dietary intake data collection. It is an interview process that reviews recorded dietary intake, eating behav- iors, recent and long- term habits of food consumption, and exercise patterns. A skilled and trained interviewer is needed to take the diet his- tory. Most dietitians use a form of diet his- tory interview in every individual assessment with a new client. This process is time consuming but well worth the effort.

A direct interviewing process can help the dietitian take a diet history relatively quickly. In this process, a

combination of open- and closed-ended questions can pace the interview within the time allotted for the ses- sion. Using an initial health history questionnaire and any food records completed, a set of clarifying questions can be formulated prior to the first visit. If the ques- tionnaire and food records are brought in on the day of the visit, the dietitian can quickly scan the informa- tion and ask questions in the order of the questionnaire and food record. The questions and format will vary for each athlete. Most sessions are time limited, and the information must be obtained as quickly and efficiently as possible to allow for education, meal planning, and goal setting.

Assessing dietary adequacy should include assess- ment not only of food intake data, but also biochemical and anthropometric parameters. Height, weight, body composition, and body mass index should be compared to appropriate standards. Laboratory assessments such as hemoglobin, albumin, electrolytes, and any clinical diagnoses should also be considered when making a complete dietary assessment. Clinical observations of the athlete’s skin, hair, and nails can provide informa- tion necessary to make accurate assessments of usual dietary intake and adequacy. Dietary adequacy should be assessed and diet plans formulated based on the total- ity of the evidence, not on dietary intake data alone.8 Information about and examples of tools used in the diet history are described in the following sections in this chapter.

What is a health history questionnaire? The health history questionnaire asks a variety of ques- tions about current health, past medical history, and daily health and wellness topics. These may have implications for nutrition care and should be addressed as part of the sports nutrition consulta- tion. It is often assumed that ath- letes are healthy and are not likely to have medical conditions. However, many high- level athletes and recreational athletes do have underlying medical issues that may affect nutri- tion status and thus dietary recommendations. Informa- tion about chronic diseases, current or past injuries, surgeries, and regular medications helps nutrition profes- sionals make a thorough assessment of the athlete’s needs and subsequently develop appropriate nutrition recommendations. A sample health and nutrition history questionnaire is shown in FIGURE 10.1 .

diet history The most compre- hensive form of dietary intake data collection. It involves an interview process that reviews recorded dietary intake, eating behaviors, recent and long-term habits of food consumption, and exercise patterns. A skilled and trained interviewer is needed to take the diet history.

health history questionnaire A survey that includes a variety of questions about current health, past medical history, and other daily health and wellness topics. The information collected in the health history questionnaire about chronic diseases, current or past injuries, sur- geries, and regular medications help nutrition professionals make a thor- ough assessment of the athlete’s needs and subsequently develop a sound nutritional program.

266 SECTION 2 The Practical Application of Sports Nutrition

Figure 10.1 Sample health and nutrition history questionnaire. Taking a health and nutrition history in the first meeting with athletes helps the dietitian determine any health concerns that should be addressed when developing the nutrition plan. Adapted from Nutrition and Wellness Solutions, LLC, www.nutritionwellnesssolutions.org.

Y N

Health and Nutrition History Questionnaire

The following information is confidential and will not be disclosed to anyone outside of this organization.

Name:____________________________________ Date:______________________ Home Phone #:____________________________ Cell Phone #:________________ Email address:________________________ ______

Address:______________________________________________________________

Birth Date:___________________ Height:______________ Weight:______________

Medical History Indicate if you currently have or ever had any of the following:

Condition Explanation:

Asthma yes no ________________________________________________________________ Anemia yes no ________________________________________________________________ Cancer yes no ________________________________________________________________ Diabetes yes no ________________________________________________________________ High blood pressure yes no ________________________________________________________________ High cholesterol yes no ________________________________________________________________ Heart disease yes no ________________________________________________________________ Heart attack yes no ________________________________________________________________ Heart surgery yes no ________________________________________________________________ Kidney disease yes no ________________________________________________________________ Osteoporosis yes no ________________________________________________________________ Stomach/GI disorder yes no ________________________________________________________________ Stress fracture yes no ________________________________________________________________ Other__________ yes no ________________________________________________________________

Do you have a family history of any of the above? Y N If yes, please explain:

Please list any medications you are currently taking and the reason for taking them:

Do you take vitamin or mineral supplements? If so, list the type and amounts: ___________________________________________

Do you take any supplements to try to boost athletic performance or increase energy (e.g., protein supplements, creatine,Vitamin B12)? If so, list the type and amounts: ________________________________________________________________________

Do you smoke? If so, how much?_________________________

Are you currently engaging in an exercise program? Y N Type of Exercise:

Frequency: (times/week)____________Length of Session: (minutes/hours)___________ Intensity: (light, mod, hard)________

Do you consider yourself overweight? Y N W ould you like to lose weight? Y N

Have you ever been on a diet for weight loss? Y N If so, please explain: (i.e., when did you diet/join weight loss program, type of program, how much weight lost/regained)

Have you ever purposefully restricted food intake and obtained what you or others felt was an extremely low or unhealthy weight? Y N If yes, please explain:

Have you ever thrown up, used laxatives, fasted or exercised for extremely long periods to try to lose weight? Y N If yes, please explain:

Please circle the typical meals and snacks that you consume on an average day: Breakfast Snack Lunch Snack Dinner Snack Other

Adapted from the National Institute for Fitness and Sport, www.nifs.org.

Chapter 10 Nutrition Consultation with Athletes 267

In addition to information about current medical con- ditions, information about family history of major chronic illnesses should also be obtained. Nutrition profession- als need to look at the athlete as a whole and make the best nutrition recommendations possible for the athlete’s health and sport performance. This may include provid- ing assessment and education on medical nutrition top- ics when the need arises. For example, a college athlete states on his health history that he has no chronic ill- nesses but has a paternal and maternal history of diabe- tes. Nutrition education for this athlete should focus on the athlete’s goals for sport performance, as well as on information about diabetes prevention.

A listing of medications is also valuable informa- tion to obtain from athletes. Some medications may have drug–nutrient interactions. Others may need to be taken with food or on an empty stomach. This may affect the timing of meals and snacks, thus affecting pre- and postexercise food intake. Reviewing current medications can also provide the dietitian with insight about medical conditions that the athlete may have forgotten to dis- close. For example, a diuretic on the athlete’s medica- tion list could suggest that he or she has hypertension or some other cardiac condition. Inquiring about the rea- sons for taking the diuretic and how often it is used will clarify the effects the medication may have on hydration status and medical nutrition management of the athlete. Athletic trainers and coaches working daily with athletes also need to be aware of medications in case of emergen- cies. These professionals play a pivotal role in helping athletes maintain their medication regimen and moni- toring the effects of these medications on sport perfor- mance. In addition, athletic trainers, coaches, and the team physician should be aware of the list of banned substances for athletes that may be present in various medications.

Additional health and wellness information gath- ered in a health history questionnaire provides more information about the nutrient needs of the athlete. Routine questions about smoking habits and consump- tion of alcohol should be included on the health history questionnaire. Athletes are less likely to smoke, but if they do, smoking may increase the need for some nutri- ents, such as vitamin C. Alcohol consumption can add extra calories with little nutrient value and may play a role in the discussion about meeting the athlete’s goals. Information about current exercise can be requested on a health history questionnaire or within a more detailed exercise log.

Many athletes seek the assistance of a dietitian because they want to change their weight or body com- position. Some may desire weight gain, whereas others desire weight loss. Others may just want to alter their body fat percentage without a change in weight. There- fore, the dietitian should obtain information on the ath- lete’s current height, weight, and body composition and assess how the athlete feels about his or her current

weight before determining whether the desired weight loss is appropriate. If an athlete states that he consid- ers himself overweight, but the anthropometric measure- ments suggest otherwise, the dietitian knows to proceed with caution. Athletes who are overly concerned about their weight may be at risk for developing eating disor- ders or eating behaviors that inhibit optimal sport perfor- mance. Information about past and current dieting and weight-loss practices also can be useful in the initial con- sultation session.

Why is an inquiry about supplement use important? Many athletes use one or more dietary supplements on a regular basis. There are two main issues to explore regard- ing an athlete’s use of supplements. First, a listing of all supplements currently being used helps determine safety and efficacy for the athlete. Some supplements may not be safe for regular consumption, may not be proven effec- tive, or could be banned by several sports organizations. Sport nutrition professionals need to know which sup- plements might fall into these categories and share that information with the athletes. The second question about supplements is to determine why the athlete is taking each of the supplements. This can provide clues about the athlete’s goals and his or her drive to achieve these goals. If the athlete is taking three different weight-gain and protein supplements several times each day, this is a sig- nificant clue that the athlete has a strong desire to build muscle mass. In addition, there may be myths about cer- tain supplements that need to be addressed with individ- ual athletes. Taking a thorough history of past and present supplement use will help guide the discussion and edu- cation necessary to help the athlete remain safe when consuming supplements.

Many athletes take a multivitamin and mineral sup- plement or single vitamins or minerals. Specifically ask- ing about vitamin and mineral supplement use may be necessary because many athletes and the general popu- lation often do not recognize vitamins and minerals as supplements. Although taking a multivitamin/mineral supplement in most cases is appropriate and for some athletes beneficial, taking mega-doses of single vitamins or minerals may not be safe. Follow-up questions to clar- ify the daily doses of vitamins and minerals along with a review of food records will help determine whether these supplements are necessary and safe and whether doses can be decreased or discontinued.

What type of food intake information should be obtained from the athlete? Any type of direct food recording provides valuable infor- mation for the initial consultation. Reviewing the types and amounts of food usually consumed, when and where meals are consumed, and how they are prepared provides a wealth of information to begin the evaluation of cur- rent intake. This information will be used to formulate

268 SECTION 2 The Practical Application of Sports Nutrition

a nutrition plan for the athlete. A variety of methods are available for collecting food intake data. The most com- mon is direct recording of food intake using a food record. The athlete is asked to keep a 1-, 3-, or 7-day food record of all foods and bev- erages consumed in the designated time period. Docu- mentation of intake throughout the day should be recorded as soon as possi- ble after consump- tion to obtain the most accurate infor- mation. The recall method requires the athlete to remember all foods and bever- ages consumed in a distinct period of time, usually within the past day. This 24- hour dietary recall can be obtained in the first session if food records are not avail- able. Another tool is a food frequency ques- tionnaire that asks the athlete to record how often com- mon foods are eaten on a daily, weekly, monthly, or even yearly basis. All of these tools can be helpful to the dietitian and may be used separately or collectively to obtain sub- stantial information about the athlete’s food intake. Each of these methods has advantages and disadvantages.9,10 The three methods are described in more detail in the following sections.

How are food records used in nutrition consultation? The first step for nutritional assessment of the athlete is to gather accurate information about food intake. The nutrition plan developed later in the consultation will be based partly on this initial information. The goal of any food recording is to gain specific information about foods consumed by the athlete. A food record kept prior to the first visit decreases the reliance on memory to determine recent food intake.

The number of days an athlete should keep a food record depends on several variables. Many athletes will not take the time or see the need for recording food intake. A 1-day food record gives a snapshot view of only 1 day of eating patterns. The athlete is asked to write down

foods eaten in a “typical” day. The athlete has to deter- mine which day is typical. This could be a weekday when practices are intense, a school day, or a weekend day. Although this 1-day record provides some dietary intake information, additional recorded days will provide better information about usual dietary intake.

A 3-day food record provides more information about foods eaten and consumption pattern differences throughout a week than a 1-day record, but is not as time intensive as a 7-day log. A 3-day food record is most useful when two weekdays and one weekend day are recorded. Often, individuals eat differently on weekdays than on the weekends. Training schedules, access to meals, and time for meal preparation may vary on dif- ferent days of the week. In general, a 3-day food record will provide an estimate of nutrient intake that can be used to develop a nutrition plan. This may not be an accurate reflection of long-term nutrient intake, but it does provide a reliable assessment of short-term pat- terns that is valuable for conducting an intake evaluation and subsequent meal plans.

A sample completed food record is shown in FIGURE 10.2 . To help cue the athlete to record a thorough and accu- rate food log, sections for the date, time of meals/snacks, amount and type of food consumed, feelings or emotions about food, and location should be included on the record- ing form. Instructions on how to complete the food record should be included for the athlete, such as a sample 1-day record with examples of the amount of detail requested when recording dietary intake. Instructions on determin- ing the amount of each food eaten, specific brands chosen, restaurant names if dining out, and where the food was eaten are necessary for cueing the athlete. If possible, the dietitian should review the recording process on the phone or have the information available in detail on a website that the athlete can access. This will help ensure the most accurate food recording prior to the first session.

Obtaining a complete and accurate food record from an athlete can be a challenge. Athletes who are not accus- tomed to keeping a food journal may forget to record every food eaten each day. Even the most conscientious ath- letes may forget to write down a snack or beverage con- sumed. The accuracy of the food record is questionable in many cases. Several studies have documented a high incidence of under-reporting of food intake.11,12 A number of studies also have reported variations in nutrient intake based on the day of the week13,14 or appetite fluctuations, especially related to physical activity or menstrual cycle changes.15,16

Many factors affect day-to-day variations in dietary intake.9 Some athletes will eat the same thing for break- fast and lunch every day of the week, and only have vari- ety with the evening meal and snacks. Other athletes have wide variations in meal intake daily. The day of the week is almost certain to affect intake based on individ- ual training and competition schedules. Food intake dur- ing the competitive season versus the off-season may

24-hour dietary recall A method of collecting food intake informa- tion that requires the athlete to remember all foods and beverages consumed within the past day (i.e., 24 hours). Although not the most accurate way of collecting food intake information, it can provide an idea of an athlete’s nutritional intake in the first consultation ses- sion if other types of food records are not available.

food record The most common method for collecting food intake data. It requires the direct recording of all food and beverage intake over a 1-, 3-, or 7-day period. Documen- tation of intake should occur at the time of consumption or as soon as possible afterward to obtain the most accurate information.

food frequency ques tionnaire A nutritional analysis survey tool that asks an athlete or client to record how often common foods are eaten on a daily, weekly, monthly, or even yearly basis.

Chapter 10 Nutrition Consultation with Athletes 269

influence dietary differences. The season of the year could also have an effect. Less food may be consumed in hot, humid months and more during cold winter months. Ath- letes may have changes in appetite based on their train- ing schedule. During intense training, athletes may not eat as much as in less intense training times. Therefore, a food record ideally covers at least 3 days, combining weekdays and weekends, as well as capturing heavy and light training days.

How is a 24-hour dietary recall used in a nutrition consultation? Even when documented food records are obtained from the athlete, a 24-hour dietary recall can be a valuable tool. The purpose of the dietary recall is to get a complete and detailed picture of what the athlete consumed over

the last 24 hours. In many cases, asking the athlete for a recall of a “typical” day of food intake will also provide information to help with the evaluation of an athlete’s usual intake. The athlete can document all foods eaten in the past 24 hours on a blank 1-day food record. This orga- nizes the informa- tion, making review and evaluation easy. The dietitian can then prompt the

Figure 10.2 Sample 1-day food record. Completing a 1-, 3-, or 7-day food record provides information on specific foods athletes eat each day.

Sample Food Record

1 cup fluid = 8 oz 3 tsp = 1 tbsp

1 pint = 16 oz = 2 cups 4 tbsp = ¼ cup

3 oz meat = size of deck of cards 1 oz cheese = size of three dice

Date:___________________

Time Food/Beverage Amount Location/Feelings

5:30 AM Granola bar Gatorade Cereal (corn flakes) Milk, 1% Cranberry juice cocktail Toast, whole grain Peanut butter Jam Wrap Sandwich: chicken, cheese, vegetables, lite ranch dressing, wheat wrap

8:30 AM

1:00 PM

Lemonade Side salad, mostly romaine lettuce Lite vinaigrette salad dressing Hamburger patty, 93% lean Ketchup, mustard, pickle relish Wheat bun Baby carrots, steamed Potato chips Water Milk, 1% Peanut butter cookies

6:00 PM

9:00 PM

1 bar 1 24-oz bottle 2 cups 2 cups 1 cup 2 slices 2 tbsp 2 tbsp 1 large 4 oz chicken 2 slices cheese 3 tbsp dressing 24 oz 1 cup 1 tbsp 4 oz 1 tbsp each 1 large 1.5 cups 20 chips 12 oz 1 cup 2 large, homemade

Hurrying to practice

Home

Panera Bread Co. Large tortilla, lettuce, tomato, sprouts

Home, hungry after practice

Stressed about doing homework

Please complete the three days of food intake using the attached blank forms. The 3-day food record is designed to give an accurate description of your typical diet. Record 2 weekdays and 1 weekend day. Please eat your typical diet on the days you record. Because the information will be used to plan appropriate dietary changes, it is important that you not change your usual eating pattern. Be as accurate as possible, recording all foods, beverages, and snacks consumed. Provide as much detail as possible on the record including the brand name of foods, restaurants, food preparation method, portion size, and type of food (e.g., fat free, high protein, reduced calorie). Record any comments about where you ate or how you felt when you ate in the location/feelings section. A sample of a 1-day food record is listed below to help you complete your 3 days.

3/15/16

Gaining the Performance Edge

Completing food records provides substantial information for the assessment of the athlete’s dietary intake. A 3-day food record is rec- ommended when assessing dietary intake. It provides enough informa- tion to learn about typical intake patterns without being time inten- sive for busy athletes.

270 SECTION 2 The Practical Application of Sports Nutrition

athlete by asking questions about specific types of foods or beverages consumed, condiments on food, and clari- fication of portion sizes. Using food models can visually aid individuals in correctly estimating the portion size of foods/beverages consumed. Clarifying questions such as, “Did you have anything to drink with that meal?” or, “Did you put anything on your sandwich in addition to the tur- key and cheese?” prompt the athlete to be more specific about all foods consumed. A 24-hour recall is not going to provide a truly accurate picture of what an athlete eats on a regular basis, but it does provide information about general eating habits.

How is a food frequency questionnaire used in a nutrition consultation? Food frequency questionnaires (FFQs) look at intake over a longer period of time than food records and dietary recalls. The FFQ puts foods into broad categories and asks the client to record intake over time. For example, an FFQ may ask, “How often do you consume dairy prod- ucts?” The responses may be daily, weekly, or monthly, and the athlete is asked to write in the number of serv- ings typically consumed in those three time periods. A sample portion of a food frequency questionnaire is shown in FIGURE 10.3 . Many FFQs have been developed to assess a specific population’s intake of a certain type of food or designed by organizations for research purposes, such as the National Cancer Institute Diet History Ques- tionnaire.17 Other FFQs provide a more general view of dietary intake and are best for the information needed to assess athletes’ usual intake over time. When select- ing a food frequency questionnaire, consider an instru- ment that is already validated, provides information on either a group or an individual’s needs, and is appro- priate for the population being assessed.18 FFQs provide information about long-term dietary patterns, which is an advantage as compared to food record data. However, assessing FFQs is time consuming, they can be costly to administer and evaluate, and they may not provide infor- mation specific to the athletic population. If the athlete has time to complete food records and an FFQ, and the dietitian has time to evaluate both tools, using them in combination is valuable. With less available time, food record data is more beneficial in assessing an athlete’s dietary intake.

How is an exercise/training log used in a nutrition consultation? Documentation of how much exercise is completed daily and weekly is essential to any sports dietitian’s assess- ment and nutritional plan.19 The training log is a valuable tool in determining energy expenditure and thus energy needs. It also provides information on the time spent training and competing that may influence food prepa- ration and consumption patterns. Information about the type, duration, and intensity of training provides an even more accurate picture of caloric expenditure.

Figure 10.3 Sample food frequency questionnaire. A food frequency questionnaire captures long-term dietary patterns of intake.

Instructions: 1. Answer each question as best as you can. 2. Put an X in the box that corresponds with your answer. 3. Follow instructions for each question.

1. In the last 12 months, how often did you eat cold cereal?

Never (Go to question 4) 1 time per month 2–3 times per month 1 time per week 2–3 times per week 1 time per day 2 or more times per day

2. When you ate cereal, what type of cereal did you choose most often?

Oatmeal Whole grain Whole grain with dried fruit Granola-type cereal Sugar sweetened

3. When you eat cereal, what is the typical serving size you consume in one sitting?

Less than ½ cup ½ cup ¾ cup 1 cup 1–1½ cups More than 1½ cups

4. In the last 12 months, how often did you drink 100% fruit juice?

Never 1 time per month 2–3 times per month 1 time per week 2–3 times per week 1 time per day 2 or more times per day

Food Frequency Questionnaire

A sample exercise log is shown in FIGURE 10.4 . As with food records, a specific form requesting information regarding daily/weekly exercise and a sample of how the log should be completed will help athletes complete the record in the detail desired. Detailed energy expendi- ture logs that record all activity within a 24-hour period are available; however, these are extremely cumbersome to complete with accuracy and are very time consuming. An exercise log that reveals actual duration, intensity, and type of exercise provides adequate information for devel- oping a nutrition plan that includes nutrition needs for energy expenditure.

Chapter 10 Nutrition Consultation with Athletes 271

Which clinical assessments should be conducted in the initial consultation session? Access to laboratory data and other medical documenta- tion is extremely helpful when consulting with athletes who present with various medical conditions. Nutrition consultations requiring the interpretations of laboratory assessments are regarded as medical nutrition therapy and should be completed by registered and licensed dieti- tians. Laboratory assessment can help to determine an athlete’s nutrition status, which will affect the develop- ment of a nutrition plan. For example, female athletes, especially long-dis- tance runners, have a tendency to develop iron deficiency dur- ing their training and competitive careers. Athletes’ laboratory reports of total iron, hemoglobin, serum

ferritin, and hematocrit levels can help the dietitian eval- uate iron status and thus provide education on ways to improve dietary iron intake if needed. Common laboratory reports often requested by dietitians include electrolyte levels, albumin, prealbumin, total protein, and potentially any clinical laboratory report related to a current disease condition. Dietitians will need detailed glucose monitor- ing values for athletes with diabetes and lipid levels for athletes with known heart disease or dyslipidemia.

Other health/sports professionals may use labora- tory or diagnostic data to evaluate and educate athletes regarding nutrition status. For example, athletic trainers may request radiology reports for athletes with poten- tial stress fractures and MRI reports for any soft or hard tissue injuries. When stress fractures are determined, the athletic trainer and physician may discuss medical as well as nutritional treatment to help the athlete heal. This is an opportunity to talk with the athlete about reg- ular calcium and vitamin D intake and decide whether supplementation would be a helpful adjunct to treatment. The dietitian, physician, and athletic trainers or physical therapists work together as a team to develop the best nutrition and healthcare plan for the athlete based, in part, on the clinical medical information available.

Figure 10.4 Sample exercise log. Keeping track of the time, amount, and intensity level of exercise helps determine energy expenditure.

Gaining the Performance Edge

The initial information gathering for the first session can be extensive or minimal. The amount of time avail- able prior to the first visit and the athlete’s interest in and ability to keep food records and to complete an exercise log will all be factors the dietitian will consider when asking the athlete to collect information before the first visit.

Exercise Log

1 D

2 D

3 D

4 D

Comments/Goals:

Complete the exercise log for each day of the week. Please write down the type of Activities (A), Duration (D) in minutes, and the Intensity level (I) of the exercise. For example: Running, 75 minutes, at 8 minutes per mile or Weight training, 45 minutes, light day.

Week Sunday Monday Tuesday Wednesday Thursday Friday Saturday

272 SECTION 2 The Practical Application of Sports Nutrition

How are food records analyzed? Once the data are collected from the athlete, clarification of the food record will help ensure that the most accurate information is obtained for analysis. In the initial con- sultation, clarifying questions can be asked to help learn more about actual food intake. Often the food consump- tion information is incomplete. The most frequently omit- ted items on a food record include:

• Actual portion sizes • Condiments used • Restaurant or name brand of item • Method of food preparation • Beverages consumed with meals or snacks • Snacks between meals

A sample food record with clarifying questions is shown in FIGURE 10. 5 . Clarification questions such as those listed in Figure 10.5 help jog the athlete’s memory without making judgments about the foods eaten or trying to lead the athlete to add or omit foods during the discussion. The question, “What else did you eat at lunch on Wednes- day?” might sound judgmental to the athlete. The athlete may feel that the dietitian does not believe the informa- tion provided on Wednesday’s food record. Similarly, ask- ing, “Did you have any juice with breakfast?” could lead the athlete to say yes if he or she feels that is the answer the dietitian wants to hear. Asking the question, “Did you

have something to drink with breakfast?” helps clarify the meal without suggesting a particular beverage or making any judgments about the intake.

Information from the food record is most often entered into a nutrient analysis software program. Many software databases are available to calculate the content of the diet to estimate macronutrient and micronutrient values. Some nutrient analysis products are available on the Internet and offer free access to any user. All of these programs perform the mathematical calculations and comparisons to the food database, saving significant time. Books of nutrient composition tables are also available to research a specific food item that may not be available in nutrient databases.

TABLE 10.1 provides a list of software, websites, and books that provide nutrient analysis information. Most computerized nutrient analysis packages come with a stan- dard nutrient database included with the software. Occa- sionally, the purchaser has the option of selecting which database to include in the software package. The database is used to compare the food data input from the dietary records to estimate nutrient intake. The most common database used in software packages is the U.S. Department of Agriculture (USDA) Database for Standard Reference. This database is appropriate for the analysis of diets of people in the United States and reflects typical foods con- sumed. It is regularly updated with new foods and uses

Figure 10.5 Sample food record and clarifying questions. Food recording provides valuable information when developing nutrition plans for athletes. The accuracy of the recording process can be improved by providing a sample record and asking clari- fying questions about the foods eaten during the consultation.

Food Amount Location/Comments Clarifying Question

Breakfast: Juice

How was the chicken cooked—grilled, baked, or fried?

Did you put any dressing on the salad? Were there croutons on the salad?

Nature Valley

Fried Whole grain

At Wendy’s

Just vegetables, no meat or cheese

1 serving

2 glasses 1 bowl

1 cup 2 2 slices 1 big bunch

1 whole Small size 1 small

1 bar

Eggs To ast Grapes

Lunch: Chicken sandwich Frosty Side salad

Snack:

Granola bar

Dinner: Frozen vegetable

lasagna Milk Ice cream

Did you put anything on your toast? How much is a “big bunch” of grapes?

What type of juice did you have?

Did you have one bar out of the two-pack portion, or did you eat both bars? Did you have anything to drink with the granola bar?

Could you estimate the size of the container of lasagna?

Chocolate What size glass of milk? What type of milk did you drink? How big was the bowl? Was it ice cream, frozen yogurt, etc?

Did you eat or drink anything after your evening meal?

At home

Food Record and Clarifying Questions

Chapter 10 Nutrition Consultation with Athletes 273

calculate the nutrient composition. The U.S. food sup- ply is highly fortified and also contains highly processed foods. This is not the case in many other countries. Using an appropriate database matched for the ath- lete’s typical intake will provide a more accurate reflection of nutrient intake.

New food products enter the marketplace daily, and no one database can keep up with the changing food mar- ket. Sports nutrition products are increasing in popularity, and new sports drinks, bars, supplements, and foods are marketed regularly to athletes. Many of these items are not in standard databases. These foods could make up a substantial portion of an athlete’s intake and need to be accounted for in the nutrient analysis. Many software and online analysis databases allow users to add new foods to their own nutrient analysis database. Information from the food label can be added to the database for each new item. Not all micronutrients are required to be listed on the supplement label, so many of them will not be avail- able for the data analysis. There will, however, be calorie, macronutrient, cholesterol, and fiber information on the label of sports-related items or other foods that are not in the database. When working with athletes, nutrition professionals should be prepared to add new foods to the nutrient analysis database to provide the most accurate nutrient analysis.

How do you compare dietary intake to nutrition recommendations? An athlete’s diet can be compared to national standards to help determine nutritional adequacy in a number of dif- ferent ways. Three common ways are to compare intake to the DRIs, to the MyPlate food guidance system, or to the Dietary Guidelines for Americans. In addition, pub- lished data on nutrition intake specific to athletes can be used to compare the intake of similar athletes. There are advantages and disadvantages to all of these methods of assessment, and several can be used together to provide the best assessment of dietary intake.

How can the DRIs be used to assess athletes’ nutritional adequacy? Most frequently, the dietary information obtained from the dietary assessment is compared to the DRI stan- dards. The DRIs include Recommended Dietary Allowance (RDA), Adequate Intake (AI), Estimated Average Require- ment (EAR), and Tolerable Upper Intake Level (UL). Most computerized dietary analysis software uses the RDA or AI data for comparing intake to dietary standards. If the RDA or AI of the athlete’s intake is met, the dietitian can

Table 10.1 Resources for Dietary Analysis

Resource Contact information Comments My Food

Record www.myfoodrecord.com Web-based analysis tool, free

to all Internet users; will save personal data and allows users to add more days; includes an energy calculator

USDA Database for Standard Reference

www.ars.usda.gov/ Services/docs. htm?docid=8964

Large database of foods consumed in the United States; updated regularly; often the database used by computerized nutrient analysis software

Nutritionist Pro

www.nutritionistpro.com Accurate, up-to-date food and nutrient data for complete analysis on over 51,000 foods and ingredients, including brand-name, fast foods, ethnic foods, and enteral products

FitDay www.fitday.com Web-based analysis tool, free to all Internet users but requires setting up a free user account

NutriBase www.dietsoftware.com Commercially available nutrition analysis program for professional or personal use

MyPlate www.choosemyplate.gov Web-based analysis tool, free to all Internet users

Bowes and Church’s Food Values of Portions Commonly Used, 19th ed.

Lippincott Williams and Wilkins Publishers (www.lww.com)

Well-organized book of many common foods listed in standard portion sizes. Includes brand names and some restaurant items. Gives macro- and micronutrient values. Excellent for determining nutrient content of a specific food

the most current Dietary Reference Intake (DRI) tables. The database used is important when selecting software or websites to assess the nutrient content of food record data. The database should be updated regularly, and updates should be included in any software package contract. The nutri- ent information is only as good as the database used to

Gaining the Performance Edge

Assessing athletes’ intake using computer analysis provides detailed information about the various nutri- ents consumed in the diet. Athletes tend to consume sports foods and beverages that typically are not included in standard nutrient data- bases. Software purchased to ana- lyze the diets of athletes should include the option of adding these foods to the database to produce an accurate dietary analysis for all foods and beverages consumed.

Food for Thought 10.1

Dietary Intake Methods and Obtaining Accurate Data

Describe the advantages and dis- advantages of various dietary intake methods, and review a food record for accuracy.

274 SECTION 2 The Practical Application of Sports Nutrition

determine with confidence that the athlete is consuming adequate amounts of the nutrient. When a UL is available, the dietitian should compare that number to each nutri- ent and determine whether too much of any nutrient is being consumed. Using the appropriate DRI values that are available for each nutrient and comparing these to the established RDA or AI are essential to any accurate dietary intake assessment.

How can the MyPlate food guidance system be used to assess athletes’ nutritional adequacy? A quick and easy way to assess overall adequacy of dietary records is to use the MyPlate food guidance system. This can be an excellent, easy guide to help the dietitian and athlete compare the number of servings from each food group consumed to the number recommended. If an athlete is consuming the minimum number of servings in all of the food groups on the plate, there is relatively good assurance that the dietary intake will meet mini- mum recommendations for most nutrients. This does not ensure that an athlete will obtain adequate calories, but may help determine generally healthful food intake with adequate micronutrients. The MyPlate system is an excel- lent tool for any professional trying to quickly assess an

athlete’s dietary intake. However, it is not the best tool for a detailed analysis of current dietary intake.

TABLE 10.2 provides a sample comparison of an ath- lete’s 1-day food intake to the recommended servings from MyPlate. In the example, the athlete’s intake meets or exceeds the minimum number of daily servings for all MyPlate categories, based on a meal plan of 2,200 calories per day. Although meeting the minimum number of serv- ings will provide adequate vitamins and minerals, it may not be enough total calories to meet the athlete’s energy requirements. Additional assessment of energy intake is discussed later in this section.

Can the Dietary Guidelines for Americans be used to assess athletes’ nutritional adequacy? The Dietary Guidelines for Americans are a set of general goals for food intake and dietary comparison developed by the USDA and the Department of Health and Human Ser- vices (HHS). They are intended to help educate Americans about healthful food consumption patterns to reduce the development of chronic diseases such as hypertension, diabetes, cardiovascular disease, obesity, and alcoholism. These are very general guidelines for the average Ameri- can and are tools that all individuals can use to decipher

Table 10.2 Comparing Athletes’ 1-Day Food Intake to the MyPlate Food Guidance System

MyPlate Categories

1-Day food intake Grains Fruit Vegetables Protein foods Dairy/Alternative Oils/Empty calories

Puffed oat cereal, 2 cups 1.5 oz

Milk, skim, 1 cup 1 cup

Raisins, ½ cup 1 cup

Eggs, poached, 2 2 oz

Apple juice, 12 oz 1½ cups

Cereal bar 1 oz

Pita bread sandwich:

Whole grain pita, 1 whole 2.5 oz

Roast beef, 3 oz 3 oz

Tomato, lettuce, cucumber, green pepper

½ cup

Potato chips, 1 oz 2 tsp oils

Iced tea, 16 oz, unsweetened

Vegetable juice, 12 oz 1½ cups

Fruit and yogurt smoothie, small 1 cup 1 cup

Cashews and almonds, 1/3 cup 1 oz

Veggie burger, 1 2 oz

Bun, 1 2 oz

Steamed broccoli and carrots, 1 cup 1 cup

Milk shake, chocolate, 12 oz 1½ cups 2 tsp oils, plus discretionary sugar calories

Daily Total 7 oz 3.5 cups 3 cups 8 oz 3.5 cups 4 tsp oils + some sugars

Chapter 10 Nutrition Consultation with Athletes 275

how their diets match up to healthy guidelines. However, athletes expend more energy and may need or tolerate higher levels of some of the nutrients than the guidelines suggest as an average intake for Americans. This public domain information is valuable for anyone working with athletes on a nutrition plan for general health. Although useful, comparing athletes’ intakes to the Dietary Guide- lines alone is the least useful method for helping to deter- mine the best nutrition plan for individual athletes.

How is energy intake assessed? Energy intake can be determined by using food record analysis data. The total calories consumed for each day or series of days is listed on the food record analysis report. This information can then be compared to the athlete’s estimated energy needs. In most cases, estimating ath- letes’ energy needs is done using one of several predic- tion equations. One of the equations is listed in TABLE 10.3 , where resting energy expenditure (REE) indicates the basic energy needs of the body, and this number is multiplied by an activity factor that reflects the energetic demands of the sport and/or level of training. The dietitian can cal- culate energy needs for individual athletes by using the athlete’s body weight and gender and age category and selecting an appropriate activity factor. Activity factors are on the low end for athletes training for less time and at lower intensity levels and are on the high end if they are highly competitive, training hard for many hours each day.

The dietitian should then compare the estimated energy expenditure to the dietary intake. In some cases, dietary intake may be below recommended energy needs based on the energy expenditure calculations. If this is the case, the athlete and dietitian can discuss ways to increase calorie intake. When energy intake is higher than calculated energy expenditure, additional discussion about weight changes may be helpful. If the

Table 10.3 Resting Energy Expenditure (REE) Calculations and Activity Factors

Gender and age (years)

Equation (BW in kilograms)*

Activity factor

Males, 10 to 18 years REE = (17.5 × BW) + 651 1.6–2.4

Males, 18 to 30 years REE = (15.3 × BW) + 679 1.6–2.4

Males, 30 to 60 years REE = (11.6 × BW) + 879 1.6–2.4

Females, 10 to 18 years REE = (12.2 × BW) + 749 1.6–2.4

Females, 18 to 30 years REE = (14.7 × BW) + 496 1.6–2.4

Females, 30 to 60 years REE = (8.7 × BW) + 829 1.6–2.4

*BW, body weight.

Data from World Health Organization. Energy and Protein Requirements, Report of a Joint FAO/WHO/UNU Expert Consultation. Technical Report Series 724. Geneva, Switzerland: World Health Organization; 1985:206.

athlete has not lost or gained weight recently and his or her diet has been consistent over time, then the dietary energy intake is probably meeting energy demands. The goals of the athlete must be considered when deter- mining the appropriateness of energy intake versus energy expenditure. If the athlete desires weight loss, then a calorie deficit is appropriate. When the athlete wants to gain weight, then additional calorie consump- tion above calculated energy needs should be encour- aged. FIGURE 10.6 provides an example of a dietary analysis report of an athlete’s 1-day food record. Note that the calories, macronutrients, and micronutrients are displayed in absolute numbers (e.g., grams, milli- grams) as well as a percentage of the established dietary recommendations.

If calorie intake needs to be altered, the absolute value and/or the relative contribution of the macronu- trients as compared to total calories may require adjust- ment. Carbohydrate intake should be assessed first because it is the macronutrient that should be consumed in the highest percentage of calories for the athlete’s diet.20 Whether working with a team sport, strength, or endurance training athlete, carbohydrates are going to be used as fuel during exercise. The recommended range of intake of carbohydrates for athletes is 3–12 grams per kilogram body weight. The amount of carbohydrate required will depend on a variety of factors including an athlete’s training volume, exercise intensity, and per- formance goals. Information from the analysis of the grams of carbohydrate intake should be compared with the calculated needs and adjusted to meet the athlete’s requirements.

Protein intake is assessed after carbohydrate intake and needs are established. Protein intake should be com- pared to overall calorie intake as well as to fat and carbo- hydrate intake to provide a well-rounded picture of the athlete’s diet. The recommended range of protein intake for athletes is 1.2–2.0 grams per kilogram body weight. Protein needs will vary based on factors such as train- ing intensity and duration, desire of the athlete to lose or gain weight, dietary protein quality, and age. Comparing protein intake from dietary assessment data to the pro- tein range appropriate for athletes will help the dietitian determine the optimal protein needs for the individual athlete and adjust the dietary intake recommendations accordingly.

Fat is the last macronutrient to be compared to over- all calorie intake and to have its levels assessed. Once the carbohydrate and protein needs are established, the rest of the calories should be derived from fat intake. A minimum of 20% of calories should come from fat in the athlete’s diet, especially for athletes performing long- duration, low to moderate intensity workouts.21,22 A range of 20–35% of calories consumed as fat is safe and ade- quate for most athletes. This range allows for plenty of flexibility in fat intake based on the other macronutrient needs for each athlete.

276 SECTION 2 The Practical Application of Sports Nutrition

How is vitamin and mineral intake assessed? Most computer programs compare the vitamin and min- eral intake to the RDA/AI values. This provides information on how an athlete’s vitamin and mineral intake compares to the recommendations for the general population. The RDA and AI are designed to prevent nutrient deficiencies for men and women in various age categories and are not targeted specifically for physical activity needs. For exam- ple, the calcium recommendation for a 30-year-old female athlete is 1,000 milligrams and for a 15-year-old female is 1,300 milligrams, regardless of activity level. Similarly, a female athlete in childbearing years may have higher iron needs than a male athlete or a female athlete who is postmenopausal.

There are no specifically designed standards for vitamin and mineral intakes of athletes. When assessing an athlete’s vitamin and mineral intake, use the cor- rect gender and age categories. A large number of research studies have assessed both intake and nutri- ent needs of athletes.

Some comparison to these studies may be appropriate. However, comparisons to these studies should be made only when the athlete is in the same gender and age group and has an equivalent exercise level as the subjects in the published study.

What are the steps for the initial consultation with the athlete? The initial consultation with an athlete is designed to gather information, assess dietary intake, develop goals, provide nutrition education based on these goals, and develop a nutritional plan. A review of why the athlete has sought nutrition education and what goal(s) he or she has regarding nutrition and sport performance is the first step in the consultation process. Information from food and exercise records are then assessed and com- pared to appropriate standards. Education on ways to improve intake is completed and goals are set to help monitor progress. This process is completed in the gen- eral format listed in Fortifying Your Nutrition Knowl- edge. However, each initial consultation will be different from the next. The dietitian must remain flexible in the consultation session and be willing to complete these steps in a different order based on how the interview progresses.

Figure 10.6 Dietary analysis report. Many computer programs are available that provide detailed dietary analyses of food records.

Gaining the Performance Edge

Comparing an athlete’s dietary intake to estimated calorie and macro- nutrient requirements as well as to established RDAs or AIs provides information on the adequacy of the athlete’s daily diet. Using this infor- mation in combination with other dietary assessment methods can help the dietitian accurately assess dietary intake and the athlete’s needs.

Dietary Analysis Printout

Calories 2278.51 2200* 103.57 Pro (g) 73.76 153.67 Fat (g) 68.12 73.33

338 104.44

48 92.9

Carb (g) 353.24 Fiber (g) 22.31 74.37 Cal (mg) 698.43 1000

30 69.84

61.43

Iron (mg) 31.37 313.7 Na (mg) 4363.33 2400 181.81 Pot (mg) 2887.23 Phos (mg) 1171.30 700 167.33 Ash (g) 15.34 330 4.65 vitA (IU) 7991.13 4000

4700

199.78 vitC (mg) 216.32 288.43 Thia (mg) 2.79 1.1 253.64 Ribo (mg) 2.36 1.1 214.55 Nia (mg) 35.14 14 251 Sat Fat (g) 13.47 24.44

24.44 55.11

Mono Fat (g) 21.21 86.78 Poly Fat (g) 10.47 24.44 42.84 Chol (mg) 66.62 300 22.21

Nutrient Total Recommendation (Rec.) % Rec

*Note: The 2200 calorie recommendation is based on the computer analysis tool used in this example and is not necessarily appropriate for calorie comparison for athletes. Using dietary analysis software helps nutrition professionals assess dietary intake, but additional assessments of nutrition adequacy for specific athletes must be made.

Analysis completed using the Nutrition Analysis Tool; myfoodrecord.com/ mainnat.html

Chapter 10 Nutrition Consultation with Athletes 277

and assessment are conducted on the playing field or in the athletic training room. Providing a comfortable envi- ronment that is quiet and conducive to communication can be achieved in even the most cramped or open spaces. Simply paying attention to the details of the environ- ment and creating a comfortable, nonthreatening space between the athlete and the professional can provide an excellent opportunity for communication.

How can you determine the reasons for a requested consultation? After establishing rapport, clarification of the purpose of the visit and the athlete’s goals will define what type of additional information the dietitian needs to elicit from the athlete. Asking specific questions about the athlete’s goals will help clarify what is necessary to improve nutri- tion, weight, and health or sport performance status. It also helps the dietitian to determine the nutrition plan and education required to assist the athlete. Some questions to determine the nutrition goals of the athlete may include:

• What would you like to improve regarding your daily diet?

• What has motivated you to seek nutrition advice? • How do you feel about your current body weight and/

or body composition? • Do you want to change your weight or body

composition? • What are your sport performance goals? • How do you think nutrition can help you achieve

these goals? Once the athlete verbalizes initial reasons for

requesting the consultation and specific nutrition/per- formance-related goals, the nutrition assessment part of the consultation can take place.

How is the nutrition assessment conducted? The majority of this section regarding the assessment stage provides a case study example of how a dietitian can interact with an athlete. The concepts in this section can be applied by all health professionals working with athletes to improve their nutrition; however, the actual assessment and nutrition plan development in this sec- tion are examples of nutrition assessment and nutrition therapy, and thus should be conducted by a registered and/or licensed dietitian.

Fortifying Your Nutrition Knowledge

Steps for the Initial Consultation Interview Not every initial consultation with an athlete will follow these particular steps in order. The dietitian must be flexible in gath- ering information and providing education based on the ath- lete’s needs and goals. The following steps will help guide dietitians in providing an efficient and effective consultation with an athlete:

■ Establish rapport. ■ Clarify the athlete’s reasons for the nutrition consultation. ■ Complete the nutrition assessment (anthropometrics,

food record analysis, exercise assessment). ■ Assess readiness for change. ■ Determine nutrition goals. ■ Provide education related to goals. ■ Summarize and set a follow-up visit date and time.

How is rapport established with an athlete? The key to any good interview is establishing rapport early in the session. Coaches, strength and conditioning staff, and athletic trainers may already have established rapport with the athlete. A consultant dietitian may not have, and might need to spend more time initially on rap- port building. Addressing the athlete by name and asking a few general questions about the sport, the athlete’s posi- tion on the team, or his or her specialty in the sport can set the athlete at ease with the process of the interview. When a dietitian knows about the sport and can converse about the type of play, positions, and typical workouts and competitions, the athlete feels that he or she is under- stood. This helps establish a personal relationship with the athlete in a supportive environment.

Projecting a positive demeanor and body language helps put the athlete at ease. Communication experts and social scientists believe that the image a person projects accounts for more than half of the total message con- veyed to another individual at a first meeting.23 Nonver- bal communication, including tone of voice, eye contact, facial expressions, posture, and physical environment, contributes to the ability to communicate with clients. A simple nod and cordial greeting can set the stage for effective communication. Conversely, a sour facial expres- sion, lack of eye contact, and a physical barrier, such as a desk between the client and interviewer, can immediately put the athlete on the defensive.

The setup of the physical space where the consul- tation occurs can be arranged to help the athlete feel at ease. Sitting behind a desk while the athlete is in a chair on the other side of the desk places the consultant in a position of power over the athlete. A better situation is to sit next to the athlete, with a table or part of a desk nearby on which to place papers or educational materi- als. There should be a comfortable distance between the athlete and the nutrition educator. Sometimes education

Jennifer’s Case Study Jennifer is a freshman and plays shortstop on her

college softball team. Her coach thinks that she has the skill to be a starter her sophomore year. She is thin and has a hard time hitting home runs, despite consistently hitting over .325 for the past three seasons of play in high school. Her coach feels that if she were to gain some muscle mass and strength her home-run hitting would improve, thus securing the starting position next year. Jennifer agrees, and she has started to eat more calories

278 SECTION 2 The Practical Application of Sports Nutrition

training three times per week. She burns a lot of energy in these workouts and gets very hungry after practice. She has started to increase her food intake but does not like meat and is concerned she may not be getting enough protein in her diet.

At the first appointment, Jennifer shares her concern about wanting to gain more power and strength without losing speed. After analyzing her food record and assess- ing current intake, the dietitian works to develop goals and objectives to achieve muscle mass gains. Jennifer states that her outcome goal is to add approximately 5 pounds of muscle mass in the next 3 months.

Three short-term goals were developed to help her achieve her long-term goal of gaining muscle mass. First, she needs to eat an additional 300–500 calories daily for weight gain. Second, she should include a minimum of two servings of high-quality protein daily to allow for protein to be used for development of additional mus- cle mass. Third, because her calcium intake was low,

Figure 10.7 Jennifer’s 1-day food record. This 1-day food record was analyzed by dietary analysis software. An abbreviated summary of the analysis highlights the categories in which Jennifer is either meeting her needs or falling short of recommendations.

in an attempt to gain weight, but she is concerned about gaining too much body fat. She is fast around the bases, and her defensive quickness is a huge asset to her team. She decides to consult with the sports dietitian at her col- lege to develop a plan to gain muscle mass and a small amount of weight.

Specific Information from Jennifer’s Initial Diet History

Height: 5′9″ Weight: 142 lbs Body mass index: 21 Body fat: 18% Usual body weight: 140–144 lbs Recent weight change: None Jennifer’s 1-day food record is shown in FIGURE 10.7 . Jennifer works out with the softball team 6 days per

week. This includes playing time at practices, three aero- bic conditioning sessions per week, and morning strength

Nutritive Analysis of Selected Nutrients from Jennifer’s One-Day Food Record

Time Food Amount Location/Feelings

8:00 AM Cheerios cereal 2 cups Home, tired Milk, 1% 1 cup Bagel, plain ½ Peanut butter 1 tbsp Orange juice 1 cup

12:30 PM Turkey sandwich 2 oz Home from class Whole wheat bread 2 slices Lite mayo 1 tbsp Lemonade 12 oz Sugar cookies 2

6:30 PM Spaghetti 2 cups Home from practice Spaghetti sauce, premade in a jar 1 cup Salad (lettuce, tomato, pepper, cucumber) 2 cups Lite ranch dressing 2 tbsp Garlic bread 1 slice Gatorade

9:30 PM Graham crackers 2 Studying, bored Apple 1

Nutrient Total Comparison to Jennifer’s needs

Calories Protein (gm) Fat (gm) Carbohydrate (gm) Calcium (mg) Iron (mg) Vitamin C (mg)

2278 73 (13% of total calories) 68 (27% of total calories) 350 (61% of total calories) 698 31 216

Meets calculated needs for weight maintenance Should increase protein for goal of muscle mass gain Meets needs; may increase to meet total calorie goals Adequate for athletic needs Below recommended daily intake of 1000 mg Meets recommended needs Meets recommended needs

16 oz

One Day of Jennifer’s Food Intake Record

Chapter 10 Nutrition Consultation with Athletes 279

Which anthropometric data needs to be collected? An important part of developing a nutrition plan for ath- letes is to analyze their current nutrition intake and com- pare it to weight and/or body composition data. Weight and body composition data may not be readily avail- able except in terms of a stated height and weight. In an office setting, the dietitian can measure the athlete’s height and weight in the first visit to establish an accu- rate measurement rather than relying on stated infor- mation. Body mass index (BMI) can be calculated from height and weight; however, body composition must be measured through specific assessment tools.

Dietitians are sometimes trained in body composition assessment and can perform these measurements. In an office or field setting, skinfold calipers or a bioelectrical impedance analyzer is the easiest way to measure body composition. If a dietitian has access to and is trained in using more elaborate and accurate body composition analysis tools such as the BOD POD or underwater weigh- ing, these methods are preferred. Often athletic trainers or strength and conditioning coaches are skilled in body composition techniques. This is an excellent opportunity for dietitians and other staff to collaborate in assessing body composition and developing a plan for improvement if needed. Comparing body weight over time is necessary to determine whether energy intake is appropriate. Ask- ing probing questions about weight changes, training

she needs to consume a minimum of two milk/alterna- tive servings per day. Jennifer will measure her progress toward these goals by keeping a food record for 3 days each week for the next 2 weeks. She will weigh herself once per week, and body composition analysis will be per- formed once each month for the next 3 months.

Education is provided to help Jennifer meet her goals. The dietitian gives Jennifer handouts on ways to increase calorie intake with nutrient-dense foods, including meat, beans, and other protein foods. Information about grocery shopping and meal and snack selection as well as foods to choose that are higher in calcium is also provided.

At the end of the first consultation, the dietitian sum- marizes the goals developed and the education related to achieving those goals. She asks Jennifer to restate the goals and how she plans to take action to meet the goals. Jennifer verbalizes a list of foods she is prepared to pur- chase the next time she goes grocery shopping.

The dietitian offers to meet with Jennifer again in the future to provide support and additional education and to monitor progress toward her goals. Jennifer decides she would like to meet again in approximately 2 weeks. She plans to bring her food records to the follow-up con- sultation as well as a list of additional questions or con- cerns that may arise over the next 2 weeks. They mutually decide on a date and time, and the consultation is ended.

Jennifer’s Case Study Jennifer’s BMI is 21, and she appears slight of build

with good muscular definition. Her BMI of 21 is in the normal healthy range (18.5–24.9); however, considering her musculature and high level of activity, an increase in BMI is appropriate to meet her goal. Assessment of body composition is indicated in Jennifer’s case. Her body fat percentage was measured at 18%, which is considered within the healthy range for athletic women. Because Jen- nifer has not gained or lost more than 5 pounds in the last 3 years, she is eating an appropriate number of calories per day for weight maintenance. To gain weight, she will need to add 300 to 500 calories per day.

How can an athlete’s food record be reviewed and analyzed? Ideally, the food record is obtained and analyzed before the athlete arrives at the initial assessment appointment. The dietitian can also ask questions about usual intake to determine whether the foods listed on the food record are typical of the athlete’s intake. If food record data are not provided in advance, the dietitian can elicit a 24-hour recall or have the athlete complete a brief 1-day food record at the very beginning of the consultation. This is an opportunity to start immediately interviewing the ath- lete and clarifying dietary intake information.

Once information from the food record or 24-hour recall is clarified, analysis of the information should be completed (covered in detail earlier in this chapter). This analysis can be done using computer software or by the dietitian comparing the information and making judg- ments based on clinical knowledge and sport nutrition practice. Most often a combination of comparing foods con- sumed to set guidelines, such as MyPlate; assessing food purchasing/preparation practices and the time available for meal preparation and consumption; and simply assess- ing the quality and quantity of food consumed will all be a part of this analysis. The anthropometric, dietary, and exercise assessments will be used in conjunction to deter- mine whether energy needs are appropriate and will aid in creation of the athlete’s nutrition plan.

Jennifer’s Case Study One day of Jennifer’s 3-day food record is listed in Fig-

ure 10.7. Jennifer’s food record contains only one serving from the milk/alternative group. Clarifying whether this is a typical amount of dairy product consumption daily will

status, energy level fluctuations, fatigue, or a drop in performance at different times during the training and competitive season will help the dietitian and the ath- lete determine whether intake is consistently adequate to meet weight and training goals.

280 SECTION 2 The Practical Application of Sports Nutrition

help in assessing calcium and protein intake. For example, Jennifer may state that she rarely has more than one serv- ing of milk each day, mainly on her cereal in the morning. The dietitian should then further clarify whether this is a food preference or a lactose intolerance problem.

Overall, Jennifer’s dietary intake is adequate in energy to meet her estimated needs to maintain weight (approxi- mately 2300 calories daily). To gain weight, she will need to add calories to her regular dietary intake. Her protein intake is below recommendations at 1.1 grams per kilo- gram body weight and 13% of her total caloric intake. To increase muscle mass and weight, some of the additional calories she needs to consume should come from addi- tional protein sources. Jennifer’s intake of vitamins and minerals exceeded the RDAs/AIs except that for calcium. Her calcium intake was less than the recommended AI, and thus needs improvement.

How is energy expenditure assessed? A review of when and how often the athlete exercises will provide information on energy expenditure. A quick exercise recall or review of an exercise log provides infor- mation on the duration, intensity, and frequency of exer- cise sessions. Additional questions should be asked about overall activity level that does not include exercise ses- sions. For example, a college athlete who drives to all

Jennifer’s Case Study Determining overall energy expenditure is necessary,

especially in Jennifer’s case because her goal is to gain weight and muscle mass. Jennifer is a very active ath- lete on and off the field. She usually walks to classes and drives only to off-campus activities. She exercises 6 days per week with the softball team at afternoon practices. They have additional strength-training sessions three mornings each week. When comparing her activity level to her energy intake, and knowing that her weight has been stable for 3 years, the dietitian determines that she is consuming enough calories to meet but not exceed her energy needs.

How can an athlete’s readiness for change be assessed? Assessing readiness to make nutrition and behavior changes is an important part of any initial consultation. A variety of methods are available to assess readiness for change. Whichever method is chosen, it is essential to determine whether the athlete realizes the need to make nutrition changes and is ready to take action. Only an athlete with some level of readiness will be able to make the changes needed to meet goals. One such strategy for eliciting behavior change is motivational interviewing. For more information on motivational interviewing, see Fortifying Your Nutrition Knowledge.

The Transtheoretical Model, developed by Prochaska and DiClemente, is a research-based model that app- roaches behavior change as a process versus a distinct event.24 The process involves a prog- ression through a series of six stages that ultimately leads to permanent life- s t y l e b e h av i o r change. Each of these stages can be applied to helping athletes change their eating patterns to improve overall health and maximize athletic potential. The following overview of the Transtheoretical Model briefly describes the six stages of behavior change and

Transtheoretical Model A con- ceptual model of how humans go about changing their behaviors. It invo lves six stages, each of which rep- resents a different mind-set toward change. Knowing which change stage an athlete or client is in can be helpful in developing strategies for altering his or her health or nutrition behaviors.

classes will have a lower energy expenditure than one who walks to all classes on campus. Information about exercise and activity habits is then compared to informa- tion obtained from dietary records and the assessment of nutrient intake to determine whether calorie intake should be increased, decreased, or maintained at the cur- rent level.

Chapter 10 Nutrition Consultation with Athletes 281

them move from the precontemplation stage to the next stage, contemplation.

What are the characteristics of Stage 2: Contemplation? An athlete is in the contemplation stage if he or she has stated the intention to make a specific dietary change within the next 6 months. Athletes in this stage are fully aware of the benefits of making dietary changes, but also are acutely aware of the disadvantages of changing. Ath- letes in this stage know they should make a change, but the barriers to achieving their goal overshadow their abil- ity to move forward. For many athletes, the acknowledg- ment that their season is quickly approaching causes them to initiate some action to improve their dietary hab- its. Dietitians can help athletes move out of this stage and into the preparation stage by discussing the pros and cons of changing versus not changing their dietary habits and the resulting effects on their athletic performance.

What are the characteristics of Stage 3: Preparation? An athlete is in the preparation stage if he or she has stated an intention to change within the next month. These athletes have taken steps to prepare for change (e.g., they have scheduled an appointment to see a regis- tered dietitian or bought a new healthy eating cookbook). Once they have reached this stage, the athletes are ready for traditional behavior change programs/services.

As a dietitian, this is an exciting and important stage—athletes are ready for change and open to profes- sional guidance. It is critical not to overwhelm a person in this stage with too much information. Providing infor- mation on ways to change dietary patterns, intake, and behaviors while emphasizing how these changes will benefit the athlete is the best educational method in this stage. Identifying one or two small changes to focus on will build the athlete’s confidence in his or her ability to make more changes and therefore will help move the ath- lete toward the action stage.

What are the characteristics of Stage 4: Action? An athlete is in the action stage if he or she has made spe- cific, overt modifications in dietary habits within the last 6 months. The changes made must be significant enough to improve athletic performance or reduce the risk of dis- ease. These athletes are not only ready for professional guidance, but also are actively putting the professional recommendations into practice. Athletes in this phase are hungry for examples of easy ways to make healthy eat- ing a reality.

Individualization is a key component in this phase. The calculation of individual energy and macronutri- ent requirements, the development of an individualized daily meal plan and exercise hydration schedule, and the provision of quick, easy recipes are popular topics often

how each stage can apply to working with athletes on changing nutrition habits. The final part of each section highlights tips for how to help athletes move progres- sively from stage to stage.

What are the characteristics of Stage 1: Precontemplation? An athlete is in the precontemplation stage if he or she states no intention of making a change in the foreseeable future (within the next 6 months). Most of the athletes in this stage are merely uninformed or unknowledgeable of the reasons why making dietary changes can influence their overall health and athletic performance. Unfortu- nately, these athletes are generally categorized as resis- tant to change and unmotivated, which may cause them to receive little attention from coaches, athletic trainers, or dietitians. Providing a clear explanation of why dietary changes are needed and the personal benefits they will realize by making positive behavior changes is essential in this stage. Educating athletes about the importance of proper dietary habits in relation to their sport will help

Fortifying Your Nutrition Knowledge

Motivational Interviewing: A Tool for Helping to Change Behavior After performing a dietary analysis, one of the biggest hur- dles that sports nutritionists face is helping athletes adopt new behaviors that can help them reach their personal and sport performance goals. While athletes may have the best of intentions to change their behaviors, actually practicing and maintaining the new behaviors is another story. This is where motivational interviewing can help. Motivational interviewing is an athlete-driven, sport nutritionist-directed consultation strategy for identifying potential barriers to behavior change and how to deal with them. The sport nutritionist merely guides the conversation while the athlete actively reflects and devel- ops ways of changing his or her behavior. Motivational inter- viewing has been shown to be an effective behavior change tool in situations ranging from helping patients comply with a prescription medication routine to helping people with extremely addictive habits. For more information and current research findings regarding the effectiveness of motivational interviewing, refer to the following review articles:

1. Christie D, Channon S. The potential for motivational interviewing to improve outcomes in the manage- ment of diabetes and obesity in paediatric and adult populations: a clinical review. Diabetes Obes Metab. 2014;16:381–387.

2. Thompson DR, Chair SY, Chan SW, Astin F, Davidson PM, Ski CF. Motivational interviewing: a useful approach to improving cardiovascular health? J Clin Nurs. 2011;20(9–10):1236–1244.

282 SECTION 2 The Practical Application of Sports Nutrition

How can appropriate nutrition goals be established? Athletes should set both short- and long-term nutri- tion and/or weight goals. Athletes generally have a long- term goal in mind, such as to gain muscle or lose body fat. This long-term goal is the final outcome the ath- lete would like to achieve and is also referred to as the outcome-oriented goal. Outcome-oriented goals help guide the athlete and dietitian to develop a nutri- tion plan, revise the plan as needed, and continue behav- ior change to meet these goals. An out- come-oriented goal will be measured throughout the edu- cational process to determine the effec- tiveness of the nutri- tion plan and the implementation of the plan by the athlete. However, this long-term goal is difficult to reach quickly, and therefore several short- term goals may be necessary to help guide the athlete to the final outcome.

A short-term or process-oriented goal is designed to help the athlete achieve the outcome desired but with small steps. Process- oriented goals may also be considered objectives. These goals help provide interim steps and ways of measuring success before the final outcome goal is achieved. Short-term goals must be made difficult enough to be challenging, but also be attainable in a short period of time. If goals are developed in this manner, success is seen in small steps, and progress toward the final goal is defined by the success of the short-term goals.

Helping athletes set realistic, achievable goals is an important part of the nutrition consultation. Both the ath- lete and the dietitian should mutually decide upon goals. If goals are set too high, or if expectations for how quickly goals should be met are too aggressive, then meeting the goals will be difficult. The athlete can help determine how many goals and what goals to start with based on his or

requested by clients. Athletes want to know not only why they need to make a change, but also how they can make the change so that implementation happens with ease. Athletes require consistent guidance by dietitians, who can provide the practical tools they need to continue mak- ing positive dietary changes over several months to reach the next stage, maintenance.

What are the characteristics of Stage 5: Maintenance? Athletes in the maintenance stage are actively working on preventing a relapse. This phase consists mainly of working on self-efficacy and the confidence that they will not resort to old habits—a process that can last from 6 months up to several years. Encouragement should be provided to make the changes fit into the athlete’s life- style. It should be noted that “relapse” is often thought to be an actual stage. However, in the Transtheoretical Model, relapse is not a distinct stage; it is instead a back- ward step to an earlier stage. If an athlete has progressed to the action or maintenance stage, he or she generally will not relapse all the way back to precontemplation. The backward step usually falls somewhere between con- templation and preparing for taking another action. This stage does not necessarily involve “change,” but it can involve finding alternatives or additional ways to meet their goals.

What are the characteristics of Stage 6: Termination? Athletes who have reached the termination stage have zero temptation of ever returning to old habits. These individuals have established such a solid plan that no emotional state, situation, or environment will cause them to resort to old habits. There is controversy regard- ing whether most individuals ever reach this stage. It appears that most people will remain in the maintenance stage for a lifetime—constantly working to adjust, adapt, and learn how to keep on track with healthy eating pat- terns. Reaching termination is possible; however, dieti- tians should realize that it is rare for individuals to fully reach termination. Therefore, athletes should be supplied with a constant stream of tools and resources to keep them at least in the maintenance stage, with termination as an ultimate goal.

Jennifer’s Case Study Jennifer is in the action stage. She asked for the nutri-

tion consultation because she realizes she needs guidance to improve her nutrition. She has already started to make some small changes to improve her nutrition intake for muscle mass gains by eating more at some of her meals. Additional education and tips for improving calorie and nutrient intake should help her continue taking action to complete the nutrition changes recommended.

outcome-oriented goal The final outcome or end result that an athlete would like to achieve as a result of changing dietary hab- its. For example, a slightly overfat athlete may have an outcome-ori- ented goal of losing 3 pounds of body fat in 6 weeks. Outcome-ori- ented goals help guide the athlete and dietitian to develop a nutrition plan, revise the plan as needed, and continue behavior change toward meeting the desired end result.

process-oriented goal An achievement based on follow- ing or complying with procedures designed to cause a specific out- come. Process-oriented goals are focused on the steps required to reach the desired outcome and not so much on the final outcome itself. For example, an athlete wish- ing to lose weight may formulate a process-oriented goal of training 30 minutes longer 4 days of the week. The end result is to lose weight, but the goal is to meet the additional exercise requirements.

Chapter 10 Nutrition Consultation with Athletes 283

How can appropriate nutrition education be provided to an athlete? Education about healthful eating is likely to be done throughout the initial consultation process. There may be moments in the conversation at the beginning of the session when education is provided. If athletes share information that they have learned that appears to be inaccurate, the dietitian can clarify that information and provide accurate information at that time. Near the end of the session, specific education should take place that will help the athlete achieve his or her goals.

Dietitians should have a variety of sample meal pat- terns ready in handout form to avoid the time-consuming process of developing the plan in the first session. Hav- ing sample plans available in a variety of calorie levels, for vegetarian and nonvegetarian patterns, and for differ- ent age levels that can be adapted for different athletes is extremely valuable for dietitians and their athletes. Adjustments to these sample patterns can be made quickly based on specific short- and long-term goals.

her motivation and lifestyle. In general, a maximum of three process-oriented goals should be agreed upon ini- tially. Nutrition professionals can gauge how many goals to suggest based on assessment of readiness to change as well as the interac- tion in the initial and follow-up sessions. Once short-term goals are developed, the athlete and dieti- tian should develop a plan for measur- ing and monitoring progress toward goal achievement. The challenge with nutri- tion goal setting is to develop goals that encourage small changes in gradual, manageable, and measurable steps to reach the ultimate (outcome) goal.

Gaining the Performance Edge

By understanding the stages of change, a dietitian can be more effective in counseling, educating, and motivating athletes to make healthy dietary changes by cater- ing to their individual needs and preparedness for change.

Jennifer’s Case Study The dietitian recognizes that to gain weight and mus-

cle mass (Jennifer’s long-term, outcome-oriented goal) Jennifer will need to increase total calories and protein in her diet. Intake of other nutrients is adequate except for calcium. Because calcium is essential to bone health, improving calcium intake is another goal the dietitian shares with Jennifer. They discuss how the long-term goal can be achieved, and together they decide on the follow- ing short-term (process-oriented) goals:

• Goal 1: Eat an additional 300–500 calories per day, focusing on nutrient-dense foods.

• Goal 2: Eat a minimum of two servings in the protein foods group each day.

• Goal 3: Consume at least two servings of dairy prod- ucts each day. Each of the short-term goals is focused on the ulti-

mate goal of gradual muscle gain without excessive weight gain. Jennifer is already in the action stage of change and is likely to succeed with three goals because her motivation level is high.

To determine progress toward these three goals, Jen- nifer will keep food records for at least 3 days of each week for the next 2 weeks. To assess the overall out- come goal, an accurate height, weight, and body compo- sition analysis is performed in the initial appointment. These measures can be repeated at 1-month intervals to assess changes in body weight and composition. Jen- nifer is asked to weigh herself only once a week, at the same time each week, to help her avoid becoming overly concerned about her weight. This will allow a monitor- ing process and feedback mechanism for her as well as for the dietitian.

Jennifer’s Case Study For Jennifer’s first goal, she is provided with a hand-

out describing healthy weight gain for athletes that includes nutrient- and calorie-dense foods. This hand- out provides examples of 300- to 500-calorie snacks and ideas for higher-calorie beverages to consume with meals and snacks. Encouraging Jennifer to consume nutrient- dense foods to increase calories rather than consuming high-fat, high-sugar snacks helps her increase nutrient intake. Providing a handout about grocery shopping that includes tips on purchasing a variety of protein foods, including vegetarian, meat, and dairy sources, will help her purchase the necessary protein foods, increasing the likelihood of regular consumption. By focusing on obtain- ing extra calories from protein-rich foods and dairy, she is learning how to increase her total calorie intake, while focusing on her other two goals of increasing protein and dairy in her diet.

Because Jennifer is not a consistent meat eater, she needs some information on nonmeat protein sources to meet her second goal. Using the MyPlate food guidance system is a simple way to show her how to incorporate both nonmeat and meat sources of protein into her daily diet.

To meet her third goal, Jennifer needs to consis- tently consume two dairy/alternative servings daily. The MyPlate food guidance system recommendation for dairy/ alternative intake is actually two to three servings per day. However, because Jennifer is currently consuming only one dairy/alternative serving daily, and has expressed difficulty with dairy food consumption, setting a goal of increasing to two servings of dairy daily is more realis- tic for her than aiming for three servings. A list of dairy

284 SECTION 2 The Practical Application of Sports Nutrition

foods and beverages, and creative ways to consume more dairy, will help her meet this goal. For example, she cur- rently consumes milk only on cereal. The dietitian could suggest milk as a beverage to consume at her evening meal. Or, if the taste of milk is unappealing, then alternate dairy sources such as plant-based milks, dairy or nondairy cheese or yogurt, and foods made with these items could help her meet this goal.

A sample meal plan for Jennifer is shown in TRAINING TABLE 10.1 . The changes in the revised meal plan

are based on her food preferences gleaned from the consultation.

Training Table 10.1: Jennifer’s Sample Meal Plan Jennifer’s Initial 1-Day Food Intake Jennifer’s Revised Meal Plan

Cheerios cereal Cheerios cereal

Milk, 1% Milk, 1%

Bagel, plain Bagel, plain

Peanut butter Peanut butter

Orange juice Calcium-fortified orange juice

Banana

Turkey sandwich Turkey sandwich

Whole wheat bread Whole wheat bread

Turkey, 2 oz Turkey, 5 oz

Lite mayo Lite mayo

Sugar cookies Sugar cookies

Lemonade Lemonade

Apple

Spaghetti Spaghetti

Spaghetti sauce, premade in a jar Spaghetti sauce, premade in a jar plus 3 oz lean ground beef

Salad (lettuce, tomato, pepper, cucumber)

Lite ranch dressing Lite ranch dressing

Garlic bread Garlic bread

Gatorade Gatorade

Graham crackers Graham crackers

Apple Hot chocolate made with milk

Total Calories: 2278 Total Carbohydrate: 350 (61%) Total Protein: 73 g (13%) Total Fat: 68 g (27%) Total Calcium: 698 mg

Total Calories: 2777 Total Carbohydrate: 401 (58%) Total Protein: 107 g (15%) Total Fat: 83 g (27%) Total Calcium: 1076 mg

How should a consultation be summarized and closed? As the initial consultation process comes to an end, a summary of the goals and meal-planning ideas, educa- tion provided, and questions from the athlete will provide a framework for further sessions. The athlete should be

Jennifer’s Case Study The dietitian summarizes Jennifer’s three goals and

asks how Jennifer plans to implement the dietary changes. Jennifer appears to understand the goals and how to add calories to her diet. She verbalizes protein sources she is going to purchase when she goes grocery shopping. She verbalizes concern about increasing dairy products, but states she is going to try to purchase more dairy foods as well. Jennifer states she would like to meet again in 2 or 3 weeks. The appointment is set and appropriate closing comments are shared.

What are the steps for a follow-up consultation with the athlete? Providing the athlete with an opportunity to meet with the dietitian after the initial assessment allows the athlete to attempt some of the changes recommended and then review these changes. This process is critical to the athlete’s continued success in accomplishing established short- and long-term goals. Making permanent dietary changes can be more challenging than most athletes initially perceive. Athletes need guid- ance along the way to help them meet their goals and pro- vide a continued resource for education, goal revision, and ultimate suc- cess in behavior change. Accountability to someone else

Food for Thought 10.2

Initial Nutrition Consultation

Describe the steps of the initial nutrition consultation process.

given an opportunity to ask for clarification or informa- tion on additional topics not covered in the session. The athlete should be asked to state, in his or her own words, how the suggested changes will be made based on the information provided. This helps the athlete understand the goals and how to implement them after leaving the consultation. If the athlete is unsure of how to put the nutrition information into practice, a review of the goals and education methods should be done prior to the ath- lete’s departure.

It is helpful to provide the athlete with a brief writ- ten list of the main objectives of the nutrition plan and how the plan can be implemented. This can be written on the back of an educational handout or on a separate form that the dietitian creates. These goals and the edu- cational plan to achieve them can be shared with other sports professionals if the athlete gives permission to do so. This improves continuity of care and helps the athlete and the rest of the professionals work together toward a common goal. At the closing of the interview, plans for follow-up appointments should be discussed.

Chapter 10 Nutrition Consultation with Athletes 285

for making recommended changes is also a motivating fac- tor in making and keeping follow-up appointments.

Follow-up visits may be more frequent for athletes with many changes to make and less frequent for oth- ers. In some cases, a one-time visit is enough to help the athlete move toward healthier eating for optimal sport performance. In most cases, at least one follow-up visit is recommended. Athletes who present with eating dis- orders or disturbed eating patterns will likely need sev- eral follow-up sessions. Athletes presenting with weight concerns, trying to either gain weight or lose weight, or those with medical conditions will likely require a series of sessions.

The process for a follow-up appointment is similar to the initial consultation but is usually much shorter. Typi- cal follow-up sessions are scheduled for approximately half the amount of time as for an initial consult. Less time is needed for the rapport-building part of the ses- sion because the athlete and dietitian already know each other. The beginning of the follow-up visit often consists of a quick review of goals and a review of any food records. A comparison of the record to the stated goals helps pro- vide input to the athlete about progress made.

Assessment of how the athlete is feeling, energy levels, and any subjective information about sport per- formance should be discussed. Often the subjective infor- mation is the first progress an athlete notices. The scale or body composition assessments may not reveal a change in body weight or body composition, but the athlete might recognize feeling better or having more energy during practice and competitions. Eliciting this subjective infor- mation is a skill all dietitians working with athletes need because it can be a strong motivating factor in continu- ing the dietary changes that influence the attainment of short- and long-term goals. Assessing weight, body com- position, and any laboratory or clinical assessments may also occur during the follow-up visit.

Based on all of the information obtained in the fol- low-up session, revision of short- and long-term goals can take place. If the athlete has mastered one or more process-oriented goals, then adding another goal may be indicated. If the athlete is having difficulty meeting some short-term goals, then revision of goals may be necessary.

The final step in the follow-up process is to determine whether additional appointments are indicated. Determin- ing this may depend on the time the athlete has to keep appointments, finances for appointments if nutrition con- sultations are not covered by the team or by insurance, and the need for additional sessions. Telephone consults may be an easy alternative to having face-to-face contact. Brief consultations and questions may be handled through email; however, nothing confidential should be shared through email. The dietitian and athlete together can determine the best follow-up plan for the athlete. Develop- ing a plan for follow-up or deciding to terminate additional appointments should be clear to both the athlete and the dietitian in the closing of the appointment.

Jennifer’s Case Study Jennifer returns after 2 weeks for a follow-up visit.

She has brought in food records for 5 of the past 14 days since the last visit. Upon review of the records, the dieti- tian sees that Jennifer is meeting two of her three goals consistently. Her calorie intake is excellent, and she is consistently consuming two or even three high-quality protein sources each day. However, dairy intake is still averaging only one serving per day. The dietitian reviews dairy intake with Jennifer to determine why this is a dif- ficult goal to meet. Jennifer states that she just does not like the taste of milk and yogurt. The dietitian provides a handout with dairy and nondairy sources of calcium to Jennifer. Calcium-fortified orange juice, instant oatmeal, and hot chocolate made with milk are options that Jen- nifer states she will try to incorporate into her diet for the next 2 weeks. They set another follow-up appoint- ment date for 2 weeks later and continue with the three original goals set. At the upcoming followup appointment, weight and body composition assessments will be made to determine progress toward the long-term weight and muscle-gain goals.

What should walk-in or short sessions with athletes involve? Often a dietitian will meet with many athletes on a walk- in or first-come, first-served basis. In these brief sessions, completed food records and health history questionnaires are generally not available. These sessions, however, can be valuable for the athlete despite the short time and lim- ited availability of prior information. This may be the only opportunity for an athlete to speak with a nutrition pro- fessional, so making the most out of the short time can significantly help the athlete.

An excellent opportunity for brief sessions occurs after a group nutrition session with a team. Athletes may be encouraged to ask questions after the group session is over. In this case, the athlete often has one specific question that can be answered relatively easily. The dieti- tian should be pre- pared for a variety of questions from the athletes. These may include ques- tions about popular sports supplements or dietary regimens seen in the media, clinical questions related to health conditions, and questions about spe- cific nutrients in foods or how to obtain certain nutrients from different foods. Answering questions and having a

Gaining the Performance Edge

Follow-up appointments are help- ful to review an athlete’s progress toward goals. They provide oppor- tunities for the athlete to continue learning about nutrition for sport performance and provide a way to gauge success toward sports nutri- tion goals.

286 SECTION 2 The Practical Application of Sports Nutrition

variety of written materials on hand for more detailed information provides a valuable service to several athletes in a short period of time.

Other settings in which brief consults with athletes can occur include health and wellness fairs, sports com- petitions, or booths at conferences. All of these settings are excellent opportunities to present accurate and help- ful nutrition information to interested and engaged ath- letes. Providing general sports nutrition information at the table or booth for athletes to read later is often the best way to provide information in these settings. Provid- ing a list of websites with credible information on a vari- ety of sports nutrition topics will be helpful for the busy athlete who may choose not to stop and talk at the table but is willing to pick up a flyer. A typical sports nutrition table display should include:

• An attractive table cover and information about what professional or company is sponsoring the display.

• Short, one-page flyers on sports nutrition topics such as hydration, energy needs, carbohydrates, pro- teins, fats, pre- and postexercise eating guidelines and additional resources such as reputable websites, books, and cookbooks. If the display is at a particular sporting event (e.g., a marathon), then nutrition and hydration information specific to the sport should be displayed.

• Interactive displays that attract attention and aid with education are desirable. Displays could include food models, samples of sports gels or bars, different options for water bottles to use during exercise, and short quizzes.

• Information about services offered and how to make appointments, including business cards, should be made available on the table. In many sports medicine clinics or physicians’ offices, a

dietitian may be available on an as-needed basis after seeing the athletic trainer, physical therapist, or sports medicine physician. In these cases, a shortened nutrition question- naire that the athlete can complete in just a few minutes will help guide the individual session. The questionnaire can be similar to the one presented in Figure 10.1, but with much less detail. Demographic information, reason for the visit, anthropometric data, and brief questions about how often an athlete eats, where meals are consumed, and dietary supplements used should be included in the brief questionnaire. This will help guide the session to meet the athlete’s needs while providing critical initial information to the dietitian.

A brief diet history and 24-hour dietary recall can be done for walk-in sessions with athletes. Information about type, duration, and intensity of exercise can also be quickly obtained. An experienced dietitian can review all of this information quickly to get a basic idea of the athlete’s cur- rent nutrient and energy intake and make assessments about changes needed. Because time is limited, only one goal may be developed to help the athlete improve nutri- tion intake. The dietitian and the athlete can mutually decide on the most important aspect of dietary change

and develop a nutri- tion plan to meet that goal. Additional appointments can be made to follow up with the athlete. These appointments can include more time to allow for a better assessment and for education, goal setting, and nutrition plan development.

Are there any concerns about the confidentiality of the health, nutrition, and exercise information provided by the athlete? Any health and medical information is considered confi- dential. Privacy acts that safeguard medical information obtained from the patient verbally or during medical treatment are in place throughout the United States. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is designed to protect insurance coverage for workers and their dependents if they lose or change jobs. It also addresses the security and privacy of health data and addresses issues to improve the efficiency and effectiveness of the nation’s healthcare system by encouraging electronic data interchange in health care.25 This act requires any healthcare provider and all health- care organizations to inform patients about their rights to privacy. In some settings, dietitians, athletic trainers, physical therapists, and team physicians may have to comply with HIPAA privacy standards. All traditional hospitals and clinics that require fees for service and/ or bill insurance companies or Medicare/Medicaid must comply with HIPAA.25 Some private consultants, such as dietitians in private practice, may also fall under HIPAA regulations. The Department of Health and Human Ser- vices (HHS) administers HIPAA, and the Centers for Medicare and Medicaid Services (CMS) agency within HHS is responsible for implementing some provisions of HIPAA. For more information on health information privacy and HIPAA regulations, consult www.hhs.gov/ ocr/privacy/hipaa/understanding/index.html. Even if the HIPAA regulations do not apply in some athletic set- tings, confidentiality of information should be strictly maintained.

Nutritional assessment information, including anal- yses of food records, health history information, and nutritional plans developed, should be kept confiden- tial. Ensuring the privacy of this information is essential to building and maintaining the trust of the athlete– dietitian relationship. Information should not be shared with other athletes, teammates, coaching staff, or the media. Care should be taken to avoid casual conversa- tions that seem harmless but if overheard could be mis- construed as sharing of confidential information. If the athlete gives permission to release the information to a

Food for Thought 10.3

Putting Together a Sports Nutrition Table Display

Identify the components of an appealing sports nutrition display.

Chapter 10 Nutrition Consultation with Athletes 287

coach, parent, spouse, or any other individual, then this information can be exchanged. However, in the absence of permission, no information should be given to anyone but the athlete, even when asked directly. Most health- care organizations and many athletic departments also have strict confidentiality policies regarding release of medical information to persons or organizations out- side the providing organization. Permission to dis- close medical information is best given in written form, thus providing the athlete with a clear understanding of what information can be disclosed, and to whom. A sample medical information disclosure form is shown in FIGURE 10.8 . The form clearly stipulates what informa- tion is going to be released, to whom, and in what for- mat (e.g., verbal, written, medical record documents). The form must have the athlete/patient signature and should have a date when permission to release the information will expire.

The issue of confidentiality and permission to dis- close information may seem excessively cautious, espe- cially as it relates to nutrition information; however, to develop a good working relationship with athletes, trust is critical. Athletes may share sensitive information in indi- vidual consultations that they have never shared with other people. This is often the case for athletes with eating disorders or weight concerns. Athletes seek- ing help for eating disorders may be less likely to return for follow-up visits if they are afraid that their coaches, parents, or teammates will learn about their personal eat- ing behaviors. Maintaining confidentiality is designed to protect the athlete and to protect the dietitian as well.

Figure 10.8 Sample medical information disclosure form. Medical information is considered protected information under HIPAA. Written permission to disclose medical information must be obtained prior to sharing the information with any medical personnel or other individuals.

Health Care Agency Address Phone/fax

I, authorize to (patient /athlete name) (agency/ institution name)

Disclose to: ___________________________________ (Medical facility, person, parent)

___________________________________ (Address)

___________________________________

___________________________________ (Phone and fax)

The following information:

(Should list specific information such as nutrition intake, concerns with nutrient density, eating behaviors, any information that the agency/person being given the information will need to help the athlete.)

Method of Disclosure:

(Verbal only—phone or in person, fax, mailed medical record copy) ____________________________ ____________________________ ______________________ Patient/Athlete Name (printed) Identifying number Date of Birth

Patient/Athlete’s Rights:* Each institution will have specific patient rights and provisions of the consent for disclosure. Typical provisions include: • The right to know what information is being disclosed • The right to revoke the consent for disclosure at any time • If consent is revoked by the patient, the following consequences (if any) may

occur ____________________________________________________________ *Note — each medical institution, athletic agency, or sports medicine clinic will have their own patient rights and provisions for disclosure. These should be described in the consent for disclosure form in writing.

Consent is valid until: _____________________________________ (date)

Patient/Athlete Signature: __________________________________ Date: ________________

Consent for Disclosure of Confidential Medical Information Form

Food for Thought 10.4

You Are the Nutrition Coach

Apply the concepts from this chapter to several case studies.

288 SECTION 2 The Practical Application of Sports Nutrition

The Box Score Key Points of Chapter

■ Nutrition consultation and communication help athletes acquire the knowledge and skills necessary to foster healthy dietary behaviors that will help them achieve their sport-specific goals.

■ Nutrition assessments of athletes should be com- pleted by a registered and/or licensed dietitian. Dietitians have the education and experience to assess dietary intake, analyze medical informa- tion, and develop specific nutrition plans for ath- letes. Other sports professionals, such as coaches and athletic trainers, can support athletes’ nutrition knowledge and behavior changes by using nutri- tion information from public domain sources when working with athletes.

■ Assessing the needs of the athlete is the first step in effective nutrition consultation. The more infor- mation the dietitian can gather about the athlete’s goals, health history, training regimens, medica- tions, and dietary practices, the more effective the first nutrition consulting session will be.

■ The diet history is the most comprehensive form of dietary intake data collection and involves an inter- view process that reviews food intake records, eating behaviors, recent and long-term eating habits, and exercise patterns. The process is very time consum- ing, but it provides a wealth of information that can help the dietitian design an individualized dietary plan for the athlete.

■ Health history questionnaires are valuable tools for gathering information about an athlete’s current health and medications, past medical history, and other health-related behaviors.

■ Obtaining information about food intake is done using a variety of tools. The most common food intake tool is the food record. Food intakes can be recorded for 1-, 3-, or 7-day periods. Other food intake assessment methods include the 24-hour food recall, food frequency questionnaires, and diet histories.

■ Documentation of how much training or exercise the athlete is currently performing is essential to any sports dietitian’s assessment and dietary plan.

■ Food records must be as detailed and accurate as possible if they are to be effective tools. Commonly

omitted pieces of information such as portion sizes, use of condiments, food brands, names of restau- rants, method of food preparation, beverage use, and snacks can severely limit a food record’s accuracy. To obtain this information, the dietitian needs to be armed with the appropriate clarification questions.

■ The initial consultation with athletes includes many steps to gather information, make a nutri- tion assessment, and develop a nutritional plan that meets the athlete’s needs. These steps include rap- port building, clarifying reasons for the consultation, nutrition assessment, assessing readiness to change, goal setting, education, and summarizing.

■ When assessing an athlete’s readiness to change his or her dietary habits, the six stages of behav- ior change presented in the Transtheoretical Model need to be considered. The six stages are precon- templation, contemplation, preparation, action, maintenance, and termination. The stage the athlete is in dictates which tools or motivational strategies can be used to help the athlete change his or her nutritional behaviors.

■ Follow-up consultations with athletes are required to review how the imposed changes are working, to address any problems encountered, to answer ques- tions, and to foster a sense of accountability on the part of the athlete. Follow-up visits may be more fre- quent for athletes with many goals/objectives, and less frequent for others.

■ Walk-in sessions are very brief consulting sessions that are done without the dietitian being armed with previous health and dietary information about the athlete. These sessions are more athlete directed and consist of the dietitian answering an athlete’s questions. Despite their brevity, walk-in sessions can still be very educational and may lead to the athlete desiring a more complete consultation.

■ Any health or medical information is considered strictly confidential and is protected by the Health Insurance Portability and Accountability Act (HIPAA). Even if the HIPAA regulations do not apply to some of the information collected, confidentiality of infor- mation should be maintained.

Study Questions

1. What information should the sports dietitian obtain from the athlete prior to the first nutrition counsel- ing session?

2. What information can be gleaned from a health his- tory questionnaire? Why does a sports dietitian work- ing with athletes need this information?

3. Besides information provided in a health history questionnaire, what other information is important for the dietitian to obtain?

4. What tools can be used to obtain information about an athlete’s diet? What are the pros and cons of each?

Chapter 10 Nutrition Consultation with Athletes 289

5. Food records must be complete to get an accurate representation of an athlete’s diet. What information about food intake is usually missing or not clearly identified in most food records?

6. Once dietary information has been collected from an athlete, what standards, tools, and/or dietary mea- sures can be used by the dietitian to assess that athlete’s diet? What are the advantages and disad- vantages of each?

7. What are the basic steps required for conducting an effective initial dietary consultation? Is it necessary

for the steps to be completed in a specific sequence? Defend your answer.

8. What is the purpose of a follow-up visit? What should be discussed in the follow-up session?

9. How do walk-in dietary consult sessions differ from the typical planned consultation? What can and can- not be accomplished in these short sessions?

10. What does HIPAA stand for? How does HIPAA affect sports dietitians and their handling of the informa- tion gathered during counseling?

References

1. Jonnalagadda S, Rosenblum C, Skinner R. Dietary practices, attitudes, and physiological status of col- legiate freshman football players. J Strength Cond Res. 2001;15(4):507–513.

2. Jacobson B, Sobonya C, Ransone J. Nutrition practices and knowledge of college varsity athletes: a follow- up. J Strength Cond Res. 2001;15(1): 63–68.

3. Cole CR, Salvaterra GF, Davis JE, Borja ME, Powell LM, Dubbs EC, Bordi PL. Evaluation of dietary practices of National Collegiate Athletic Associa- tion division I football players. J Strength Cond Res. 2005;19(3):490–494.

4. Nichols PE, Jonnalagadda SS, Rosenbloom CA, Trinkaus M. Knowledge, attitudes, and behaviors regarding hydration and fluid replacement of collegiate ath- letes. Int J Sport Nutr Exerc Metab. 2005;15(5):515–527.

5. Burns RD, Schiller MR, Merrick MA, Wolf KN. Intercol- legiate student athlete use of nutritional supplements and the role of athletic trainers and dietitians in nutri- tion counseling. J Am Diet Assoc. 2004;104(2):246–249.

6. Smart L, Bisogni CA. Personal food systems of male college hockey players. Appetite. 2001;37:57–70.

7. Commission on Dietetic Registration. State Licensure. Available at: http://www.cdrnet.org/state-licensure. Accessed January 22, 2013.

8. Institute of Medicine. Dietary Reference Intakes: Applica- tions in Dietary Assessment. Washington, DC: National Academies Press; 2000.

9. Beaton GH, Milner J, Corey P, et al. Sources of variance in 24-hour dietary recall data: implications for nutri- tion study design and interpretation. Am J Clin Nutr. 1979;32:2546–2559.

10. Driskell JA, Wolinsky I. Nutritional Assessment of Ath- letes. Boca Raton, FL: CRC Press; 2002.

11. Lichtman SW, Pisarska K, Berman ER, et al. Dis- crepancy between self-reported and actual caloric intake and exercise in obese subjects. N Engl J Med. 1992;327:1893–1898.

12. Mertz W, Tsui JC, Judd JT, et al. What are people really eating? The relation between energy intake derived

from estimated diet records and intake determined to maintain body weight. Am J Clin Nutr. 1991;54:291–295.

13. Tarasuk V, Beaton GH. The nature and individuality of within-subject variation in energy intake. Am J Clin Nutr. 1991;54:464–470.

14. Van Staveren WA, Hautvast JG, Katan MB, Van Mont- fort MA, Van Oosten-Van Der Goes HG. Dietary fiber consumption in an adult Dutch population. J Am Diet Assoc. 1982;80:324–330.

15. Barr SI, Janelle KC, Prior JC. Energy intakes are higher during the luteal phase of ovulatory menstrual cycles. Am J Clin Nutr. 1995;61:39–43.

16. Tarasuk V, Beaton GH. Menstrual cycle patterns in energy and macronutrient intake. Am J Clin Nutr. 1991;53:442–447.

17. National Cancer Institute, Division of Cancer Control and Population Sciences. Diet History Questionnaire. Available at: http://appliedresearch.cancer.gov/dhq2/. Accessed November 24, 2015.

18. Subar AF. Developing dietary assessment tools. J Am Diet Assoc. 2004;104(5):769–770.

19. Clark KS. Sports nutrition counseling: documentation of performance. Top Clin Nutr. 1999;14(2):34–40.

20. Maughan RJ, Greenhaff PL, Leiper JB, Ball D, Lambert CP, Gleeson M. Diet composition and the performance of high-intensity exercise. J Sports Sci. 1997;15(3):265–275.

21. Bloch TD, Wheeler KB. Dietary examples: a practi- cal approach to feeding athletes. Clin Sports Med. 1999;18:703–711.

22. Kleiner SM. Eating for peak performance. Physician Sportsmedicine. 1997;25(10):123.

23. Holli BB, Calabrese RJ. Communication and Education Skills: The Dietitian’s Guide. 2nd ed. Philadelphia, PA: Lea & Febiger; 1991.

24. Prochaska JO, Norcross JC, DiClemente CC. Changing for Good. New York, NY: Avon Books; 1994.

25. Centers for Medicare and Medicaid Services. The Health Insurance Portability and Accountability Act of 1996 (HIPAA). Baltimore, MD. Available at: http:// www.cms.hhs.gov/hipaa. Accessed August 20, 2004.

290 SECTION 2 The Practical Application of Sports Nutrition

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Key Questions Addressed 1. What are the common weight management concerns for athletes?

2. What are the prevalence and significance of overweight and obesity?

3. What methods are used to determine weight status?

4. Why is body composition important?

5. What are the components of energy intake and energy expenditure?

6. What methods do athletes use to lose weight?

7. What are the weight loss issues for athletes in weight classification sports?

8. What happens when weight loss efforts develop into disordered eating patterns?

9. How can athletes gain weight healthfully?

You Are the Nutrition Coach Ian is an 18-year-old gymnast training at a private gym with many other male and female gymnasts. He is competing at an advanced level and is likely to make the next Olympic team. Lately he has been finding some of his balance and strength moves on the rings and paral- lel bars more difficult. He has gone through a bit of a growth spurt and has gained approxi- mately 5 pounds over the last year. He suspects the weight gain is causing his performance difficulties. He decides to try a weight loss program that will help him lose weight before his next big competition in 6 weeks. He is not sure how many calories to consume and therefore arbitrarily decides to eat 1500 calories per day.

Questions • Which assessments are required to determine whether Ian needs to lose weight?

• What type of diet and exercise plan would you recommend for Ian?

• What additional concerns do you have for Ian’s health and sport performance?

Weight Management

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CHAPTER 11

What are the common weight management concerns for athletes? Almost all athletes are looking for ways to improve sport performance. To gain a performance edge on their com- petitors, athletes may try to lose weight, gain weight, or modify their body composition. Overall health is also a concern for most athletes; weight modifications may be necessary in some cases if the athlete presents with risk factors such as prehypertension, insulin resistance or pre- diabetes glucose levels, or lipid abnormalities.

A common reason athletes strive to lose weight is aesthetics. Athletes have similar concerns as the general population about weight and body composition. They are concerned about their appearance and try to meet the ideals of cultural norms. Athletes often perceive addi- tional pressure to maintain or achieve an ideal weight to enhance, improve, or sustain optimal sport performance.

Performance may improve following weight loss in some athletes. For example, a few pounds lost, especially as body fat, may improve speed. If an athlete has less body weight to carry but maintains the same muscle mass and power, speed may improve. Agility may increase as well for similar reasons. Less body fat may help the ath- lete jump higher or plant and turn with greater speed. Therefore, in some cases, weight loss may improve sport performance. In other cases, attempting to make these changes may lead to an obsession about weight or body composition and result in disordered eating.

Some sports have weight classifications requiring athletes to compete in a specific weight category. These athletes must “make weight” before each event or they will not be able to compete in the event. This places extra pressure on athletes to lose or maintain their body weight, which often involves altering their daily diet, sometimes in a dramatic fashion.

Many athletes want to gain weight or increase lean muscle mass to improve sport performance. As the strength-to-weight ratio increases, more power per pound can be produced, and potentially an athlete can increase speed, decrease time over long distances, and produce more power in explosive sports. Increasing lean mass or overall weight requires nutrition and exercise changes to enhance the ability of the body to develop and maintain additional body mass.

This chapter discusses the various weight manage- ment concerns of athletes and ways athletes can alter body weight, if needed. The chapter begins with an intro- duction of the prevalence and health consequences of overweight and obesity and assessment of weight and body composition. A discussion of energy balance, includ- ing intake, needs, and expenditure in athletes and the general population, provides the background necessary for the reader when the topics of weight loss and weight gain in athletes are discussed. A section on issues per- taining to weight-classified sports and eating disorders in athletes is also included in this chapter.

What are the prevalence and significance of overweight and obesity? Data from the National Health and Nutrition Examination Survey (NHANES) show that there has been a significant rise in the incidence of overweight and obesity.1,2 FIGURE 11.1 shows the alarming trends in the rise of over- weight and obesity in adult males and females in the United States from 1960 to 2012.1 Overweight and obesity are determined in these data sets using body mass index (BMI) measurements. A BMI of 18.5–24.9 is considered

normal weight, ≥25 is considered over- weight, and ≥30 is considered obese. The NHANES data show that approxi- mately 69% of adult Americans are over- weight or obese, with 35.7% of these being obese.1 Overweight

and obesity in children and adolescents ages 3 to 19 has also been on the rise, with approximately 17.5% of this age population being obese in the United States.2

The prevalence of overweight and obesity in athletes in most competitive sports is relatively low. However, in some sports, such as football, heavyweight wrestling, and boxing, the prevalence of overweight and obesity may be high. As an example, for the past decade there has been a perception that bigger is better in almost all positions in football. Indeed, players are bigger than in years past. This may or may not pose additional health risks to the athlete. If the majority of the weight gain is fat-free mass, then the increase in disease risk is negligible. A study of Division I football players to determine body mass and body com- position found the mean BMI of all positions was 29.4 ± 0.6%.3 Body fat percentages ranged from 15.2–25.4%. Quar- terbacks, defensive and offensive backs, and receivers were the leanest and weighed less, whereas the linemen

were the heaviest and had the highest body fat percentages. Though the NHANES data are reflective of the U.S. population as a whole, not an athletic population, the trends toward overweight and obe- sity in the general population are likely to affect the health and performance of athletes, particularly young athletes, in the future.

body mass index (BMI) An indicator of nutritional status that is derived from height and weight measurements. Body mass index has also been used to provide a rough estimate of body composi- tion even though the index does not account for the weight contri- butions from fat and muscle.

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Overweight and obesity affect nearly two-thirds of the adult Amer- ican population. Athletes have a much lower prevalence of over- weight than the general popula- tion. However, athletes participating in some power sports and sports in which a greater body mass is ben- eficial (e.g., football, heavyweight wrestling, some field events) have a higher incidence of overweight or obesity.

What are the main health consequences and health risks of overweight and obesity? The health consequences associated with obesity as a risk factor carry with them significant morbidity and mortality in adults and health problems in children and adolescents. Some of the major health conditions associ- ated with obesity include hypertension, type 2 diabetes, coronary heart disease, stroke, osteoarthritis, respiratory problems, and some types of cancer. There are additional psychological, emotional, and social costs to obese indi- viduals as well. Obese athletes are at risk for develop- ing these health consequences as well. Despite their high activity levels, which offer some preventive effects, obese athletes can develop obesity-related conditions, and pro- fessionals working with them should provide screening and education for the athlete just as they would the gen- eral population.

BMI and mortality rates have a strong correlation. Individuals in the underweight (< 18.5 BMI) and obese (≥ 30 BMI) categories have increased mortality relative to individuals in the normal weight category.4 There is relatively low risk in the 18.5–24.9 and even the 25–29.9 BMI categories when there is an absence of concurrent comorbid conditions. Obesity is generally defined as an excess of body fat accumulation. It is the excess adipose tissue that is the cause of the comorbid conditions, not necessarily the excess weight.5 A person’s absolute risk status is based not only on the BMI classification, but also on waist circumference measurements, existing dis- ease conditions, and summation of other obesity-associ- ated diseases. Increased risk is found in individuals with

Overweight

Obesity

Extreme obesity

Men

1960– 1962

1971– 1974

1976– 1980

1988– 1994

1999– 2000

2003– 2004

2007– 2008

2011– 2012

WomenOverweight

P er

ce nt

Figure 11.1 Trends in overweight, obesity, and extreme obesity among adults aged 20 to 74 years: United States, 1960–1962 through 2011–2012. Notes: Age adjusted by the direct method to the 2000 U.S. Census population using age groups 20 to 39, 40 to 59, and 60 to 74. Overweight is a body mass index (BMI) ≥ 25 kg/m2 but, < 30 kg/m2; obesity is a BMI ≥ 30; and extreme obesity is a BMI ≥ 40. Sources: Courtesy of CDC/NCHS, National Health Examination Survey I 1960–1962; National Health and Nutrition Examination Survey (NHANES) I 1971–1974; NHANES II 1976–1980; NHANES III 1988–1994; NHANES 1999–2000, 2001–2002, 2003–2004, 2005–2006, 2007–2008, and 2009–2010.

cardiovascular dis- ease risk factors and other obesity-asso- ciated risk factors, such as osteoarthri- tis, physical inactiv-

ity, hypertension, and gynecological abnormalities. Very high absolute risk status would include individuals with high BMI that already have an existing disease, such as coronary heart disease, atherosclerotic disease, diabetes, or sleep apnea.

The National Institutes of Health (NIH) and the National Heart, Lung, and Blood Institute published practical guidelines for managing overweight and obe- sity in adults in 2013.6 This guide includes a treatment algorithm that helps the client and practitioner assess overweight and obesity as well as associated educational tools and treatment options based on the assessment. The treatment algorithm was designed primarily for use in a clinical medical setting. However, this algorithm can be applied to the athletic population to assess and help prevent or treat medical conditions that may be associ- ated with overweight or obesity. The initial assessment can occur during a preseason physical or at other times throughout the athletic season when the need arises. The main steps in assessing, preventing, and treating over- weight and obesity, adapting the algorithm for use with athletes, are the following: 1. Measure height, weight, waist circumference, and

body composition. 2. Calculate BMI.

waist circumference A measure of abdominal girth taken at the narrowest part of the waist as viewed from the front.

Chapter 11 Weight Management 293

for various heights and weights are widely available. This makes BMI an easy and available tool for both health pro- fessionals and the public to use to assess their weight and health status.

BMI correlates well with body fatness.8,9 Evidence sup- ports the use of BMI in risk assessment because it provides a more accurate measure of total body fat than does the assessment of weight alone.7,10 However, BMI has some limitations when applied to athletes. Individuals with higher muscle mass (like most athletes) may have a BMI above 24.9 because muscle tissue is denser than fat tis- sue, weighing more when compared with an equal vol- ume of fat tissue, leading to a higher body weight and BMI. Although total body weight in these athletes may be higher, they may be very lean and thus have a lower health risk despite being in the overweight BMI category. Athletes can use BMI for a general idea about their weight status, but body composition measures (the ratio of lean muscle to fat) will provide a better understanding of their overall health status as well as their sport performance needs. BMI can be used as a basic screening tool for athletes. It is a

3. Determine whether BMI, waist circumference, and body composition are within normal ranges for the athlete.

4. Assess health parameters (e.g., cholesterol and blood pressure).

5. If within normal limits, encourage weight maintenance.

6. If above normal limits, determine athlete’s interest in and ability to attempt weight/fat loss; provide educa- tion and monitoring of behaviors.

7. Follow up assessments and provide education regu- larly to determine progress toward goals. The treat- ment algorithm is focused on disease risk factors and prevention of disease complications related to obesity. A discussion of BMI and waist circumference measures and their relevance to health and sport per- formance are presented in the next section.

What methods are used to determine weight status? The two most commonly used ways to assess weight sta- tus are BMI and waist circumference. Both of these mea- sures are used to determine health and health risk and can be used as a starting point when determining a weight that is best for athletic performance. BMI and body fat distribution measures combined with body composition assessments (discussed in the next section) offer sport nutrition professionals helpful information to establish a weight management plan for athletes.

What is body mass index? The most widely used height for weight index in adults is the BMI. It is a measure of height versus weight using a metric calculation. BMI data were obtained from large gen- eral population groups to determine the midpoint range of health. BMI is calculated by dividing a person’s weight in kilograms by the square of their height in meters. It can also be calculated using body weight in pounds and height in inches (versus kilograms and meters). Fortify- ing Your Nutrition Knowledge presents the calculations for both methods.

TABLE 11.1 outlines the recommended classifications for BMI adopted by the National Institutes of Health Expert Panel on the Identification, Evaluation, and Treat- ment of Overweight and Obesity in Adults.7 The BMI is not gender specific and therefore is appropriate for all men and nonpregnant women of all races and ethnic groups. A BMI of 18.5–24.9 is considered normal or healthy for the average population, 25–29.9 is considered over- weight, greater than or equal to 30 is considered obese, and greater than or equal to 40 is considered extreme obe- sity. The BMI should be used to classify overweight and obesity and to estimate relative risk for disease compared to normal weight. Nomogram charts with calculated BMIs

Table 11.1

Body Mass Index Classifications

BMI (kg/m2) Classification < 18.5 Underweight

18.5–24.9 Normal weight

25.0–29.9 Overweight

30.0–34.9 Obesity class I

35.0–39.9 Obesity class II

≥ 40 Obesity class III (extreme obesity)

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Calculating Body Mass Index Metric Calculation Equation Weight in kilograms ÷ (Height in meters)2

Height: 74 inches Weight: 195 pounds Convert inches to meters:

74 inches × 2.54 cm/inch = 188 cm = 1.88 meters Convert pounds to kilograms:

195 lbs ÷ 2.2 = 88.6 kg 88.6 kg ÷ (1.88 m)2 = 25.1 BMI

Nonmetric Calculation Equation (Weight in pounds ÷ [Height in inches]2) × 703

Height: 74 inches Weight: 195 pounds

(195 ÷ [74 inches]2) × 703 = .0356 × 703 = 25.1 BMI

quick and easy way to assess weight; how- ever, it is only one part of a comprehen- sive assessment to help an athlete deter- mine the best weight for both health and sport performance.

What can measures of body fat distribution tell us? BMI can be used to predict potential health risks. Other measures of risk assessment also can be employed to obtain a clearer picture of health. Waist circumference measures the degree of weight distribution around the waist. Fat located in the abdominal area is associated with a greater health risk than fat in the gluteal-femoral region. A waist circumference greater than 40 inches (> 102 cm) in men and 35 inches in women (> 88 cm) is considered high, placing individuals at greater risk for disease.

Waist circumference is measured using a flexible tape at the narrowest part of the waist as viewed from the front while the person is standing. The measure is best conducted against bare skin or tight-fitting clothing. The tape should be snug, but not compress the skin, and should be parallel to the ground all the way around the waist. For individuals who do not have an obvious narrow part of the waist on visual inspection, it is best to mea- sure the waist at the midpoint between the iliac crest and the lower rib. Waist circumference can be an independent predictor of disease risk. However, often waist circumfer- ence and BMI are used together to estimate risk status. A high waist circumference measure when BMI is between 25 and 34.9 is associated with an increased disease risk

for type 2 diabetes, dyslipidemia, hypertension, and car- diovascular disease.11,12 TABLE 11.2 presents the relative risk of waist circumference combined with BMI levels. At a BMI ≥ 35, waist circumference measurements have little added predictive power over BMI alone, and it may not be necessary to measure waist circumference in this case. Measuring waist circumference is part of the evaluation guidelines from the NIH and is preferred over waist-to-hip ratio measurement for assessing overweight and obesity. Although waist circumference measures are primarily used to determine health risk, athletes, especially those in heavyweight sports, should have a waist circumference measure as part of an annual sport physical.

Waist-to-hip ratio (WHR) is another fat distribution measure that compares abdominal circumference to hip

girth. It gives an indi- cation as to where fat deposition is occurring (i.e., upper body versus lower body). For example,

individuals with fat deposition that occurs primarily in the hips are described as having a pear shape (see FIGURE 11.2 ). The opposite fat deposition pattern results in a body shape resembling an apple. To determine WHR, the waist measurement is taken as described above for the waist circumference. The hip measurement is taken around the hips and over the buttocks wherever the greatest girth is found. Once the measurements are taken, the WHR is calculated by dividing the waist girth by the hip girth. Females and males with WHRs greater than 0.80 and 0.91, respectively, run a higher risk for cardiovascular disease, diabetes, hypertension, and certain cancers.13 A low-risk WHR value is less than 0.73 and 0.85 in women and men, respectively.13

waist-to-hip ratio (WHR) A comparison of waist girth to hip girth that gives an indication of fat deposition patterns in the body.

Table 11.2

Classification of Overweight and Obesity by BMI and Waist Circumference, and Associated Disease Risk*

Underweight, Normal, Overweight, Obesity, and Extreme Obesity

BMI (kg/m2) Obesity Class Men ≤ 102 cm (≤ 40 in) Women ≤ 88 cm (≤ 35 in)

Men >102 cm (> 40 in) Women > 88 cm (> 35 in)

Underweight < 18.5 — — —

Normal+ 18.5–24.9 — — —

Overweight 25.0–29.9 — Increased High

Obesity 30.0–34.9 I High Very high

35.0–39.9 II Very high Very high

Extreme obesity ≥ 40 III Extremely high Extremely high

* Disease risk for type 2 diabetes, hypertension, and cardiovascular disease.

+ Increased waist circumference can also be a marker for increased risk, even in persons of normal weight.

Reproduced from National Heart, Lung and Blood Institute, National Institutes of Health, U.S. Department of Health and Human Services. Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults, Evidence Report, 1998. NIH Publication No. 98-4083.

Chapter 11 Weight Management 295

Food for Thought 11.1

Body Mass Index: Calculation and Interpretation

Calculate body mass index and interpret results in relation to health and need for weight loss.

In females, some essential body fat is also associated with mammary glands and in the pelvic region. The essential body fat percentage or the minimum level of body fat com- patible with health in men is approximately 3–5% and in

women is approxi- mately 12–14%.14 Nonessential body fat is found in adi- pose tissue.

Fat-free mass (FFM) is the weight of all body components except fat and is primarily made up of the skeletal muscles and bone,

including minerals, protein, water, and fat-free organ weight. The term FFM is often used inter- changeably with lean body mass (LBM); h o w ev e r, L B M includes essential fat and FFM does not. Approximately 70% of the FFM is made up of water. Bone mineral mass (BMM) is the weight of the mineral content of bone based on esti-

mations of bone density. Bone consists of approximately 50% water and 50% minerals and protein. Total bone weight is approximately 12–15% of total body weight, but only 3–4% of this is minerals.

Percent body fat (%BF) is the percentage of total body weight that is fat mass. The %BF is the number that most

athletes and their coaches and trainers use to determine whether the athlete is at an optimal body composition. This

combined with BMI will give a better picture of overall health and ability to perform in the sport.

The World Health Organization (WHO) and the NIH have not yet determined body composition recommen- dations for the average population. These organiza- tions have not made these recommendations primarily because there are many techniques used to determine body composition, thereby making it difficult to compare results and make recommendations. In addition, some methods are costly, are time consuming, may lack reli- ability, and are not readily available to the public or the average medical provider. As previously discussed, BMI and waist circumference measures are available, easy, and inexpensive, making these assessments appropri- ate for the general population. For athletes, body com- position remains the preferred assessment (versus BMI

fat-free mass (FFM) The weight of all body substances except fat. Fat-free mass is primarily made up of skeletal muscles and bone and includes minerals, protein, water, and fat-free organ weight.

lean body mass (LBM) The portion of a body's makeup that consists of fat-free mass plus the essential fats that comprise those tissues.

percent body fat (%BF) The amount of fat mass found on the body expressed as a percentage of total body weight.

Why is body composition important? Measures of height versus weight and measures of dis- tribution of body fatness in the waist and hip areas are simple, noninvasive, and inexpensive ways to determine appropriate weight and the health risk status of individ- uals. However, these measures do not provide specific information about the actual quantity of body fat, mus- cle mass, and other components in the body that make up total body mass. Determining actual body fat, muscle mass, and bone mineral mass percentages (body compo- sition) helps further determine health status and, for ath- letes, is an excellent way to determine whether weight is optimal for sport performance.

What makes up the composition of the body? The body is made up of a variety of tissues and substances that contribute to total body mass. Fat mass (FM) is the weight of body fat. Body fat is made up of about 10% water

and 90% adipose tis- sue. Essential body fat is the fat associ- ated with the inter- nal organs, central nervous system, and bone marrow. Without fat in these areas, the body can- not function properly.

Figure 11.2 Apple vs. pear shape. Android and gynoid fat distribution patterns. Individuals exhibiting android fat distribution have high waist-to-hip ratios and are at greater risk for cardiovascular disease.

Apple (android)

Pear (gynoid)

nonessential body fat Fat found in adipose tissue. Nonessen- tial body fat is also called "storage fat."

fat mass (FM) The portion of body composition that is fat. Fat mass includes both fat stored in the fat cells and essential body fat.

essential body fat Fats found within the body that are essential to the normal structure and func- tion of the body.

bone mineral mass (BMM) The weight of the mineral content of bone.

296 SECTION 2 The Practical Application of Sports Nutrition

and waist circumfer- ence) because it is a better method for determining the quantities of both FFM and FM.

Body composi- tion varies greatly between individuals. It is influenced by a myriad of factors, including genetics, gender, age, disease, diet, and activity level. Young indi- viduals tend to have higher resting meta- bolic rates, are more

active, and as a result are lean. As puberty approaches, the males begin to build more muscle mass and the females more fat mass because of increasing sex hor- mone levels. In adulthood, job and family responsibilities tend to replace regular exercise, sports participation, or recreational activities, and the result over time is muscle mass decreases and fat mass increases. In older indi- viduals, the continued decreased activity level and onset of certain chronic diseases, such as osteoarthritis, can compound muscle loss and fat accumulation. For these reasons and based on genetics and response to training, athletes in the same sport and with the same training regimen will have varied body composition measures.

What are the methods for measuring body composition? Body composition can be measured in a variety of ways. Some methods are quick and relatively inexpensive to complete, whereas others are time consuming, highly technical, and costly. The accuracy of the various body composition measurements is also highly variable. In fact, even the most accurate techniques have measure- ment errors in the 2–3% range. This section addresses the commonly used body composition measurement tools used in the field and laboratory, which include underwa- ter weighing (UWW), air displacement plethysmography, bioelectrical impedance analysis, skinfold measurement, dual-energy X-ray absorptiometry (DEXA), and others.

The gold standard (or criterion) methods of deter- mining body composition are underwater weighing (i.e., densitometry) and DEXA. These techniques are consid- ered accurate, and their validity and reliability have been established in the research literature. UWW and DEXA are used to help validate other methods of body composition.

What is underwater weighing? Underwater weighing, or hydrostatic weighing, is an assessment of body composition based on the determi- nation of body density or densitometry. To determine the

Figure 11.3 Underwater weighing. During underwater weighing, the subject must exhale completely, submerge without tak- ing a breath, and remain motionless until the water is still and the scale is steady.

density of the body, the athlete is first weighed on land and is then submerged in a tank of water to determine his or her underwater weight

(see FIGURE 11.3 ). The basic premise of this technique is that fat-free mass sinks and fat floats; therefore, the more the body weighs in the water, the less fat within the body. Most of the error associated with this method arises from the assumptions made when converting body density to percent body fat. Although fat density from one person to the next is fairly consistent, assumptions about fat- free mass can decrease accuracy because it is assumed that all of the component tissues making up fat-free mass exist in the same percentages from person to per- son. This assumption is flawed because, for example, an osteoporotic female would have less dense bones than normal, and her skeletal weight would therefore make up a lower percentage of her FFM than assumed. Fortunately, the induced error is relatively small under most circum- stances, which is why underwater weighing is still con- sidered the standard for body composition assessment. In addition, researchers have developed conversion equa- tions for various subpopulations to account for known differences in FFM to increase the accuracy of this tech- nique. Under ideal measurement conditions and applying the appropriate conversion formula, the standard error of measurement is approximately ±2.5%.13

underwater weighing The gold standard of body composition de- termination that involves weighing a person while he or she is totally immersed in water.

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Gaining the Performance Edge

Height, weight, and waist circumfer- ence measures are fast, easy, inex- pensive, and noninvasive tools that every healthcare provider should use. Calculating BMI or using a nomogram with BMI levels for vari- ous heights and weights is sim- ple and gives reliable information quickly about the patient. Waist- only and waist-to-hip circumfer- ence measures can give additional information to help assess health risk as well as body fat distribution.

The disadvantages of underwater weighing are that it has to be conducted in a laboratory because the water tank is not mobile; the protocol is fairly complex, so obtaining all the data needed requires some technical expertise; and many people do not like getting into a small tank of deep water, much less totally submerging themselves for several seconds while their underwater weight is mea- sured. Finally, the test requires the person being mea- sured to follow some very specific directions that some populations, especially children, can find difficult.

What is air displacement plethysmography? A newer method of body composition analysis that is simi- lar to UWW but enables determination of body density based on air displacement rather than water is air displace- ment plethysmography. Just as in UWW, once body volume is known, the density of the body can be calculated and

used to determine percent body fat. The commercially avail- able machine that uses air displacement plethysmography is called the BOD POD. The BOD POD is an egg-shaped container in which the person sits (see FIGURE 11.4 ).

air displacement plethysmog- raphy A technique that measures the volume of air displaced by an object or body. In body composi- tion assessment, air displacement plethysmography is used to determine the volume of the body so that the density of the body can be determined.

Figure 11.4 BOD POD. By using air displacement, the BOD POD pro- vides an alternative to underwater weighing that is sim- pler, quicker, and of similar accuracy. Courtesy of COSMED USA, Inc.

The accuracy of air displacement plethysmography is similar to underwater weighing. It is prone to many of the same assumption errors as UWW because once body den- sity is calculated, assumptions have to be made to convert to percent body fat. The advantages to this method over UWW are that subject participation in the measurement is minimal, the subject stays dry, and the fear of going underwater is removed. It is relatively simple to use, and obtaining the measurement is quick. Also, the BOD POD is easier to maintain than the water tank used for UWW and is smaller, lighter, and more portable. The disadvan- tage is that the BOD POD is expensive and well above the budget of many facilities.

What is dual-energy X-ray absorptiometry? Dual-energy X-ray absorptiometry (DEXA) has been used for measuring bone mineral density for research and health assessment for many years. It is commonly used

to assess risk for osteoporosis and can measure bone min- eral density (BMD) by region in the body. In addition to assessing BMD, DEXA also can be used for body composition deter-

mination. During assessment, the individual is placed in a supine position on a table in the DEXA machine, and the DEXA scanner passes over the entire length of the body (see FIGURE 11.5 ). Just as with any X-ray technology, the var- ious body tissues absorb or reflect the X-rays to varying degrees, allowing for differentiation between tissue types. The X-ray information is analyzed by computer software that differentiates between the various tissue types and calculates body fat percentage. Unlike UWW and the BOD

dual-energy X-ray absorpti- ometry (DEXA) A method of body composition assessment that involves scanning the body using radiography technology to distinguish between fat and lean body tissue.

Figure 11.5 DEXA (dual-energy X-ray absorptiometry). The two- dimensional image produced from a DEXA scan can be used to assess body composition. © Photodisc

298 SECTION 2 The Practical Application of Sports Nutrition

POD, which are based on a two-component model of body composition (FM and FFM), the DEXA provides a three- component look at body composition (FM, bone mass, and lean body mass). Most studies have concluded that DEXA is accurate and correlates well with results from UWW.15,16

DEXA’s advantages are that it is the only method that provides regional as well as whole body composi- tion measures; it requires minimal cooperation from the participant, thus expanding its use to all ages and levels of health; it is easy to operate; and it is relatively fast (it takes 15 to 20 minutes). The limiting factors in using DEXA are that the machine is large, costly, and not mobile. As a result, these machines are usually found only in research institutions or clinical settings.

What is bioelectrical impedance analysis? Bioelectrical impedance analysis (BIA) has become a popular way to assess body composition. A variety of BIA machines are available to the general population for home use, and more sophisticated machines are available

for clinical and research settings. During BIA in a lab, the person lies flat on a nonconducting surface. Electrodes are placed on two different parts of the body, usually one on the foot and one on

the hand on the same side of the body (see FIGURE 11.6 ). An insensible electrical current is passed between the elec- trodes, and the resistance to the flow of the electricity is

bioelectrical impedance analy- sis (BIA) A body composition assessment technique that mea- sures the resistance to flow of an insensible electric current through the body; percent body fat is then calculated from these impedance measurements.

Figure 11.6 Bioelectrical impedance analysis (BIA). The measured resistance to a small electrical current passed through the body is used to estimate body composition.

measured. Because the physical properties of fat make it an insulator, the greater the resistance to flow (i.e., imped- ance) of the electric current, the higher the percent body fat. Computer software then uses prediction equations based on gender and age to convert the impedance mea- sures to percent body fat.

The accuracy of BIA depends on which prediction equations are used and whether certain premeasurement conditions are met. Of particular concern are any pre- assessment activities that might affect hydration level.17 An athlete who is overhydrated prior to BIA assessment is likely to have a higher calculated body fat percentage, and a dehydrated athlete is likely to have a lower cal- culated body fat percentage than if the measures were taken in a normal hydrated state.17 To obtain accurate measures, subjects should avoid alcohol consumption within 48 hours of testing; avoid moderate or vigorous physical activity within 12 hours of assessment; abstain from eating within 4 hours of the test; avoid ingestion of any substances that have diuretic effects, including caf- feine, prior to assessment; and empty the bladder imme- diately before the test. When the appropriate prediction equation is applied and measurement conditions are met, the standard of error for BIA can be fairly small (±5%).18

The handheld or foot bathroom scale types of BIA do not provide as accurate of a measure as the typical labo- ratory devices. However, they can be used in combination with body weight to assess changes in mass over time. Athletes making dietary and exercise changes to alter body composition (either to gain FFM or to lose FM) may use these scales as an adjunct to weight measures alone. They can plot changes in %BF and weight over time to determine the trend in changes in these two parameters. For better success with assessing trends in using the hand- held or foot scales, measurements should be done weekly on the same day and at the same time of day, before exer- cise, and with the same average amount of hydration.

What is a skinfold assessment? Body composition can be estimated by measuring subcu- taneous fat. The thickness of the layer of fat directly underneath the skin is measured using skinfold calipers. During skinfold measurement, the tester pinches a fold

of skin between the thumb and index fin- ger. While holding the fold, the thick- ness of the fold is

measured by placing the skinfold calipers perpendicular to and about a half an inch below the pinching fingers. The spring tension in the caliper jaws slightly presses in on the fold, and the skinfold thickness is measured in millimeters. FIGURE 11.7 shows the skinfold calipers being used to measure the thickness of the triceps skinfold. Measurements are taken at several anatomical locations on the body. TABLE 11.3 lists the common skinfold sites and their anatomical locations.

skinfold calipers An instrument used to measure the thickness of skinfolds in millimeters.

Chapter 11 Weight Management 299

After the skin- fold measurements are taken, prediction equations can be applied to determine the overall percent- age of body fat. The accuracy of skinfold assessment depends on many factors. First, not all fat is deposited under the skin. In fact, up to 50% or more of the body’s fat can be found in areas other than subcutane- ously. As a result, an assumption has to be made that subcuta-

neous fat levels are accurate indicators of overall body fat. Many formulas have been used to improve the accuracy of subcutaneous measures as they relate to total body fat. In addition, technical errors in the skinfold measurement can decrease accuracy. Learning to take skinfold mea- surements requires proper instruction, education, and substantial practice. Pinching poorly shaped skinfolds, taking measurements at the wrong locations, placing the calipers incorrectly on the fold, and so on can all affect measurement accuracy. If experienced testers follow the standardized measurement techniques and apply the

Table 11.3

Common Sites for Skinfold Measurements

Skinfold site Direction of fold

Anatomical location

Abdominal Vertical 2 centimeters to the right of the umbilicus

Biceps Vertical Anterior midline of upper arm over the mid-belly of bicep muscle, 1 centimeter above the level of the triceps skinfold

Triceps Vertical Posterior midline of upper arm halfway between acromion process and olecranon process

Chest or pectoral Diagonal Men: half the distance between anterior axillary fold and nipple

Women: one-third the distance between anterior axillary fold and nipple

Medial calf Vertical Midline of the medial aspect of calf muscle at the level of greatest girth

Midaxillary Vertical Midaxillary line at the level of the xiphoid process of sternum

Subscapular Diagonal 1–2 centimeters below inferior angle of scapula

Suprailiac Diagonal Anterior axillary line just superior to iliac crest

Thigh Vertical Anterior midline of thigh halfway between inguinal crease and proximal edge of patella

Data from American College of Sport Medicine. Health-related physical fitness testing and interpretation. In: Pescatello LS, Arena R, Riebe D, Thompson PD, eds. ACSM's Guidelines for Exercise Testing and Prescription. 9th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2014.

Figure 11.7 Skinfold measurements. A significant amount of the body's fat stores lies just beneath the skin, so, when done correctly, skinfold measurements can provide an indication of body fatness. An inexperienced or careless measurer, however, can easily make large errors. Skinfold measurements usually work better for monitoring malnu- trition than for identifying overweight and obesity. They also are widely used in large population studies.

correct prediction equations, then skinfold assessment can accurately predict %BF to within 3–4% of UWW.19

As has been discussed, many methods can be used to assess body composition in athletes. Selection of the method used will depend on what equipment and staff are available and its cost. Regardless of the method selected, the athlete should use the same body composi- tion method in subsequent reevaluations. This reduces data variability caused by methodological differences between body composition protocols and makes it easier to follow actual changes that may be occurring in body composition over time. Generally, a lower body fat per- centage and higher lean mass are optimal for athletes. However, the ideal body composition for each athlete can be very different. Therefore, coaches and nutrition profes- sionals should be careful not to set a single body composi- tion level that an entire team or group of athletes should attain. Rather, body composition levels should be devel- oped based on the individual athlete, their genetics, the physical demands of their sport, their performance goals, and their overall health.

300 SECTION 2 The Practical Application of Sports Nutrition

Gaining the Performance Edge

Monitoring body composition in athletes provides a standard of measure that more accurately reflects body fatness than BMI or waist circumference measures. Periodic assessment of body com- position, using the same mode of testing and following standardized protocols, will provide an ongoing way for athletes to assess their body composition over the course of a season and thus help them evalu- ate whether weight loss or gain is needed.

Skin

Skinfold calipers

BoneMuscle Fat

How does body composition affect sport performance? There are basic body composition levels identified for health of the general population but no set standards or ideals for athletes in specific sports or athletes as a group. When considering weight management and body composition issues, each athlete and his or her support staff must look at both the actual value of body fatness and lean body mass and determine whether changes in weight or body composition are warranted for that individual athlete. Assessment data can be compared to any published data for the specific sport, and additional considerations of the athlete’s current sport perfor- mance, goals, diet, exercise patterns, and health should be made to determine whether body composition is in the ideal range.

Although the WHO and NIH have yet to set body composition standards for the general population, oth- ers have suggested healthy body fat ranges of 10–20% for men and 20–30% for women.20 These general recom- mendations may not reflect sport performance norms for athletes. Athletes often assume there is an ideal weight or body composition that is best for their sport and thus for them personally. Suggesting ideal body composition or body fat percentages by sport assumes that there is a known optimal combination of fat mass and fat-free mass that is best for sport performance in a particular sport or activity. However, “ideal” is difficult to define from athlete to athlete because there are so many indi- vidual considerations that contribute to body composi- tion. Genetics, natural physique differences, and muscle and fat distribution are just a few things to consider. Sport performance is determined by a myriad of factors, only one of which is the makeup of FM and FFM in athletes.

The body composition levels required for maintain- ing health tend to be more lenient than those required for optimal performance in many sports. Therefore, body composition recommendations for athletes have been determined by taking the average body weights and fat percentages from large groups of elite athletes in various sports. Manore and Thompson did an extensive review of body fat percentages in male and female athletes in a large variety of sports.21 They found variations in the ranges of body fat percentage in athletes within the same sport and of the same gender. These body fat percentages ranged from approximately 5–19% for male athletes and 7–20% for female athletes. These levels, and those from other research studies of body composition in athletes, can be healthy for some athletes but also could be quite low for other athletes and should not necessarily be con- sidered ideal for a specific sport.

Different sports have different typical body composi- tion levels. For example, sports such as gymnastics, track, and others in which the athlete must work against his or her own body weight to perform in competition tend to benefit from low body fat percentages. In these sports,

excess body fat merely weighs the athlete down and does not provide any benefit in regard to force or energy pro- duction. In other words, fat weight in these athletes is considered “dead weight.” At the other extreme are ath- letes performing in events where weight may be advanta- geous. For example, football linemen and sumo wrestlers benefit from the extra fat weight. Increased body weight in these athletes improves their stability, helps them to hold their ground, and/or helps them move lighter oppo- nents out of the way. Another example where fat can be beneficial is for an athlete participating in long-distance cold water swimming; increased levels of body fat help the athlete float, decreasing drag and providing thermal insulation from the cold water. In these cases, excess body fat can enhance sport performance but is not good for car- diovascular health.22

There are many sports that fall somewhere in between the extremes in regard to body fat require- ments. In some sports, body height is more important than body fat (e.g., basketball). In other sports, moderate levels of body fat can be beneficial as long as it is not at the expense of speed (e.g., rugby, hockey). Despite the fact that body fat levels vary from sport to sport, with all other sport-related requirements (e.g., skills, height) being equal, excess body fat is generally a disadvantage for athletes.

Many athletes closely monitor their body weight as if it is a good indicator of fat levels or body composition. Nothing could be further from the truth. Two athletes can weigh the same on a scale and even be the exact same height but have vastly different FM and FFM per- centages. As a result, athletes who train regularly should not only track body weight but also have body composi- tion measured routinely, especially if they are planning to either increase or decrease weight. Assessing body composition along with body weight can help the athlete determine which component of body mass is changing and thus whether the program is working. For example, if an athlete loses body weight, it could be resulting from either a decrease in muscle mass or a decrease in body fat. A decrease in muscle mass is not beneficial because of its negative impact on metabolism, strength, and power, thus indicating a change is needed in either the athlete’s training regimen or his or her daily diet. Alter- natively, an athlete aiming to lose weight on a particu- lar diet and exercise program may not see a change in total body weight as measured by a scale. The failure to see a body weight loss does not necessarily mean the program is not working because muscle mass could have increased and balanced out any

Chapter 11 Weight Management 301

Food for Thought 11.2

Body Composition: Methods and Calculations

Define various body composition measurement tools, and calculate fat mass and fat-free mass based on body fat percentage.

weight loss caused by decreased fat levels. Obviously, tracking changes in body composition over time is pref- erable and more informative than monitoring changes in body weight alone. TABLE 11.4 provides a list of consider- ations and information that should be collected to help determine an optimal body weight and body composi- tion for individual athletes and their sport.

Table 11.4

Considerations and Information Needed When Setting Body Weight or Body Composition Goals for Athletes

1. The goal is to find the weight that is best for the athlete, not necessarily the lowest possible weight.

2. Assess genetics, resting metabolic rate (RMR), body composition, and activity level.

3. Calculate BMI. 4. Measure waist circumference. 5. Measure body composition. 6. Assess current eating habits. 7. Determine changes in dietary intake and exercise patterns that

may naturally produce weight and body composition changes. 8. Assess training regimen—strength, cardiovascular, stretching,

time, and intensity. 9. Review data on typical body composition for sport and assess

whether this is reasonable for the athlete. 10. Determine whether modifying body composition or weight poses

a risk (e.g., for injury, for an eating disorder) to the athlete. 11. Assess the athlete’s attitude toward nutrition and behavior change.

Figure 11.8 Hunger, satiation, and satiety. Hunger helps initiate eat- ing. Satiation brings eating to a halt. Satiety is the state of nonhunger that determines the amount of time until eating begins again.

I’m full

Let’s eat

I’m beginning to get hungry

Hunger signals you to begin eating.

Satiation signals you to stop eating.

B etw

een m

eals

Grow ing hunger

tin g

Satiety is the satisfaction between meals.

What are the components of energy intake and energy expenditure? An individual is in energy balance when energy intake is equal to energy expenditure. When an individual is in

energy balance, weight remains sta- ble. Positive energy balance occurs when energy intake is greater than energy expenditure, leading to weight gain. Nega- tive energy balance is the opposite— when energy expen- diture is greater than energy intake, caus- ing weight loss. Maintaining energy balance is essential for the maintenance of lean tissue mass,

immune and reproductive function, and optimal athletic performance.23 When trying to lose weight, athletes must

energy balance A state in which energy intake is equal to energy expenditure.

positive energy balance A state in which the total daily calo- ries consumed are greater than the total daily calories expended. A positive energy balance will result in weight gain.

negative energy balance A state in which the total daily calories consumed are less than the total daily calories expended. A negative energy balance will result in weight loss.

achieve negative energy balance. However, the right bal- ance must be struck, in which the calorie intake deficit or the increase in energy expenditure through training is not so great that it compromises sport performance. This sec- tion will cover energy balance, including assessing energy expenditure as well as the multiple components of energy intake and energy expenditure.

What influences energy intake? Energy intake is simply calories consumed in the form of the macronutrients (carbohydrates, fats, and proteins) and alcohol. As discussed previously, carbohydrates and proteins contain 4 kcal/g and fats contain 9 kcal/g. Alco- hol contains 7 kcal/g but does not provide any appre- ciable nutrients, vitamins, or minerals. Energy intake is usually higher in athletes versus nonathletes because of their higher energy expenditures. Food records, 24-hour dietary recalls, and dietary history interviews are used to determine an athlete’s energy intake.

Physiological, environmental, social, and emotional factors all regulate food consumption. These include both internal and external cues for eating. Internally, hunger and satiation provide signals for intake (see FIGURE 11.8 ). External factors include environmental stimuli such as smell, sight, and taste of food as well as the influence of the eating environment.

Internally, hunger prompts eating through physical cues such as gurgling or growling of the

stomach. These are physiological signs that the body is depleted of energy

hunger A physical cue such as gurgling or growling of the stomach that prompts an individual to eat.

302 SECTION 2 The Practical Application of Sports Nutrition

and needs fuel. Satiation is the feeling of fullness that accompanies food intake and signals the time to end a meal. Satiety refers to the feeling of fullness that maintains

after a meal and helps determine the intervals between meals. The composi- tion of the diet can influence hunger, satiation, and satiety. Protein has an increased satiety effect compared to

fat and carbohydrates. The fiber content of a meal or food can enhance satiety by slowing gastric emptying. Total energy content can affect satiation and satiety as well. Energy-dense diets (those high in fat and low in fiber) tend to delay satiation and may encourage overeating. When any type of food is eaten, the stomach and intestines become enlarged and distended; this internal action has a satiation effect.

Appetite often is confused with hunger, and therefore a distinction between the two is important in discussions

of dietary intake and attempts to lose weight. Appetite is a psychological or

emotional desire for food, whereas hunger is driven by a physiological need or drive for food. A number of factors stimulate appetite. External factors such as the smell of fresh baked bread or the anticipation of the taste of a favorite dessert can stimulate appetite. Social influences

such as the time of day, social circumstances, and social events all affect appetite. Cultural influences of family and friends, foods that have special meaning, and tradi- tions around food all can influence the desire to eat regardless of physiological hunger. Stress or other emo- tions can also encourage or discourage food intake that is not related to a physiological need for food.

What are the components of energy expenditure? Three main components make up the total amount of energy expended each day. These components include the resting metabolic rate (RMR), the thermic effect of food (TEF), and the thermic effect of activity (TEA). Our body expends energy to maintain basic physiological functions (e.g., circulation, respiration, cellular functions), to allow for muscular activity, to process nutrients consumed, and, to a lesser degree, to help with temperature control. Energy expenditure increases during physical trauma, growth periods, fevers, and in extreme hot or cold envi- ronments and during exercise. FIGURE 11.9 illustrates the primary components of energy expenditure.

What is resting metabolic rate? Figure 11.9 demonstrates that the largest portion of calo- rie expenditure is attributable to fueling basic physiologic functions. The body is constantly building and tearing down cells to continue functions for life. This portion of total energy expenditure is termed basal metabolic rate (BMR) or resting metabolic rate (RMR). RMR and BMR are often used interchangeably. However, RMR is usually slightly higher than BMR because RMR is assessed several

satiation The feeling of fullness that accompanies food intake and signals the time to end a meal.

satiety The feeling of fullness that maintains after a meal and helps determine intervals between meals.

appetite A psychological or emotional desire for food.

Figure 11.9 Major components of energy expenditure. The majority of daily energy expenditure is used to maintain physiological functions. Energy expended by athletes during physical activity and exercise is significant and could equal or exceed the energy needed for maintaining resting energy expenditure. The thermic effect of food is the energy required to digest, absorb, transport, metabolize, and store food.

Fuel to process the food we eat

Physical activity

(15–30%)

Thermic effect of

food (~10%)

Resting energy expenditure (60–75%)

Fuel for physical activity

Fuel used to maintain basic physiological functions

Chapter 11 Weight Management 303

hours after a meal or physical activity and BMR is assessed while the individual is in a totally rested state (no exer- cise for 12 to 18 hours and after an overnight sleep). RMR reflects a more practical measure. The functions included in RMR are the respiratory process, circulation, heartbeat, muscle functions, nervous functions, temperature regula- tion, and all of the organ functions that are very metaboli- cally active. It is estimated that 60–75% of the total energy expenditure daily is RMR.24

Many factors can influence RMR. Individuals with higher body weight or larger surface area have a higher RMR. Those with increased lean body mass have a higher RMR because muscle tissue is more metabolically active than fat tissue. Caffeine intake and smoking increase RMR, as does hot or cold ambient temperature. Rapid growth and some medical conditions can increase or decrease RMR. Each individual’s RMR remains relatively consistent over time, but significant differences in RMR can be found when comparing different individuals.

Actual total daily energy expenditure can be assessed in several ways. Many are used in research or hospital set- tings and are available only to research participants or hospitalized patients. These measures include direct calo- rimetry using a whole body calorimeter; indirect calorime- try, which measures oxygen consumed and carbon dioxide produced; and doubly labeled water that measures isotope excretion rates. These methods are costly to administer and not widely available to the public. Because these meth- ods are not quick and easy to use in the athletic training room, on the field, or in a sports professional’s office, other methods to estimate energy expenditure must be used.

Regression or prediction equations are the most com- monly used practical method to help determine energy expenditure and thus energy requirements. TABLE 11.5 pres- ents four calculation methods that can be applied in clini- cal and training settings to provide an estimation of daily energy requirements. One consideration when using predic- tion equations to estimate energy needs of athletes is how the equations were developed. Most prediction equations used the general population, both obese and non-obese, and did not use athletes in their studies that resulted in the development of the equations. Each equation can be applied to athletes, but the sport nutrition professional must be aware that these are prediction equations, meaning just that—they predict or estimate energy expenditure. Practi- tioners working with athletes should use their clinical and sport knowledge and expertise along with the equations to determine baseline energy needs for athletes.25

What is the thermic effect of activity? In the average population, RMR is the highest percent- age of total daily energy expenditure. In athletes, the energy expended through exercise can actually meet or exceed estimated RMR rates. The thermic effect of activ- ity (TEA) includes the energy costs for skeletal muscle contraction and relaxation as well as the costs to main- tain posture and position. TABLE 11.6 lists the energy costs

Table 11.5

Calculating Energy Needs

Harris-Benedict equation method

Adult males Adult females

Resting energy expenditure = 66.5 + 13.7 (Weight in kg) + 5.0 (Height in cm) – 6.8 (Age)

Resting energy expenditure = 655 + 9.6 (Weight in kg) + 1.8 (Height in cm) – 4.7 (Age)

Data from Harris J, Benedict F. A Biometric Study of Basal Metabolism in Man. Washington, DC: Carnegie Institute of Washington; 1919. Dietary reference intakes (DRI) method: estimated energy requirements for adults

Males Females

662 – 9.53 (age) + PA × (15.91 × [Weight in kg] + 539.6 × [Height in meters])

354 – 6.91(age) + PA × (9.36 × [Weight in kg] + 726 × [Height in meters])

PA (physical activity): PA (physical activity): Sedentary = 1.0 Sedentary = 1.0 Low active = 1.11 Low active = 1.12 Active = 1.25 Active = 1.27 Very active = 1.48 Very active = 1.45

Data from Institute of Medicine. Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fatty Acids, Cholesterol, Protein, and Amino Acids (Macronutrients). Food and Nutrition Board. Washington, DC: National Academies Press; 2005. Resting energy expenditure (REE) calculations and activity factors

Gender and age (years) Equation (BW in kilograms)

Activity factor

Males, 10 to 18 years old REE = (17.5 × BW) + 651 1.6–2.4

Males, 19 to 30 years old REE = (15.3 × BW) + 679 1.6–2.4

Males, 31 to 60 years old REE = (11.6 × BW) + 879 1.6–2.4

Females, 10 to 18 years old REE = (12.2 × BW) + 749 1.6–2.4

Females, 19 to 30 years old REE = (14.7 × BW) + 496 1.6–2.4

Females, 31 to 60 years old REE = (8.7 × BW) + 829 1.6–2.4

Data from World Health Organization. Energy and Protein Requirements. Report of a Joint FAO/WHO/UNU Expert Consultation. Technical Report Series 724. Geneva, Switzerland: World Health Organization; 1985. Cunningham equation

Males and females

RMR = 500 + (22 × [FFM in kg])

Data from Cunningham JJ. A reanalysis of the factors influencing basal metabolic rate in normal adults. Am J Clin Nutr. 1980;33:2372–2374.

of various daily and sport activities. For example, a male tri- athlete weighing 60 kilograms who bikes

thermic effect of activity (TEA) The amount of energy required to meet the energy de- mands of any physical activity.

304 SECTION 2 The Practical Application of Sports Nutrition

Table 11.6

Energy Expenditure of Sport Activities

Kcal/hr at different body weights

Description Kcal/hr/kg Kcal/hr/lb 50 kg 110 lb

57 kg 125 lb

68 kg 150 lb

80 kg 175 lb

91 kg 200 lb

Aerobics

Light 3.0 1.36 150 170 205 239 273

Moderate 5.0 2.27 250 284 341 398 455

Heavy 8.0 3.64 400 455 545 636 727

Bicycling

Leisurely, < 10 mph 4.0 1.82 200 227 273 318 364

Light, 10–11.9 mph 6.0 2.73 300 341 409 477 545

Moderate, 12–13.9 mph 8.0 3.64 400 455 545 636 727

Fast, 14–15.9 mph 10.0 4.55 500 568 682 795 909

Racing, 16–19 mph 12.0 5.45 600 682 818 955 1091

BMX or mountain 8.5 3.86 425 483 580 676 773

Daily activities

Sleeping 1.2 0.55 606 882 95 109

Studying, reading, writing 1.8 0.82 90 102 123 143 164

Cooking, food preparation 2.5 1.14 125 142 170 199 227

Home activities

House painting, outside 4.0 1.82 200 227 273 318 364

General gardening 5.0 2.27 250 284 341 398 455

Shoveling snow 6.0 2.73 300 341 409 477 545

Running

Jogging 7.0 3.18 350 398 477 557 636

Running, 5 mph 8.0 3.64 400 455 545 636 727

Running, 6 mph 10.0 4.55 500 568 682 795 909

Running, 7 mph 11.5 5.23 575 653 784 915 1045

Running, 8 mph 13.5 6.14 675 767 920 1074 1227

Running, 9 mph 15.0 6.82 750 852 1023 1193 1364

Running, 10 mph 16.0 7.27 800 909 1091 1273 1455

Sports

Frisbee, ultimate 3.5 1.59 175 199 239 278 318

Hacky sack 4.0 1.82 200 227 273 318 364

Wind surfing 4.2 1.91 210 239 286 334 382

Golf 4.5 2.05 225 256 307 358 409

Skateboarding 5.0 2.27 250 284 341 398 455

Rollerblading 7.0 3.18 350 398 477 557 636

Soccer 7.0 3.18 350 398 477 557 636

Field hockey 8.0 3.64 400 455 545 636 727

Swimming, slow to moderate laps 8.0 3.64 400 455 545 636 727

Skiing downhill, moderate effort 6.0 2.73 300 341 409 477 545

Skiing cross country, moderate effort 8.0 3.64 400 455 545 636 727

Tennis, doubles 6.0 2.73 300 341 409 477 545

Tennis, singles 8.0 3.64 400 455 545 636 727

(continues)

Chapter 11 Weight Management 305

for 4 hours (average speed 18 mph) and runs (7:30 minute per mile) for 1 hour could expend 3690 calories during one training day.

What is the thermic effect of food? The thermic effect of food (TEF) is the increase in energy expenditure associated with food consumption. The diges-

tion and absorption processes of food intake require energy, as does the metabo- lism and eventual storage of nutrients

throughout the body. The TEF is estimated to account for approximately 10% of total daily energy expenditure when a mixed diet is consumed.27 For example, an athlete who consumes 3000 calories per day will expend approxi- mately 300 calories (10% TEF) to metabolize the food. Sim- ply eating calories contributes to the daily total energy expenditure.

Variance in the type of macronutrient consumption may affect TEF. Protein and carbohydrates have slightly

higher TEF because they require more calories to be con- verted into storage forms (i.e., fat and glycogen) than fat. Conversely, fat con- sumed in the diet takes little energy to digest and then store as fat in the body. It appears that con- suming a diet that contains a higher percentage of carbo- hydrates and protein

and a lower percentage of fat may be beneficial in pro- ducing weight loss. However, regardless of the TEF, the most important reason that reducing intake of dietary fat can produce a calorie deficit resulting in weight loss is because fat is more calorically dense than carbohydrates or protein.

What methods do athletes use to lose weight? Weight loss methods for athletes contain similar compo- nents as weight loss plans for nonathletes. There must be a calorie deficit through reduced calorie intake, increased exercise, or a combination of both. Weight loss should occur slowly, at a rate of approximately 1 to 2 pounds per week, and should include goal setting and a moni- toring system to encourage continued progress toward the weight, and fat loss goals. Weight loss programs spe- cific to competitive athletes should maintain a good bal- ance of macronutrients for sport training (emphasizing adequate carbohydrate for glycogen use and replenish- ment and protein for lean tissue maintenance) and con- tain adequate energy and nutrients to continue to train and improve sport performance. If weight loss (fat loss) is desired, it should start early, before the athlete starts the competitive season.23

This section of the chapter covers calculating calorie needs, calorie deficit, macronutrient composition, meal planning, exercise, goal setting, and monitoring to help athletes lose weight.

How are weight and body composition goals for athletes determined? After it has been determined that weight or body fat loss is indicated for an athlete, a goal weight or body fat percent- age should be determined. Sport nutrition professionals

thermic effect of food (TEF) The increase in energy expenditure associated with food consumption.

Table 11.6

Energy Expenditure of Sport Activities

Kcal/hr at different body weights

Description Kcal/hr/kg Kcal/hr/lb 50 kg 110 lb

57 kg 125 lb

68 kg 150 lb

80 kg 175 lb

91 kg 200 lb

Walking

Strolling, < 2 mph, level 2.0 0.91 100 114 136 159 182

Moderate pace, ~3 mph, level 3.5 1.59 175 199 239 278 318

Brisk pace, ~3.5 mph, level 4.0 1.82 200 227 273 318 364

Very brisk pace, ~4.5 mph, level 4.5 2.05 225 256 307 358 409

Moderate pace, ~3 mph, uphill 6.0 2.73 300 341 409 477 545

Source: Modified from Nieman DC. Exercise Testing and Prescription. 4th ed. Mountain View, CA: Mayfield Publishing; 1999.

(continued)

306 SECTION 2 The Practical Application of Sports Nutrition

Gaining the Performance Edge

Athletes may have a high total energy expenditure because of a higher RMR and the high energy costs of training. RMR is increased in most athletes because they have higher levels of lean body mass, which is highly metabolically active tissue. The energy costs of training and daily activity (TEA) could be as high or even higher than RMR, resulting in very high total energy expenditure daily.

should help athletes avoid choosing an arbitrary goal weight and instead use individual weight and body com- position data to determine the most appropriate goals.

Body mass index can be used initially to determine weight goals. In using a BMI nomogram or on-line calcu- lator, athletes plug their height and weight into the chart to determine their current BMI. Next, they can choose a weight on the chart that is one or more points below their current BMI or one that may correspond with a BMI in the normal range. The choice of a BMI goal weight depends greatly on current BMI, level of overweight or obesity, weight history and/or history of recent weight gain, level of exercise, and commitment to a long-term weight man- agement plan. The weight goal chosen also should fall within the general guideline of not losing more than 1–2 pounds per week and, as discussed earlier in the chap- ter, should fall within the goal of a 5–10% loss of current body weight.

In many instances, athletes should use weight and body composition data to determine appropriate weight (fat) loss goals. Athletes attempting to lose weight should have both BMI and body composition measured before starting a weight loss program. Once %BF is determined, a calculation can be completed to determine optimal body weight based on desired body fat level. For example, a 20-year-old college male middle-distance runner had a BOD POD measurement of 11% body fat. He is 5′10′ and weighs 160 pounds (BMI = 23). Typically, college middle- distance runners have 6–9% BF. He and his sports dieti- tian determine that 8% body fat is a good goal for him based on his BMI and current percentage of body fat. His weight loss goal can be calculated using the follow- ing formulas:

FM = %BF × Body weight (lb or kg) FFM = Body weight – FM Desired body weight = FFM ÷ (1 – [Desired %BF]) Calculate FM: 0.11 × 160 = 17.6 Calculate FFM: 160 – 17.6 = 142.4 Desired Body Weight: 142.4 ÷ (1 – 0.08) = 154.8

This example shows that a modest weight loss of approximately 5 pounds (primarily fat loss) could be enough for this athlete to achieve a 3% drop in his body fat percentage and a reduction to a BMI of 22. Once the goal weight and body composition are determined, ath- letes can consult with their sports dietitian to determine the energy intake that will produce this loss.

How are energy needs for weight loss determined? To lose weight, energy expenditure must be greater than energy intake. When exercise and activity are equal to energy intake, weight maintenance occurs. If dietary intake is greater than energy expenditure, weight gain occurs. To achieve negative energy balance for weight loss, athletes can decrease food intake, modify exercise and activity levels, or both, creating a total energy deficit.

The first step in estimating an athlete’s calorie needs is to use one of the equations listed in Table 11.5. This establishes an estimate of the athlete’s baseline energy expenditure and a starting point for determin- ing the number of calories the athlete should reduce to produce weight loss. Once this baseline is established, calorie intake recommendations should decrease this number by 250–1000 calories per day. This general guide- line allows for a modest change in energy intake that will most likely not affect daily energy levels or the ath- lete’s ability to recover from workouts. This large range of 250–1000 calories allows the athlete and the sports nutrition professional to have flexibility in calorie reduc- tion levels based on the athlete’s weight, current dietary intake, and goal rate of weight loss. Athletes must be reminded not to dramatically decrease calorie intake because it can negatively affect sport performance. The calorie recommendations for weight loss should always be compared to actual current intake and evaluated for necessary adjustments. For example, an athlete’s total energy needs may be calculated at 3500 calories, which would translate into a weight loss recommendation of about 3000 calories per day. However, if the athlete is currently consuming 4000 calories, then suggesting a decrease in caloric intake merely to the originally calcu- lated 3500 estimate may initiate some weight loss and appear less drastic to the athlete.

Combining a dietary reduction in calories with increased caloric expenditure is most likely to produce weight loss results for athletes. Obtaining a daily deficit of 250–1000 calories by changing only diet or exercise by itself may be challenging. Cutting calories too low often leads to hunger and discomfort. Most athletes cannot tol- erate being hungry and thus have trouble adhering to the strict weight loss diet. In addition, very low calorie diets can result in the body going into a protective mode, thus lowering basal metabolic rate making further weight loss and long-term weight management difficult. Conversely, creating the calorie deficit solely from physical activity and exercise can lead to overtraining and injury. A com- bination of a reduction of 250–500 dietary calories and a deficit of 250–500 calories produced from increased exer- cise and physical activity can produce a weight loss of approximately 1–2 pounds per week.

What dietary changes are necessary for athletes to lose weight? Dietary changes to reduce caloric intake are necessary for athletes to lose weight. Athletes need to concentrate on matching the macronutrient intake recommended for weight loss to that required for continuing sport activities. Portion control, regardless of macronutrient composition of the diet, is important in helping athletes reduce calories. Eating regular meals to avoid becoming ravenous as well as proper meal planning also play an important role in any healthful weight reduction nutrition plan for athletes.

Chapter 11 Weight Management 307

How does the macronutrient composition of the diet affect weight loss for athletes? When weight loss diets are objectively studied, it appears that, regardless of macronutrient composition, if calo- ries are reduced, then weight loss occurs. Macronutri- ent intake in athletes is of great importance in regard to sport performance. Carbohydrates, fat, and protein all perform essential functions within the body related to overall health, energy production, and sport perfor- mance. Therefore, when modifying an athlete’s total daily intake, consider the relative importance of the various macronutrients.

Carbohydrates are the primary macronutrient that ath- letes need to perform well in sport and exercise activities. Carbohydrates are essential fuel for the working muscles during exercise and are valuable to muscles after exercise to replenish muscle glycogen stores. Many popular diets recommend severe restriction in carbohydrates, including those foods that contain valuable nutrients (fruits, vegeta- bles, whole grain breads, milk, and yogurt); these plans are recipes for performance disaster, often depleting an ath- lete’s body of carbohydrates as well as essential vitamins and minerals. It can be beneficial to reduce some carbo- hydrates in the diet if the sources of carbohydrates do not provide nutritional value; for example, reducing foods that contain high amounts of added sugars (candy, cookies,

soda, etc.) will reduce overall calories consumed without reducing the nutrient density in the athlete’s diet. Substi- tuting higher-fiber foods such as grains, fruits, and vege- tables for some of these calorie-dense foods can increase feelings of fullness and satiety so that athletes may con- sume fewer calories throughout the day.

Protein is important in any athlete’s diet for maintain- ing muscle mass, building and repairing tissues, and pro- viding satiety. Consuming adequate amounts of protein to maintain these functions is critical, especially when athletes are making lifestyle changes for weight loss. Maintenance of muscle mass can help keep the resting metabolic rate elevated, aiding in the weight loss effort and improving the likelihood of weight loss maintenance. Athletes who consume at least the minimum amount of protein recommended for their sport activities should obtain enough protein to maintain protein’s necessary functions in the body. Protein intakes at the high end of the recommended ranges may be appropriate for some athletes to produce better satiety levels. Athletes should be encouraged to choose lean, low-fat protein sources that will contribute fewer total calories than high-fat options.

Fat is an essential component of a healthful athlete’s diet; however, intake should be moderated while trying to lose weight. Fat contains more than twice the amount of calories per gram as carbohydrates or protein. Therefore, a reduction in fat can help produce a calorie deficit for weight loss because it is more calorie dense. It should be emphasized that athletes are not encouraged to eliminate fat from the diet; a modest decrease in total fat intake to a level of approximately 20% of total calories will allow for the consumption of essential fatty acids without the contribution of excessive calories.

A weight loss plan that produces a reduction in calories, regardless of the macronutrient composition, should lead to weight loss. For all athletes, the macro- nutrient composition of the reduced-calorie diet should match their individual needs to produce weight loss while maintaining quality sport performance. Athletes should be educated on the detrimental effects of some popular diet plans that dramatically decrease or eliminate certain macronutrients, while encouraging the excessive intake of other macronutrients. For athletes aiming to lose weight, balance, variety, and moderation should remain the mantras of healthy eating to ensure that all nutrient needs are being met.

How can athletes plan meals to meet weight loss and body composition goals? If possible, athletes should attempt initial dietary changes for weight loss in the off-season. This allows the athlete to focus on moderating eating behaviors without the concern of how these changes might affect sport perfor- mance. Off-season modifications also allow time for the dietary changes to become a habit that the athlete can then follow throughout the season.

308 SECTION 2 The Practical Application of Sports Nutrition

The emphasis of dietary changes should be on how athletes can decrease calorie intake without compromis- ing sport performance. Meal skipping to reduce calories is not recommended because the lack of fuel prior to or after training can decrease exercise performance. How- ever, consuming smaller meals and/or snacks frequently throughout the day will keep the body fueled while mod- erating calorie intake.

A small reduction in the size of portions eaten at each meal or snack can produce a calorie deficit for weight loss. This deficit can occur even without any change in the types of foods eaten. Because serving sizes in restaurants and in food packages have become enormous, individuals mistak- enly assume that one item or one meal served is a “normal” serving size. For example, a serving size from the MyPlate food guidance system for a bagel is half of a 2-ounce bagel. A 2-ounce bagel (two servings of grains) contains approxi- mately 150 calories. A 6-ounce plain bagel, typical of many gourmet bagel and coffee shops, counts as six servings of grains and contains approximately 450 calories. This phe- nomenon of large servings of carbohydrate-rich foods has mistakenly led people to believe that carbohydrates cause weight gain. In actuality, it is the large number of calories consumed, which is often underestimated, that is contrib- uting to weight gain. In the example of the 2- and 6-ounce bagels, the larger bagel has an additional 300 calories! Therefore, a reduction in portions, regardless of the food item, can produce the necessary calorie deficit for weight loss. The portion control tips shown in TRAINING TABLE 11.1 can help athletes reduce total calorie intake.

Eating three to five times per day or approximately every 3 to 4 hours will sustain metabolism and energy levels. This schedule of eating can prevent athletes from becoming too hungry and subsequently overeating when a meal is finally consumed. Eating based on physical needs for food (hunger) helps the athlete fuel up when energy levels are low and provides regular intake of calo- ries without overconsumption.

Training Table 11.1: Portion Control Tips • Choose low-calorie, nutrient-dense foods such as vegetables, fruits,

and whole grains.

• Serve smaller portions than usual on meal and snack plates.

• Purchase preportioned meals, entrée, and snacks and read labels to determine how many servings are in each package. Purchase more economical sizes of foods and package them into single serving sizes immediately once home from the grocery store.

• Use the MyPlate food guidance system serving sizes as a guide for portions consumed.

• Weigh or measure cooked food for a week to gain an understanding of appropriate serving sizes.

• At restaurants, plan ahead to take home leftovers. Remove bread and chips from the table and focus on enjoying the meal. Ask the wait staff to bring a take-out box when the entrée is served. Place half of the meal into the take-out box before starting the meal.

• Order off the appetizer or lunch menu. Many appetizers when combined with a salad or soup can make a meal.

Consuming carbohydrate calories from sports bever- ages may be indicated for athletes during high-intensity workouts or during training or competition sessions last- ing more than an hour. Some athletes avoid sports drinks during long-duration training or competition events for fear that the calories in these products will prevent weight loss; however, this concern is not valid. Sports bev- erages have multiple benefits, including enhanced endur- ance and sport performance, as well as the prevention of dehydration and electrolyte imbalances. Emphasis should be placed on helping the athlete improve performance by using these products. Sports nutrition professionals can weave these calories into an athlete’s training diet, thereby providing the performance benefit of sports bev- erages while keeping on track for weight loss.

After exercise, athletes trying to lose weight must consume a postexercise meal or snack. Many athletes find the elimination of the postexercise meal or snack an easy way to decrease calorie intake. However, by neglecting to replenish the body, the athlete will feel sluggish, fatigued, and sore during subsequent workouts. Therefore, athletes should consume moderate amounts of nutrient-dense grains, vegetables, fruits, low-fat dairy products, and lean protein sources after exercise while limiting calorie-dense high-fat and high-sugar foods.

A sample meal plan for weight loss is listed in TRAINING TABLE 11.2 . Notice that substitutions of lower-fat,

higher-fiber foods created the 500-calorie decrease. This method of modification retains the athlete’s basic dietary pattern while selecting foods that have lower levels of calories.

How do exercise and physical activity influence weight loss for athletes? Most athletes engage in more exercise than is recommended for the overall population in regard to health, prevention of weight gain, and to aid in weight loss. The physical activity recommendations for adults from the American College of Sports Medicine (ACSM) and the American Heart Association (AHA)28 state that to promote and maintain health, adults need the following amounts of activity:

• A minimum of 30 minutes of moderate intensity aer- obic physical activity on 5 days each week or 25 min- utes of vigorous-intensity aerobic physical activity on 3 days each week.

• A combination of these two aerobic intensity levels of exercise is acceptable.

• In addition to the aerobic activity, adults should per- form moderate- to high-intensity muscle-strength- ening activity at least 2 days per week. This amount of exercise may be challenging for non-

athletes to achieve in 1 week, but athletes could easily attain this amount of physical exercise in only 2 or 3 days of training. The updated guidelines are outlined for the adult population to maintain health, prevent chronic dis- ease, and prevent weight gain.

Chapter 11 Weight Management 309

To lose weight, additional exercise and physical activ- ity are needed, along with dietary reductions in calories. The ACSM and AHA guidelines further delineate that to lose weight or to maintain a significant weight loss, as much as 60 to 90 minutes of physical activity 5 days per week may be necessary. Typically, athletes who are train- ing for competition are going to get that amount of exer- cise in 1 week. So, for athletes to benefit from exercise to lose weight, they may need to alter their training routine and try to get more activity as part of their daily routine. Activities such as walking to class or work, using the stairs instead of elevators, yard work, active housework, and get- ting off the bus one stop early and walking could produce modest calorie burning that, when combined with sport training, could help produce weight loss. Making sure they are getting the right amount of aerobic and strength train- ing in each week can also help athletes achieve weight loss. Aerobic exercise (e.g., cycling, running, swimming, aerobic dance) increases energy expenditure. Exercising at higher intensities or for longer durations can produce higher energy expenditure. Changing the type of aerobic

Training Table 11.2: Sample Meal Plan for Weight Loss 2500 Calories 2000 Calories

Breakfast Breakfast

1 cup dry cereal 1 cup dry cereal

¼ cup raisins ¼ cup raisins

1 cup 2% milk 2 tbsp slivered almonds

1 cup orange juice 1 cup skim milk

1 small orange

Lunch Lunch

1 small whole grain pita sandwich 1 small whole grain pita sandwich

3 oz deli meat 3 oz deli meat

Tomato slices, sprouts, lettuce Tomato slices, sprouts, lettuce

1 tbsp mayonnaise 1 tbsp low-fat mayonnaise

1 bag potato chips 1 bag baked chips

12 oz soda 10 baby carrots

12 oz water

Snack Snack

Frozen yogurt with chocolate sprinkles

2 graham cracker sheets

Dinner Dinner

1½ cups pasta 1 cup whole wheat pasta

1 cup tomato/vegetable spaghetti sauce

3 small meatballs (5 oz) 3 small meatballs (3 oz)

1 cup cooked broccoli 1 cup cooked broccoli

1 cup 2% milk 1 cup skim milk

Snack Snack

1 cup low-fat yogurt 1 cup low-fat yogurt

1 large banana 1 small banana

Similar to dietary modifications, athletes should attempt changes in exercise and physical activity during the off-season. Athletes are not necessarily focused on competitive performance in the off-season and therefore may be more willing to spend additional time on activities that may produce weight loss. Athletes should be encour- aged to make gradual increases in workout intensity or duration to avoid overuse injuries.

How does goal setting help athletes lose weight? It is difficult sometimes for athletes to make the necessary changes to achieve weight loss and maintain the weight loss over time. Assessing readiness to change is one way that nutrition professionals and athletes work together to make dietary changes. Once the athlete is ready to make changes in dietary behaviors, the athlete and nutrition professional should set goals and a establish a method to measure the progress toward those goals for weight loss. The following section provides a brief overview of goal setting as it relates to athletes attempting to lose weight.

What types of goals should athletes set for weight loss? The NIH recommends initially losing 5–10% of cur- rent body weight over a period of 3 to 6 months. It then recommends maintaining that lost weight for 3 to 6 months before attempting further weight loss. If the athlete is able to maintain the initial weight loss, and it is deemed appropriate to lose additional weight, then a goal of an additional 5–10% of current body weight is recommended. Using this recommendation, an athlete

workout performed can also help the body burn more calories per workout. Anaerobic exercise (e.g., resistance training, sprint training) increases and helps maintain lean body mass, which is the most metabolically active tissue in the body. This raises and helps sustain RMR during weight loss and weight management. Table 11.6 describes the amount of calories burned in many sport activities.

310 SECTION 2 The Practical Application of Sports Nutrition

Fortifying Your Nutrition Knowledge

Exercise Is Medicine ACSM and the American Medical Association launched "Exer- cise Is Medicine" in November 2007. It is a program designed to "encourage America's patients to incorporate physical activity and exercise into their daily routine." In addition, the program calls on doctors to prescribe exercise to their patients.

The program's website, www.exerciseismedicine.org, pro- vides educational information for physicians to use in their practice and information for patients, the media, and policy makers, as well as links to supporting organizations.

to change, track prog- ress toward their goals, and regularly review the behavior and adjust as needed. Food diaries are help- ful monitoring tools. Monitoring food intake by recording foods and portion sizes helps athletes become more con- scious of food intake as well as the types of foods eaten. Athletes are often surprised at how often they eat without realizing it

and how much is consumed at meals. Noting the level of hunger and satiation before and after eating can also add value to the food diary process. Athletes with already full exercise schedules might monitor intensity level of exer- cise or ability to train longer or harder once modest weight loss is achieved.

Monitoring weight or body composition is another useful tool for weight management success. Weighing once each week and plotting the progress over time can help individuals see gradual progress toward the long- term weight loss goal. Daily weighing is not recommended because it can become obsessive, and daily fluctuations in weight can occur regardless of food eaten or how much exercise is completed, leading to a false impression of weight loss or gain. Ideally, weight should be measured only once per week, on the same day of the week, and at the same time of day, to achieve consistency. Body com- position measurements should be taken monthly or quar- terly to evaluate progress. Evaluation of the effectiveness of an athlete’s weight loss plan should include regular weight or body composition information as well as other measures of sport performance, energy levels, and satis- faction with the diet and exercise plan.

Evaluation of sport performance is another measure of success or failure of the weight loss plan. If sport per- formance declines, it could mean calorie intake is too low to sustain training levels and replenishment of glycogen stores. If sport performance is maintained or improves, the athlete is likely on the right track for weight loss success.

What are the summary recommendations for athletes regarding weight loss? Successful weight loss practices for athletes include a combination of dietary, exercise, and behavior changes that can be maintained for a lifetime. Meal planning that encourages healthful eating at regular intervals while being mindful of portion sizes can provide the appropriate

weighing 220 pounds would have a goal of losing 11–22 pounds in the first 3 to 6 months. If the weight loss is successfully maintained, then a reevaluation of weight and sport performance goals is appropriate. A total def- icit of 500–1000 calories per day should produce this amount of weight loss gradually over the recommended time period. Weekly weight loss should not exceed 2 pounds per week. Rapid weight loss can contribute to muscle mass loss, fluid/electrolyte imbalances, and pos- sibly cardiovascular complications. Therefore, if weight loss occurs too quickly, an increase in calorie intake or a decrease in physical activity may be indicated to slow the progression. Slow, gradual weight loss is safer for overall health, is more likely to target the loss of body fat versus muscle mass, is less likely to negatively affect sport performance, and has been shown to have a greater success rate long term.

Setting a weight loss goal is essential to any weight loss plan, but goals for how to accomplish the weight loss are also needed. Goals should be developed that are short term, or “process oriented,” and long term, or “outcome oriented.” Short-term goals help the individual design a specific plan for dietary, exercise, or behavior changes needed to meet the long-term weight loss goal. These might include eating a high-fiber breakfast cereal every day for the next 7 days or spending an additional 15 min- utes on strength training at practice twice per week. Long- term goals might include a weight loss goal or a body composition goal, such as a reduction in body fat percent- age. Once a short-term goal has been maintained for sev- eral weeks, a different goal can be established to further progress toward the long-term goal.

Other goals, such as those that focus on changes in sport performance, may motivate athletes to continue healthful eating behaviors. A goal of achieving a per- sonal best in a sprint or long-distance event may motivate the competitive runner to continue with healthy eating behaviors. Realizing improvements in sport performance typically keeps athletes motivated, especially if weight loss is slow. Similarly, using both body composition and weight as measures of success is beneficial to the ath- lete. Because dietary and physical activity recommenda- tions for weight loss produce slow, gradual weight loss, it may be difficult for athletes to stay motivated when the scale does not show big losses. However, if body compo- sition changes occur, the athlete can be confident that improvements are being made, despite slower weight loss. By setting both short- and long-term goals based on physical health or improving sport performance, the ath- lete establishes several ways to monitor success besides body weight.

How do athletes monitor progress toward goals? Monitoring of goals and progress toward those goals is essential for continued weight loss success. Self-monitor- ing helps athletes identify the behavior they are attempting

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Gaining the Performance Edge

Healthful weight loss programs for the general population and for ath- letes include a combination of diet and exercise changes to induce weight loss. A calorie deficit is essen- tial to any weight loss plan. Athletes trying to produce a calorie deficit need to be careful to eat enough cal- ories to continue optimal sport per- formance, while allowing for gradual weight loss. Weight loss should be attempted during the noncompeti- tive season, when possible.

amount of calories and nutrients to maintain sport per- formance and allow for gradual weight loss. Exercise and physical activity lev- els are generally high in athletes, but slight modifications in the amount, type, or intensity of exercise can help produce a calorie deficit to achieve weight loss.

TABLE 11.7 provides a summary of recommendations for athletes trying to lose weight.

Table 11.7

Weight Loss Recommendations for Athletes

Determine Energy Needs • Measure height, weight, waist circumference, and body composition. • Calculate athlete's estimated daily energy needs. • Determine calorie deficit appropriate for individual athlete to lose

weight. • Calorie deficit of 250–1000 calories per day via diet and/or exercise. Dietary Modifications • Emphasize healthful eating patterns and foods, not a "diet." • Eat more often to fuel activities and avoid extreme hunger. • Enjoy small amounts of favorite foods occasionally. • Exercise portion control. • Choose nutrient-dense foods with more fiber for better nutrient intake

and satiety. Set and Monitor Goals • Attempt weight loss during the noncompetitive part of sport season. • Aim for a loss of 5–10% of current body weight. • Lose at a rate of no more than an average of 1–2 pounds per week. • Monitor weight weekly. • Measure body composition monthly. • Assess training and sport performance level.

What are the weight loss issues for athletes in weight classification sports? Weight classifications are typically found in sports such as wrestling, martial arts, crew (rowing), boxing, and horse rac- ing (jockey). Athletes participating in these sports often try to perform in a weight class lower than their typical body weight to potentially gain a competitive edge over their competition. Athletes in these sports often struggle with their weight during the season and potentially use drastic weight loss measures to achieve their weight class goals.

Rapid weight loss prior to weighing in before an event, or weight cutting, is common for these athletes. Cutting weight is a practice of self-induced dehydration and star-

vation to reach a cer- tain predetermined weight. It occurs often during a sea- son, depending on how many events the athlete competes in and how well weight

loss is maintained over the course of the season. Common weight cutting or rapid weight loss practices include excessive exercise, exercising in rubber or plastic suits, exercising in saunas or hot environments, fluid restric- tion, food restriction, spitting, fasting, self-induced vomit- ing, and laxative and diuretic abuse. Alderman reported that the most common rapid weight loss practices of wrestlers were excessive running, using saunas, and wearing vapor-impermeable suits.29 These methods are usually undertaken immediately prior to the event so that

weight cutting The practice of losing weight, usually in prepara- tion for a competitive event in hopes of making a lower weight class and thus improving perfor- mance.

312 SECTION 2 The Practical Application of Sports Nutrition

Food for Thought 11.3

Weight Loss Guidelines: Los- ing Weight Without Sacrificing Performance

Define appropriate weight loss guidelines for athletes.

Fortifying Your Nutrition Knowledge

Mobile Apps: Technology in Weight Management Once the body composition measurements have been per- formed and the numbers crunched, the next steps are to set goals for weight gain (i.e., increasing muscle mass), weight maintenance (i.e., maintaining percent body fat in the optimal range), or weight loss (i.e., decreasing fat mass) and to devise a dietary plan to help the athlete achieve those goals. One of the keys to success for weight management is to keep a daily food log. Fortunately, new technology in the form of mobile apps has been developed to keep athletes on track and focused on their goals.

A growing number of free and pay-for-use applications are now available; each provides tools and levels of assistance that vary in sophistication. Many of the apps offer barcode scan- ners. Some scanners give a quick health grade to foods and others reveal detailed nutritional information about the food. This enables athletes to assess foods right in the store and to quickly determine whether to buy or not. These apps can help create healthy grocery lists, track nutrient intake using food diaries, and help individuals grade their progress each day with regard to sticking to their dietary plan. Some also include phys- ical activity trackers in hopes of stimulating increased physi- cal activity.

Researchers are just starting to examine the effectiveness of these mobile apps. A study published in the Journal of Medical Internet Research performed a meta-analysis of 12 studies that investigated the effectiveness of mobile apps in weight loss and the promotion of physical activity.a The study revealed that use of mobile phone app–based interventions was useful for weight loss but not for stimulating increased physical activity. While the number of studies investigating the efficacy of mobile app use for weight management is small, it does appear these apps have potential. Only time will tell how effective they can be.

aMateo GF, Granado-Font E, Gerre-Grau C, Montana-Carreras X. Mobile phone apps to promote weight loss and increase physical activity: a sys- tematic review and meta-analysis. J Med Internet Res. 2015;17(11):e253.

event prompted the National Collegiate Athletic Asso- ciation (NCAA) to change collegiate wrestling rules in part to curb excessive weight-cutting practices. The new rules included adding 6 pounds to each of the 10 weight class categories; holding weigh-ins closer to the start of the competition; starting a wrestling weight certification program, including a body fat assessment at the begin- ning of the season; and requiring the minimum competi- tive weight classification to be determined by December. Wrestlers can move up in a weight classification after December, but not down to a lower weight classification (see FIGURE 11.10 ). These new rules were implemented in full for the 1998–1999 NCAA season. The wrestling weight certification program (WWCP) requires the weigh-in at the beginning of the season to be a hydrated weight.32 The program uses the specific gravity of urine to deter- mine hydration status. If specific gravity is at or below 1.02, then the athlete is well hydrated; if specific gravity is above 1.02, the athlete must come back the next day for a retest and weigh-in. High schools now have simi- lar weight management guidelines to discourage rapid weight loss. Beginning with the 2006–2007 season, the

rapid weight loss occurs in time for the weigh-in. Once the weigh-in is completed, rapid weight regain typically occurs through rehydration and food intake.

Some of these rapid weight loss methods can have significant health consequences. Dehydration and elec- trolyte imbalances caused by fluid restriction, exercis- ing in saunas, and/or the use of diuretics and laxatives can negatively affect the cardiovascular system. Rapid weight loss, induced by a variety of methods, can quickly decrease plasma volume, thus acutely straining the cardiovascular system, thermoregulation system, and renal function. Food restriction can cause hypoglycemia, resulting in fatigue, an inability to mentally focus, and a decrease in physical stamina.30 Clearly, all of these conse- quences are a detriment to sport performance, the safety of the athlete, and overall health.

Wrestling has been a very popular sport for years and is one of the sports most commonly known for weight-loss practices. Significant research has been con- ducted on wrestlers’ weight loss methods and the asso- ciated concerns. In 1997, three collegiate wrestlers died trying to cut weight for competition.31 This unfortunate

Chapter 11 Weight Management 313

Fortifying Your Nutrition Knowledge

Should Athletes Go on a “Diet”? There seems to be an endless parade of diet plans promoting weight loss. These popular diets are often the first thing individuals try when aiming to lose weight. Unfortunately, most of these plans either are deficient in the nutrients required by athletes or do not pro- mote long-term weight loss success, causing an athlete's performance to suffer and body weight to fluctuate over time. Athletes should be educated on how to decipher between a well-balanced, credible approach to weight loss and a quick-fix "fad" diet.

Diet books are a main source of popular diet information for consumers. It seems that every year several "revolutionary" new diet books are published that claim to be the best new weight loss method.26 From low carbohydrate to high protein to wheat free to getting in the "zone," there seems to be no end to the number of weight loss diets available. One thing that all of these plans have in common is that they are low-calorie diets.

If fewer calories are consumed than expended, weight loss will occur over time. Therefore, in most cases, people who follow a popular diet plan lose weight. The problem is that weight loss is usually not sustained over time with these diets. Individuals may have success when "on" the diet but return to an equivalent or higher prediet body weight once they go "off" the plan. Athletes should be encouraged to avoid fad diets. Fad diets are too low in energy, do not provide enough nutrition for recovery needs, and will only decrease sport performance in the long run. Therefore, athletes should look for a diet and exercise regimen that they can continue long term and develop into a habit.

The main differences among popular diet programs are the macronutrient composition and the way foods are eaten or combined. Some plans suggest that a certain macronutrient composition is the key to weight loss success. Several current popular diets recommend low- ered carbohydrate intake with subsequent higher fat and/or protein intake. Other plans suggest the opposite—low fat and high complex carbohydrates. Still others tout the benefits of a precise ratio of carbohydrates, protein, and fat eaten at every meal. In addition, some diets recommend a certain eating style, the combination of foods, or the avoidance of certain foods altogether. Athletes should look for weight loss plans that maintain a balance in macronutrients, allowing all foods to fit into a healthy diet, with a focus on portion control of all foods.

Being a good consumer of health and dieting information will improve an athlete's chances of success in weight management. Athletes can look for a number of cues to determine whether a diet is a fad or has potential for long-term weight loss success. A credible diet should:

■ Provide slow, progressive weight loss. ■ Emphasize health and emotional benefits, not aesthetics. ■ Include a sound, nutritionally balanced eating plan. ■ Include physical activity and exercise. ■ Include favorite foods in small amounts as part of the regular meal plan. ■ Include behavior modification changes and skill development for lifelong habits. ■ Include reasonable short- and long-term goals for weight loss, physical activity, nutrition, and health. ■ Be developed or monitored by credible medical personnel with experience in nutrition, exercise, and health.

weight certification program includes a hydration level not to exceed 1.025 urine specific gravity and minimum body fat percentage no lower than 7% for male wrestlers and 12% for female wrestlers.33

Opplinger et al.34 studied 741 responses to questions from 43 collegiate wrestling teams about weight loss prac- tices since the institution of the new rules. They reported that 40% of wrestlers in the study indicated that the new NCAA rules influenced their weight management prac- tices; however, more than 25% of the wrestlers contin- ued to use saunas and rubber/plastic suits and fasting as weight loss techniques. They also found that weight man- agement behaviors were more extreme among wrestlers in lighter weight classes and became less extreme at the heavier weight classes. Little evidence existed for disor- dered eating in this sample. Davis reported that, based on their data, they believe the new NCAA WWCP and cor- responding rule changes have begun to break the sport’s historical cycle of weight cutting.33

Weight cutting can have both physical and emotional consequences. There is concern that athletes in sports that use weight-cutting practices may be at increased risk for eating disorders. Dale and Landers used the Eating Disorders Inventory (EDI) and Eating Disorders Examina- tion (EDE) to assess wrestlers for eating behaviors.35 The EDI is made up of eight different subscales. Only data collected from the first three subscales—drive for thin- ness, bulimia, and body dissatisfaction—were used. These three subscales examine attitudes and behaviors relating

to body image, eating, and dieting. The EDE is a semis- tructured interview that was used on participants identi- fied as being at high risk based on their EDI scores. The researchers found that there was an increased drive for thinness in wrestlers but not an increase in actual eating disorders or eating disorder risk. Wrestlers in the study actually had a better body satisfaction rate than the matched nonwrestler controls. Wrestlers are more weight conscious than nonwrestlers, but this does not mean they have eating disorders. Often the worrisome weight control practices occur only in-season. During the off-season, eat- ing and weight control issues are not a concern. It is clear, however, that weight-cutting practices can be harmful to physical health, and focusing research and education on the physical consequences of weight-cutting practices may help alleviate these harms to athletes in the future.

Similar concerns for making weight are seen in other sports. Lightweight crew (rowing) is a team sport that requires the entire team to meet a weight standard to compete. If one athlete does not make the weight, then the entire team may be excluded from the event. Ath- letes in sports that require weigh-ins should focus their nutrition and exercise plans on maintaining a consistent weight throughout the season, rather than struggling to make weight prior to each event. Although dramatic weight loss methods are used less frequently by rowers than by wrestlers, they still may use unhealthy nutrition and weight loss practices during their training and com- petitive seasons. Coaches, trainers, and dietitians working with these athletes need to be aware of fast weight loss methods the athletes may be using and encourage health- ful weight loss that can be maintained during the season.

When competing in events where weight must be measured, the best defense is a good offense. Athletes should attempt to maintain body weight year round within a few pounds of the weight class in which they compete. Some athletes may need to move up a weight class to comfortably maintain weight year round, which potentially means competing against tougher opponents. However, weight classes are designed to even out the competition from a weight standpoint. An athlete that moves up a weight class is likely to have more muscle mass and competitively should be on the same playing field as other athletes in the same weight class.

In summary, athletes in weight class sports face addi- tional challenges in maintaining a competitive weight. Strategies for athletes to lose and maintain a healthy, competition weight are similar to the strategies used by other athletes. Establishing an appropriate, achievable weight early in the season or in the off-season, and then aiming to maintain that weight within a few pounds over the entire year, can help athletes avoid drastic weight loss measures to make weight. Coaches, strength train- ers, dietitians, and athletic trainers can help the ath- lete decide the best competition weight to work toward.

314 SECTION 2 The Practical Application of Sports Nutrition

Figure 11.10 Weighing in. The NCAA discourages athletes from reduc- ing their weight through intentional dehydration, a dan- gerous and potentially deadly practice. © Kamran Jebrili/AP Photos

A sports diet and exercise plan that helps achieve that weight in a healthy manner can help the athlete achieve and maintain a stable competitive weight throughout the competitive season.

What happens when weight loss efforts develop into disordered eating patterns? Problems with eating behaviors have become more preva- lent in the last decade in the United States and in other parts of the industrialized world. Athletes not only face the same sociocultural influences on eating behaviors, size, and shape as the general population, but they also have the pressure of fitting into the “ideal” for their sport. They see other athletes in their sport and assume they should look a certain way. Coaches, parents, and trainers may also suggest that a certain body type is advantageous and encourage changes in the athlete’s body size or shape to help them excel in their sport. In many sports, athletes and coaches believe excess weight inhibits speed, agility, and endurance while increasing fatigue.36 Although opti- mal body types may exist in general for certain sports, some athletes simply cannot achieve these stereotypes. Disordered eating develops when athletes continue to strive for that “ideal” at the expense of overall health and sport performance. As the obsession to achieve or main- tain a certain ideal continues, athletes may develop eating disturbances that can lead to diagnosable eating disor- ders. Eating disorders have serious health consequences. Athletes with full-blown eating disorders often have decreased sport performance, are more likely to become injured, and suffer emotional and psychological conse- quences that affect life functioning.

Certain sports have an increased likelihood of encour- aging negative body image and eating disorders. These sports place more emphasis on a certain body type as ideal or emphasize lean body shape or low body weight as opti- mal for the sport. Casual comments from coaches, offi- cials, judges, and peers within competitive or practice environments can lead to negative self-perceptions asso- ciated with disordered eating.37 Social physique anxiety is a sense of anxiety resulting from situations in which

one’s physique or fig- ure is being observed or evaluated by oth- ers.38 Monsma and Malina, in a study of female figure skaters, found that after con-

trolling for age and BMI, social physique anxiety was related to the EDI score.38 The authors suggest that disor- dered eating may be a response to social physique anxiety stemming from the subjective evaluative nature of figure skating. Clothing choices within sports can place athletes at greater risk for developing body image issues and

disordered eating patterns, especially when not only the body, but also the clothing, can be subjected to judgment.

ACSM developed the following list of sports likely to place athletes at risk for developing eating disorders:

• Sports where the athlete is subjectively judged, such as diving, skating, gymnastics, and ballet

• Sports where minimal, tight, or revealing clothing is required, such as track, swimming, diving, gym- nastics, and volleyball, which can make athletes uncomfortable

• Endurance sports, such as long-distance running, cycling, and triathlons, where excess body weight may hinder performance, and therefore emphasis is placed on a lean body type

• Sports where weigh-ins are required, such as wres- tling, horse racing, boxing, martial arts, and rowing39

These sports by their nature can place athletes, female or male, at greater risk for developing disordered eating. However, many women and men in these sports have normal dietary and exercise patterns, maintain their weight in a comfortable range, and never develop eat- ing disorders. The sports listed are not the only sports in which athletes could potentially develop disordered eat- ing patterns. Any athlete in any sport can succumb to the pressures of their sport or other issues in their lives and ultimately develop an eating disorder.

What are the different types of eating disorders? The prevalence of eating disorders is difficult to deter- mine because many individuals do not seek treatment. There are no national research projects or databases that gather statistics about eating disorders, and treatment can be sought from a variety of professionals—medical, nutrition, or mental health. Studies of the prevalence of eating disorders in athletes suggest an increased risk and incidence in athletes compared to the general population. Sundgot-Borgen and Torstveit reported a 13.5% incidence of eating disorders in athletes compared to a 4.6% inci- dence in nonathlete controls.40 They studied a large group of elite Olympic athletes in Norway and a comparable control group. The researchers found the incidence of ath- letes who exhibited eating disorders was different based on the sport. In females, those in aesthetic sports had a 42% incidence, endurance sports 24%, technical sports 17%, and ball game sports 16%. Among male athletes, the prevalence of eating disorders was more common in antigravitation sports such as gymnastics or skating (22%) than in ball game sports (5%) and endurance sports (9%).40

The major classifications of eating disorders are defined by specific medical and emotional criteria. The American Psychiatric Association’s Diagnostic and Statisti- cal Manual of Mental Disorders, 5th edition (DSM-5), defines the classifications for diagnosis of three different eating disorder categories: anorexia nervosa, bulimia nervosa, and binge eating disorder.41

social physique anxiety A feel- ing of personal uneasiness or ner- vousness about how other people view or perceive the athlete's body shape or fatness level.

Chapter 11 Weight Management 315

Anorexia nervosa is a complex disorder with many causes and manifestations in behaviors. The main dietary concern with anorexia is severe caloric restriction leading

to significantly low body weight relative to the individual’s age, gender, develop- mental stage, and physical health. Indi- viduals with anorexia do not maintain a body weight at or

above a level considered minimally normal. They have an intense fear of weight gain or demonstrate behaviors that interfere with weight gain despite their low body weight. They also have a distorted body image. Some of these indi- viduals also binge and purge the food they consume, whereas others just maintain a constant low energy intake.

Complications of anorexia can be quite severe. Energy deficit and hormonal imbalances can lead to decreased bone density. Irregular and slow heart rates are commonly observed in anorexic patients. Dehydration, nutritional deficiencies, dizziness, fatigue, and social withdrawal are other common complications of anorexia. These compli- cations can be dangerous to the overall health of the ath- lete and can significantly reduce sport performance levels.

Bulimia nervosa is characterized by an individual who binges on larger-than-normal amounts of foods and

then uses inappro- priate compensatory methods to rid him- or herself of the food consumed. The binge episodes are charac- terized as being out of control, with an inability to stop eat- ing despite being

overly full. The common misconception of bulimia is that purging is done exclusively through vomiting. The inap- propriate compensatory behaviors after a binge can be any one of the following: vomiting, laxative abuse, exces- sive exercise, fasting, or any combination of these behav- iors. Bulimia, similar to anorexia, is also characterized by a distorted body image and appearance having undue influence on self-esteem, eating, and exercise behaviors.

The prevalence of bulimia is higher in all population groups than anorexia is. Complications of bulimia ner- vosa can be quite severe. Erosion of tooth enamel, tears in the esophagus, chronic reflux, heart abnormalities, aspi- ration pneumonia, and even death can occur with vomit- ing as the main purging method. If laxatives are abused as a purging method, the intestinal tract becomes dependent on laxatives to move the bowels. This can lead to chronic constipation. Excessive exercise places the individual at greater risk for athletic-related injuries. Emotional and

anorexia nervosa A clinical con- dition manifested by extreme fear of becoming obese, a distorted body image, and avoidance of food. Anorexia nervosa can be life- threatening and requires medical and psychiatric treatments.

bulimia nervosa A clini- cal condition characterized by repeated and uncontrolled food bingeing in which a large number of calories are consumed in a short period of time followed by purging methods, such as forced vomiting or use of laxatives or diuretics.

psychological concerns of lack of self-worth, self-loath- ing, anxiety, and depression can be concurrent conditions with bulimia nervosa.

The third eating disorder is binge eating disorder. Binge eating is characterized by frequent overeating at

least one time per week for 3 months. These episodes of overeating are com- bined with feelings of lack of control and depression or guilt afterwards. Eating food very rapidly, eating until uncom-

fortably full, and eating alone are all diagnostic criteria associated with binge eating disorder. As with any type of eating disorder, the effects of low energy intake and/or the binge/purge cycle can eventually be detrimental to sport performance.

Anorexia athletica is not in the DSM-5, but it is impor- tant in the discussion of athletes and eating disorders. There are many similarities to both bulimia and anorexia in the description of anorexia athletica. However, athletes

are a unique popula- tion, and their behav- iors and symptoms may be somewhat different from those manifested in non- athletes. As a result, an athlete’s behavior might not meet the diagnostic criteria required for an eat- ing disorder. Several factors distinguish anorexia athletica

from the other eating disorders. Often athletes (both male and female) with anorexia athletica show a reduced energy intake and reduced body weight but maintain high levels of physical performance; athletes with other eating disorders typically have a diminished capacity or toler- ance for training and competition. Another distinguishing factor of anorexia athletica is that the reduction in body weight or loss of body fat is based on performance rather than appearance or concern with body shape or size.

The actual criteria for defining anorexia athletica are still not completely agreed upon by researchers in this area. However, different authors working with athletes in the eating disorder arena have published several reviews of the characteristics of anorexia athletica. With anorexia athletica, the athlete often has a rigid training schedule, tries to delay eating to save calories, and then often binges because of excessive hunger and lowered glucose levels. The common characteristics of anorexia athletica are listed in TABLE 11.8 and are similar to anorexia nervosa,

binge eating disorder A clinical condition characterized by frequent feelings of being unable to control what or how much is being eaten. Typically the amount eaten is considered an abnormally large amount of food.

anorexia athletica A subclini- cal condition in which individuals practice inappropriate eating be- haviors and weight control meth- ods to prevent weight gain and/ or fat increases. Anorexia athletica does not meet the criteria for a clinically defined eating disorder, but the behaviors exhibited are on a continuum that could lead to the more severe clinically recognized eating disorders.

316 SECTION 2 The Practical Application of Sports Nutrition

but with some additional characteristics related specifi- cally to female athletes.40,42

Many athletes do not meet the criteria for anorexia, bulimia, or binge eating but still struggle with eating issues. These may be athletes who rarely binge and use compensatory behaviors, but might do so in a particu- larly stressful situation. They may also chronically diet; be overly concerned with their weight, body composi- tion, and appearance; and make judgments about them- selves based on the types of foods they have eaten or the number on the scale. Sport performance can suffer if the athlete does not eat enough calories to maintain energy levels during practice or competition. Some ath- letes may avoid carbohydrates as a way to diet, and glyco- gen stores will chronically be low, resulting in poor sport performance. Excessive exercise as a means to burn more calories could lead to injuries that keep the athlete out of competition. Although athletes with these types of eating behaviors do not meet the criteria for an eating disorder, the behaviors can negatively affect daily life and inhibit maximal sport performance.

What are the effects of eating disorders on athletic performance? Athletes with eating disorders may appear normal and healthy and be able to maintain training levels for a period of time before any concerns develop. Typically, a change in weight is noticed that may not initially affect perfor- mance. Behavioral changes, such as withdrawal from teammates and coaches or atypical behaviors relating to other members, can also occur. Mental toughness and typ- ical competitiveness may decrease, especially as caloric intake is decreased. Self-esteem and self-confidence may be reduced, and depression or anxiety can occur.

Table 11.8

Characteristics of Anorexia Athletica

• Decreased energy intake • Decreased weight in the absence of medical illness or affective

disorder explaining the weight reduction • Maintenance of high physical performance • Desire to lose weight not based on appearance • Desire for weight loss based on performance or perceived

performance improvements • Intense fear of weight gain • Weight cycling based on training levels • Dietary restraint • Bingeing and purging • Gastrointestinal complaints • Menstrual dysfunction • Compulsive exercise despite illness or injury • View self-worth by athletic ability or performance • Individual does not meet DSM-5 criteria for eating disorders, but

possesses many eating-disorder characteristics

Physically, once the eating disorder has progressed, the athlete’s performance during training and compe- tition suffers. In some athletes this happens within a few months of restricting intake or bingeing and purg- ing, whereas others can maintain a low caloric intake or binge and purge for many months before performance is altered. Eating-disordered athletes may develop nutri- tional deficiencies over time as a result of reduced caloric intake, chronic vomiting, or laxative abuse. If calories are significantly decreased, carbohydrate levels are often low. This causes an increased reliance on fat and protein as energy sources. When more protein is used for energy, less is available to maintain muscle mass. A decreased muscle mass almost certainly will decrease sport perfor- mance. Calcium, iron, and other vitamins and minerals may be lacking in the diet. This may eventually lead to iron deficiency, bone loss, and other consequences of vita- min and mineral deficiencies. Possibly most significant is the effect that reduced energy availability has on physical performance and health. When too few calories are con- sumed, energy expenditure from exercise is extreme, or a combination of both occurs, the body lacks the energy necessary to sustain high levels of exercise intensity. In addition, this “energy drain” affects hormone responses that lead to menstrual irregularities and potential issues with bone health described later in the section titled “What is the female athlete triad?”

Some of the health concerns and psychological effects that may be noticed in athletes with eating disor- ders include the following:

• Decreased fat-free mass • Dehydration • Glycogen depletion • Hormonal disturbances • Decreased BMR • Increased risk of poor nutritional status • Poor exercise performance • Anxiety, rapid heart rate, inability to sleep, and dehy-

dration caused by the stimulant effect of diet pills and diuretics

• Dehydration, electrolyte loss, and gastrointestinal complications resulting from laxative use

• Increased risk of overuse injuries and fatigue caused by excessive exercise

• Decreased concentration • Increased likelihood of food and weight obsession

What are the main concerns regarding female athletes and eating disturbances/disorders? Female athletes are at greater risk for developing eating disorders than age-matched nonathletes.42–44 Identifying eating concerns in female athletes early on can keep the athlete from developing a diagnosable eating disorder in the future. Certain physical characteristics, strict training regimens, dietary restraint, and attitudes and behaviors toward food and body weight are accepted as normal for

Chapter 11 Weight Management 317

patterns seen in the triad are similar to those described earlier in this chapter for anorexia nervosa and anorexia athletica.

Irregular menstruation can be defined based on the number of menstrual cycles in 1 year. Eumenorrhea is defined as at least 10 or more menses per year and is con- sidered normal. Oligomenorrhea is defined as four to six cycles per year, and amenorrhea is defined as fewer than four cycles per year. Oligomenorrhea and amenorrhea both are seen with the female athlete triad. These menstrual

irregularities often cause changes in sex hormone secretion. Changes in hormone regulation are one of the causes of the decrease in bone min- eral density found with dysmenorrheic female athletes.

eumenorrhea A term used to describe normal menstruation consisting of at least 10 menstrual cycles per year.

oligomenorrhea A condition in which the female menstrual period is irregular, with cycles occurring only four to six times per year.

many female athletes, making it difficult to use the usual criteria for defining disordered eating in this population. Many different questionnaires are used to assess eating behaviors in this population (such as the EDI, EDI-2, and EDE discussed earlier), but few assessment tools have been designed specifically to determine early signs of eat- ing problems in female athletes.

The Female Athlete Screening Tool (FAST), designed by Affenito et al.45 and researched by McNulty et al.,46 can be used as a screening tool for eating disorders in female athletes. The FAST is able to measure the purpose of aber- rant exercise and eating behaviors in those athletes with eating disorders, whereas the EDI-2 and EDE do not con- sistently differentiate between athletes and nonathletes with eating disorders. Athletic programs in which female athletes participate at a highly competitive level should screen these athletes for eating disorders as part of an annual physical.

What is the female athlete triad? The female athlete triad (see FIGURE 11.11 ), typically observed in young female athletes, consists of three defin- able symptoms: disordered eating, menstrual irregulari-

ties, and osteopenia/ osteoporosis. Cobb et al. reported that the actual existence of all three parts of the triad at the same time has not been well documented in

the research.47 These authors report that the relationship between disordered eating and menstrual irregularities, as well as separate studies that establish the relationship between menstrual irregularities and low bone mineral density, are well documented. Regardless of the ability to document all or some of the three components of the female athlete triad existing simultaneously, female ath- letes with one or more of the triad symptoms need early diagnosis and treatment for these concerns.

Disordered eating includes restrictive eating behaviors associated with eating disorders but may not meet the actual diagnostic criteria for eating disorders. Female ath- letes that exhibit disordered eating behaviors often restrict caloric intake and fat intake. They maintain a high training intensity and duration, thus producing a high energy expen- diture and calorie deficit. Loucks and others have researched issues of energy availability and its effects on female athlete menstrual function. This research consistently reports that amenorrhea occurs because of insufficient energy avail-

ability or ingestion of too few calories to fuel both physical activity and normal body functions.48–50 The disordered eating

female athlete triad A group of three interrelated conditions, typically diagnosed in young female athletes: disordered eating, menstrual irregularities, and osteo- penia/osteoporosis.

amenorrhea The absence or abnormal cessation of menstrua- tion; defined as fewer than four cycles per year.

Figure 11.11 Female athlete triad. Disordered eating in female athletes that results in significant weight loss, energy drain, amen- orrhea, or menstrual irregularities can also cause a loss of bone mineral density or osteoporosis.

The athlete develops one or more harmful eating behaviors in an attempt

to lose weight. The result is an energy deficit.

fficient energy availability, Insu which leads to a decrease in

estrogen production, eventually results in menstrual

irregularities and amenorrhea.

The lack of estrogen decreases calcium absorption and retention. Dietary deficiency of calcium also is common.

Left untreated, this lack of calcium leads to bone loss, stress fractures, and osteoporosis.

Disordered eating

Amenorrhea/menstrual irregularities

Osteoporosis/osteopenia

Disordered Eating

Amenorrhea

Osteoporosis/Osteopenia

318 SECTION 2 The Practical Application of Sports Nutrition

at higher risk for developing eating disorders than their sedentary counterparts. However, it is difficult to deter- mine the actual prevalence of eating disturbances and dis- orders in male athletes because there is a lack of research in this area. As with females, there is also a lack of report- ing, and men are even less likely than women to seek help for their eating or body image concerns.

Certain sports may place male athletes at higher risk for eating disturbances. Sports with established weight classifications and those where low body weight is emphasized, such as distance running, are considered higher-risk sports. Body builders and weight lifters also

The third part of the female athlete triad, osteopenia/ osteoporosis, can occur when female athletes decrease nutrient intake and lose significant body fat. A significant reduction in body fat to unhealthy levels can alter hor- mone levels that affect bone mineral density. A reduction in nutrients that are necessary for bone health, such as calcium, vitamin D, and magnesium, can also contribute to bone loss. Bone mineral density (BMD), as previously discussed in the body composition section, is often mea- sured by a DEXA scan. BMD can be decreased in females exhibiting disordered eating and dysmenorrheic tenden- cies. Cobb et al. found that BMD was lower in the lumbar spine, hip, and whole body in oligomenorrheic and amen- orrheic female athletes in their study.47

The relationship among all components of the triad is complex. Cobb et al.47 completed an extensive study of all three components separately as well as the interrelation- ship of each component. Ninety-one female competitive runners 18 to 26 years old were surveyed by questionnaire and EDI to assess disordered eating, and BMD testing was performed using DEXA. The authors confirmed that the triad exists and that in female runners: (1) disordered eat- ing is correlated with oligomenorrhea, (2) the association between oligomenorrhea and amenorrhea and low BMD is independent of body weight and composition, and (3) new evidence reveals that disordered eating is associated with low BMD in eumenorrheic women. The female athletes with elevated EDI scores reported 19% lower daily caloric intakes compared with the female athletes with normal EDI scores. Both groups had adequate calcium intakes. Of the 23 women with increased EDI scores, 65% had oli- gomenorrhea versus 25% of the 67 with normal EDI. Total energy intake was not associated with menstrual distur- bance; however, a positive correlation was found with low percent fat intake. BMD was lower in the oligomenorrheic/ amenorrheic women when compared to eumenorrheic women. When adjusted for body weight and composition, women with increased EDI scores had significantly lower BMD compared to women with normal EDI.

In summary, female athletes are at higher risk for developing eating disorders than female nonathletes. Dis- ordered eating is one part of the triad, and the decrease in nutrient intake seen in disordered eating can lead to the other two parts of the triad. A reduction in body fat per- centage and the hormone abnormalities occurring with this reduction can lead to the development of menstrual irregularities and decreased bone mineral density. Early detection and treatment of one or all of the triad compo- nents can help the athlete avoid chronic health issues and poor sport performance.

What are the main concerns regarding male athletes and eating disturbances/disorders? Most research, public concern, and prevention and treat- ment strategies for eating disorders are aimed at females. However, as many as 1 million men and boys have eating disorders. As with female athletes, male athletes may be

Chapter 11 Weight Management 319

Fortifying Your Nutrition Knowledge

Relative Energy Deficiency in Sport (RED-S): The Female Triad and More Relative energy deficiency in sport, or RED-S for short, is a syndrome of interrelated conditions that has evolved from the female athlete triad. The International Olympic Committee (IOC) introduced RED-S because they felt that a broader, more comprehensive terminology was required to better describe what they felt was only partially covered by the female ath- lete triad.a Because male athletes can also be afflicted and because research has shown that there are more physiologi- cal and psychological ramifications to poor energy availability, the IOC felt a new name was warranted. Similar to the female athlete triad, the common thread that initiates this group of interrelated conditions is poor energy availability (i.e., energy deficiency). However, the effects associated with RED-S also include perturbations in endocrine function, metabolism, hematological function, growth and development, gastro- intestinal function, mental health, immune function, and cardiovascular health. Clearly, the female athlete triad makes up only a small portion of the multitude of issues associated with RED-S.

While recognition of RED-S is increasing, it should be noted that its use is not universally accepted. A group of renowned scientists feels that RED-S is not sufficiently supported by scientific research to warrant adoption at this time. Further- more, they feel that placing the female athlete triad under the umbrella of RED-S has the potential to "confuse rather than enlighten and undo decades of work educating and advocat- ing for awareness, prevention, and treatment for the Triad."b While the acceptance of RED-S is in question, its increasing use in the field of sports nutrition warrants exploration. Whether or not it becomes recognized as a true clinical syndrome is yet to be determined.

aMountjoy M, Sundgot-Borgen J, Burke L, et al. The IOC consensus state- ment: beyond the female athlete triad—relative energy deficiency in sport (RED-S). Br J Sports Med. 2014;48:491–497.

bDe Souza MJ, Williams NI, Nattiv A, et al. Misunderstanding the female athlete triad: Refuting the IOC consensus statement on relative energy deficiency in sport (RED-S). Br J Sports Med. 2014;48:1461–1465.

What are the best treatment options for eating disorders? Treatment of eating disorders is best accomplished with a team approach to assessment and management of the condition.56 A multidisciplinary team made up minimally of the team physician, psychological and psychiatric staff, and dietitians who can assess and provide treatment for the athlete is necessary. Including athletic trainers, coaches, and parents, if indicated, will give the eating-dis- ordered athlete the best chance of regaining physiological and psychological health.

A thorough medical examination, including medical history; weight assessments; laboratory tests; bone scans, if needed; electrocardiogram; and patient history should be conducted. This information can be used to deter- mine whether it is safe for the athlete to continue sport activities or whether restrictions in activity are necessary. Most athletes with diagnosable eating disorders will not be allowed to continue to compete if medical information obtained suggests that training and competition could compromise their health status. Medical staff should pro- vide ongoing monitoring of physical health, especially if the athlete continues to train.

Eating disorders are not about food; they are based on emotional and psychological issues in the athlete’s life that manifest themselves in disordered eating and exer- cise behaviors. An evaluation with a psychologist, clini- cal social worker, or psychiatrist is encouraged to assess emotional issues that underlie the eating problems. Ath- letes with eating disorders require regular counseling for long-term recovery. Without help from a therapist to dis- cover the root of the problem, athletes are unlikely to be able to make the necessary dietary and behavior changes to recover from the eating disorder. It may also be neces- sary to consult with a psychiatrist to evaluate the need for psychotropic medications to improve the eating disorder recovery process.

The dietitian should assess current dietary intake and compare that to estimated calorie needs, assess weight status, and determine any nutritional deficiencies. Dieti- tians play an integral role in the treatment team to help athletes understand the need for food as fuel as well as to help them make dietary behavior changes. Many ath- letes with eating disorders are very knowledgeable about nutrients, vitamins, minerals, and calories; however, their knowledge is not enough to translate needed changes into action plans to improve nutrition intake. Dietitians need to establish rapport with the athlete and work with him or her to develop a plan that aids in treatment of the disorder and also provides the nutrients required for exer- cise and competition.

How can eating disorders be prevented? Prevention of eating disorders is the best defense against the development of an unhealthy relationship with food, medical problems, and the associated negative effects

appear to be at high risk for developing disordered eat- ing and body image distortion/disturbance. These athletes are more concerned with a “drive for bulk” rather than a “drive for thinness” as described in anorexia.

Muscle dysmorphia is a newly defined syndrome characterized by highly muscular individuals (usually men) having a pathological belief that they are of very small musculature.51 Pope et al.52 first coined this phrase and defined it as an intense and excessive preoccupation or dissatisfaction with body size and muscularity.53 This con- cept also is referred to as reverse anorexia or bigorexia54

because it is charac- terized as seeing one- self as small or frail, when in fact the indi- vidual is large and muscular. Athletes with muscle dysmor- phia exhibit a strong drive for muscular- ity.55 They have a

strong compulsion for spending hours resistance training, purchasing nutritional supplements, and following diets that supposedly help increase muscle mass. Similar to those with anorexia and bulimia, they have a preoccupa- tion with body size and weight and demonstrate pathologic eating patterns and behaviors. Pope et al.54 have deter- mined a list of characteristic features suggesting muscle dysmorphia in males. TABLE 11.9 lists these features.

muscle dysmorphia A type of distorted body image in which individuals have an intense and excessive preoccupation and/or dissatisfaction with body size and muscularity. Muscle dysmorphia is most prevalent in male body builders and weight lifters.

Table 11.9

Signs of Muscle Dysmorphia

1. Preoccupation with body shape and size. Feels insufficiently lean and/or muscular. Common signs of preoccupation exhibited include appearance checking; frequent weighing; criticizing self about weight, size, and shape; camouflaging body with baggy clothing.

2. Preoccupation with muscularity causes significant distress or impairment of social, occupational, or other life functioning such as personal relationships. This is demonstrated by two or more of the following: • Avoids social, occupational, or recreational activities to maintain

compulsive exercise or diet regimens • Avoids situations where body would be exposed (pool, beach) or

is very anxious in these situations • Preoccupation about inadequacy of size/muscularity

causes clinically significant distress or impairment in social, occupational, and personal functioning

• Continues to exercise, diet, and use performance-enhancing drugs/supplements despite knowledge of or experience with adverse physical or psychological consequences

3. Individual engages in excessive exercise, demonstrates preoccupation with food, follows strict diet regimen, or abuses steroids or other supplements.

Source: Adapted from Pope HG, Gruber AJ, Choi P, et al. Muscle dysmorphia: an underrecognized form of body dysmorphic disorder. Psychosom. 1997;38:548–557.

320 SECTION 2 The Practical Application of Sports Nutrition

on sport performance. Prevention of eating disorders, including the diagnosable eating disorders, anorexia athletica, and muscle dysmorphia, occurs on three lev- els: primary, secondary, and tertiary. Each of these levels can help the athlete prevent the development of dis- ordered eating patterns, recognize that problems are occurring, or seek out medical and psychological treat- ment to prevent the problem from becoming chronic and debilitating.

Primary prevention includes practices that help iden- tify, eliminate, and reduce personal, social, and cultural factors that contribute to eating disorders. Nutrition strat- egies for primary prevention include nutrition education focused on healthful eating to fuel sport activities, includ- ing eating nutrient-dense foods for adequate dietary intake. Nutrition education that emphasizes health and improved performance, not weight loss, encourages a healthy relationship with food and a well-balanced diet. Coaches, parents, and athletic trainers can influence ath- letes using various primary prevention strategies, includ- ing the following:

• Taking the emphasis off weight and body composi- tion by eliminating weekly weigh-ins or body fat test- ing (unless it is required by the sport)

• Emphasizing skills and performance and recogniz- ing that athletes come in different shapes and sizes; encouraging a positive sport-based atmosphere that helps prevent body image distortions and eating problems

• Discouraging the use of fad diets or quick weight loss methods

• Modeling of healthy eating and exercise behaviors by coaches, parents, athletic trainers, and other staff

• Preventing muscle dysmorphia through early iden- tification of body image distortion that often occurs in strength athletes, as well as establishing stan- dard prevention strategies for preventing eating disorders

• Developing a healthy gym environment where edu- cation about myths associated with physique, dietary supplements, and the ability to obtain the “perfect” body are not perpetuated

• Setting achievable goals, avoiding comments about specific parts of the body, and dispelling myths about certain supplements and dietary practices that are unhealthy; this can be done by personal trainers, ath- letic trainers, and strength coaches Secondary prevention includes identifying and rec-

ognizing warning signs that suggest early development of eating disorders. Once warning signs are recognized, immediate referral to medical, psychological, and/ or nutrition professionals is essential for the athlete. Coaches, athletes, dietitians, teammates, trainers, and parents of athletes should educate themselves about the warning signs of eating disorders. Knowing the resources available in the community and establishing relation- ships with these resource personnel will help the referral

Table 11.10

Warning Signs of Eating Disorders in Athletes

Behavioral signs Preoccupation with food, weight, or body

composition Criticism of weight, shape, body

composition; comparisons of these to other teammates

Limited type and amount of food eaten Fear of becoming “fat” Excessive rigid exercise; exercise more than

at scheduled practices Recent switch to restrictive diet Secretive eating (food disappears) Consumption of large amounts of food

inconsistent with athlete’s weight Evidence of self-induced vomiting—

bathroom smells, trips to bathroom immediately after meals

Laxative, diuretic, or diet pill abuse Recurring injuries, especially overuse injuries Isolation from social situations, family,

friends, teammates Withdrawal from team activities or change in

interaction with teammates Mood changes, depressive signs, anxiety

Physical signs Normal, underweight,

or overweight Fatigue Lethargy Weakness Impaired concentration Dizziness Abdominal pain Faintness Salivary gland

enlargement Sore muscles Chills or cold sweats Frequent sore throat Diarrhea Constipation Tooth enamel erosion Esophagitis Callus on fingers, back

of hand Oligomenorrhea Amenorrhea

process proceed smoothly for the athlete. Early detection and treatment mean better outcomes. Education of high- risk teams and their coaches early in the season or dur- ing recruitment will help athletes and those who work with them recognize early warning signs in themselves and others. TABLE 11.10 lists common warning signs that indicate an athlete may be moving toward disordered eat- ing behaviors.

Tertiary prevention includes efforts to keep the disor- der from becoming chronic. An athlete who is diagnosed with an eating disorder should get immediate evaluation and treatment from a physician and a mental health pro- fessional. These professionals should refer the athlete to a registered dietitian who can help the athlete with an appropriate nutritional plan. Obtaining professional assis- tance through either an inpatient or outpatient treatment facility is critical. Athletes with eating disorders may resist treatment because it means time away from their sport and requires them to realize they have a problem. Pushing the athlete to accept and work at treatment with trained profes- sionals to guide the

Chapter 11 Weight Management 321

Food for Thought 11.4

Weight Loss Issues: Female Ath- lete Triad and Eating Disorders

Describe the components of the female athlete triad and warn- ing signs indicative of eating disturbances/disorders.

How can athletes gain weight healthfully? Although it seems that most athletes and the general public are spending most of their time trying to maintain or lose weight, there are some athletes who are interested in increasing body weight. As has already been discussed, gaining fat weight for most athletes is not desirable; there- fore, any weight gain strategies should focus on increas- ing muscle mass. By increasing muscle mass, the athlete not only accomplishes his or her goal of gaining weight, but also becomes stronger, thereby increasing his or her strength-to-weight ratio, which is a desirable training adaptation for most athletes. Gaining weight via increases in fat mass decreases the strength-to-weight ratio, which is why weight gain should be aimed at increasing muscle mass with minimal contribution from added fat mass. There are three main requirements for increasing body weight, particularly in regard to muscle mass:

• Participation in an appropriately planned resistance training program

• Achieving a positive energy balance • Achieving a positive nitrogen balance

Each of these requirements is discussed in more detail in the following sections.

What kind of resistance training program is best for gaining weight? Most athletes know that regular resistance training (also referred to as strength training) is effective for improving muscle mass, strength, and power. They also know that it can strengthen connective tissues such as tendons,

process may save the athlete a lifetime of struggles with eat- ing problems.

Several nation- wide resources are available to help ath- letes prevent eating problems and to help sports professionals treat athletes with eating problems (see TABLE 11.11 ). Resources may also be available in the athlete’s local community. Profes-

sionals working with athletes should know the resources in their communities so that referrals can be made quickly to match the athlete’s needs with the resources available.

Table 11.11

Eating-Disorder Prevention and Treatment Resources

Organization Resources offered National Institute of Mental Health www.nimh.nih.gov/health/topics/

eating-disorders/index.shtml

Website provides information on signs and symptoms, treatment, statistics, and outreach programs for eating disorders.

National Eating Disorders Association www.nationaleatingdisorders.org

Website offers information on eating-disorder education, treatment, and links to referral sources for individuals struggling with eating concerns.

Harris Center, Massachusetts General Hospital www.blackdiamondmarketing

group.com/harris/about.asp

Website focuses on expanding knowledge of eating disorders, research, and education on identifying, treating, and preventing eating disorders.

American College of Sports Medicine www.acsm.org/

public-information/ position-stands

Website contains position papers on the female athlete triad, weight management, and sports nutrition. Other educational materials and resources are available at this site.

The Renfrew Centers and Foundation www.renfrewcenter.com

Residential treatment center for people with eating disorders. Several centers exist in various locations throughout the United States.

Sports, Cardiovascular and Wellness Nutritionists (SCAN) Dietetic Practice Group of the American Dietetic Association www.scandpg.org/nutrition-info/

Information on sports nutrition, eating disorders, rapid weight loss in wrestlers, and how to find a registered dietitian with sports nutrition experience.

322 SECTION 2 The Practical Application of Sports Nutrition

Gaining the Performance Edge

Athletes are at higher risk for devel- oping eating disturbances and dis- orders than the general population. Preventing eating disorders is essen- tial for athletes to avoid negative consequences to health and sport performance. Regular screening of athletes at high risk for developing eating disorders helps identify prob- lems early and prevents more seri- ous complications later.

ligaments, and bone, thus decreasing risk for injuries. How- ever, many athletes do not know that not all resistance training programs produce the same results. The type of exercises performed, the amount of weight lifted, the num- ber of repetitions performed in each set, the total number of sets completed for each exercise, and the amount of rest taken between sets can all affect the outcomes of a resis- tance training program.

The first criterion for any resistance training program designed to increase muscle mass is that it must chal- lenge the muscles to work against resistances to which they are not accustomed. One of the basic principles of training, known as the “overload principle,” states that resistance training must place a greater-than-normal stress on the muscle cells to stimulate adaptation. The amount of stress imposed on the muscle can be altered based on how much weight is being lifted and the num- ber of repetitions and sets performed. When the muscle is challenged to contract against an appropriate resistance, the muscle cells respond and are stimulated to grow. The end result is muscle hypertrophy (i.e., the muscle gets big- ger), and thus increased muscle mass.

The resistance training program chosen by an athlete wishing to gain weight should focus on stimulating mus- cle hypertrophy. As noted earlier, a common misconcep- tion is that all resistance training programs are created equal. Training for muscle hypertrophy is different from training for maximal strength or power. Resistance train- ing programs designed to increase muscle mass should work all the major muscle groups with a training fre- quency of at least twice per week and incorporate weight loads that allow a minimum of 8 and a maximum of 12 repetitions per set. Three to five sets should be performed for each exercise. Athletes should allow 48 hours between workouts for the same muscle groups so that the mus- cles can recover and adapt to the training. As the muscles adapt and become stronger, the amount of weight lifted should be increased to keep the repetitions performed per set in the 8 to 12 range. By progressively increasing the loads to accommodate the strength increases, the mus- cles will continue to be challenged and thus continue to hypertrophy. This format of resistance training is often referred to as “progressive” resistance training.

How can an athlete achieve a positive energy balance? The second requirement of a weight gain program is that the athlete must attain a positive energy balance. In other words, calorie intake must exceed calorie expenditure for muscle gains to occur. A positive energy balance can be achieved by consuming more calories, decreasing energy expenditure, or both. In many instances, decreasing energy expenditure (i.e., training less) is not an option because of the necessity of training for the sport. Thus, increasing food intake is the most productive way for most athletes to gain weight; however, it should not be done indiscriminately. Doing so can result in higher levels of fat weight gain.

Approximately 2300–3600 calories above current requirements are needed to increase muscle mass by 1 pound. However, the body does not necessarily make more muscle solely because extra calories are consumed in the diet. The extra calories must be combined with the stimulus for muscle growth that results from resis- tance training. Even then, the body will use only what it needs to recover and adapt. A study involving indi- viduals who were resistance training and consuming an extra 500–2000 calories per day indicated only 30–40% of the weight gained was lean body tissue.57 The remain- ing calories are stored as energy, usually in the form of fat. In short, consuming large quantities of food will not result in increased muscle mass beyond what resistance training induces. The goal is to provide enough calories to cover the body’s need to synthesize new muscle tis- sue without exceeding calorie requirements. The num- ber of extra calories needed to support muscle growth is highly individual, and thus frequent body composition assessments should be performed so that caloric intake can be adjusted accordingly. Weight gain in the form of muscle is a gradual process, so increases in dietary intake should be modest to maximize muscle gain ver- sus fat gain.

A weight gain goal of one-half to 1 pound per week is generally considered appropriate. The amount of addi- tional calories needed to accomplish weight gain depends on the individual’s goals for rate of weight gain, the inten- sity and volume of their current training, the ability of the athlete to consume additional calories, and genetics. Consuming an additional 300–500 calories per day could provide for a weight gain rate of half a pound to 1 pound per week. This modest increase in caloric intake can gen- erally be consumed without the athlete feeling overly full or uncomfortable after meals. During the weight gain period, if increases in training volume occur, in particu- lar any increases in aerobic-type exercise, then more than 300–500 additional calories may be needed to meet the additional energy demands of the training.

Finally, the composition of the additional calories is important. Many athletes assume that protein should make up the largest percentage of the additional calories because protein is essential for muscle synthesis. Protein intake is important, but it is more important to ensure that the total energy needs of the body are met regardless of the contributing macronutrients. Carbohydrates are a critical energy source and must be present in the diet or the body will break down and use protein for energy. In other words, carbohydrates spare proteins from being broken down for energy, thus enabling them to be used for muscle tissue building. As a result, the largest propor- tion of the additional calories (55–60%) should be obtained from carbohydrate-rich foods. In summary, consuming 300–500 extra calories per day, primarily in the form of carbohydrates, will place the athlete in a positive energy balance and support a rate of weight gain that increases muscle mass and minimizes fat gain.

Chapter 11 Weight Management 323

How can an athlete achieve a positive nitrogen balance? With adequate additional caloric intake, athletes can suc- cessfully gain weight. Even though carbohydrates should contribute a majority of the extra calories needed for muscle mass gain, adequate protein intake is also nec- essary. Protein needs for athletes are greater compared to sedentary individuals. During a targeted weight gain period, protein needs are also increased. Some of this additional protein is needed to support the energy costs of additional training. Most of the additional protein will be used to produce muscle hypertrophy. The RDA for pro- tein is 0.8 grams per kilogram body weight for the average healthy individual. The recommendation for athletes dur- ing strength training activities ranges from 1.4–2.0 grams per kilogram body weight. This range provides a level of protein intake that is approximately twice the RDA and should be adequate to place the athlete in a state of posi- tive nitrogen balance.

Attaining a daily protein intake of 1.4–2.0 grams per kilogram of body weight is not difficult for most athletes. In general, if an athlete is consuming enough food to meet his or her daily caloric needs and including protein-rich foods and beverages at each meal and snack throughout the day, obtaining adequate amounts of protein to support muscle mass gains is typically not of concern. For exam- ple, an 85-kilogram athlete who requires an estimated 3200 calories to meet daily energy demands and main- tain weight will require approximately 3700 calories after adding 500 calories per day to support muscle mass gains (see TRAINING TABLE 11.3 ). If the athlete wanted to boost pro- tein intake to 1.8 grams per kilogram of body weight, then a total of 153 grams of protein would be required daily. When comparing total energy needs to protein require- ments, only 16.5% of total calories would need to come from protein ([153 grams × 4 kcal per gram of protein] ÷ 3700 kcal = 16.5% of total calories from protein). The nor- mal diet of most individuals consists of 10–20% of calories from protein. Clearly, an athlete who eats a diet on the high end of normal will more than likely meet the daily protein requirements to support muscle growth.

Do athletes need dietary supplements to gain weight? Use of protein supplements is common in athletes desir- ing to gain weight, primarily because the popular press touts the importance of supplementation for muscle growth (see FIGURE 11.12 ). The marketing efforts of sup- plement companies that promote high protein intake for muscle growth sway athletes into believing they need supplements to meet protein demands. However, as dem- onstrated in the previous example, supplementation is not a necessity if the caloric needs of the athlete are being met and protein intake is on the upper end of the rec- ommended range for athletes. Athletes need to keep in mind that any excess protein (i.e., protein not used for

muscle growth) will be stored as fat. Con- versely, if the athlete has food intoler- ances or preferences that challenge the adequate intake of protein from food sources, then sup- plementation may be recommended. If protein supplements are incorporated into the athlete’s eating plan, they should

be used in moderation with a continued focus on food sources of protein.

Weight gain or calorie supplements may also be help- ful for athletes who have extremely high energy needs and just can’t seem to eat enough food necessary to gain weight (see FIGURE 11.13 ). These calorie supplements typi- cally provide between 300 and 500 calories and are usually

Training Table 11.3: Sample Meal Plan for Weight Gain 3200 Calories (166 g protein) 3700 Calories (183 g protein)

Breakfast Breakfast

2 scrambled eggs, with salsa and shredded cheese

2 slices whole wheat toast with jelly 2 slices whole wheat toast with jelly

12 oz orange juice 12 oz orange juice

Mid-morning Snack Mid-morning Snack

Granola bar Granola bar Pear

Lunch Lunch

3 oz turkey sandwich with Swiss cheese

Apple Apple

Baked potato chips Baked potato chips

12 oz 1% milk 4 small oatmeal cookies 16 oz 1% milk

Mid-afternoon Snack Mid-afternoon Snack

3 oz tuna with saltine crackers 3 oz tuna with saltine crackers

Dinner Dinner

4 oz chicken breast 4 oz chicken breast

2 cups white rice 2 cups white rice

2 cups broccoli 2 cups broccoli

12 oz chocolate milk 16 oz chocolate milk

Evening Snack Evening Snack

12 oz apple juice 2 oz ham sandwich 12 oz apple juice

324 SECTION 2 The Practical Application of Sports Nutrition

Gaining the Performance Edge

To gain weight primarily as muscle mass, athletes must strength train to provide a stimulus for muscle growth, eat an additional 300–500 or more calories per day consis- tently, consume the majority of the additional calories as carbohydrate (to spare protein for muscle build- ing), and consume adequate protein to achieve positive nitrogen balance.

Figure 11.13 Weight gain powders and drinks. Athletes who have dif- ficulty meeting high-energy demands and want to gain weight may benefit from easy-to-use powdered or liquid high-calorie supplements. Caution should be taken when using these supplements because they could contain banned or other substances the athlete does not want or should not consume.

Training Table 11.4: Nutrition Tips for Weight Gain • Consume fluids after meals to avoid becoming full on liquids.

• Avoid carbonated beverages that produce gas and bloating and the feeling of fullness.

• Use predetermined cues to eat (e.g., plan meals with friends, always have a 10:00 am snack).

• Have frequent meals and snacks throughout the day.

• Consume a variety of nutrient-dense and energy-dense foods.

• Consume high-calorie beverages with meals.

• Use sports drinks instead of water during training.

• Include a bedtime snack approximately 1 hour prior to sleep.

sold as an 8-ounce drink or in powdered form. As with any dietary supplement, athletes should pay careful attention to the Supplement Facts label. Some weight gain or pro- tein supplements may contain stimulants or other herbal or synthetic ingredients that may be banned by the NCAA, the International Olympic Committee (IOC), and other pro- fessional sports organizations. Ignorance is not an excuse to these agencies, so reading the labels and asking about the ingredients of any supplement are very important.

What other dietary practices might help an athlete gain weight? For many athletes on a tight schedule, taking in extra calo- ries during the day is not an easy thing to do. Likewise, there are other individuals who have to work very hard at con- suming enough calories to gain weight. For these individ- uals and others wanting to add weight, TRAINING TABLE 11.4 lists some helpful dietary tips. Eating numerous small meals throughout the day and/or drinking juices or milk rather than water can help pack in the extra calories. This is especially helpful to athletes who already feel full after their meal and therefore need to add calories throughout the day versus solely at meals. Also, cut- ting back on drink- ing fluids during the meal, especially car- bonated fluids, can leave more room for a few extra calories. For those athletes who are always on the go and find fre- quent snacking a bother, commercially prepared liquid meals can be an appropriate and easy-to-consume snack option. Alternatively, mixing up smoothies or calorie sup- plement drinks before leaving home will make taking in extra calories throughout the day more convenient. Finally, late-night snacking is an excellent way to add the extra cal- ories needed for weight gain. Regardless of the weight gain strategies chosen, it is important that the methods are not too disruptive to the normal routine of the athlete. Dietary strategies that look good on paper but do not fit the ath- lete’s behaviors/habits will not result in the regular boost of calories required for attaining specific weight gain goals.

Figure 11.12 Protein supplements are vigorously marketed to athletes. Adequate protein intake is necessary for muscle growth. If the athlete cannot meet daily protein needs through food sources, protein supplements might be appropri- ate. However, protein consumed in excess, whether from supplements or foods, can be stored as fat. © Photos.com

Chapter 11 Weight Management 325

Food for Thought 11.5

You Are the Nutrition Coach

Apply the concepts from this chapter to several case studies.

A PROTEIN SUPPLEMENT

BUILD RIPPED UP abs, a CHISELED BACK, and THICKER chest

Our special ionized-protein formula has been specially formulated for superior absorption directly into the muscle.

BREAKTHROUGH!

The Box Score Key Points of Chapter

n Athletes are concerned about weight loss for a vari- ety of reasons. They may feel it will help improve their sport performance or make their appearance more attractive to judges. Many sports have a par- ticular “look,” such as the very thin appearance of long-distance runners. Athletes may aspire to change their weight to achieve a particular per- ceived ideal appearance for their sport.

n Body mass index (BMI) is equal to body weight (in kilograms) divided by height (in meters) squared. BMI measures can be calculated using the nonmet- ric pounds and inches conversions or the published nomogram charts as well. Although BMI is not a true measure of body composition, it is commonly used to provide an indication of body composition in the general population. Athletes should not solely use BMI as a measure of weight status because it is a crude indicator of body composition.

n Overweight and obesity are significant medical con- cerns for adults in the United States. Approximately two-thirds of the adult population has a BMI greater than 25, placing them in the overweight or obese category. Higher-than-normal BMI can result in increased risk for chronic illnesses such as diabetes, heart disease, and hypertension.

n A variety of methods to measure body composition are available. All have varying levels of cost, ease of assessment, and ability for use in the field with athletes. Skinfold measurements are a fairly accu- rate way to easily and inexpensively assess athletes’ body composition in the training room. These mea- sures can be done at intervals during the training season to track trends in body composition changes.

n Weight loss success is hard to achieve in many cases. Success depends on creating an energy deficit (i.e., negative energy balance) by reducing calorie intake, increasing energy expenditure, or a combination of both. The energy deficit created for weight loss in ath- letes should be small (approximately 500 calories per day). By creating a slight energy deficit, athletes los- ing weight will continue to have the energy needed to train and will minimize loss of muscle mass.

n Athletes in weight classification sports are at higher risk for using weight loss measures that are unhealthy. Athletes in these sports should attempt to maintain their training weight at competition weight to avoid having to “make weight” and use rapid weight loss measures that are detrimental to health.

n Eating disorders are more common in athletes than in nonathletes. Sports where appearance is judged or where subjective scoring occurs may impose a higher risk to athletes in developing eating disorders. Early detection of dieting or eating-disturbed behav- iors will help prevent the associated consequences to health and sport performance.

n Weight gain for athletes can be as difficult to achieve as weight loss in some cases. Athletes need to con- sistently consume additional calories and adequate protein and maintain or increase resistance training to gain weight. Because athletes already have high calorie needs, increasing food consumption may be difficult for some athletes. Consuming more calorie- dense foods and beverages and including high-calo- rie snacks can help athletes achieve increased mass in a healthy way.

326 SECTION 2 The Practical Application of Sports Nutrition

Study Questions

1. What are some of the various ways to determine an athlete’s body composition? Briefly discuss the pros and cons of each.

2. How is body mass index (BMI) calculated? Is it truly a measure of body composition? Defend your answer.

3. Why do athletes tend to focus so much on body weight? Is this beneficial or detrimental? Defend your answer.

4. What is the significance of waist and hip measure- ments in regard to disease risk? What are the waist- to-hip ratios expected in individuals with gynoid and android fat distribution?

5. What is the difference between nonessential body fat and essential body fat? Do females have the same amounts of essential and nonessential fat as males?

6. What are the three major components of energy expenditure? Briefly explain each. Which compo- nent accounts for the largest portion of daily caloric expenditure?

7. How does the concept of energy balance pertain to weight gain or weight loss?

8. Discuss the various factors that can affect energy intake.

9. What is the recommended range of daily calorie defi- cit if weight loss is the goal?

10. What are some of the differences between credible diets and fad diets?

11. What are some dietary practices that will increase the chances of long-term weight loss success?

12. What are the commonly encountered eating disor- ders? Which athletes are at highest risk for eating disorders? Why?

13. What is muscle dysmorphia and what are some of its warning signs? Which athletes are at greatest risk for muscle dysmorphia?

14. What conditions make up the female athlete triad? 15. Discuss some of the ways that eating disorders can

be prevented. 16. What are the three main requirements necessary for

an athlete wanting to gain weight? What is an appro- priate rate of weight gain for an athlete?

References

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16. Van Loan MD. Is dual-energy X-ray absorptiometry ready for prime time in the clinical evaluation of body composition? Am J Clin Nutr. 1998;68:1155–1156.

Chapter 11 Weight Management 327

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29. Alderman B, Landers DM, Carlson J, Scott JR. Fac- tors related to rapid weight loss practices among international-style wrestlers. Med Sci Sports Exerc. 2004;36(2):249–252.

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35. Dale K, Landers DM. Weight control in wrestling: eat- ing disorders or disordered eating? Med Sci Sports Exerc. 1999;31(10):1382–1389.

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39. Otis CL, Drinkwater B, Johnson M, Loucks A, Wilmore J. American College of Sports Medicine position stand: the female athlete triad. Med Sci Sports Exerc. 1997;29(5):1–10.

40. Sundgot-Borgen J, Torstveit MK. Prevalence of eating disorders in elite athletes is higher than in the gen- eral population. Clin J Sport Med. 2003;14(1):25–32.

41. American Psychiatric Association. Diagnostic and Sta- tistical Manual of Mental Disorders. 5th ed. Washington, DC: American Psychiatric Association; 2013.

42. Sundgot-Borgen J. Risk and trigger factors for the development of eating disorders in female elite ath- letes. Med Sci Sports Exerc. 1994;26:414–419.

43. Beals KA, Manore MM. The prevalence and conse- quences of subclinical eating disorders in female ath- letes. Int J Sport Nutr. 1994;4:175–179.

44. Wiggins DL, Wiggins ME. The female athlete. Clin J Sport Med. 1997;16:593–612.

45. Affenito SG, Yeager KA, Rosman JR, Ludemann MA, Adams CH, Welch GW. Development and validation of a screening tool to identify eating disorders in female athletes. J Am Diet Assoc. 1998;98(9 suppl 1):A78.

46. McNulty KY, Adams CH, Anderson JM, Affenito SG. Development and validation of a screening tool to identify eating disorders in female athletes. J Am Dietet Assoc. 2001;101:886–892.

47. Cobb K, Bachrach LK, Greendale G, et al. Disor- dered eating, menstrual irregularity, and bone min- eral density in female runners. Med Sci Sports Exerc. 2003;35(5):711–719.

48. Loucks AB. Energy availability, not body fatness, regu- lates reproductive function in women. Exerc Sport Sci Rev. 2003;31:144.

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49. Loucks AB, Verdun M, Heath EM. Low energy avail- ability, not stress of exercise, alters LH pulsatility in exercising women. J Appl Physiol. 1998;84:37.

50. Sherman RT, Thompson RT. Practical use of the Inter- national Olympic Committee Medical Commission position stand on the female athlete triad: a case example. Int J Eat Dis. 39;3:193–201.

51. Choi PYL, Pope HG, Olivardia R. Muscle dysmorphia: a new syndrome in weightlifters. Br J Sports Med. 2002;36:375–376.

52. Pope HG, Gruber AJ, Choi P. Muscle dysmorphia: an unrecognized form of body dysmorphic disorder. Psychosomatics. 1997;38:548–557.

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Additional Resources

Miller WC, Niederprume MG, Wallace JP, Lindeman AK. Dietary fat, sugar and fiber predict body fat content. J Am Diet Assoc. 1994;94(6):612–617.

Siri WE. The gross composition of the body. In: Lawrence JH, Tobias CA, eds. Advances in Biological and Medical Physics. 4th ed. New York, NY: Academic Press; 1956:239–280.

Chapter 11 Weight Management 329

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Key Questions Addressed 1. What is different about endurance athletes?

2. What energy systems are utilized during endurance exercise?

3. Are total energy needs for endurance athletes different from energy needs of other types of athletes?

4. Are macronutrient needs different for endurance athletes?

5. How important are carbohydrates to endurance athletes?

6. Are protein needs different for endurance athletes?

7. Should endurance athletes eat more fats to meet their energy needs?

8. Are vitamin/mineral needs different for endurance athletes?

9. Why are fluids critical to endurance performance?

10. What meal-planning/event logistics need to be considered during endurance events?

You Are the Nutrition Coach Adam is a 14-year-old distance swimmer. He swims with a club team and competes regularly. The team’s weekly yardage ranges from 30,000–35,000 yards, with 2 to 3 days of dry land exercises. Several months ago, Adam decided to cut out all junk food from his diet in hopes of improving his swimming performance. After making the dietary change, his times for the 200 butterfly, 500 freestyle, and 1-mile freestyle began to improve, and he was feeling good. Another result of his dietary changes and hard efforts in the pool was a 28-pound weight loss in 6 months, dropping to a mere 140 pounds for his 5′ 11″ frame. His mother and coach became concerned with his weight loss, afraid that he had lost too much and was also losing muscle mass, which would eventually hurt his performance. In addition to these concerns, Adam was approaching the time for a switch to the high school team, which meant more yardage in the pool and more dry land exercises. Adam was open to eating more food to keep his weight and strength stable, but was unsure of how to do it in a healthy way.

Questions • What are Adam’s daily calorie needs?

• Should Adam begin eating ice cream, candy bars, and other high-calorie “junk” foods again to increase his daily calorie intake?

• What advice would you give Adam?

Endurance and Ultra-Endurance Athletes

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CHAPTER 12

key factor not only for athletic success, but also for over- all health. Failure to maintain adequate dietary intake of nutrients can quickly result in chronic fatigue, dehy- dration, increased risk for illness (e.g., upper respiratory infection) and injuries, as well as muscle wasting.

Although endurance sports require high calorie intakes, they do not give athletes a license to eat indis- criminately. Although eating enough calories to offset the energy demands of their sport may sometimes be difficult, athletes must pay careful attention to dietary composi- tion and the timing of consumption to help ensure their success. For ultra-endurance athletes, not only is their training diet crucial, but so is their nutrient consumption during lengthy competitions. This chapter focuses on the dietary requirements of these “high-caloric-need” endur- ance and ultra-endurance athletes.

What energy systems are utilized during endurance exercise? As with most sports, all three energy systems (i.e., phos- phagen, anaerobic, aerobic) are working to contribute energy during endurance exercise. However, the primary energy system relied upon during endurance exercise is the aerobic system (shown on the right side of FIGURE 12.1 ). The chemical energy our bodies rely upon is ATP. The aer- obic energy system has an almost unlimited capacity for producing ATP. The downside is that the aerobic system cannot produce ATP very quickly; as a result, the speeds at which endurance and ultra-endurance activities are car- ried out are slower relative to that of anaerobic athletes. However, with appropriately designed training programs, the aerobic energy system of muscles can be improved, thus enabling higher rates of ATP production. The rate of aerobic ATP pro- duction is known as aerobic power. The faster the rate of ATP production, the higher the aerobic power demonstrated by that athlete. Elite endurance athletes exhibit remarkable aerobic power. They can sustain relatively high-velocity movements for hours that an untrained individual may only be able to maintain for several minutes before fatiguing.

Are total energy needs for endurance athletes different from energy needs of other types of athletes? One of the main concerns for endurance athletes is matching energy consumption with energy expenditure. Long-distance, strenuous exercise requires a large num- ber of calories. Elite athletes can potentially burn more

What is different about endurance athletes? In general, endurance is one of the basic components of physical fitness. As a result, most athletes have to possess some degree of muscular and cardiorespiratory endurance to perform in their respective sports. Muscular endurance is the ability of a muscle or group of muscles to repeatedly develop or maintain force without fatigu- ing. Cardiorespira- tory endurance is the ability of the cardio- vascular and respira- tory systems to deliver blood and oxygen to working muscles, which, in turn, enables the working muscles to perform continuous exercise. In other words, a person who possesses good cardiorespiratory fitness will be able to perform higher-intensity activity for a longer period of time than a person with poor cardiorespiratory fitness.

Obviously, endurance is important to almost all ath- letes, even those involved in sports requiring short, inter- mittent bursts of intense anaerobic activity that are repeated over the course of an hour or more. Because so many sports require endurance, clarification is needed regarding which athletes fall into the category of “endur- ance and ultra-endurance athletes.” For the purposes of this chapter, endurance athletes are those who are engaged in continu- ous activity lasting between 30 minutes and 4 hours. Ultra- endurance athletes are a subgroup of endurance ath- letes who engage in extremely long bouts of continuous activ- ity lasting more than 4 hours.

Because of the duration and contin- uous nature of their sports, endurance athletes expend a tremendous number of calories not only during competi- tion, but also in their preparatory training. For example, energy expenditures of 6000–8000 calories per day are not out of the ordinary for ultra-endurance athletes. This puts a tremendous drain on energy reserves that must be replenished after daily training bouts, making diet a

cardiorespiratory endurance The ability of the cardiovascular and respiratory systems to deliver blood and oxygen to working muscles, which, in turn, enable the working muscles to perform continuous exer- cise. It is an indicator of a person’s aerobic or cardiovascular fitness.

muscular endurance The ability of a muscle or group of muscles to repeatedly develop or maintain force without fatiguing.

endurance athlete An athlete who participates in sports involving continuous activity (30 minutes to 4 hours, as defined in the chapter) involving large muscle groups.

ultra-endurance athlete A sub- group of endurance athletes who engage in extremely long bouts of continuous activity lasting more than 4 hours. Ironman triathletes and ultra-marathoners are examples of this group of endurance athletes.

aerobic power The rate of aerobic ATP production. It is usually repre- sented by the fastest pace or rate of physical activity an athlete can sus- tain and is an indicator of cardiore- spiratory fitness.

Chapter 12 Endurance and Ultra-Endurance Athletes 331

than two to three times the number of calories as their untrained, weight-matched counterparts. If these calories are not replaced daily, energy for training and the ability to perform during competitions will decline.

How are daily energy needs calculated for endurance athletes? To estimate the total energy needs for an endurance ath- lete, use the resting energy expenditure (REE) equations provided in TABLE 12.1 .

For example, Bill is a 35-year-old marathoner who runs 60–80 miles a week. His weight has been stable at 140 pounds for the last 12 months. Using the equation presented in Table 12.1, Bill’s daily calorie needs are: 1. Calculation of REE for a 35-year-old man: (11.6 × BW)

+ 879 2. Convert pounds of body weight to kilograms: 140 ÷

2.2 = 63.6 kg 3. Determine Bill’s REE: (11.6 × 63.6 kg) + 879 = 737.8 +

879 = 1616.8 calories 4. Multiply the REE by the activity factor of 1.6–2.4:

1616.8 × (1.6–2.4) = 2587–3880 calories per day The daily calorie range calculated for Bill is quite

large—a difference of 1293 calories. Bill can use this range to adjust his intake based on his daily volume of run- ning. Rest and recovery days will require approximately 2500–2800 calories, whereas high-mileage or hard work- out days will require an intake of 3600–3900 calories. With a weekly mileage of 60–80 miles, Bill is running about 10–12 miles per day. Therefore, on most days he will need to consume a diet providing calories at the high end of his estimated range to perform well and recover completely from workouts.

Anaerobic

Aerobic

Phosphagen, Anaerobic Systems

100-meter dash

(~100% anaerobic)

Ice hockey (90:10)

Tennis, Soccer (70:30)

Squash (60:40)

200-meter swim

(50:50)

% anaerobic

% aerobic

Key (40:60)

2-mile run

(20:80)

Cross- country running (10:90)

Marathon (~100% aerobic)

Oxygen System

Boxing (50:50)

Rowing 2,000 meter

(40:60)

Figure 12.1 The anaerobic–aerobic continuum. The primary energy system relied upon during endurance exercise is the aerobic system.

Table 12.1 Resting Energy Expenditure (REE) Calculations and Activity Factors

Gender and age Equation (BW in kilograms)

Activity factor

Males, 10 to 18 years REE = (17.5 × BW) + 651 1.6–2.4

Males, 18 to 30 years REE = (15.3 × BW) + 679 1.6–2.4

Males, 30 to 60 years REE = (11.6 × BW) + 879 1.6–2.4

Females, 10 to 18 years REE = (12.2 × BW) + 749 1.6–2.4

Females, 18 to 30 years REE = (14.7 × BW) + 496 1.6–2.4

Females, 30 to 60 years REE = (8.7 × BW) + 829 1.6–2.4

Even though the activity factors of 1.6–2.4 will cover most recreational and competitive athletes, the range may not estimate calories appropriately for all athletes. For example, cyclists participating in staged races that last from 1 to 3 weeks may burn calories in the range of 7000–8000 calories per day. If Bill, from the previous exam- ple, was a stage-racing cyclist, an activity factor of 4.3–4.9 would be appropriate. On the other end of the spectrum, endurance athletes who want to lose weight may find that an activity factor of 1.4–1.6 estimates an appropri- ate calorie level. Therefore, use the calculation guidelines while also making individualized adjustments for specific athletes.

It can sometimes be challenging for athletes to increase their daily intake to match their actual caloric

332 SECTION 2 The Practical Application of Sports Nutrition

Training Table 12.1: Sample Meal Plans Providing 3000, 4000, or 5000 Calories per Day

3000 Calories

Meal/Snack Food/Beverage Carbohydrate Content (grams)

Breakfast 2 cups raisin bran 94

1 cup skim milk 12

1 banana 28

Lunch 4 oz turkey and cheese sandwich

6 oz low-fat yogurt 34

¼ cup trail mix 23

1 plum 9

1 apple 21

During workout

20 oz sports beverage 48

Postworkout snack

½ peanut butter sandwich

12 oz chocolate milk 39

Dinner 2 cups pasta 78

¾ cup marinara sauce 15

6 oz chicken breast 0

2 cups steamed broccoli 9

12 oz skim milk 18

Total Calories = 2973 Total Carbohydrates = 470 g 61% of total calories

4000 Calories

Meal/Snack Food/Beverage Carbohydrate Content (grams)

Breakfast Smoothie:

2 frozen bananas 55

2 cups skim milk 24

2 scoops protein powder

Snack Orange 15

Granola bar 29

Lunch 2 cups chili 54

4 oz roast beef sandwich 25

2 cups fruit salad 61

During workout

32 oz sports beverage 76

Postworkout snack

6 oz yogurt ½ cup dry cereal

34 13

Dinner 6 oz salmon 0

2 cups wild rice 70

3 cups salad with dressing

16 oz skim milk 24

Snack 1½ cups frozen yogurt 73

½ cup frozen blueberries 9

Total Calories = 4016 Total Carbohydrates = 606 g 59% of total calories

(continues)

needs. Training, work/school, sleep, and other non-sport activities take time away from preparing and eating meals and snacks. Some athletes also complain about feeling too full and not being able to comfortably add more calories to meet their needs. Also, strenuous effort during train- ing or competition tends to decrease appetite, causing athletes to eat small meals and snacks. Athletes in these sit- uations are looking for quick, easy, and nutrient-dense ways to increase their cal- ories while enjoy- ing their food and not spending all day in the kitchen. Meal plans should be created that fit the daily schedule of the athlete and incorporate nutrient- and calorie-dense meals/snacks that are within the athlete’s cooking/prepa- ration skills.

When planning meals for individuals needing to increase calories, a balance of macronutrients is essential. If an athlete increases mainly carbohydrate-and fiber- rich foods, the result is a feeling of fullness and bloating. If protein-rich foods are the focus, the endurance ath- lete may neglect to fully replenish glycogen stores, ulti- mately hindering training and racing. Too many fat-rich foods can delay gastric emptying, potentially disrupting training sessions because of a sense of fullness, stomach cramps, or diarrhea. By balancing the macronutrients and increasing carbohydrates, protein, and fat in proportional amounts, athletes can reap the benefits of increasing total calorie intake while feeling good and performing well.

TRAINING TABLE 12.1 presents sample meal plans for three different calorie levels: 3000, 4000, and 5000 calories. Note that as the number of calories increases, the frequency of meals and snacks increases, as does the number of calo- rie-dense foods. Three meals plus several snacks distrib- ute caloric intake throughout the day, preventing athletes from feeling “stuffed” or uncomfortable after eating. Calo- rie-dense foods increase energy intake considerably, with- out large increases in the volume of food consumed.

How many calories should be consumed during endurance training or competition? The number of calories expended while participating in endurance sports varies. The energy requirements for an individual can be estimated based on the sport, the intensity and duration of activity, and the athlete’s body weight. However, often it is not physically or logistically possible for an athlete to fully match his or her energy expenditure with intake while exercising. Movement (e.g., running, biking), mental focus (e.g., mountain biking, race car driving), and lack of feasibility (e.g., swimming, row- ing) can create circumstances where athletes are unable to meet their calorie needs. It can be not only extremely

Gaining the Performance Edge

Knowing how to estimate the daily energy needs for an endurance ath- lete is a crucial first step to devel- oping a dietary plan that provides enough calories to meet training and competition energy needs.

Chapter 12 Endurance and Ultra-Endurance Athletes 333

sports beverage used contains 14–15 grams of carbohydrates per 8 fluid ounces, the runner would need to drink only about 24–32 fluid ounces per hour to meet his carbohydrate needs. Twenty four to 32 fluid ounces per hour is much more man- ageable than 124 fluid ounces.

How many calories are required after a training session or competitive event? A general guideline for endurance athletes is to consume 200–300 calories immediately following a training session or competitive event. This small snack should be followed by a substantial meal within the next 1 to 2 hours, supplying more calories, macronutrients, micronutrients, and fluids. Two hundred to 300 calories is not a large amount of food and can be easily obtained by eating half of a sandwich, a large glass of milk, or a glass of 100% juice. Often, ath- letes complain of not wanting to eat immediately following exercise—especially intense exercise. However, the sugges- tion of consuming a small snack versus a full meal is often per- ceived as more man- ageable, is generally well tolerated, and puts the recovery wheels in motion.

Are macronutrient needs different for endurance athletes? The main difference between the diets of endurance athletes and those of athletes in other sports is in the quantity of food consumed, not necessarily the macro- nutrient composition of the diet. The extreme caloric demand of long-duration training, day in and day out, stresses the body’s energy reserves, particularly the gly- cogen stores. Therefore, carbohydrates play a key role in the endurance athlete’s diet. Similar to other ath- letes with high calorie needs, dietary fats are valuable for providing extra calories in a small volume of food. Another consequence of high calorie demands that is unique to endurance athletes is the use of protein for energy production. Proteins are not typically used by the body for energy production; however, they can play an energetic role, contributing up to 15% of the calories required during endurance and ultra-endurance sports.

5000 Calories

Meal/Snack Food/Beverage Carbohydrate Content (grams)

Breakfast 2-egg omelet with cheese

2 pieces of toast with 1 tbsp butter

12 oz orange juice 39

Snack 1 cup mixed nuts and raisins

Lunch 2 hamburgers with buns 69

16 oz skim milk 24

2 pieces fresh fruit 52

Snack Smoothie:

2 cups frozen mixed fruit

1 cup pineapple juice 35

8 oz yogurt 46

2 scoops protein powder

During workout

48 oz sports beverage 114

Dinner 2 pieces lasagna 75

2 pieces garlic bread 26

2 cups green beans and carrots

16 oz skim milk 24

Snack 8 oz skim milk 12

3 oatmeal raisin cookies 23

Total Calories = 4992 Total Carbohydrates = 749 g 59% of total calories

Training Table 12.1 (continued): Sample Meal Plans Providing 3000, 4000, or 5000 Calories per Day

challenging for an athlete to physically consume enough food to match energy expenditure during activity, but also difficult for the body to digest high volumes of food without developing nausea or cramping. Therefore, it is more practical and realistic to develop a plan based on the nutrition basics needed for endurance performance: carbohydrates, fluids, and sodium.

For example, a 125-pound half-marathoner running a 6:30 minute per mile pace will burn approximately 775 cal- ories in 1 hour of continuous running.1 If this athlete were trying to match his energy needs by consuming a sports beverage (containing 50 calories per 8 ounces), he would need to drink 124 fluid ounces in 1 hour! An average range of fluid intake that can be consumed comfortably and safely for most athletes is approximately 24–48 ounces per hour— three to five times this amount is needed to obtain 775 calories. However, if the nutrition plan was based on fluid and carbohydrate needs, the requirements could be eas- ily met. The current recommendation is that athletes con- sume 30–60 grams of carbohydrates per hour. Assuming the

Gaining the Performance Edge

Matching energy expenditure dur- ing exercise with energy intake may not be practical or feasible for endurance and ultra-endur- ance athletes. It is more impor- tant to develop a nutrition plan that focuses on the performance requirements of carbohydrates, flu- ids, and sodium rather than achiev- ing energy balance.

Food for Thought 12.1

Calculating Daily Calorie Needs

Calculate the daily caloric needs for a female ultra-endurance runner.

334 SECTION 2 The Practical Application of Sports Nutrition

The bottom line is that endurance athletes need the same macronutrients as other athletes except in larger quantities so that the energy requirements of their sport can be met. The upcoming sections outline more spe- cific recommendations and guidelines for carbohydrate, protein, and fat intakes for endurance and ultra-endur- ance athletes.

How important are carbohydrates to endurance athletes? Carbohydrates are crucial to endurance athletes not only because they are an important energy source, but also because carbohydrates play a role in the rapid metaboliz- ing of fats for energy. If the liver and muscles are depleted of glycogen, the endurance athlete experiences extreme fatigue (see FIGURE 12.2 ). This is called “hitting the wall,” or bonking. When bonking occurs, the athlete can no longer generate the energy needed to maintain his or her race pace, and his or her per- ception of effort is greatly increased. The end result is a catastrophic decrease in performance.

Carbohydrate stores in the body are limited, and because of the long duration and repetitive muscle activ- ity involved with endurance training and sport perfor- mance, the need for carbohydrates is increased. In fact, the time to exhaustion during endurance exercise is directly related to the initial levels of stored glycogen in

M us

cl e

gl yc

og en

( m

m ol

/k g)

Exercise time (h)

Perceived fatigue

Muscle glycogen

Blood glucose suffers depletion.

Muscle begins to use blood glucose.

Liver glycogen is converted to glucose.

175

150

125

100

200

0 1 2 3 4

Extreme

Perceived fatigue

Very

Moderate

bonking A condition in which the endurance athlete experiences extreme fatigue and an inability to maintain the current level of activ- ity. It is also known as “hitting the wall” and results when the body has depleted muscle and liver gly- cogen levels.

Figure 12.2 Glycogen depletion and the sensation of fatigue. If the liver and muscles are depleted of glycogen, the endur- ance athlete experiences extreme fatigue.

the muscles. In addition, carbohydrates are also neces- sary for normal functioning of the central nervous sys- tem. Maintenance of blood glucose levels is important in preventing mental fatigue because nerve cells rely on blood glucose for energy. For these reasons, it is difficult to overstate the importance of adequate carbohydrate intake for daily training as well as performance in com- petition. For the endurance athlete, carbohydrates are truly the “master fuel.”

How are daily carbohydrate needs calculated for endurance athletes? Current daily carbohydrate recommendations for endur- ance athletes, exercising 1–3 hours per day, range from 6–10 grams of carbohydrates per kilogram of body weight.2–5 Ultra-endurance athletes who are exercising for more than 4–5 hours per day will need 8–12 grams of carbohydrates per kilogram of body weight, per day.5 Let’s apply this recommendation to Tony, a moderately active (exercises 1–2 hours per day), 22-year-old male who weighs 150 pounds:

Convert pounds to kilograms: 150 lbs ÷ 2.2 = 68.1 kg of body weight

Calculate carbohydrate needs: 68.1 kg × 6–10 g of carbo- hydrate per kg = 409–680 g of carbohydrates per day

The recommended 409–680 grams is a large range! To narrow the recommendation for practical purposes, the calculated carbohydrate requirements need to be com- pared to the athlete’s total calorie requirements. Using the equation from Table 12.1, Tony’s calorie needs are esti- mated to be 2753–3442 calories per day: 1. Select the REE equation for a 22-year-old male: REE =

(15.3 × BW) + 679 2. Calculate Tony’s REE: (15.3 × 68.1) + 679 = 1721 3. Determine Tony’s total energy needs: REE × activity

factor (for Tony’s moderate activity level) = 1721 × (1.6–2.0) = 2753–3442 calories per day To establish a narrower range for a carbohydrate rec-

ommendation, determine the percentage of total calories coming from carbohydrates at each end of the spectrum. For example, each gram of carbohydrates has 4 calories, and 409 grams of carbohydrates equals 1636 calories, which is about 59% of 2753 calories. Endurance athletes should generally aim for 50–65% of their total calories from carbohydrates. Therefore, the recommendation of 409 grams of carbohydrates providing 59% of the esti- mated total daily calories is appropriate. However, the high end of the carbohydrate recommendation would not be appropriate for a 2753-calorie diet, supplying nearly 99% of total calories: ([680 grams × 4] ÷ 2753) × 100 = 99%! Even at the high end of the estimated calorie range (3442 calories), 680 grams of carbohydrate would be supplying 79% of the total calories, which is generally too high for a balanced daily diet. Athletes should aim to meet both

Chapter 12 Endurance and Ultra-Endurance Athletes 335

total calorie and carbohydrate requirements while main- taining a balance of all macronutrients. Recommenda- tions for carbohydrates, as well as protein and fat, should always be compared to total calorie estimations.

Fortifying Your Nutrition Knowledge

Train Low, Compete High? The phrase “train low, compete high” has been coined to indi- cate the level of carbohydrate availability to muscle during train- ing and competition. In other words, some sport nutritionists are suggesting that adaptations resulting from endurance train- ing with low levels of carbohydrates in the body can stimulate greater metabolic adaptations compared to current high carbo- hydrate intake strategies, thus ultimately improving endurance performance on competition day. Current recommendations are that athletes ingest carbohydrates before, during, and after training in hopes of keeping carbohydrate levels in the body as high as possible to provide energy for sustained high-intensity training that elicits training adaptations. In contrast, the “train low” theorists propose that further challenging the muscles while training under conditions of low carbohydrate availabil- ity leads to increased muscle glycogen storage, enhanced fat metabolism, and increased oxidative enzyme activity compared to training under conditions of higher carbohydrate availability. Although there is some research basis to the “train low, compete high” mantra, the research findings translating the improved enzyme activities have not resulted in convincing evidence when it comes to actual improvements in performance. Experts suggest that if athletes want to experiment with the “train low” strategy that they do so early in their training cycle for a race and that the high-carbohydrate nutrition strategy be used as high- intensity training becomes more frequent later in the training cycle and when peaking for competition.

How should endurance athletes carbohydrate- load before competition? Carbohydrate loading is often cited as an effective way of maximizing muscle glycogen stores prior to an endur- ance event. As noted earlier, increasing muscle glyco- gen levels can increase the time to exhaustion and thus prevent or delay bonking. In the 6 to 7 days leading up to a competition, endurance athletes should be taper- ing and resting their muscles. When tapering, endur- ance athletes decrease the volume and intensity of their training. During the taper, the percent- age of carbohydrates consumed each day should slowly increase from about 50–55% of total calo- ries to 65–70%. This progression allows

tapering A scheduled decrease in the volume and intensity of training 6 or more days prior to competition. The purpose is to allow for recovery from training and replenishment of glycogen stores in the liver and muscle.

During a tapering period, the decrease in calorie expenditure in the days leading up to an event needs to be realized and factored into a car- bohydrate-loading plan. As previously mentioned, carbohy- drate requirements increase during car- bohydrate loading. However, due to a

Gaining the Performance Edge

Juices, milk, smoothies, and other liquid forms of carbohydrates are ideal for endurance athletes during a taper and carbohydrate loading.

(top left) © iStockphoto/Thinkstock; (top right) © LiquidLibrary; (bottom left) © Tihis/Shutter-Stock, Inc.; (bottom right) © Creatas

for carbohydrate storage within the muscles to be maxi- mized while training time is minimized. The combi- nation of rest and a full fuel tank produces an athlete who is mentally and physically fresh and nutritionally energized for race day.

A carbohydrate intake of approximately 10–12 grams of carbohydrates per kilogram of body weight– in the 36–48 hours prior to events lasting longer than 90 minutes is required to maximize glycogen stores. For a 150-pound athlete, a range of 10–12 grams of carbohy- drates per kilogram of body weight can be calculated as follows: 1. Convert pounds to kilograms: 150 ÷ 2.2 = 68.2 kg 2. Calculate carbohydrate needs: 68.2 kg × 10–12 grams

carbohydrates/kg = 682–818 grams of carbohydrates per day Training Table 12.1 uses the 3000-, 4000-, and

5000-calorie per day sample meal plans to demonstrate the quantity of food needed to reach approximately 500–800 grams of carbohydrates per day.

336 SECTION 2 The Practical Application of Sports Nutrition

Athletes who are competing several times a week do not have time to taper for 7 days while increasing carbo- hydrate intake. These athletes should ensure an adequate consumption of carbohydrates on a daily basis, which can also effectively keep glycogen stores near their maximum.

Should carbohydrates be consumed in the hours or minutes prior to endurance activities? Research has demonstrated that consuming carbohy- drates in the hours leading up to an endurance training session or competition is critical for optimal perfor- mance, especially during activities lasting longer than 2 hours.6,7 Carbohydrates consumed prior to exercise increase blood glucose, which leads to a sparing of mus- cle and liver glycogen, thus enhancing endurance per- formance. The question for endurance athletes is not whether they should consume carbohydrates prior to exercise, but rather when and how many carbohydrates should be consumed.

Even though it appears obvious in the research that carbohydrate consumption prior to exercise can prevent fatigue, the reality is that many athletes choose to forgo consuming any food, including carbohydrates, prior to training or competitions. Athletes need to be educated on the detrimental effects of this behavior. After an overnight fast, liver glycogen stores are depleted, which can lead to premature fatigue during exercise.8 Some athletes justify not consuming carbohydrates before training because they plan to consume carbohydrate-rich sports beverages, gels, or bars during exercise. Although consuming these products during exercise is clearly advantageous, it does not completely negate the need for a preexercise meal.9

A study by Chryssanthopoulos et al.10 examined the effects of a preexercise meal and carbohydrate con- sumption during endurance running as compared with running on an empty stomach (no preexercise meal) and no carbohydrate supplementation during exercise. The authors reported a 9% increase in running capacity when a meal (containing 2.5 grams of carbohydrates per kilogram of body mass) was eaten 3 hours prior to exer- cise versus when no meal was consumed. An additional endurance benefit (22% increase) was observed when the subjects ate a carbohydrate-rich meal 3 hours prior to exercise and consumed a 6.9% carbohydrate beverage during running, as compared to those who did not eat a preexercise meal and did not drink the sports beverage during running. Endurance athletes are encouraged to consume a well-rounded, carbohydrate-rich preexercise meal, and then continue consuming carbohydrates dur- ing exercise to optimize performance.

When is the ideal time to consume carbohydrates prior to endurance training or competition? The ideal time for consuming carbohydrates prior to exer- cise has been debated. Popular thought has led to the rec- ommendation of consuming carbohydrate-rich foods in the

decrease in calorie needs, total calories need to be cut to prevent weight gain and a feeling of sluggishness. The best way to decrease calories without sacrificing overall nutrition or carbohydrate intake is to cut back on fat con- sumption temporarily (until the event). Protein is needed to repair muscle tissue and therefore should not be decreased dramati- cally to cut calories. Because fiber intake should be moderated in the days leading up to an event, juices, milk, smoothies, and other liquid forms of carbohydrates are ideal for use dur- ing a taper. Refer to TRAINING TABLE 12.2 for

an example of how to increase carbohydrates while decreasing total calo- ries, fat, and fiber in preparation for an endurance event.

Gaining the Performance Edge

Keep in mind that the suggested range of 6–10 grams of carbohy- drate per kilogram of body weight per day may not work for all ath- letes. Daily nutrition plans must be developed on an individual basis, and recommendations may fall above or below this range.

Training Table 12.2: Training Meal Plan vs. Carbohy- drate-Loading Plan

Training Meal Plan Carbohydrate-Loading Plan

Breakfast Breakfast

2 cups raisin bran 2 cups Cheerios

1 cup skim milk 1 cup skim milk

1 banana 12 oz orange juice

Lunch Lunch

Roast beef sandwich with cheese and mayonnaise

Roast beef sandwich, no cheese or mayonnaise

2 cups lentil soup 1 cup tomato soup

1 apple 10 crackers

16 oz water 1 cup applesauce

16 oz water

Afternoon Snack Afternoon Snack

½ cup trail mix 6 oz fruit-flavored yogurt

1 banana

Dinner Dinner

Stir-fry with 5 oz chicken, 1 cup broccoli, and 1½ cup brown rice

2 cups spaghetti with ¾ cup marinara sauce

3 cups tossed salad with 2 tbsp ranch dressing

3 oz ground turkey

1 cup skim milk 2 slices French bread with 1 tbsp butter

2 oatmeal cookies ½ cup green beans

1 cup skim milk

1 cup chocolate pudding

Total Calories = 3000 Total Calories = 2700

Total Carbohydrate = 407 grams Total Carbohydrate = 462 grams

Total Fat = 100 grams Total Fat = 54 grams

Total Fiber = 50 grams Total Fiber = 27 grams

Chapter 12 Endurance and Ultra-Endurance Athletes 337

1 to 4 hours leading up to exercise and avoiding carbohydra- tesin the hour immediately prior to activity. The reasoning for this advice has been that the combined effects of insu- lin (secreted in response to carbohydrate consumption) and muscle contraction mediated glucose uptake (physical activ- ity) would result in hypoglycemia imme- diately prior to or at the onset of exercise and thus negatively affect performance. However, a review of the current literature has revealed that only one study has reported a decrease in performance, whereas a majority of the studies have shown either no impact or enhance- ment of up to 20% on subsequent endurance performance.11

An article studying the impact of precarbohydrate feedings on a series of 4000-meter swims performed by tri- athletes confirmed a positive impact on performance when carbohydrates are consumed within an hour of exercise. Smith et al.12 examined the effect of consuming a 10% glu- cose solution 5 minutes prior to a 4000-meter swim, the same solution 35 minutes prior to the swim, or the equiv- alent volume of a placebo, on swim time to completion. Although no statistical significance was found between the trials, the findings were meaningful, revealing a differ- ence ranging from 24 seconds to 5 minutes in 8 out of the 10 subjects studied when either glucose protocol was fol- lowed compared with placebo. The reported time difference would make an impact, for example, on the final place- ment of a triathlete performing a similar distance swim in an Ironman distance race (3.8-kilometer swim distance).

The timing of a preexercise carbohydrate meal will vary greatly based on the quantity of carbohydrates con- sumed and an athlete’s individual tolerance. Athletes typically consume their preexercise meal as close as 30 minutes before the initiation of endurance exercise to as long as 4 hours prior. In general, the greater the quantity of carbohydrates consumed, the longer an athlete should leave between eating and the beginning of an exercise session. The current guidelines recommend that athletes consume 1–4 grams of carbohydrates per kilogram of body weight in the 1 to 4 hours prior to endurance exercise.5,13-14 For a female endurance athlete weighing 125 pounds, the minimum quantity of carbohydrates required prior to a long-duration training session or competition would be 57 grams, calculated as follows: 1. Convert pounds to kilograms: 125 ÷ 2.2 = 56.8 kg of

body weight 2. Minimum amount of carbohydrates needed prior to

exercise: 1 × 56.8 kg = 56.8 g As noted in the 3000-calorie meal plan presented in

Training Table 12.1, 57 grams can easily be obtained by

eating 2 cups of raisin bran, 1 cup of skim milk, and a banana, which provides a total of 134 grams of carbohydrates.

Once an athlete knows the optimal quantity of carbo- hydrates to eat before endurance training, the athlete can then experiment with varying time periods between eat- ing and exercise. The athlete should aim to eat far enough in advance to ensure that the food digests well before exer- cising, thus minimizing stomach and intestinal discom- fort, but not so long that hunger ensues. Therefore, the optimal timing of a preexercise carbohydrate-rich meal or snack will ultimately be determined by each athlete.

Should the endurance athlete consume carbohydrates during endurance activities? As glycogen stores in the body are depleted, muscles rely more heavily on blood glucose for fuel, especially after 2 to 4 hours of continuous physical activity.15 To main- tain blood glucose for oxidation and continued energy production, athletes need to ingest carbohydrates while exercising. Although consuming enough carbohydrates during exercise can enhance endurance performance, ingesting too many carbohydrates can lead to stom- ach cramping, intestinal discomfort, and diarrhea, all of which can hinder performance. It is critical that athletes know their carbohydrate needs during activity and prac- tice the ingestion of carbohydrate-rich foods and fluids during training to establish a nutrition plan based on per- sonal preferences and tolerances.

As stated earlier in this chapter, carbohydrate needs during exercise are approximately 30–60 grams of car- bohydrates per hour. Some athletes can easily consume and digest upward of 60–90 grams of carbohydrates per hour, whereas others can barely tolerate 30–40 grams. Athletes need to experiment with varying quantities of carbohydrates in the range of 30–60 grams to determine the best estimate for them individually. Carbohydrates can be consumed through a variety of foods and fluids, such as sports drinks, energy bars, energy gels, fruits, gra- nola bars, fig cookies, and even sandwiches. In addition to individual preferences, a nutrition plan needs to be developed with the limitations of the sport in mind. Refer to the section “What meal planning/event logistics need to be considered during endurance events?” at the end of this chapter for several examples of nutrition plans devel- oped to meet the nutritional needs of endurance athletes while factoring in the inherent limitations of the sport.

Is carbohydrate intake important during the recovery period after endurance training or competition? Carbohydrates are critical for recovery from endurance exer- cise. Repeated exercise sessions of long duration can deplete muscle glycogen stores. If glycogen stores are not replen- ished, performance in subsequent training or competitive sessions will suffer. Carbohydrates should be consumed as soon as possible after exercise in adequate amounts for glycogen replenishment, based on individual needs.

Gaining the Performance Edge

Endurance athletes should experi- ment and aim to eat far enough in advance that food digests well before competition, thus minimiz- ing stomach and intestinal discom- fort, but not so far in advance that hunger ensues.

338 SECTION 2 The Practical Application of Sports Nutrition

To optimize the replenishment of glycogen after endurance exercise, carbohydrates should be consumed as soon as possible after exercise—ideally within 15 to 30 minutes after exercise. The short time between cessa- tion of exercise and carbohydrate consumption allows for digestion, absorption, and delivery of carbohydrates to the muscles for replenishment when muscles are most recep- tive to glycogen storage. Endurance athletes who train daily at high intensity levels or for a long duration need to consume adequate amounts of carbohydrates within this time frame to be prepared for the next exercise session.

Fortifying Your Nutrition Knowledge

Tart Cherry Juice Carbohydrate-rich foods are an important part of every endur- ance athlete’s diet, including 100% juices, such as tart cherry juice. However, there is more to tart cherry juice than just car- bohydrates. Tart cherries, more specifically known as Mont- morency cherries, contain significant amounts of flavonoids and anthocynanins, both of which have strong antioxidant and anti-inflammatory properties. In addition, melatonin, which is a sleep-promoting compound, is present in relatively high amounts.16 All of this adds up to a carbohydrate drink that offers potential recovery benefits for athletes. Several well- designed, placebo-controlled studies have indicated that drinking 8–12 ounces of juice in the morning and again in the evening can decrease markers of muscle damage, inflam- mation, and oxidative stress.17-19 Some studies have found sleep improvements in older adults with insomnia20 and in athletes,18 which is possibly the result of the juice’s melato- nin content. In summary, it appears that tart cherry juice has strong potential for being an effective nutritional recovery aid worthy of continued research.

Data from Burkhardt S, Tan DX, Manchester LC, Hardelan R, Reiter RJ. Detection and quantifi cation of the antioxidant melatonin in Montmo- rency and Balaton tart cherries (Prunus cerasus). J Agric Food Chem. 2001;49:4898–4902; Howatson G, McHugh MP, Hill JA, Jewell AP, van Someren KA, Shave RE, Howatson SA. Infl uence of tart cherry juice on indices of recovery following marathon running. Scand J Med Sci Sports. 2010;20:843–852; Bowtell JL, Sumners DP, Dyer A, Fox P, Mil- eva KN. Montmorency cherry juice reduces muscle damage caused by intensive strength exercise. Med Sci Sports Exerc. 2011;43(8):1544– 1551; Connolly DAJ, McHugh MP, Padilla-Zakour OI. Effi cacy of a tart cherry juice blend in preventing the symptoms of muscle damage. Br J Sports Med. 2006;40:679–683; and Pigeon WR, Carr M, Gorman C, Perlis ML. Effects of a tart cherry juice beverage on the sleep of older adults with insomnia: A pilot study. J Med Food. 2010;13(3):579–583.

Endurance athletes should consume approximately 1.0–1.2 grams of carbohydrates per kilogram of body weight every hour for 4 hours postexercise. The first dose of car- bohydrate should be consumed within 15 to 30 minutes of the end of the training session. For example, a 130-pound athlete in training for a marathon should consume approx- imately 59–71 grams of carbohydrates every hour for 4 hours after exercise, and a 160-pound marathoner would

need 73–87 grams of carbohydrates every hour for 4 hours. Whenever possible, athletes should focus on consuming whole food carbohydrates, juices, and low-fat dairy prod- ucts to meet postex- ercise carbohydrate needs. Some athletes are not hungry after a long exercise session and may feel uncom- fortable eating within 30 minutes after exercise cessation. In this case, athletes can consume high- carbohydrate bever- ages that are usually more tolerable than whole foods. This encourages rehydration as well as carbo- hydrate replenishment. TABLE 12.2 provides some examples of both fluid and whole food combinations of carbohy- drate sources to help endurance athletes meet their needs immediately postexercise. By following the guidelines for both the amount and timing of carbohydrate consumption after endurance exercise, athletes will recover quickly and perform well in their next training session.

Many supplements are marketed to endurance ath- letes for recovery from training sessions and competitive events. Before purchasing and using one of these supple- ments, consider the following:

• How much carbohydrate is supplied in the supplement? Some of the recovery supplements do not provide an

Gaining the Performance Edge

Carbohydrates are truly the master fuel for endurance athletes. Indi- vidual needs should be calculated for daily consumption, as well as for before, during, and after training. Through trial and error, athletes will discover their individual tolerances, which should be built into the over- all nutrition plan.

Table 12.2 Sample Postexercise Carbohydrate Options

Food Carbohydrates (grams)

1 orange 15

1 cup soy milk 15

2 sheets graham crackers 20

2 small fig cookies 22

1 cup animal crackers 24

½ cup applesauce 25

1 cereal bar 25

1 cup chocolate milk 26

½ whole grain bagel 26

1 cup apple juice 27

1 whole banana 28

1 cup cranberry juice 36

1 cup fruit yogurt 40

12 oz carbohydrate energy drink 78

Note: Combine a high-carbohydrate fluid with a high-carbohydrate solid food to obtain approximately 1.0–1.2 g carbohydrates per kilogram of body weight within 15 to 30 minutes after exercise.

Chapter 12 Endurance and Ultra-Endurance Athletes 339

adequate amount of carbohydrates. Athletes should calculate the number of grams they require and then determine whether the supplement is adequate.

• What are the levels of other nutrients in the supplement? Look on the Supplement Facts label for the %DV (% Daily Value) of the various nutrients supplied in one serving of the product. If specific vitamins or minerals are present in quantities greater than 100– 200% DV, the quantities are excessive and in general should be avoided.

• How much does the supplement cost? Supplements of any kind can cost two to three times as much as whole foods, milks, and juices. If an athlete is on a limited budget, whole foods are generally more affordable and often supply a variety of nutrients.

• Are foods and beverages available? Supplements, espe- cially those that do not require refrigeration, are very useful when athletes are traveling or away from home. Powders, bars, and liquids can be transported easily, carried in a gear bag, and consumed quickly after exercise when other options are not available. However, if whole food, juice, or dairy/alternative options are available, athletes should choose these items over supplements.

Are protein needs different for endurance athletes? The dietary protein requirement for athletes has been a subject of debate for years, particularly for strength and power athletes. However, protein is important to the endurance athlete as well. Contrary to popular belief, recent research suggests that endurance athletes may actually require more protein than their resistance train- ing counterparts. Tarnopolsky et al.21 found that endur- ance athletes required approximately 1.4 grams of protein per kilogram of body weight to maintain nitro- gen balance—a level higher than that needed by the resis- tance-trained subjects in the study. Although endurance athletes do not possess or strive to build the muscle mass of strength and power athletes, research has clearly dem- onstrated that endurance training results in increased protein turnover in the body. The trauma of repeated con- tractions and high-impact activities can increase protein breakdown during exercise. In addition, because of the huge energetic demands of endurance training it is now realized that some proteins are mobilized for energy. Pro- tein is not typically used as a source of energy for the body; however, when caloric expenditure is high, the body will turn to proteins to supplement its energy needs. This reliance on proteins for energy is exacerbated when an athlete’s diet is not adequate to maintain energy balance and/or carbohydrate intake is low. After endurance exer- cise, protein synthesis has been shown to increase 10–80% within 4 to 24 hours.22 Because of the rise in protein catab- olism during activity and protein synthesis after exercise,

appropriate daily protein intake is important. Endurance athletes should focus on consuming adequate quanti- ties of protein daily to achieve a positive protein balance, which is important for muscle maintenance and recovery after daily training and competition.

How are daily protein needs calculated for endurance athletes? Several factors need to be considered when determin- ing daily protein needs for endurance athletes. A gen- eral recommendation proposed by Lemon23,24 based on a review of the literature, as well as Tarnopolsky et al.’s find- ing stated previously, suggests that endurance athletes should aim to consume approximately 1.2–1.4 grams of protein per kilogram of body weight daily.21 Others have recommended a higher daily intake ranging up to 2.0 grams per kilogram of body weight for a greater safety margin.25,26 Anywhere from 1.2–2.0 grams per kilogram can be appropriate for endurance athletes.5 The final rec- ommendation for an individual should be based on the following:

• How many hours per week and how intensely is the ath- lete training? The greater the number of hours and the higher the intensity, the more protein an athlete will need. Recreational athletes should be encouraged to consume approximately 1.2–1.4 grams of protein per kilogram of body weight, whereas elite athletes should aim for daily intakes closer to 1.7–2.0 grams per kilogram.

• Is the athlete aiming to lose, maintain, or gain weight? Often endurance athletes are trying to lose weight in an attempt to increase their speed in sports such as long-distance running, duathlons, or cycling. When combining intense training and weight loss, protein needs will increase to the higher end of the spectrum (1.7–2.0 grams per kilogram). Athletes attempting to gain weight will also need more protein daily to build new tissue (1.7–2.0 grams per kilogram). Those with the goal of maintaining their weight will require a more moderate level of protein (1.2–1.7 grams per kilogram).

• Is the athlete in a state of overtraining? Because of the nature of endurance sports and the higher volume of training, endurance athletes are more likely than other athletes to experience the effects of overtrain- ing. Individuals who are overtrained feel fatigued, sore, and stale because of the inability of muscles to completely recover from long, intense training ses- sions. These individuals, and those recovering from an injury, can benefit from higher daily intakes of protein (>2.0 grams per kilogram of body weight), aiding in the repair and recovery of muscles and tissues.

• Is the athlete consuming adequate carbohydrates? For all endurance athletes, emphasis should be placed on consuming enough carbohydrates, as well as

340 SECTION 2 The Practical Application of Sports Nutrition

adequate total calories, to spare protein. Without adequate carbohydrates and total energy, proteins are used at a higher rate for energy production, thus increasing total daily requirements for dietary pro- tein. However, if glycogen stores are high, carbo- hydrates are consumed during activity, and total calorie needs are met, protein can be spared and daily intake will remain moderate. The importance of car- bohydrates for protein sparing was demonstrated in a study conducted by Lemon and Mullin.27 The researchers revealed that protein accounted for 4.4% of the energy needed to complete 1 hour of cycling at 60% VO2max in a glycogen-loaded state versus 10.4% of the energy required in a glycogen-depleted state. The bottom line: Athletes should ensure that carbohydrate intake is adequate while incorporating moderate amounts of protein on a daily basis. Refer to TABLE 12.3 for daily protein recommendations for endurance athletes.

How can a daily meal plan be developed to meet the protein needs of an endurance athlete? Dave is a competitive cross-country skier who trains 3 hours per day, 6 to 7 days per week. Dave is 22 years old and weighs 170 pounds. To develop a sample meal plan for Dave, the first step is to determine Dave’s daily energy needs and protein requirements. The second step is to show Dave how he can put the recommendations into practice by developing a sample meal plan that pro- vides adequate calories and protein. Following the energy requirement equations listed in Table 12.1 and the protein requirement calculations presented in Table 12.3, Dave’s needs can be calculated as follows: 1. Determine Dave’s calorie and protein needs:

a. Convert Dave’s body weight to kilograms: 170 lb ÷ 2.2 = 77.2 kg

b. Select the REE equation for a 22-year-old male: (15.3 × BW) + 679

c. Determine Dave’s REE: (15.3 × 77.2) + 679 = 1860 calories

Table 12.3 Daily Protein Recommendations for Endurance Athletes

Activity level Daily protein recommendation (grams protein per kilogram body weight)

Recreational athlete (exercising 10 to 12 hours per week)

1.2–1.4

Competitive amateur athlete (training 12 to 20 hours per week)

1.4–1.7

Elite athlete (training and competing 20+ hours per week)

1.7–2.0

Training Table 12.3: Dave’s Meal Plan Meal/Snack Food/Beverage Protein Content (grams)

Breakfast Smoothie:

2 frozen bananas 2

2 cups skim milk 16

1 scoop protein powder

8.5

Snack 2 oranges 2

Granola bar 4

Lunch 1 cup chili 22

3 oz roast beef sandwich 22.5

2 cups fruit salad 4.5

During workout 48 oz sports beverage 0

Postworkout snack

6 oz yogurt 1 cup dry cereal

8 2

Dinner 4 oz salmon 21

2 cups wild rice 13

3 cups salad with dressing

16 oz skim milk 16

Snack 1½ cups frozen yogurt 10

1 cup frozen blueberries 0

Total Calories = 3750 Total Protein = 156 grams 16% of total calories

d. Multiple by an activity factor of 1.6–2.4 to deter- mine total energy needs: 1860 × (1.6–2.4) = ~3000– 4500 calories per day

e. Determine Dave’s average energy needs: (3000 + 4500) ÷ 2 = 3750 calories per day

f. Dave exercises about 20 hours per week, so he needs 1.7–2.0 grams of protein per kilogram of body weight: (1.7–2.0) × 77.2 kg = 131–154 g of pro- tein per day

g. Dave’s average protein needs: (131 + 154) ÷ 2 = 143 grams of protein per day, or 15% of total calories

2. Develop a meal plan to supply adequate calories and pro- tein per day. Modifying the 4000-calorie example meal plan presented earlier in this chapter, a meal plan can be developed that meets Dave’s needs for 3000–4500 calories per day, as well as his requirement for 131– 154 grams of protein each day. See TRAINING TABLE 12.3 for a sample meal plan that meets Dave’s total calo- ries and protein requirements.

What is the effect of consuming protein prior to endurance activities? As established earlier in this chapter, carbohydrates con- sumed prior to endurance activities are critical to optimal endurance performance. Is protein intake just as important? The answer depends on when the protein is consumed.

Chapter 12 Endurance and Ultra-Endurance Athletes 341

Protein-rich foods consumed in the preactivity meal 2 to 4 hours prior to the initiation of endurance exercise contribute to a feeling of satiation and a slowing of diges- tion, thus maintaining energy levels for a longer period of time. In addition, some studies have suggested that protein consumption prior to exercise is beneficial in regard to the provision of branched chain amino acids (BCAAs). It has been suggested that consuming BCAAs before exercise might delay fatigue during exercise via a mechanism involv- ing the attenuation of central fatigue; however, the effect of consuming BCAAs immediately prior to exercise has so far been shown to be small at best.28,29 Carbohydrate-rich foods should still take center stage in the preactivity meal to supply the muscles with glucose for energy, with proteins assuming a supporting role. Consuming too much protein before exercise can lead to a sluggish feeling resulting from a lack of carbohydrates as well as dehydration because of increased urine production to flush out the by-product of protein breakdown, urea.

Some researchers have found that consuming pro- tein-rich foods within an hour of endurance exercise has a negative impact on performance. Wiles et al.30 reported a higher oxygen consumption rate during various exer- cise intensities as well as an increased rating of per- ceived exertion when subjects consumed a moderate to high protein meal within 1 hour of exercise. No negative effects were shown when the same quantity of protein was consumed 3 hours prior to exercise. Therefore, it appears that moderate protein intake before exercise is beneficial if consumed with adequate quantities of car- bohydrates several hours prior to exercise. By consum- ing carbohydrates, protein, and very small amounts of fat before exercise, athletes can maintain a balance and variety of foods within one meal, which is the goal for all meals throughout training.

Should proteins be ingested during endurance activities? A significant amount of research has demonstrated that amino acids are secreted from the muscle, oxidized, and metabolized during exercise, thus implying their usage and importance during endurance activities.31,32 A major- ity of this research has focused on the BCAAs: leucine, valine, and isoleucine.

The magnitude of BCAA usage is an important con- sideration for endurance athletes. It has been reported that a mere 2 hours of exercise at 55% VO2max oxidizes close to 90% of the daily total requirement for at least one of the BCAAs.33 It appears that as endurance train- ing intensity increases, the use of BCAAs also increases proportionately.34 These studies reveal that amino acids

are used during endurance exercise and thus suggest a need for increased overall daily protein intake for ath- letes. However, is it essential and beneficial to be con- suming protein during an activity versus before and after training and competitions?

Some research has suggested that the consumption of protein during exercise may enhance endurance per- formance. Several theories have arisen:

• Usage of protein for energy production. Utilization of BCAAs and provision of Krebs cycle intermediates have been suggested as the pathways for energy pro- duction and metabolism with protein ingestion.35,36

• Increased stimulation of insulin secretion. A combination carbohydrate–protein supplement has been found to stimulate insulin secretion after prolonged exer- cise.36-39 This rise in plasma insulin has been hypoth- esized to lead to an increased glycogen synthesis, thus aiding in recovery from exercise. Researchers suggest that it is possible that a similar action may occur during exercise; that is, that protein (with car- bohydrate) ingestion during exercise might increase insulin secretion and, in turn, spare muscle and liver glycogen usage during exercise. Some studies have found an ergogenic effect of adding protein to a car- bohydrate supplement during exercise; however, they have failed to directly correlate insulin levels or any other plasma or metabolic reason for the enhanced performance.40

• Suppression of central fatigue. During endurance exer- cise there is a decrease in plasma BCAAs. At the same time, tryptophan is unloaded from albumin at a higher rate into the plasma. BCAAs and tryptophan compete for the same transporters across the blood– brain barrier; therefore, when BCAA levels decrease, a higher percentage of tryptophan can attach to the transporters, increasing the brain’s uptake of tryp- tophan. Tryptophan converts into serotonin, which has a relaxation effect, ultimately causing an athlete to feel fatigued and eventually cease exercising (see FIGURE 12.3 ).28,41 Some researchers have suggested that the ingestion of BCAAs during exercise will maintain the plasma concentration and thus delay fatigue and enhance endurance performance. This theory has been supported in some studies and refuted in oth- ers.42-45 More research is needed to draw definitive conclusions. These theories and relevant research are still in their

infancy and require more studies to clarify the actions of ingested proteins and amino acids during exercise and their associated mechanisms and effects on performance.

Regardless of actual performance benefits from ingest- ing amino acids, foods and drinks containing protein can be beneficial to consume during endurance activities, especially ultra-endurance events, from a practical stand- point. Items containing some protein in general will be less sweet but more salty than the typical endurance sport fare. When a training session or competition continues for

branched chain amino acids (BCAAs) A group of amino acids whose carbon side chain, unlike other amino acids, is branched. The BCAAs are leucine, isoleucine, and valine.

342 SECTION 2 The Practical Application of Sports Nutrition

4 to 24 hours, flavor fatigue is of great concern, because when an athlete stops ingesting calories, energy levels will soon plummet. Many sports nutrition products have a sweet flavor, and therefore salty foods are generally a welcomed change of taste. Conversely, if too much pro- tein is consumed, gastric emptying can be delayed, which can cause stomach cramping and delayed absorption of nutrients. Some practical ideas for items that have moder- ate amounts of protein, are easily digestible, and are com- pact for carrying during activities such as hiking, day-long bike trips, or adventure races include energy bars, sesame sticks, peanut butter sandwiches, peanut butter crackers, meat jerky, trail mix, and mixed nuts.

Is protein needed for recovery from endurance exercise? Although not as critical as carbohydrate consumption, protein consumption after endurance exercise aids in the recovery process. Several proposed roles of protein after endurance exercise include enhancing the insulin response to accelerate glycogen synthesis and rebuilding damaged muscle tissue.

Research began with the investigation and discov- ery that protein added to a carbohydrate supplement can enhance the insulin response, suggesting a hastened delivery of nutrients into the cells versus carbohydrates alone.46,47 Further studies then explored whether the

Figure 12.3 Suppression of central fatigue. A decrease in BCAA levels can cause an increase in the brain’s uptake of tryptophan (TRP). Tryptophan converts into serotonin (5-HT), which has a relaxation effect, resulting in fatigue and ultimately the cessation of exercise. A = albumin, FA = fatty acid, f-TRP = free tryptophan. Reproduced with permission from American Society for Nutrition, from Davis JM, Alderson NL, Welsh RS. Serotonin and central nervous system fatigue: nutritional considerations. Am J Clin Nutr. 2000;72:573S–578S; permission conveyed through Copyright Clearance Center, Inc.

TRP

Rest

Exercise

B r a i n

5-HT 5-HT

5-HT

5-H T

TRPTRP

TRP 5-HT

C a p i l l a r y

B r a i n

C a p i l l a r y

TRP

f-TRP: BCAA

TRP

TRP TRP

BCAA

BCAA BCAA

BCAA

FA FA

TRP

TRPTR P TRP

Chapter 12 Endurance and Ultra-Endurance Athletes 343

study. Chocolate milk is highly palatable and inexpen- sive compared to many ready-to-drink sport supple- ments. This research could prove valuable for athletes to practically and inexpensively apply recovery nutrition to their daily diet.

The repetitive nature of endurance sports has led to the recommendation to consume protein after exercise to repair muscle tissue. Especially after repetitive eccen- tric movements, such as running, muscles may experience microtrauma, requiring amino acids as building blocks to repair the damage. Some research suggests that the micro- trauma to the muscle cells contributes to muscle soreness after exercise. Therefore, if protein-rich foods consumed immediately after endurance exercise supply amino acids for hungry muscles, muscle soreness may be decreased.

Similar to carbohydrate foods, protein-rich foods should be consumed 15 to 30 minutes postexercise to max- imize the delivery of nutrients to the muscles. Approxi- mately 15–25 grams of protein (or 0.25–0.30 grams per kilogram of body weight) immediately following endur- ance exercise appears to be sufficient to initiate the recov- ery process. Continuing to consume protein in subsequent meals throughout the day will supply the total daily require- ments of protein for an athlete and thus aid in the continuous rebuilding and repair of tissues before the next endurance exer- cise bout.

Should endurance athletes eat more fats to meet their energy needs? Because the body relies on fats for energy and the energy requirements for endurance athletes are high, one might be foolishly misled into thinking that fat intake should be of prime importance in the diet of endurance athletes. Numerous studies have demonstrated that endurance training does indeed cause metabolic adaptations that enable the body to rely more heavily on fat metabolism for energy during exercise. This is an important adaptation because it decreases the drain on the body’s somewhat limited carbohydrate reserves ( FIGURE 12.4 ). However, the onset of fatigue during endurance training and competi- tion is not caused by exhausting the body’s fat reserves; in most cases it is caused by depletion of carbohydrate stores. Therefore, increasing the percentage of calories from fats in the diet does little to enhance performance because it is the availability of carbohydrates that ulti- mately limits the metabolizing of fats in relation to delay- ing the onset of fatigue.

However, some researchers have suggested that a high-fat diet, consumed either for a single meal or for

increase in insulin levels correlated with greater amounts of glycogen several hours postexercise. A study completed by Zawadzki et al.38 often is cited when justifying the need for protein after exercise to maximize glycogen lev- els. The researchers reported that after several hours of cycling, the athletes who consumed a combination car- bohydrate and protein supplement had higher levels of glycogen than the cyclists who consumed only carbohy- drates. However, it should be noted that the combination supplement had more total calories than the carbohy- drate-only supplement, which may have contributed to the enhancement, not necessarily the pairing of protein and carbohydrates. More recent studies have found that combining carbohydrate and protein postexercise does increase the insulin response when compared to inges- tion of carbohydrates alone; however, the rate of both liver and muscle glycogen resynthesis is the same.39 There- fore, the take home message is that while adding protein does not appear to speed muscle and liver glycogen reple- tion compared to consumption of carbohydrates alone, it does not slow the process, and it offers the benefits of providing protein after exercise for muscle repair and adaptation.39

Researchers at Indiana University (Karp et al.48) studied chocolate milk compared to traditional carbohy- drate replacement beverages as a recovery aid following exhaustive exercise in nine endurance-trained cyclists. Subjects performed an interval workout to deplete mus- cle glycogen, followed by 4 hours of recovery, and then an endurance performance trial to exhaustion. Subjects consumed an equivalent amount of carbohydrates (1 g/ kg body weight) from a traditional ready-to-drink car- bohydrate replacement drink or chocolate milk imme- diately after the depletion exercise and again 2 hours later. Results showed that consumption of chocolate milk after exercise was equal to or better than tradi- tional carbohydrate drinks in time to exhaustion and total work for the endurance trial to exhaustion. More research is needed to determine whether the combined protein and carbohydrates in chocolate milk, instead of carbohydrates alone, helped improve these athletes’ performance during the endurance trial phase of the

Food for Thought 12.2

Hitting the Wall

Describe the concept of “hitting the wall” or “bonking” as it relates to energy utilization during exercise.

344 SECTION 2 The Practical Application of Sports Nutrition

several weeks, may actually be advantageous to endur- ance athletes. The theory is that because fat usage during exercise is caused, in part, by the concentration of free fatty acids in the plasma, if blood levels can be increased, more fats will be used for energy, sparing carbohydrates and possibly enhancing endurance performance. Studies have investigated the ergogenic benefit of both short- and long-term high-fat diets to determine whether increasing the fat content of one meal or the daily diet can cause the body to adjust and adapt to become a higher fat-burning machine.

Several methodical strategies have been used in short-term studies of high fat intake. Most of the research showing a positive result from a single high-fat meal has included the infusion of heparin. Heparin stimulates lipoprotein lipase activity, which, in turn, increases the plasma levels of free fatty acids in the blood. Because the infusion of heparin before endurance activities is not con- sidered a sound medical practice, these studies provide little relevant information to the practical world of endur- ance sports. In the studies that involve strictly high-fat meals and subsequent tests of endurance (without hepa- rin injections), most show no benefit over a high-carbo- hydrate meal.49,50

The effect of fat loading (i.e., consuming high levels of fat in the diet) on endurance performance has been evaluated in stud- ies of high-fat diets consumed for 3 to 5 days prior to exer- cise. Studies have compared the effect

Figure 12.4 Endurance training causes metabolic adaptations that enable the body to rely more heavily on fat metabolism for energy during exercise. This is an important adapta- tion because it decreases the drain on the body’s some- what limited carbohydrate reserves.

fat loading The die tary practice of eating a diet high in fats (i.e., > 60% of total daily calories) 3 to 5 days prior to competition.

of a high-fat diet (more than 74% of total calories) versus a high-carbohydrate diet (more than 77% of total calories) on performance tests to exhaustion. Results have consis- tently shown that high-fat diets have a negative impact on endurance performance.13,51,52 At this time, fat loading cannot be recommended as a method of improving per- formance in endurance activities.

Another set of studies focused on the effect on endur- ance performance of a high-fat diet consumed for 1 to 4 weeks. It appears that individuals consuming a high-fat diet for this moderate length of time can adapt to using more fat for fuel, and thus increase time to exhaustion in endurance tests. Lambert et al.32 studied five endurance cyclists who consumed either a high-fat diet (76% of total calories) or a high-carbohydrate diet (74% of total calo- ries). After 2 weeks on the diet, the subjects consumed a normal diet for 2 weeks and then consumed the opposite diet plan for 2 weeks. After each 2-week experimental set, the cyclists performed a Wingate power test, a high- intensity exhaustion test (90% of VO2max), and a moder- ate-intensity exhaustion test, cycling at 60% of VO2max. No difference was noted on the power test or the high- intensity test. However, the cyclists performed better in the moderate-intensity cycle test (increased endurance) when consuming the high-fat diet. The authors attributed the benefit to a lower respiratory exchange ratio, mean- ing the individuals were relying more on fats for energy than carbohydrates. However, it should be noted that the endurance test was performed after two other intense physical tests, with little rest between tests, which can affect endurance performance and thus make the inter- pretation of these results difficult. Other studies have suggested a benefit from a moderate- or high-fat diet, but with varying levels of fat intake, the use of trained and untrained subjects, and different testing/diet proto- cols, comparisons are difficult and drawing conclusions has been challenging.53-55

In addition to inconsistent results from short-term studies, long-term high-fat diets should be evaluated based on the following:

• Fat takes longer to digest, and therefore high-fat meals put the athlete at higher risk for gastrointesti- nal issues during exercise.

• High-fat diets can lead to flavor fatigue relatively quickly, causing an athlete to stray from the prescribed diet, thus making a long-term plan impractical.

• High-fat diets have been shown to negatively affect cardiovascular health long term and therefore are not generally recommended.

• High-fat, low-carbohydrate diets may result in low fiber, vitamin, and mineral intake. Currently, the available research does not support

a widespread recommendation for athletes to consume a high-fat meal prior to endurance exercise or to follow a high-fat diet plan. More research is needed to fully under- stand the effects of high-fat meals on endurance athletes and the mechanisms involved.

Chapter 12 Endurance and Ultra-Endurance Athletes 345

endurance sports, and protein is critical for repairing muscle tissue after long-duration activities, especially weight-bearing sports. Therefore, both macronutrients take precedence over fat. However, the importance of dietary fat should not be downplayed; fatty acids are criti- cal for meeting total energy needs, obtaining essential fatty acids, and absorbing fat-soluble vitamins from foods and beverages.

One of the main functions of fat in the endurance ath- lete’s diet is to provide a concentrated source of energy. For athletes training 3 to 6 hours or more per day, energy needs can climb as high as 4000–6000 calories. Consuming enough food to meet these energy needs can be challeng- ing, especially if an athlete is aiming to meet these needs with predominantly carbohydrates and protein. Meeting high energy needs with mainly carbohydrate- and pro- tein-rich foods will require an athlete to eat very large volumes of food, which can cause gastrointestinal dis- comfort. The large volume of food may also be challeng- ing from a schedule standpoint, requiring an athlete to eat more than six meals and snacks per day; eating that frequently becomes difficult when 3 to 6 hours or more per day are spent exercising. Conversely, fat-rich foods are calorie dense, allowing an athlete to consume more calo- ries with less food and without feeling too full or bloated.

As with any athlete, moderate amounts of fat must be consumed on a daily basis to obtain the essential fatty acids provided in food. Endurance athletes—especially those trying to lose weight or body fat—often become too focused on carbohydrates and lean protein sources while attempting to minimize or eliminate fat intake. Athletes need to remember that fat is a healthy part of a daily diet. Essential fatty acids provide energy; help to produce hor- mones in the body; surround all nerves, contributing to proper nerve function; and aid in the absorption of fat- soluble vitamins and antioxidants.

Fat-soluble vitamins—vitamins A, D, E, and K—are all critical nutrients for an endurance athlete. Vitamins A and E are classified as antioxidant vitamins, helping to neutralize oxidative damage that occurs during exercise. Vitamin D works closely with calcium to provide structure and strength to bones, which are essential for weight- bearing activities and the prevention of stress fractures. Vitamin K has the role of helping blood to clot. Cuts and gashes can occur during some endurance sports, such as mountain biking or adventure racing, and an athlete will be thankful that his or her blood can clot properly, ceas- ing the flow of blood and allowing the injury to heal. All of these vitamins cannot be absorbed to their full capac- ity if not consumed with a small amount of dietary fat.

In summary, fat is important in an endurance athlete’s diet, but only moderate amounts are needed. If carbohy- drate needs are calculated at 50–65% of total calories, and protein needs fall between 15% and 30%, then the remain- ing calories should be contributed by fat—approximately 20–35% of total calories. Most often, fat needs for endur- ance athletes will be calculated at the lower end of this

Fortifying Your Nutrition Knowledge

High-Fat, Ketogenic Diets: Is There Potential for Enhanced Performance in Endurance Sports? Ultra-endurance events involve continuous activity lasting for hours at a time. Because of their length, they put a con- siderable energy drain on the body. While the total energy drain is large, the rate of energy demand is low compared to other shorter-duration, higher-intensity endurance events. Current nutritional plans for ultra-endurance athletes focus on carbohydrate intake, both before and during the event. However, the body stores relatively little energy in the form of glycogen (~2,500 kcals) compared to fat (~70,000 kcals). Because carbohydrate stores are limited and carbohydrate ingestion during activity can cause gastrointestinal distress, it has been proposed that a better strategy would be to have the body switch to burning fats, of which we have a huge reserve.

It is well known that the body is capable of adapting pri- marily to burning fats if challenged by diet or disease condi- tions that limit carbohydrate availability. Low carbohydrate availability results in formation of ketone bodies, which are the incomplete breakdown products of fat metabolism. These ketone bodies can accumulate in the body and result in a con- dition known as “ketosis.” If low carbohydrate availability per- sists, and the body remains in ketosis for several weeks, the body’s cells adapt and get better at metabolizing the ketones for energy. In light of the body’s ability to adapt to using ketones for energy, scientists have begun to investigate long- term (> 4 weeks) low-carbohydrate, ketogenic diets on per- formance in ultra-endurance events. A review of the research literature on ketogenic diets by Volek et al.a resulted in the fol- lowing concluding statement: “In stark contrast to long-stand- ing dogma in sports nutrition emphasizing the essential need for dietary carbohydrate in all forms of exercise regardless of duration or intensity, these observations have brought us to a threshold beyond which exercise capacity may be improved by those who reduce their dependence on dietary sugars and starches before and during especially prolonged exercise.” While there is still much to learn about the long-term effects of ketosis and low-carb, high-fat diets in regard to individual tolerances, health ramifications and overall nutritional status, research evidence suggests that for some individuals, there is strong potential for improvement in ultra-endurance perfor- mance. There is no question that this will be a hotly contested area of research in coming years.

aVolek JS, Noakes T, Phinney SD. Rethinking fat as a fuel for endurance exercise. Eur J Sport Sci. 2015;15(1):13–20.

How are daily fat needs calculated for endurance athletes? For endurance athletes, fat requirements are generally calculated after determining carbohydrate and protein needs. Carbohydrates are the main fuel in the body for

346 SECTION 2 The Practical Application of Sports Nutrition

range. However, if calorie needs are very high, fat intake at 30–35% of total calories will ensure adequate total calories, a feeling of satiety, and a decrease in the total volume of food that needs to be consumed in one day.

To estimate fat requirements for endurance athletes, calculate total energy needs first. Then, determine carbo- hydrate and protein requirements in total grams as well as a percentage of total calories. The remaining percent- age of calories should come from fat. Double-check the calculations to ensure that fat intake does not fall below 20% of total calories to prevent fatty acid deficiencies and does not exceed 30–35% to ensure heart health and over- all dietary balance. The ranges for carbohydrates, protein, and fat provide a wide spectrum of appropriate options to develop a nutrition plan that incorporates balance, variety, and moderation while simultaneously providing enough fuel for an athlete to remain energetic and fresh and to recover well from hard workouts and competitons.

For example, Brooke is a cyclist, riding 150–200 miles per week. She is 30 years old, is 5′ 8″, weighs 132 pounds, and wants to maintain her weight. To calculate her fat needs: 1. Determine her total energy needs:

REE = (14.7 × 60 kg) + 496 = 1378 × (1.6–2.4) = ~2200–3300 Brooke’s average calorie needs = 2750 calories per day

2. Determine her carbohydrate needs: 6–10 grams carbohydrates × kilograms of body weight = 6–10 g × 60 kg = 360–600 grams Brooke’s carbohydrate needs = 450 grams of carbohy- drates per day (65% of total calories)

3. Determine her protein needs: Training 12 to 20 hours per week requires 1.4–1.7 grams of protein per kilogram of body weight: (1.4–1.7) × 60 kg = 84–102 grams of protein Brooke’s average protein needs = 93 grams of protein per day (14% of total calories)

4. Determine her fat needs: Remaining calories based on percentage = 100 – 65 (carbohydrate) – 14 (protein) = 21% of total calories from fat 21% of 2750 = 577.5 calories ÷ 9 kcal/gram of fat = ~64 grams of fat per day

Should fats be eaten while performing endurance activities? During activities of low to moderate intensity, a majority of energy is derived from fatty acids in the blood. Because fats are such an important fuel source, it would seem logi- cal that consuming fats (long-chain triglycerides) while competing in endurance sports would be a good practice. However, other factors must be taken into consideration regarding fat intake during competition. First, depleting the body’s fat stores, even on the leanest of individuals, is not a likely scenario and thus not an energetic cause of fatigue. In addition, fatty foods are slow to digest, delay gastric emptying, and may cause gastrointestinal cramp- ing and diarrhea—none of which will enhance perfor- mance. Despite the negative effects of consuming dietary

fats during endurance exercise, some researchers have suggested that ingestion of medium-chain triglycerides (MCTs) may be beneficial by sparing endogenous carbo- hydrate stores and enhancing endur- ance performance. MCT supplements marketed to endur- ance athletes have suggested benefits such as increased energy levels, enhanced endurance, increased fat metabolism, and lower body fat levels. Although these claims sound appealing, research has not been able to consistently sup- port these statements.

An early focus of research was centered on the fact that MCTs can be oxidized as rapidly as exogenous glu- cose. The theory derived from this fact was that MCTs could potentially spare the usage of muscle glycogen as well as exogenous glucose during endurance exercise, thus delaying fatigue. Two different studies56,57 from the early 1980s with similar methodology revealed similar results. Both studies compared the effects of consum- ing 25–30 grams of MCTs or 50+ grams of carbohydrates before 1 hour of exercise at 60–70% VO2max on substrate utilization and glycogen sparing. The amount of carbohy- drates and fat used during the hour of exercise was virtu- ally identical across experimental groups, and glycogen stores were not spared.

The next step was for researchers to investigate the effects of larger quantities of MCTs to determine whether earlier studies did not find a benefit because of low dos- ages. It should be noted that earlier studies documented preliminary findings of gastrointestinal intolerances of MCTs at doses higher than 50–60 grams.57 Despite this information, future studies were completed with doses upward of 85 grams of MCTs. The first study, performed by Van Zyl and associates,58 studied the effects of glucose, MCT, or glucose plus MCT ingestion during cycling. Six endurance-trained cyclists performed a 2-hour bout of cycling at 60% VO2max, followed by a 40-kilometer time trial. While cycling on separate occasions, the subjects consumed one of three beverages in random order: 10% glucose, 4.3% MCT, or 10% glucose + 4.3% MCT solution. The MCT-only beverage negatively affected the time trial performance by 5.3 minutes, whereas the combination beverage improved performance by 1.7 minutes com- pared to glucose alone. Unfortunately, muscle glycogen levels were not directly measured in this study, and there- fore the glycogen sparing theory of MCTs could not be confirmed.

A follow-up study was performed by Jeukendrup and associates,59 once again testing cyclists consuming glu- cose only, MCT only, or a combination beverage. Several differences in experimental design were implemented as compared to the Van Zyl study:58

• A 5% MCT solution was used instead of a 4.3% solu- tion (the 10% glucose solution remained the same).

medium-chain triglycerides (MCTs) A glycerol molecule with three medium-chain fatty acids attached.

Chapter 12 Endurance and Ultra-Endurance Athletes 347

• A placebo group was included. • The time trial after the 2 hours of cycling at 60%

VO2max involved the maximum amount of work pro- duced in 15 minutes versus the time to complete a 40-kilometer distance.

• Carbohydrate and protein utilization during exercise was measured. The authors found no difference in performance

among the placebo, glucose, and glucose + MCT trials. However, they did find a 17–18% decrease in performance when cyclists consumed the MCT-only beverage. The MCT beverage also did not alter carbohydrate or protein utili- zation during exercise, thus not sparing glycogen stores. It was documented that several subjects vomited during the MCT trials, and others suffered from diarrhea.

In conclusion, long-chain triglycerides are not rec- ommended for consumption during endurance sports. Small amounts may be consumed during ultra-endur- ance events lasting more than 4 to 6 hours without conse- quence; however, the amount should remain minute, with the focus placed primarily on carbohydrates and second- arily on protein. Some examples of fat-containing foods that may be tolerated during long-duration activities include peanut-butter sandwiches, trail mixes, and ses- ame sticks. Intake of these foods should be tested during training and incorporated based on individual tolerance. Although a few researchers suggest a benefit of consum- ing small amounts of MCTs during endurance activities, the results have not consistently shown improvements in endurance performance. Although greater amounts may have a more significant impact on substrate utilization, large quantities of MCTs have also been shown to increase gastrointestinal distress. At this time, a recommendation cannot be made for endurance athletes to consume MCTs prior to and during training or competition.

Is fat needed for recovery from endurance exercise? Unlike carbohydrates and protein, it is not essential to replace fat used during endurance exercise by consum- ing certain quantities or types of fat immediately follow- ing training or competition. The body’s stores of fat are so great that they will not be depleted in an exercise ses- sion, even after prolonged endurance events. Because ingesting carbohydrates and protein is the main prior- ity after endurance training, allowing the replacement, res- toration, and replen- ishment of muscles, fat should be kept to a minimum. Fat causes the stom- ach to empty more slowly than do car- bohydrates and

protein, which could potentially delay the delivery of nutrients to the muscles in a timely fashion. However, fats add flavor to foods and create a sense of satiety and therefore can be included in small amounts in the postex- ercise meal or snack.

Are vitamin/mineral needs different for endurance athletes? Endurance athletes need higher levels of various nutri- ents, including some vitamins and minerals, as compared to their sedentary counterparts. But are specific vita- mins and minerals of greater importance to endurance athletes versus team sport or strength/power athletes? Although all vitamins and minerals are needed in ade- quate amounts for proper health and bodily functioning, a handful of vitamins and minerals are in the spotlight for endurance athletes: B vitamins, vitamin C, vitamin E, iron, calcium, sodium and potassium.

Why are the B vitamins important for endurance athletes? B vitamins, specifically thiamin, riboflavin, and niacin, are involved in energy production pathways and thus are required in higher amounts for endurance athletes.60 Thiamin plays a role in the conversion and utilization of glycogen for energy and the catabolism of BCAAs. Ribo- flavin is highly involved in the production of energy from carbohydrates, proteins, and fats for both health and performance. Niacin is a component of two coenzymes: nicotinamide adenine dinucleotide (NAD) and nicotin- amide adenine dinucleotide phosphate (NADP). These coenzymes are involved in oxidation-reduction reac- tions required for the progression of metabolic pathways toward the synthesis of fatty acids and glycogen.

Increased intake of these B vitamins is important on a daily basis but is not necessarily required during exercise. The key is for endurance athletes to consume thiamin-, riboflavin-, and niacin-rich foods throughout the day, at meals and snacks. See TABLE 12.4 for examples of thiamin-, riboflavin-, and niacin-rich foods.

Why are vitamins C and E important for endurance athletes? Vitamins C and E have been acknowledged as potent antioxidants, helping to combat the oxidative damage that can occur during intense endurance exercise. Some research has shown that vitamins C and E actually work in concert with one another, each enhancing the antioxi- dant properties of the other.

Megadose supplements of vitamins C and E are often marketed to endurance athletes, touted as enhancing recovery from intense workouts. Although these vitamins can make an impact on the recovery process, there is a safe and acceptable limit for daily intake. Vitamin C intake

Food for Thought 12.3

Macronutrient Recommenda- tions for Endurance Athletes

Recall the daily macronutrient recommendations for endurance athletes, as well as macronutrient guidelines for before, during, and after exercise.

348 SECTION 2 The Practical Application of Sports Nutrition

of 250–500 milligrams per day is above the RDA of 90 mil- ligrams for males and 75 milligrams for females, yet far below the UL of 2000 milligrams daily for adults.61 Intake of 250–500 milligrams will ensure that endurance athletes are meeting minimum needs and also provide for pos- sible additional antioxidant needs from the added stress of physical activity. This level is easily obtained through a balanced, calorie-sufficient diet that includes plenty of fruits and vegetables.

Supplementation of vitamin E has become popu- lar with endurance athletes because of studies tout- ing its antioxidant properties.62 However the research is conflicting; a prudent approach to vitamin E intake is to remain below the UL of 1000 milligrams (1500 IU) daily. Endurance athletes who may not meet daily energy needs or are restricting dietary intake for weight control may require vitamin E supplementation. Because large amounts of vitamin E are rarely toxic, supplementation at far higher than the RDA of 15 milligrams (23 IU) is not a concern for most endurance athletes. However, it is also not clear whether, and at what level of supplementation, vitamin E might enhance the performance of endurance athletes. Combined dietary and supplemental vitamin E intakes of 100–270 milligrams daily (or approximately 150–400 IU) are appropriate and will ensure adequate

intake without concern for negative side effects. See Table 12.4 for examples of foods rich in vitamin C and vitamin E.

Why is iron important for endurance athletes? Iron is best known for aiding in the formation of com- pounds essential for transporting and utilizing oxygen (myoglobin and hemoglobin) and is therefore critical for aerobic activities and endurance training. Iron deficiency is one of the most common nutrient deficiencies in the United States and therefore deserves special mention. Because of the nature of endurance sports, athletes expe- rience an increased loss of iron. Hematu- ria, or the presence of hemoglobin or myo- globin in the urine, is caused by a break- down of red blood cells. The break- down of red blood cells, also known as hemolysis, results in the release of hemoglobin and ultimately its elimination from the body via urine. Hemolysis, which is believed to

Table 12.4 Key Vitamins and Minerals for Endurance Athletes

Importance for endurance sport athletes

Food sources Critical consumption time frame

Vitamins

Thiamin Energy production Fortified and whole grains, legumes, wheat germ, nuts, pork

Daily meals and snacks

Riboflavin Energy production Milk, yogurt, bread and cereal products, mushrooms, cottage cheese, and eggs

Daily meals and snacks

Niacin Energy production Beef, poultry, fish, legumes, liver, seafood, fortified and whole grain products, mushrooms

Daily meals and snacks

Vitamin C Antioxidant Citrus fruits, berries, melon, tomatoes, green leafy vegetables, bananas, sweet potatoes

Daily meals and snacks as well as after intense, long training sessions

Vitamin E Antioxidant Nuts, seeds, wheat germ, fortified cereals, strawberries Daily meals and snacks as well as after intense, long training sessions

Minerals

Iron Oxygen-carrying compounds and energy-producing enzymes

Beef, poultry, fish, soy products, dried fruits, legumes, whole grains, fortified cereals, green leafy vegetables

Daily meals and snacks

Calcium Bone strength Milk, yogurt, cottage cheese, hard cheese (and nondairy alternatives), fortified foods, and juices

Daily meals and snacks

Sodium Electrolytes lost in sweat Table salt, condiments, canned foods, processed foods, fast foods, smoked meats, salted snack foods, soups

Daily meals and snacks, during workouts lasting longer than 4 hours, after exercise to replenish sodium losses

Potassium Electrolytes lost in sweat Fruits, vegetables, coffee, tea, milk, and meat Daily meals and snacks, small amounts during exercise, after exercise to replenish potassium losses

hemolysis The breakdown of red blood cells in the body. This, in turn, results in the release of hemoglobin into body fluids.

hematuria The presence of hemoglobin or myoglobin in the urine. Hematuria is an indicator of hemolysis.

Chapter 12 Endurance and Ultra-Endurance Athletes 349

be at least partially caused by repeated impact, is com- mon in distance runners.63 Nonimpact endurance sport athletes, such as rowers or cyclists, can also experience hemolysis resulting from a loss of iron from the intesti- nal wall, in urine or feces, because of an irritation caused by equipment and body friction, oxidative stress caused by the formation of free radicals, and/or the consump- tion of nonsteroidal anti-inflammatory drugs.63,64 Iron can also be lost through sweat. Endurance athletes lose a lot of sweat on a daily basis, further justifying an increased emphasis on adequate daily intake of iron.

Endurance athletes should focus on consuming iron- rich foods on a daily basis during meals and snacks. Simi- lar to B vitamins, it is not necessary to consume iron-rich foods during activities. See Table 12.4 for examples of iron-rich foods.

Why is calcium important for endurance athletes? Calcium is widely recognized as a bone-strengthening mineral. However, calcium’s role in endurance perfor- mance extends beyond the skeleton. Calcium helps to produce fibrin, the protein responsible for the structure of blood clots. It is required for proper nerve function, releas- ing neurotransmitters that facilitate the perpetuation and activation of nerve signals. Calcium is pumped into and out of muscle cells to initiate both muscle contraction and relaxation in smooth muscle, skeletal muscle, and the heart. These functions are all essential for endurance athletes to maintain the intensity and duration of train- ing and competition. During exercise, heart rate, muscle contraction and relaxation, and nerve impulse activity are all increased at incredible rates for sustained peri- ods of time. Calcium also activates several enzymes that affect the synthesis and breakdown of muscle and liver glycogen, which is the main energy source during endur- ance exercise. Although critical in many ways for peak performance, many athletes are consuming suboptimal amounts of calcium on a daily basis. By striving for three to four servings of dairy/alternatives or other calcium- rich sources every day, athletes can meet their calcium needs. Calcium intake is not required during training ses- sions or competitions. Calcium stored within the body and the small amounts consumed in preexercise meals will provide the calcium needed during activity for proper nerve function and muscle contraction. See Table 12.4 for examples of calcium-rich foods.

Why are sodium and potassium important for endurance athletes? Sodium and potassium are crowned as heroes for their critical roles during endurance exercise. Sodium, one of the extracellular electrolytes, acts in conjunction with potassium, one of the intracellular electrolytes, to maintain proper fluid balance throughout the body dur- ing long-duration exercise. The interchange and flow of

these electrolytes into and out of cells are responsible for the transmission of nerve impulses and muscle con- tractions. Sodium and potassium are both lost in sweat; however, sodium losses are of greater magnitude and significance. If sodium loss during exercise is excessive, without replacement, a life-threatening condition called hyponatremia can result. Sodium also aids in the absorp- tion of glucose, which makes it a key component to any sports beverage.

Most Americans, including athletes, consume plenty of sodium on a daily basis. For athletes participating in ultra-endurance events, adding a little more sodium to meals and snacks in the days leading up to an event can help to “stockpile” a little extra sodium for race day. Sodium consumption during endurance training and competitive events is important for health and perfor- mance. Refer to the following section titled, “Why are fluids critical to endurance performance?” for more infor- mation on calculating sodium needs for athletes during endurance events as well as guidelines for developing a nutrition plan that includes sports beverages, foods, and sodium supplements. The replacement of sodium after endurance exercise is easily accomplished by consuming salty foods and beverages.

In contrast, most Americans, including athletes, are not doing a good job of consuming enough potassium on a daily basis. This suboptimal intake has been attributed to a low consumption of fruits, vegetables, and low-fat dairy products. Endurance athletes should be encour- aged to eat more of these foods every day. During exercise, potassium can be obtained from sports beverages, as well as commonly consumed endurance fare such as bananas and oranges. See Table 12.4 and FIGURE 12.5 for examples of sodium- and potassium-rich foods.

Why are fluids critical to endurance performance? Sixty percent of our body weight is water. Fluid intake and maintenance of body water levels are critical to the endurance athlete for several reasons, in particular for the regulation of body temperature and maintenance of blood plasma volume. During exercise, the body’s pri- mary means of cooling itself is through the evaporation of sweat. Failure to adequately rehydrate during and after training leads to dehydration, which, in turn, results in elevated body temperatures during exercise. Elevated body temperature can increase strain on the cardiovas- cular system, which is already a weak link in the aero- bic power of most athletes, and lead to overheating of the body, which has negative, and sometimes deadly, consequences.

Blood plasma volume is one of the most important determinants of aerobic capacity because the cardiovas- cular system’s ability to deliver oxygen is rate limiting

350 SECTION 2 The Practical Application of Sports Nutrition

athlete’s total daily calorie needs. Note that replacement of fluid lost during exercise is in addition to daily fluid recommendations. Because of the frequency and dura- tion of endurance athletes’ training and competition ses- sions, maintaining euhydration is of utmost importance and should be a dietary focus every day.

How are fluid and electrolyte needs during endurance activities determined? Maintaining euhydration during endurance activities is dependent on making accurate estimations of indi- vidual sweat rates and electrolyte losses, practicing the consumption of the estimated amounts of fluid while exercising, and overcoming any logistical barriers to fluid availability.

How do endurance athletes determine their individual fluid needs? If left to their own devices, endurance athletes will typ- ically not drink enough fluid during exercise to main- tain euhydration.65,66 In a study conducted by Iuliano et al.,67 female and male junior elite triathletes performed a simulated duathlon event consisting of either a 2-kilo- meter run, 12-kilometer bike ride, and 4-kilometer run or a 1-kilometer run, 8-kilometer bike ride, and 2-kilometer run based on age. All subjects were allowed to drink ad lib of their chosen beverage during all three segments of the simulated duathlon. All groups drank suboptimally, as revealed by a loss of body mass, in both absolute and relative terms. Many endurance athletes are not aware of how much fluid they are losing during exer- cise; therefore, the first step in pro- moting an athlete’s awareness is to per- form a sweat trial and then to prac- tice his or her “ideal” fluid consumption frequently in training sessions. Sweat trial calculations are as follows: 1. Determine body weight (BW) lost during exercise:

BW before exercise – BW after exercise = Pounds of water weight loss

2. Determine the fluid equivalent, in ounces, of the total weight lost during exercise: Pounds of water weight lost during exercise × 16–24 ounces = Number of ounces of additional fluid that should have been consumed to maintain fluid bal- ance during the exercise session

3. Determine the actual fluid needs of the athlete during an identical workout: Total fluid needs = Ounces of fluid consumed + Ounces of additional fluid needed to establish fluid balance

Figure 12.5 Choose foods with potassium (e.g., bananas and oranges) and sodium (e.g., soup and pretzels) after long exercise bouts to replenish these lost electrolytes. © Photodisc © Photos.com © Photodisc © Photodisc

in regard to exercise intensity. The more blood that can be delivered to working muscles, the faster oxygen can be used for the aerobic production of ATP. The direct consequence of this is that the athlete can perform or maintain a faster race pace without the build up of lac- tic acid, which ultimately can cause fatigue. If an ath- lete becomes dehydrated, the blood plasma volume decreases to support sweat formation for evaporative- cooling purposes. The resulting decrease in blood plasma volume leads to a decrease in the cardiac output of the heart, which, in turn, decreases delivery of oxygen to the working muscles and slows aerobic performance. Obvi- ously, maintenance of hydration is of utmost importance to the endurance athlete because of the direct nega- tive consequences inadequate fluid intake can have on performance.

How are daily fluid needs calculated for endurance athletes? An endurance athlete cannot rely on becoming well- hydrated during activity by drinking copious amounts of fluids if he or she is not well-hydrated at the onset of exercise. To be well-hydrated at the onset of exer- cise, endurance athletes should follow the daily hydra- tion guidelines. The AI of water for men and women over age 19 is 3.7 liters and 2.7 liters of water per day, respec- tively. Basic fluid needs can also be estimated based on an

Gaining the Performance Edge

Endurance athletes should make it a habit to carry a water bottle throughout the day. The physical reminder of holding a water bottle and the immediate availability of water will help athletes meet their daily fluid needs.

Chapter 12 Endurance and Ultra-Endurance Athletes 351

4. Determine the number of fluid ounces needed per hour of exercise: Total fluid needs/Duration of the sweat trial, in hours = Number of fluid ounces needed per hour of exercise For example, Jack is preparing for an ultra-endurance

bike ride called the RAIN ride (Ride Across INdiana), which consists of riding 162 miles across the state of Indiana in 1 day. As part of his training, he participates in a 110- mile group bike ride. The ride takes 7.5 hours. During this time, he drinks 224 fluid ounces of a sports drink. By the end of his workout, he had lost 8 pounds of body weight. What is the ideal amount of fluid he should be consum- ing per hour?

Using the steps stated previously: 1. His body weight loss during the workout was 8

pounds. 2. The fluid equivalent of his loss was 128–192 ounces

(8 × 16–24 oz). 3. His total fluid needs for the 7.5 hours of cycling are

352–416 ounces (224 oz + 128–192 oz). 4. Jack needs 47–55 ounces of fluid per hour to match

his sweat losses (352–416 ÷ 7.5). For practical purposes, 47–55 ounces of fluid per

hour is equivalent to 2.3–2.75 bottles per hour (assuming 20-ounce bottles). For Jack, it would be in his best interest to install at least four water bottle holders on his bike so that he could carry enough fluid for several hours of rid- ing. Because Jack was only drinking about 30 ounces per hour during the 110-mile training ride (224 oz ÷ 7.5 hours = 29.8 oz/hour), he will need to practice drinking 60–80% more fluid per hour before participating in the RAIN ride. A change in drinking behavior of this magnitude should be incorporated over time and not made overnight, to allow the body to adjust.

It is ideal for an athlete to consume mainly sports beverages during endurance activities lasting longer than an hour. A sports beverage delivers not only flu- ids, but also carbohydrates, sodium, and other electro- lytes to the body. Generally, liquids or semisolid foods consumed while exercising settle better than solid food. Therefore, if calories, carbohydrates, and electrolytes can all be obtained while maintaining hydration, the athlete will minimize the gastrointestinal issues that can result from eating solid foods during exercise.

How do you determine fluid and electrolyte needs for “big sweaters”? Athletes who lose excessively large quantities of fluid and/or sodium during endurance exercise are often classified as “big sweaters.” Although sports beverages are critical for the health and performance of these athletes, plain water can also be added into the nutri- tion/hydration plan for during activity. Some individu- als require 64 fluid ounces or more per hour—that is a lot! If an athlete was to consume solely sports drinks in quantities to match fluid needs, the total amount of

carbohydrates consumed could potentially reach a level that exceeds current recommendations. For example, if an athlete requires 54 ounces of fluid (based on sweat tri- als), this quantity of most sports bev- erages would sup- ply approximately 94–101 grams of carbohydrates in 1 hour—far exceeding the recommended range of approxi- mately 30–60 grams of carbohydrates per hour. In this example, the athlete should con- sume 32 fluid ounces of a sports beverage and then drink an additional 22 ounces of water to meet his or her total fluid needs without exceeding carbohydrate recommendations.

Big sweaters will often complain of muscle cramps during training sessions and competitions. Muscle cramping is mainly caused by inadequate fluid con- sumption and dehydration. By performing a sweat trial and developing a hydration plan based on individual needs, cramping issues are often resolved. After an inquiry on the fluid choices of big sweaters, it is often revealed that they are drinking mainly water (versus a sports beverage) during training sessions. By switching from water to sports drinks, thereby supplying sodium, potassium, and other electrolytes lost in sweat, a second line of defense against muscle cramps is established. If these two approaches do not work, the athlete should seek professional help from a dietitian, physician, and athletic trainer. In some cases, athletes are not only big sweaters, but also “big salt sweaters,” meaning that they are losing excessive amounts of sodium and other elec- trolytes because of higher concentrations in their sweat, which, in turn, cause muscle cramps. For big salt sweat- ers, an electrolyte supplement in addition to a sports beverage may be indicated. The provision of specific elec- trolyte supplements on a regular basis should be moni- tored by a physician to avoid any complications and to ensure that supplements are taken safely. The excessive consumption of electrolyte supplements can disrupt the electrolyte balance in the body and ultimately alter heart function.

How do you determine electrolyte needs for ultra- endurance athletes? Ultra-endurance athletes, even those who are not con- sidered big salt sweaters, may require additional sodium during long-duration training sessions and competitive events. Sodium losses are estimated at 50 mmol per liter of sweat, or 1 gram per liter, during exercise, with a range

Gaining the Performance Edge

Suggest endurance athletes start performing sweat trials months in advance of an important athletic event or competition. Changing fluid (as well as food) intake while exercising should be incorporated over time. Gradual increases in fluid are perceived as less challenging and overwhelming.

352 SECTION 2 The Practical Application of Sports Nutrition

Are fluids needed for recovery from endurance exercise? Absolutely! Endurance athletes can potentially lose huge quantities of fluid while exercising, which need to be replaced as quickly as possible after exercise. Endurance athletes should:

• Drink fluids to replace any weight loss during endur- ance exercise. For every pound lost, an athlete should consume 16–24 ounces of fluid.

• Consume fluids slowly and gradually, instead of through a large bolus of fluid in one sitting. Athletes should begin drinking immediately after exercise and then continue to drink through- out the day.

• It is ideal to con- sume fluids con taining carbo- hydrates, sodium, and potassium, which help to maximize not only fluid replen- ishment, but also glycogen stores and lost elec- trolytes. Sports drinks, vege- table and fruit juices, milk, and smoothies are examples of flu- ids containing more than just water. Fluid replenish-

ment ranks as high as carbohydrate replen- ishment on the recov- ery importance list for endurance ath- letes. Athletes should strive for consuming individually optimal amounts of fluids in a timely manner.

of 20–80 mmol per liter.68 Therefore, sodium require- ments for athletes participating in training sessions and competitions lasting longer than 4 to 6 hours require approximately 500–1000 milligrams of sodium per hour of exercise, based on sweat rate. If the sodium lost in sweat is not replaced in adequate amounts, blood levels of sodium begin to drop, and hyponatremia can ensue.

Hyponatremia is defined as blood sodium levels below 130–135 mmol per liter. As the duration of an endurance event increases, the risk for hyponatremia also increases. However, with proper nutrition and hydration planning, it can be avoided. Salt tablets are commonly used to boost sodium intake above what is supplied in a sports bever- age for events lasting longer than 4 hours. The quantity of sodium in a salt tab- let can range from as little as 40 milligrams up to 750 milligrams per tablet. Salt tab- lets are sold online, in athletic stores and in local pharmacies. Salt tablets should be used in modera- tion and used only to supplement the sodium obtained from sports beverages during training sessions and competitive events lasting longer than 4 hours. Consuming sports drinks alone, in adequate amounts, is typically sufficient for endurance activity lasting less than 4 hours.

To reiterate the importance of monitoring intake, cau- tion should be taken to ensure that excessive sodium is not ingested. Salt tablets are not required on a daily basis. The average American diet provides adequate sodium to replace losses through sweat. If necessary, additional salt can be consumed by using the salt shaker at the table in small amounts. Refer to the example in the Fortifying Your Nutrition Knowledge section regarding Mark, a half- Ironman triathlete, which demonstrates the development of a race-day nutrition plan, including the appropriate use of salt tablets.

Gaining the Performance Edge

Remember to use moderation with sodium intake. Replacing sodium losses is important for the preven- tion of hyponatremia; however, excessive amounts of sodium intake on a regular basis can contribute to high blood pressure. Use salt tablets discriminately and consume salty foods and table salt in moderation.

Gaining the Performance Edge

Some sports beverage companies have developed formulas contain- ing almost twice as much sodium as regular sports beverages. Endurance athletes regularly engaging in train- ing and competitive sessions last- ing longer than 4 hours should use the higher-sodium versions. Look for beverages containing approximately 150–350 milligrams of sodium per 8 fluid ounces of the beverage.

Gaining the Performance Edge

Remember that each athlete is dif- ferent. Some athletes can digest and tolerate more carbohydrates and fluid than the recommended ranges. Trial runs and practice will fine-tune a nutrition plan in prep- aration for hard training days and competitions.

Fortifying Your Nutrition Knowledge

Mark’s Race-Day Nutrition Plan Mark contacted a dietitian to help him determine how to prevent the cramping he was experiencing during long bike rides and runs while training for a half-Ironman triathlon (1.2-mile swim, 56-mile bike ride, 13.1-mile run). He was baffled regarding the source of the problem because he had been taking three salt tablets an hour (150 milligrams of sodium per tablet) during long workouts since a training partner had suggested that low sodium levels were most likely the culprit of his cramps. Mark also reported that he was drinking plenty of water— consuming a full 20-ounce water bottle per hour during training.

The dietitian asked Mark to perform a sweat trial to determine the amount of fluid loss he was experiencing during training. After per- forming the trial and reporting the results, the dietitian informed Mark that he was only meeting a portion of his fluid needs. Mark was

(continues)

Chapter 12 Endurance and Ultra-Endurance Athletes 353

losing 32–36 ounces of fluid per hour and only replacing 20 ounces. In addition to not meeting his fluid needs, he was also falling short on his sodium intake. Even though he was taking salt tablets, he was consuming only 450 milligrams of sodium per hour because he was drinking solely water, which provides no sodium. The dietitian calculated his total fluid, carbohydrate, and sodium requirements and helped Mark develop a nutrition and hydration plan for the race using the following steps:

1. The first step was to determine his fluid needs. As stated earlier, the sweat trial results revealed a fluid loss of 32–36 ounces of fluid per hour.

2. The next step was to determine how much carbohydrate and sodium would be supplied if all of his fluid needs were met by a sports beverage. Thirty-two to 36 ounces of a sports beverage per hour supplies approximately 56–63 grams of carbohydrates and 440–495 milligrams of sodium per hour, depending on the brand used. A sports beverage is preferred over water because fluid, carbohydrates, and sodium can all be provided, versus only fluid supplied in water.

3. The quantity of carbohydrates supplied through the sports beverage was sufficient to meet his needs during exercise. Mark can also consume carbohydrate gels, energy bars, bananas, or other foods, if needed, to supplement the carbohydrates supplied through the sports beverage.

4. Mark had been consuming approximately 450 milligrams of sodium through salt tablets. This quantity of sodium was just slightly below the minimal level of sodium recommended per hour, which may have been contributing to his muscle cramps in addition to dehydration. Preferably, sodium would be obtained by drinking a sports beverage that simultaneously supplies fluid, sodium, and carbohydrates for optimal performance and hydration. In Mark’s case, basing his intake of a sports beverage solely on fluid needs, the quantity of sodium supplied by the sports beverage is slightly below the 500-milligram minimum level recommended per hour. If he consumes 440–495 milligrams of sodium in the sports beverage, an additional 150–500 milligrams need to be obtained from other sources. If he chooses to use an energy gel, bar, or peanut butter/cheese crackers for food during the bike portion of the triathlon, then additional sodium will be supplied in small quantities from these foods. By also planning on taking one to two salt tablets per hour, 150 milligrams of sodium per tablet, Mark can easily reach the goal of 500–1000 milligrams of sodium per hour.

See TRAINING TABLE 12.4 for an excerpt of Mark’s half-Ironman plan focused on his needs during the race. The plan is designed to pre- vent muscle cramps by supplying adequate fluids and sodium while also providing the carbohydrates needed to keep him performing at his best.

What meal planning/event logistics need to be considered during endurance events? The nature of the sport will be a major factor in deter- mining a specific nutrition plan for an endurance athlete. Endurance training prepares athletes for events that can last minutes, hours, or days. Training may occur in a con- trolled environment or can be held in a remote area with limited access to facilities. When developing a nutrition plan for endurance athletes, the feasibility of consuming foods or fluids, length of the event, availability of refrig- eration/heating equipment, and space for carrying sup- plies must be considered.

How can a nutrition plan be developed for sports that are not conducive to consuming foods or fluids while exercising? Long-distance swimming, mountain biking, and rowing events are examples of sports that do not lend them- selves to easily consuming foods and fluids during an event. Swimming and rowing involve both upper and lower body movement, requiring an athlete to come to a complete stop to eat or drink. In a competitive envi- ronment, coming to a halt will translate into the loss of precious seconds or minutes to competitors. In rowing,

carrying any food or fluid will add weight to the boat, thus potentially slowing the athlete and negatively affecting performance. Mountain biking requires con- centration and attention to the course, with legs needed for pedaling while arms and hands are steering the bike and keeping it upright and on course. In these situations, proper nutrition before and after the event will be critical in supplying nutrients and fluids to the athlete, because minimal consump- tion will occur dur- ing exercise.

Several fac- tors should be con- sidered in the days prior to and imme- diately before train- ing or competition. Consuming higher levels of carbohy- drates in the 3 to 4 days prior to an endurance compe- tition can super- compensate muscle and liver glycogen

Gaining the Performance Edge

Euhydration is not a static state; therefore, maintaining euhydration should be a daily focus for endur- ance athletes. Optimal performance hinges on an athlete’s correct esti- mation of fluid needs before, during, and after training and competitions. It is critical for athletes to know their individual sweat rates and daily fluid requirements and follow through with diligent and appropriate fluid consumption.

Fortifying Your Nutrition Knowledge (continued)

354 SECTION 2 The Practical Application of Sports Nutrition

Training Table 12.4: Mark’s Half-Ironman Nutrition/Hydration Plan Swim 1.2 miles

Total Time = 45 minutes No food or drink

Bike 56 miles

Total Time = 3:18 (~17 mph)

Hours Elapsed on the Bike Food/Fluid Fluid (oz) Carbohydrates (g) Sodium (mg)

1 32–36 oz sports beverage* 1 salt tablet**

32–36 56–63 440–495 150

2 32–36 oz sports beverage ½ energy gel*** 1 salt tablet

32–36 56–63 14

440–495 25 150

3 32–36 oz sports beverage 1 salt tablet

32–36 56–63 440–495 150

3 hours, 18 minutes 10–12 oz sports beverage 10–12 18–21 138–165

Average intake on bike 32–36 oz/hour 60–67 g/hour 580–638 mg/hour

Run 13.1 miles

Total Time = 1:51 (~8:30 min/mile pace)

Aid Stations on Course at Mile Markers Food/Fluid Fluid (oz) Carbohydrates (g) Sodium (mg)

1 5 oz sports beverage 5 9 69

2 5 oz sports beverage 1 salt tablet

5 9 69 150

3 5 oz sports beverage 5 9 69

4 5 oz sports beverage 5 9 69

5 5 oz sports beverage 1 salt tablet ½ energy gel

5 9

69 150 25

6 5 oz sports beverage 5 9 69

7 5 oz sports beverage 1 salt tablet

5 9 69 150

8 5 oz sports beverage 5 9 69

9 5 oz sports beverage 5 9 69

10 5 oz sports beverage 1 salt tablet

5 9 69 150

11 5 oz sports beverage 5 9 69

12 5 oz sports beverage 5 9 69

13.1–strong to the finish!

Average intake on run 32 oz/hour 66 g/hour 785 mg/hour

*Using a sports beverage with 14 grams of carbohydrates and 110 milligrams of sodium per 8 oz serving. **Using a salt tablet with 150 milligrams of sodium per tablet. ***Using an energy gel with 28 grams of carbohydrates and 50 milligrams of sodium per gel.

stores. This allows additional energy stores to be avail- able during long events where carbohydrate consump- tion is logistically impossible. The nutrients and fluid supplied in the hours leading up to the event will be the fuel used during exercise. If an athlete runs short on cal- ories, carbohydrates, or fluids, performance will suffer, because additional nutrients will not be consumed dur- ing the activity. Athletes should consider eating a larger preactivity meal, which might also mean planning addi- tional time before a training session or event to allow

for the digestion of the meal. Athletes should continue to sip on fluids between the preactivity meal and the beginning of a training session or competition to ensure proper hydration. Athletes also need to plan ahead and pack food and beverages to be consumed immediately following the activity to replenish lost nutrients and fluids.

There are some exceptions to the rule. For example, several ultra-endurance open water swimming events allow support boats to follow swimmers, giving the

Chapter 12 Endurance and Ultra-Endurance Athletes 355

Figure 12.6 Swimmer Jim Barber during an open water swim. Hav- ing support staff carry fluids and foods in long-distance endurance races makes adequate replenishment of needed nutrients more likely. Courtesy of Jim Barber

15 to 20 minutes. Amy alternates between water, sports drinks, and more concentrated recovery-type nutrition drinks to supply fluids, carbohydrates, and electrolytes. In addition to fluids, Amy consumes sports gels and small pieces of energy bars to supply more calories and carbo- hydrates to her muscles.

Although the kayaker makes it easy to have fluids and food available at any time, it is not always easy to eat and drink. Depending on the roughness of the water, actual ingestion of fluid and food can be challenging. The constant bobbing of the body in the waves can lead to seasickness and vomiting, which is obviously detrimental to athletic performance. Amy experienced this scenario in the 2000 race when she had to stop to tread water for 90 minutes while vomiting. She now takes medication several days before the race to prevent the seasickness, allowing her to consume fluids and food comfortably, which has led to several great race performances.

English Channel 21-Mile Open Cold Water Swim Since 1992, Jim Barber has completed numerous cold- and warm temperature, open water swims in both fresh- and saltwater ranging from 1 to 28.5 miles. One of his greatest accomplishments was swimming the English Channel. Swimming the channel presents two major challenges to fueling: rough, salty water and cold temperature.

During the English Channel swim, Jim had to deal with not only the intestinal upset of swallowing saltwater, but also the unique logistical issue of the delivery of fluids and fuel from his crew members. A large motorized boat, not a kayak, is used in channel swims and follows the swimmer throughout the course. Unlike Amy’s Key West swim, which used a kayak, handing water bottles from the crew member to the swimmer was not easy. Two factors made the hand-offs challenging: the 4- to 6-foot distance between the crew member on the deck of the boat and the channel’s water surface, and the risk of the swimmer getting hit by the boat as it lifted and dropped with the unpredictable waves. The solution was a rope- and -pulley buoy delivery system that Jim created. The rope allowed the crew members to easily lower fluid and fuel down to the water and then float the snack back to Jim, who was a safe distance from the boat.

Another major challenge was preventing hypother- mia while swimming in the cold waters of the chan- nel. Jim used two strategies to overcome this problem: a decreased frequency of fueling and the ingestion of warm fluids. When doing warm-water swims, Jim typically fuels every 30 minutes; however, in cold-water swims, such as the English Channel, he fuels every 45 minutes. While swimming the channel, each fueling session was no more that 30 seconds long, and Jim never stopped or lost the horizontal position in the water. The short, less frequent breaks also decreased the likelihood of core body tem- perature declining to a dangerous level. During his fuel- ing breaks, Jim would drink a sports beverage as well as

athletes a chance to stop, drink or eat, and then continue swimming. Follow- ing are example case reports of two open water swim- mers, Jim Barber (see FIGURE 12.6 ) and Amy Krauss, both of whom are noted for their long- distance swimming accomplishments.

Key West 12.5-Mile Open Water Swim Most open water swims consist of a 1-, 2-, or 6-mile

course. The Swim Around Key West event is an incredi- ble 12.5-mile swim completed in one session. During the event, each swimmer must have a kayaker following along- side for safety reasons. The accompanying kayak also pro- vides the opportunity for the competitors to have access to fluids and food during the event. On average, it will take a swimmer 4 to 6 hours to complete the race. By maintaining proper hydration and supplying a steady stream of energy to the body, the swimmer can perform at his or her best.

Over the years, Amy Krauss has experimented with various hydration/fueling schedules, including different fluids, food, and nutrition products, to determine which options taste appealing and digest easily while swimming. Her hydration goal has been to drink 24 ounces of fluid per hour, which is achieved by stopping to drink every

Gaining the Performance Edge

If the sport is not conducive to eat- ing and drinking while moving, ath- letes must place a strong emphasis on consuming nutrients and fluids before and after the event. Encour- age athletes to plan ahead and pack coolers of food and drinks to have nutrition easily accessible when eat- ing/drinking is feasible.

356 SECTION 2 The Practical Application of Sports Nutrition

a warm liquid such as hot chocolate or coffee. Ingesting warm or hot beverages doesn’t usually appeal to athletes while exercising, but when an athlete’s body is submerged in 55- to 60-degree water, a hot drink is appealing and has a much-needed warming effect.

Jim successfully finished the English Channel swim in the impressive time of 9:06:37.

How can a nutrition plan be developed for sports lasting 24 hours or longer? Ultra-endurance events once reserved for really “crazy” peo- ple are now becoming more mainstream. Ultra-marathons and adventure races have exploded in popularity, draw- ing recreational and elite athletes into events lasting 8 to 24 or more hours. When events are spanning the majority of 1 day, energy expenditure increases dramatically while simultaneously making it challenging to consume enough fuel because regular meals are essentially skipped.

Fortunately, these ultra-endurance sports are condu- cive to eating and drinking while moving, though only in small quantities at a time. In some cases, aid stations with supplies may be available on the race course, whereas other events are self-sustaining.

In cases when an athlete is planning on relying on aid stations for food and fluids, planning and practicing before an event are paramount. Athletes should contact the race director or consult the race information packet or website to discover what type of food and fluids will be available on the course. Athletes should then consume the same type of food and fluid throughout their training. For example, Barbara, an ultra-marathoner, typically uses All-Sport, oranges, and PowerBars during her training. She registers for a race and discovers that Gatorade, bananas, and fig bars are going to be supplied on the course. Bar- bara should immediately switch to using these products and foods during her training. Even though All-Sport, oranges, and PowerBars are nutritionally similar to Gato- rade, bananas, and fig bars, they are not identical and can potentially cause taste aversions and gastrointestinal problems if an athlete is not accustomed to the products. As the length of an endurance event increases, nutrition becomes even more critical to performance. As with any sport, there should be no surprises on race day! Athletes should find out what products are going to be supplied during their scheduled races and then practice, practice, practice during training.

Another issue to address during events lasting 8 to 24 hours or more is the variety of flavors and textures of food consumed. A common complaint of ultra-endur- ance athletes is flavor fatigue for sweet products. Sports drinks, bars, and gels are made of carbohydrates that taste sweet—some more intensely than others. When an athlete is consuming these foods over 1 to 4 hours, flavor fatigue is not typically a concern. However, when athletes are consuming large quantities of food to meet the energy needs of events lasting more than 8 hours, flavor fatigue is a reality that must be addressed during

training. If an athlete gets “tired” of the sweet taste, and all he or she has practiced consuming during training is sports drinks, fruits, and bars, then a switch to different foods or fluids during a race can be disastrous. Athletes should practice consuming foods and fluids with salty or bland flavors to balance with sweet items. Examples of salty items that are commonly used in races are pretzels, peanut butter crackers, chicken broth, sesame sticks, and even lunchmeat sandwiches. Continuing the ingestion of calories will ensure that an athlete keeps moving forward on pace and feeling good.

In an adventure race, when many different sports are involved in one event and athletes are typically self- supporting, the timing of food and fluid intake as well as the reliance on nonperishable items makes the nutri- tion plan unique. Keep in mind that nutrition plans need to include an athlete’s favorite training foods and flu- ids, while maintaining the feasibility of transporting the items while moving and ensuring food safety. For exam- ple, an adventure racer might really enjoy eating a turkey and cheese sandwich 10 hours into a race. However, if the race is self-sufficient and without access to refrigeration, keeping a lunchmeat and cheese sandwich outside refrig- eration for more than 2 hours will increase the risk for a foodborne illness. A peanut butter and jelly sandwich or turkey jerky might be better options.

How can a nutrition plan be developed for a multiday event that will be fully supported? Multiday endurance events, or stage events, may be fully supported with team vehicles and overnight accommo- dations supplying refrigeration and cooking capabilities. These types of events are logistically much easier to plan for because athletes can in some cases stay on a “normal” sched- ule of eating meals and snacks. The vari- ables to consider in this type of scenario are the refrigeration, preparation, and storage space for supplies as well as the length and frequency of exercise during the multiday event.

An example of this type of event is the Race Across America (RAAM). RAAM, first held in 1982, is a nonstop cycling event across the United States. The 2900- to 3000- mile race begins on the West Coast and travels across the mountains and plains to the East Coast. Racers can enter the event as a solo rider or as a two-, four-, or eight- person team. Individuals and teams are allowed to have multiple support vehicles throughout the race and along the course. Most competitors will have a motor home to allow for meal preparation and vans to fetch additional supplies while the cyclists continue to progress en route.

Gaining the Performance Edge

Encourage athletes to research what products will be supplied on the race course so that the identical products can be used during train- ing. Be creative when developing a nutrition plan for events lasting 8 to 24 or more hours. Make sure to include different flavors, textures, and types of food and fluids.

Chapter 12 Endurance and Ultra-Endurance Athletes 357

TRAINING TABLE 12.5 gives a sample day of meals, snacks, and fluids consumed by a rider on the four-man Team 70+.

How can a meal plan be developed for a sport such as a long-distance triathlon that includes a nonconducive eating environment, a length of time spanning several meals, and race course support? The sport of triathlon has exploded in popularity in the past decade. Triathlons can be categorized into four dis- tances: Sprint (500-meter swim, 10-mile bike ride, 5-kilo- meter run), Olympic (1.5-kilometer swim, 40-kilometer bike ride, 10-kilometer run), half-Ironman (1.2-mile swim, 56-mile bike ride, 13.1-mile run), and Ironman (2.4-mile swim, 112-mile bike ride, 26.2-mile run). Sprint and Olym- pic distance races can be completed within 1 to 3 hours for a majority of competitors, requiring a proper prerace meal, a strong focus on hydration, and minimal amounts of sports bars, gels, and other foods during the race. How- ever, the half and full Ironman distance races can last 4 to 17 hours, making nutrition a critical component of race day success. Triathlon is unique because of the three sports included, each providing a different environment and plan for hydration and fuel consumption. No food or drink is available during the swim portion of a triathlon, making prerace nutrition and hydration a top priority. The bike segment of the race is most conducive to drinking and eating. Bikes can carry fluids in bottles attached to the bike frame, behind the seat, and in specialized bot- tles that fit within the aerobars placed on the front of the bike. Athletes can pack their own food to be carried in the back pockets of a bike jersey or in a variety of bike bags, pouches, or “boxes” that attach to the bike frame or seat. This allows an athlete to drink and eat gradually

Training Table 12.5: Jack’s Meal Plan During RAAM Jack Boyer was a 70-year-old member of Team 70+. He was 5′8″ and weighed 158 pounds. His daily energy and carbohydrate needs, accounting for 4 to 8

hours of cycling per day, were estimated at 5422 calories and 990 grams of carbohydrates. To meet this goal, he was instructed to consume the following each day: • 6 liters of Cytomax sports beverage, supplying 1278 calories and 360 grams of carbohydrates • 1 “Meal A,” supplying 1100 calories and 150 grams of carbohydrates • 2 “Meal Bs,” each supplying 800 calories and 120 grams of carbohydrates • 12 snacks, each supplying 120 calories and 20 grams of carbohydrates

Meal options included, but were not limited to: oatmeal, dry cereal, spinach lasagna, turkey chili, stuffed potatoes, bagel sandwiches, and pasta dishes. Snacks were eaten during breaks from cycling. Snacks included, but were not limited to: PowerBars, granola bars, GatorPro, Gatorlode, pretzels, bagels with jelly, dry cereal, trail mix, peanut butter crackers, and Ritz snack crackers. The four-man team was split into two subteams. The subteams alternated 8-hour shifts—8 hours in the motor home resting, eating, and getting massages, alternating with 8 hours of cycling. The 8 hours of cycling by each subteam of two men was then split into alternating 1-hour time blocks of riding and then resting in the van following directly behind the cyclist on the road. All meals were eaten in the motor home while sports beverages and snacks were consumed during the 8-hour shift of cycling.

Because the motor home had a refrigerator and a microwave, foods could be prepared for the team on-site. However, most of the food was prepared before leaving on the adventure and frozen, minimizing the time and effort of meal preparation during the race. Therefore, the menu was planned around foods that could be reheated well, made from scratch in a microwave, or prepared with no cooking. A small cooler was taken during the 8-hour shift of cycling, allowing for drinks and other foods to stay cold.

Jack, as well as the other three riders, was monitored daily through a food record and by obtaining body weights before and after 8-hour riding shifts. The riders stayed on plan for the entire race, feeling good and riding strong. Tastes changed during the ride, requiring the menu to be flexible, allowing for foods from restaurants and “interesting” requested combinations such as baked potatoes with raisins, milk, and salt. The nutrition plan fueled Jack and the rest of the 70+ Team to a successful RAAM finish of 9 days, 2 hours, and 27 minutes.

throughout the bike segment of the race, playing a little “catch-up” from the swim and “stocking up” before the run. Because biking is nonimpact, athletes experience fewer gastrointestinal issues with eating and drinking while cycling as opposed to running, and therefore the second segment of a triathlon is an ideal time for fuel- ing. The nutrition plan for the run is typically developed around what is available on the course at aid stations. Some athletes choose to rely mainly on their own fluid and food choices by wearing belts with bottle holders and pouches for food. However, for the Ironman distance races, the amount of fluid and fuel needed during the marathon will exceed the carrying capacity of the belt. Therefore, a combination plan of self-support and race course support may work best. One other opportunity for food and fluid consumption occurs during the two transitions during a triathlon—one after the swim and the second after the bike segment. During shorter triathlons, athletes aim to keep transition time to a minimum, often choosing not to take time to consume anything during transition. In lon- ger-distance triathlons, during transition is an ideal time for changing clothes, taking a minute to rest before the next segment of the race, and consum- ing small amounts of food or fluids.

The Ironman distance is by far the most taxing and most reliant on proper nutrition and hydration. TRAINING TABLE 12.6 pro vides a sam- ple of the Ironman plan followed by Heather Fink when she completed Ironman Coeur d’Alene. Her race and nutrition plan progressed flawlessly, allowing her to qualify for the Hawaii Ironman.

Food for Thought 12.4

You Are the Nutrition Coach

Apply the concepts from this chapter to several case studies.

358 SECTION 2 The Practical Application of Sports Nutrition

Training Table 12.6: Heather’s Ironman Nutrition/Hydration Plan After 5 years of competing in sprint through half-Ironman distance triathlons, Heather decided to participate in an Ironman distance race. Ironman Coeur

d’Alene, held in late June and located in northern Idaho, involved a cold swim in Lake Coeur d’Alene; a challenging bike course with several tough, steep hills; and a relatively flat run course. Heather, being a dietitian, knew the importance of practicing her race-day nutrition throughout her training, and therefore developed a proposed plan by January and spent the next 4 to 5 months refining the plan for race day. From past experience in triathlons, she knew sports beverages, gels, and bars worked well and settled well for her during races. However, she knew she would need to take in more energy and sodium during Ironman and therefore began experimenting with other foods, drinks, and products. The schedule below was the result of using tried- and-true products, newly discovered products, and beverages/foods known to be available on the race course:

Breakfast (4 hours prior to race start) • 1½ cups dry cereal with one scoop of protein powder and 1 cup soy milk • 1 banana and 8 ounces of orange juice • Sips of Gatorade between breakfast and race start

2.4-Mile Swim (total time = 1:05:00)

No food or drink Transition #1 (after swim, before bike; total time = 3:36)

• ½–1 can of Ensure

112-Mile Bike Ride (total time = 6:02:00)

Nutrition goals during the bike ride: 32 ounces of fluid per hour (specifically, Gatorade), 70–75 grams of carbohydrates per hour, and 500–750 mg sodium per hour. Plan was broken down into 10-mile increments because aid stations were located every 10 miles on the bike course. Three 24-ounce bottles of Gatorade were placed on the bike at the beginning of the race and replaced throughout the course. A bento box was attached to the bike frame holding salt tablets, Baker’s Breakfast Cookies, peanut butter crackers, and one gel. The specific nutrition plan for the bike ride progressed as follows: • 10 miles—Bottle pick-up • 20 miles—3/4 of a Baker’s Breakfast Cookie • 30 miles—Bottle pick-up • 40 miles—3 peanut butter crackers • 50 miles—Bottle pick-up 1 one sodium tablet (1000 mg) • 60 miles—1 gel • 70 miles—Bottle pick-up • 80 miles—3/4 Baker’s Breakfast Cookie • 90 miles—Bottle pick-up • 100 miles—3 peanut butter crackers 1 one sodium tablet • 110 miles—Bottle pick-up

Transition #2 (after bike, before run; total time = 2:51) • ½–1 can of Ensure

26.2-Mile Run (total time = 3:43:00)

Nutrition goals during the run: 28 ounces of fluid per hour, 60–65 grams of carbohydrates per hour, and 500–750 mg sodium per hour. The plan was broken down into 1-mile increments because aid stations were located every mile on the run course. A gel flask filled with four gels was carried during the run with a small plastic pouch attached to the flask to hold several sodium tablets. • 4–6 ounces of fluid were consumed every mile on the course, mainly Gatorade, with a little water, cola (for a flavor change), and ice cubes. • Half of a gel was originally planned to be consumed every 3 miles during the race for a total of four gels over the 26.2 miles. However, only one to

two gels were actually consumed. The temperatures on race day climbed to 97 degrees, increasing the need for fluids during the race. Because of an increased ingestion of fluids, which contained calories, fewer gels were consumed to stay on track with the planned quantity of carbohydrates needed per hour.

Total Ironman race time=10:58 (second female in 30 to 34 age group, qualifying Heather for the Hawaii Ironman) 2.4-mile swim (total time = 1:05:00) 112-mile bike ride (total time = 6:02:00) 26.2-mile run (total time = 3:43:00)

Chapter 12 Endurance and Ultra-Endurance Athletes 359

The Box Score Key Points of Chapter

n Endurance athletes expend a tremendous number of calories not only during competition, but also in pre- paratory training. Energy expenditures of 6000–8000 kilocalories per day are not out of the ordinary for ultra-endurance athletes. This puts a huge drain on energy reserves that must be replenished after daily training bouts and thus makes diet a key factor in athletic success.

n Of the three energy systems, endurance athletes rely most heavily on the aerobic energy system. Appro- priately designed training programs challenge the aerobic system and increase the athlete’s aerobic power so that he or she can maintain a faster race pace.

n It is critical for endurance athletes to consume suf- ficient calories on a daily basis to supply the energy for daily training and competition, ensure the deliv- ery of nutrients needed for complete recovery from workouts, and stay healthy and injury-free. Daily energy needs can be estimated using the follow- ing formula: Resting energy expenditure × Activity factor.

n Often it is not physically or logistically possible for an endurance athlete to fully match his or her energy expenditure with intake during actual train- ing or competition. As a consequence, the event nutrition plan should be based on meeting the per- formance requirements of carbohydrates, fluids, and sodium.

n The main difference between diets of endurance athletes and those of other sports is in the quantity of food consumed, not necessarily the macronutri- ent composition of the diet.

n Carbohydrate intakes of 6–10 grams per kilogram of body weight are recommended for endurance ath- letes exercising 1 to 3 hours per day. Ultra-endurance athletes who are training more than 4 to 5 hours per day require 8–12 grams of carbohydrate per kilo- gram of body weight per day. When expressed as a percentage of their total daily caloric intake, carbo- hydrates should be approximately 50–65% for daily training and approximately 65–70% during carbohy- drate loading.

n Research has demonstrated that consuming carbo- hydrates in the hours leading up to an endurance training session or competition is critical for optimal performance, during activities lasting longer than 2 hours. Endurance athletes should be encouraged to consume a carbohydrate-rich preactivity meal 1 to 4 hours prior to a training session or event and then continue consuming carbohydrates throughout exercise to optimize performance.

n Carbohydrate needs during exercise are approxi- mately 30–60 grams of carbohydrates per hour. Some athletes can easily consume and digest upward of 60–90 grams of carbohydrates per hour, whereas others can barely tolerate 30–40 grams. Athletes need to experiment with varying quantities of car- bohydrates in the range of 30–60 grams to determine the best estimate for them individually.

n Carbohydrate intake is also important after compe- tition to help replenish glycogen stores. Consuming 1.0–1.2 grams of carbohydrates per kilogram of body weight every hour for 4 hours after the cessation of exercise provides glucose to muscles at a time when they are most receptive to absorbing and storing glucose as glycogen.

n Although protein is not typically used by the body to provide energy, the extreme energy demands of endurance training and competition do result in the metabolizing of some protein for energy. As a result, the protein intake recommendation for endurance athletes is higher than the current RDA and falls in the range of 1.2–2.0 grams per kilogram of body weight.

n The effect of protein intake during competition and its impact on performance require more research; however, for ultra-endurance athletes, the consump- tion of protein seems prudent.

n Despite the fact that fats are a major energy source during endurance sports, high-fat diets have not been shown to improve endurance performance. The diet of endurance athletes should include enough fat to account for approximately 20–35% of total daily calories consumed. Immediately prior to train- ing, during exercise, and immediately after training, fat intake should be kept to a minimum while focus- ing primarily on carbohydrates and secondarily on protein.

n Vitamin and mineral needs of endurance athletes are similar to those of other athletes. However, there are a few vitamins and minerals that should be given particular attention. These include the B vita- mins, vitamin C, vitamin E, iron, calcium, sodium, and potassium.

n Adequate fluid intake is important for maintain- ing the hydration status of endurance athletes during their prolonged training bouts and dur- ing competition. Failure to do so can have deadly consequences.

n An excellent way to monitor hydration status is to weigh athletes before and after training or competi- tion. For every pound of body weight lost, the athlete should drink 16–24 ounces of fluid.

360 SECTION 2 The Practical Application of Sports Nutrition

n The risk for hyponatremia increases as the duration of an endurance event lengthens. As a result, the sodium intake of ultra-endurance athletes should be considered when developing a nutrition plan. Sports beverages can provide both fluid and sodium;

however, experimentation before the event is critical for successful use.

n Each endurance athlete requires an individualized nutrition plan. Sport-specific logistics must be con- sidered to plan food and fluid intake appropriately and to implement the plan successfully.

Study Questions

1. Can endurance athletes adopt an “eat-as-you-like attitude”? Defend your answer.

2. Of the three energy systems, which one do endurance athletes rely upon most for energy? Under what cir- cumstances would the other two energy systems play a bigger role during endurance competition?

3. What pieces of information would you need as a dietitian to estimate an endurance athlete’s daily caloric needs?

4. What is the reasoning behind the statement “An ath- lete who cuts back on carbohydrate intake is commit- ting performance suicide”?

5. What should the percent composition of carbohy- drates, proteins, and fats be for an endurance ath- lete’s diet?

6. How does the combination of tapering and carbohy- drate loading affect endurance performance?

7. What role do proteins play in regard to the needs of the endurance athlete? What is the current recom- mendation for protein intake in endurance athletes?

8. For ultra-endurance athletes, is there a training or performance benefit to eating a high-fat diet? Should you recommend eating higher-fat foods during and after training or competition? Discuss why or why not.

9. What are BCAAs and MCTs? What role, if any, do they play in meeting the needs of the endurance athlete?

10. What is hyponatremia? Which athletes are at greatest risk for developing it (be very specific)? What nutri- tional strategies would you use to prevent it?

11. Which vitamins and minerals are of special concern to endurance athletes?

12. What strategies could be employed to help ensure the hydration status of endurance athletes?

13. What is a “sweat trial,” and why is it important to the endurance athlete?

14. What are some of the logistical and nutritional issues that must be dealt with when working with ultra- endurance athletes who are competing in events last- ing longer than 8 hours?

References

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14. Febbraio MA, Keenan J, Angus DJ, Campbell SE, Garnham AP. Pre-exercise carbohydrate ingestion, glucose kinetics and muscle glycogen use: effect of the glycemic index. J Appl Physiol. 2000;89: 1845–1851.

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Chapter 12 Endurance and Ultra-Endurance Athletes 361

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19. Connolly DAJ, McHugh MP, Padilla-Zakour OI. Efficacy of a tart cherry juice blend in preventing the symptoms of muscle damage. Br J Sports Med. 2006;40:679–683.

20. Pigeon WR, Carr M, Gorman C, Perlis ML. Effects of a tart cherry juice beverage on the sleep of older adults with insomnia: a pilot study. J Med Food. 2010;13(3):579–583.

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29. Newsholme EA, Blomstrand E, Ekblom B. Physi- cal and mental fatigue: metabolic mechanisms and importance of plasma amino acids. Br Med Bull. 1992;48:477–495.

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31. Graham TE, Turcotte LP, Kiens B, Richter EA. Train- ing and muscle ammonia amino acid metabolism in humans during prolonged exercise. J Appl Physiol. 1995;78:725–735.

32. Lambert EV, Speechly DP, Dennis SC, Noakes TD. Enhanced endurance in trained cyclists during mod- erate intensity exercise following 2 weeks adapta- tion to a high fat diet. Eur J Appl Physiol Occup Physiol. 1994;69(4):287–293.

33. Evans WJ, Fisher EC, Hoerr RA, Young VR. Protein metabolism and endurance exercise. Physician Sports Med. 1983;11:63–72.

34. Tarnopolsky M, Atkinson S, MacDougall JD, Senor BB, Lemon P, Schwarcz H. Whole body leucine metabolism during and after resistance exercise in fed humans. Med Sci Sports Exerc. 1991;23:326–333.

35. Wagenmakers A, Coakley J, Edwards R. Metabolism of branch-chain amino acids and ammonia during exer- cise: clues from McArdle’s disease. Int J Sports Med. 1990;11:101S–113S.

36. McCleave EL, Ferguson-Stegall L, Ding Z, Doerner PG III, Wang B, Kammer LM, Ivy JL. A low carbohy- drate-protein supplement improves endurance per- formance in female athletes. J Strength Cond Res. 2011;25(4):879–888.

37. Van Loon L, Saris W, Kruijshoop M, Wagenmakers A. Maximizing post-exercise muscle glycogen synthesis: carbohydrate supplementation and the application of amino acid and protein hydrolysate mixtures. Am J Clin Nutr. 2000;72:106–111.

38. Zawadzki K, Yaspelkis B, Ivy J. Carbohydrate- protein supplement increases the rate of mus- cle glycogen storage post exercise. J Appl Physiol. 1992;72:1854–1859.

39. Detko E, O’Hara JP, Thelwall PE, Smith FE, Jakovljevic DG, King RFGJ, Trenell MI. Liver and muscle glycogen repletion using 13C magnetic resonance spectroscopy following ingestion of maltodextrin, galactose, pro- tein and amino acids. Br J Nutr. 2013;110:848–855.

40. Ivy JL, Res PT, Sprague RC, Widzer MO. Effect of a car- bohydrate-protein supplement on endurance perfor- mance during exercise of varying intensity. Int J Sport Nutr Exerc Metabol. 2003;13(3):382–395.

41. Davis JM, Bailey SP. Possible mechanisms of central nervous system fatigue during exercise. Med Sci Sports Exerc. 1997;29:45–57.

42. Blomstrand E, Hassman P, Ekblom B, Newsholme E. Administration of branched-chain amino acids dur- ing sustained exercise—effects on performance and on plasma concentration of some amino acids. Eur J Appl Physiol. 1991;63:83–88.

43. Blomstrand E, Andersson S, Hassmen P, Ekblom B, Newsholme E. Effect of branched-chained amino acid and carbohydrate supplementation on the exercise- induced change in plasma and muscle concentration

362 SECTION 2 The Practical Application of Sports Nutrition

of amino acids in human subjects. Acta Physiol Scand. 1995;153:87–96.

44. Mittleman KD, Ricci MR, Bailey SP. Branched-chain amino acids prolong exercise during heat stress in men and women. Med Sci Sports Exerc. 1998;30:83–91.

45. Van Hall G, Raaymakers SH, Saris WHM, Wagen- makers AJM. Ingestion of branched-chain amino acids and tryptophan during sustained exercise in man: failure to affect performance. J Physiol. 1995;486:789–794.

46. Pallota JA, Kennedy PJ. Response of plasma insulin and growth hormone to carbohydrate and protein feedings. Metabolism. 1968;17:901–908.

47. Spiller GA, Jenesen CD, Pattison TS, Chuck CS, Whit- tam JH, Scala J. Effect of protein dose on serum glu- cose and insulin response to sugars. Am J Clin Nutr. 1987;46:474–480.

48. Karp JR, Johnston JD, Tecklenburg S, Mickleborough T, Fly A, Stager JM. The efficacy of chocolate milk as a recovery aid. Med Sci Sports Exerc. 2004;36(5 suppl):126S, Abstract 0850.

49. Okano G, Sato Y, Murata Y. Effect of elevated blood FFA levels on endurance performance after a sin- gle high fat meal ingestion. Med Sci Sports Exerc. 1998;30(5):763–768.

50. Satabin P, Portero P, Defer G, Bricout J, Guezennec CY. Metabolic and hormonal responses to lipid and car- bohydrate diets during exercise in man. Med Sci Sports Exerc. 1987;19:218–223.

51. Galbo H, Holst JJ, Christensen NJ. The effect of different diets and of insulin on the hormonal response to prolonged exercise. Acta Physiol Scand. 1979;107:19–32.

52. Karlsson J, Saltin B. Diet, muscle glycogen and endur- ance performance. J Appl Physiol. 1971;31:203–206.

53. Helge JW, Wulff B, Kiens B. Impact of a fat-rich diet on endurance in man: role of the dietary period. Med Sci Sports Exerc. 1998;30:456–461.

54. Venkatraman JT, Pendergast D. Effects of the level of dietary fat intake and endurance exercise on plasma cytokines in runners. Med Sci Sports Exerc. 1998;30:1198–1204.

55. Helge JW, Richter EA, Kiens B. Interaction of training and diet on metabolism and endurance during exer- cise in man. J Physiol. 1996;492:293–306.

56. Decombaz J, Arnaud MJ, Milon H, et al. Energy metabo- lism of medium-chain triglycerides versus carbohy- drates during exercise. Eur J Appl Physiol. 1983;52:9–14.

57. Ivy JL, Costill DL, Fink WJ, Maglischo E. Contribution of medium and long-chain triglyceride intake to energy metabolism during prolonged exercise. Int J Sports Med. 1980;1:15–20.

58. Van Zyl CG, Lambert EV, Hawley JA, Noakes TD, Den- nis SC. Effects of medium-chain trigylceride ingestion on fuel metabolism and cycling performance. J Appl Physiol. 1996;80:2217–2225.

59. Jeukendrup AE, Thielen JJ, Wagenmakers AJ, Brouns F, Saris WH. Effect of medium-chain triacylglycerol and carbohydrate ingestion during exercise on substrate utilization and subsequent cycling performance. Am J Clin Nutr. 1998;67:397–404.

60. Williams MH. Vitamin supplementation and athletic performance. Int J Vitam Nutr Res. 1989;30(suppl):163–191.

61. Institute of Medicine. Dietary Reference Intakes for Vita- min C, Vitamin E, Selenium, and Carotenoids. Food and Nutrition Board. Washington, DC: National Acade- mies Press; 2000.

62. Takanami Y, Iwane H, Kawai Y, Shimonitsu T. Vitamin E supplementation and endurance exercise: are there benefits? Sports Med. 2000;29(2):73–83.

63. Telford RD, Sly GJ, Hahn AG, Cunningham RB, Bryant C, Smith JA. Footstrike is the major cause of hemo- lysis during running. J Appl Physiol. 2003;94(1):38–42.

64. Shaskey DJ, Green GA. Sports haematology. Sports Med. 2000;29(1):27–38.

65. Gore CJ, Bourdon PC, Woolford SM, Pederson DG. Involuntary dehydration during cricket. Int J Sports Med. 1993;14(7):387–395.

66. Meyer F, Bar-Or O, Salberg A, Passe D. Hypohydra- tion during exercise in children: effect on thirst, drink preference, and rehydration. Int J Sports Nutr. 1994;4(1):22–35.

67. Iuliano S, Naughton G, Collier G, Carlson J. Exami- nation of the self-selected fluid intake practices by junior athletes during a simulated duathlon event. Int J Sports Nutr. 1998;8:10–23.

68. Shirreffs SM, Armstrong LE, Cheuvront SN. Fluid and electrolyte needs for preparation and recovery from training and competition. J Sports Sci. 2004;22:57–63.

Additional Resources

Bergstrom J, Hermansen L, Hultman E, Saltin B. Diet, mus- cle glycogen and physical performance. Acta Physiol Scand. 1967;71:140–150.

Christensen EH, Hansen O. Work capacity and diet. Skand Arch Physiol. 1939;81:160–171.

Davis JM, Alderson NL, Welsh RS. Serotonin and central nervous system fatigue: nutritional considerations. Am J Clin Nutr. 2000;72(2 suppl):573S–578S.

Chapter 12 Endurance and Ultra-Endurance Athletes 363

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Key Questions Addressed 1. What is different about strength/power athletes?

2. What energy systems are utilized during strength/power exercise?

3. Are the calorie needs of strength/power athletes different from those of other types of athletes?

4. Are carbohydrate needs different for strength/power athletes?

5. Are protein needs different for strength/power athletes?

6. Are fat needs different for strength/power athletes?

7. Are vitamin and mineral needs different for strength/power athletes?

8. Are fluid needs different for strength/power athletes?

9. What meal-planning/event logistics need to be considered during strength/power events?

You Are the Nutrition Coach Robert is a 45-year-old competitive master’s power lifter who competes in the 181-pound weight class. He has been having trouble keeping his body weight low enough to compete in the 181- pound class and is concerned that his body fat level is actually increasing despite his heavy weight- training regimen. He has a rather sedentary office job and tries to walk about a mile every weekday evening with his wife. He states that he eats well (approximately 3500 calories per day). To help build muscle and enhance recovery, he consumes about 250 grams of protein per day from natural food sources and supplementation. He has decreased his carbohydrate intake because he has been experimenting with a low-carbohydrate diet to control his weight.

Questions • Why is Robert having trouble controlling his body weight?

• What are the most glaring concerns about his diet?

Strength/Power Athletes

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CHAPTER 13

What is different about strength/power athletes? The terms strength and power are often used interchange- ably when describing athletes. Although strength and power are important aspects of physical fitness, and strength is a compo- nent of power, they are not synonymous. Strength is the abil- ity of a muscle or group of muscles to generate force. Strength is purely a measure of how much weight can be moved or lifted by an athlete. It is highly dependent on the amount of mus- cle tissue an athlete possesses. In other words, the bigger the muscle, the greater the strength. Power, in contrast, is depen- dent not only on how much force is capable of being devel- oped by the muscles (i.e., strength), but also on how fast the force can be generated. Because velocity of move- ment is an integral part of power, power is often referred to as speed-strength. The ability to run, jump, throw, and quickly change direction are all very dependent on the ability of muscle to rapidly generate force (i.e., power). For the purposes of this chapter, strength/power athletes are those involved in the explosive track and field events (i.e., javelin, shot put, discus, high jump, long jump, hammer, sprints), weight lifting, gymnastics, and wrestling, just to name a few. In short, strength/power athletes are athletes who participate in sports in which success is dependent primarily on demonstration of brute strength or relatively short bursts (i.e., ≤ 1.5 minutes) of near maximal muscle force production.

The pure strength/power athletes are different from many other athletes in that success in their sport relies on activities of short duration; for example, any of the throws in track and field take only a few seconds to per- form. As a result, the energy needs and goals of training differ vastly from those of the endurance athlete. This chapter discusses the macro- and micronutrient needs of strength/power athletes along with issues regarding hydration and meal planning.

What energy systems are utilized during strength/power exercise? The body’s three energy systems (the phosphagen, anaerobic, and aerobic systems) are constantly working

together to meet the body’s immediate energy demands. The short, high-intensity muscle contractions required to perform strength and power sports rely heavily on the phosphagen system, with increasing contribution from the anaerobic system as the length of the activity increases (see FIGURE 13.1 ). In the case of a strength athlete performing a one-repetition maximum bench press, the actual time the athlete spends performing the lift may be only 4 seconds. The time interval is even shorter for a javelin thrower or a person performing the shot put (i.e., the left-most region of area 1 in Figure 13.1). Mus- cle stores of adenosine triphosphate (ATP) and creatine phosphate (CP) enable the muscles of these athletes to meet the immediate demands for energy and thus com- plete a successful lift or throw. On the other end of the strength/power spectrum is an athlete such as an 800- meter sprinter. These athletes derive the majority of their energy from the combined efforts of the phosphagen and anaerobic energy systems (i.e., right-most region of area 2 in Figure 13.1).

Depending on the nature of the sport, it may be nec- essary to repeat the strength/power movement numerous times. Even though the phosphagen and the anaerobic systems supply the immediate energy need, the aerobic system should not be neglected or shrugged off as unim- portant. In the case of a shot putter, aerobic metabolism is relatively unimportant because there is usually plenty of rest time between puts to recover; however, other strength/power sports require the athlete to repeatedly perform strength/power movements over a period of time with relatively short intervals of rest in between. In these cases, the aerobic system is important for supplying the energy for recovery, which, in turn, indirectly affects per- formance by delaying the onset of fatigue. An example of a sport requiring repeated, powerful bursts of muscle activity can be seen during gymnastics competitions. In competition and during training, skills requiring muscle strength and power are separated by short rest periods that occur during the event (e.g., between tumbling runs during floor exercise) or between apparatus as the ath- letes rotate from one to another. Muscle recovery and the associated recharging of the creatine and ATP stores are dependent on the aerobic system. Therefore, if strength/ power athletes neglect the development of their aero- bic system, their ability to recover will be impaired, and fatigue will ensue more quickly.

In summary, strength/power athletes rely primarily on the phosphagen energy system to provide ATP dur- ing strength/power events, with increasing contribu- tions of ATP coming from the anaerobic energy system as the duration of the activity increases. Although the aerobic energy system contributes little ATP during the actual strength/power activity, it is important for recov- ery after the activity. During the recovery period, the aer- obic energy system replenishes ATP and CP levels, thus recharging the phosphagen system and delaying the onset of fatigue.

power The ability of a muscle or group of muscles to generate force at high movement speeds. In other words, the more work performed per unit of time, the greater the power output of the muscle. Power is also known as speed-strength.

speed-strength This term is synonymous with power.

strength The ability of a muscle or group of muscles to generate force. Strength is purely a measure of how much weight can be suc- cessfully lifted by an athlete. It is highly dependent on the amount of muscle tissue an athlete pos- sesses.

Chapter 13 Strength/Power Athletes 365

Are the calorie needs of strength/power athletes different from those of other types of athletes? As with most athletes, the main dietary concern with indi- viduals involved in strength/power sports is the consump- tion of adequate amounts of total daily calories. Energy needs are based on several factors, including age, gender, body mass, and sport-specific demands, which can vary tremendously between athletes. No single macronutrient is more important than the others; thus the dietary com- position for strength/power athletes is not much differ- ent from the recommended healthy diet of nonathletes. This section will review calculating total calorie needs for strength/power athletes, and subsequent sections will focus on the roles of each of the macronutrients, micro- nutrients, and fluids.

How are daily calorie needs calculated for strength/power athletes? For strength/power athletes, similar to other athletes, there are three main considerations when determining energy needs and developing an individualized meal plan: Does the athlete want to maintain, lose, or gain weight? In the category of strength/power athletes, weight goals span an enormous continuum. On one end of the spec- trum are weight lifters who, in general, are trying to gain muscle tissue and build mass. At the other end are

Table 13.1

Resting Energy Expenditure (REE) Calculations and Activity Factors

Gender and age Equation (BW in kilograms) Activity factor

Males, 10 to 18 years REE = (17.5 × BW) + 651 1.6–2.4

Males, 18 to 30 years REE = (15.3 × BW) + 679 1.6–2.4

Males, 30 to 60 years REE = (11.6 × BW) + 879 1.6–2.4

Females, 10 to 18 years REE = (12.2 × BW) + 749 1.6–2.4

Females, 18 to 30 years REE = (14.7 × BW) + 496 1.6–2.4

Females, 30 to 60 years REE = (8.7 × BW) + 829 1.6–2.4

Source: Data from World Health Organization. Energy and Protein Requirements: Report of a Joint FAO/WHO/UNU Expert Consultation. Technical Report 724. Geneva, Switzerland: World Health Organization; 1985:206.

gymnasts who, in general, are attempting to minimize body mass while simultaneously aiming for increased strength and power. Therefore, nutrition plans need to meet the athlete’s basic nutrient requirements while also reflecting the athlete’s desires and goals.

The energy needs for strength/power athletes can be calculated using the equations and activity factors presented in TABLE 13.1 . The following examples provide real-life scenarios of strength/power athletes who want to lose, maintain, or gain weight. Each scenario reviews

Figure 13.1 Strength/power athletes rely primarily on the phosphagen and anaerobic energy systems to provide ATP. The shaded area 1 in the graph represents all-out activities that progress in length from 1 second (left margin) to 30 seconds (right margin). Area 2 involves all-out efforts that progress from 30 seconds to about 1.5 minutes. Strength/power athletes tend to perform activities that fall in areas 1 and 2. Although the aerobic energy system is not a major provider of energy for these athletes, it is important for recovery afterward. Reproduced with permission of McGraw-Hill Education LLC from Bowers RW, Fox EL. Sports Physiology, 3rd ed. Dubuque, IA: William C Brown Publishers; 1992, p. 34.

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366 SECTION 2 The Practical Application of Sports Nutrition

how to calculate energy needs and provides recommen- dations based on the athlete’s goals and objectives.

How can calorie needs be calculated for athletes aiming to lose/minimize body weight while increasing strength/power? Female gymnasts are a category of strength/power ath- letes who are generally aiming to lose weight or main- tain an already low weight. To obtain their goal, many gymnasts are eating suboptimal levels of not only total calories, but also a variety of nutrients. Several studies have examined the differential between recommended and actual calorie intake. The results are staggering— gymnasts are consuming only 47–84% of their daily calo- rie requirements!1–4 When working with female gymnasts or any other strength/power athlete whose goal is to lose weight, calculate energy needs and then compare the calculations to actual current intake before developing a meal plan and making recommendations.

Lyndsi’s Case Study Kari, the mother of an 11-year-old gymnast named

Lyndsi, calls to make an appointment with a sports nutri- tionist. Kari has grown increasingly concerned about her daughter’s eating habits and weight loss over the past sev- eral months. Lyndsi has been part of a local club team for several years that practices 2 to 3 hours a day, 5 to 6 days a week. While on summer break, the club team hosted a

2-week gymnastic camp. Lyndsi was very excited about the opportunity to train and learn from the older girls on the team, commenting to her mother several times about how she envied their performance and abilities. At the end of camp, Kari noticed gradual changes in her daugh- ter’s eating habits—Lyndsi began to turn down her favor- ite foods, and she had developed a strong aversion to any food containing fat. Lyndsi’s eating habits subsequently became very routine, consisting of a plain bagel for break- fast, an iceberg lettuce and green pepper salad with non- fat dressing for lunch, and a chicken breast, baked potato, and broccoli every night for dinner (see TRAINING TABLE 13.1 ). Lyndsi would usually have a small bowl of nonfat fro- zen yogurt or dry cereal for a snack in the evening. Kari has noticed a “drawn” look to Lyndsi’s face and that her clothes seemed to just hang loosely on her body. The point at which she knew it was time to seek professional assis- tance was when Lyndsi went to the doctor for a routine checkup, and her 5’ 3” frame weighed only 95 pounds. She is certain Lyndsi is not eating enough but is unsure of how much she should be consuming and how she can get Lyndsi back on track to “normal” eating.

Making recommendations. In this situation, Lyndsi has made some drastic changes to her diet and, as a result, noticeable weight loss has occurred. 1. The first step is to estimate her total calorie needs:

REE = (12.2 × BW in kg) + 749 = (12.2 × 43.2) + 749 = 1276

Total calorie needs = REE × Activity factor = 1276 × (1.6 – 2.4) = 2041–3062 calories/day

Training Table 13.1: Lyndsi’s Initial and Revised Meal Plans Lyndsi’s initial meal plan Lyndsi’s Revised Meal Plan

Meal/Snack Food/Beverage Calorie Content (kcal) Food/Beverage Calorie content (kcal)

Breakfast Bagel 195 Bagel 195

with 2 tbsp peanut butter 190

8 oz orange juice 112

Lunch 2 cups iceberg lettuce with 13 2 cups iceberg lettuce with 13

½ green pepper 10

½ green pepper 10 ½ tomato 13

3 tbsp fat-free French dressing 68 ½ cup mushrooms 13

3 tbsp fat-free French dressing 68

3 oz turkey sandwich 388

8 oz skim milk 85

Dinner 4 oz chicken 187 4 oz chicken 187

1 baked potato 220 1 baked potato 220

1½ cups broccoli 66 1½ cups broccoli cooked in 66

1 tbsp olive oil 119

12 oz skim milk 128

Snack 1 cup fat-free frozen yogurt 157 1 cup Total raisin bran 180

8 oz skim milk 85

Total calories = 916 Total calories = 2072

Total carbohydrates = 153 g Total carbohydrates = 290 g

Chapter 13 Strength/Power Athletes 367

Lyndsi needs at least 2041 calories per day on rest or easy days, and up to 3062 calories a day for heavy training days (3+ hours per day).

2. The second step is to estimate her calorie intake. Refer to Training Table 13.1 for Lyndsi’s initial meal plan. After making changes to her diet, she was only consuming ~900 calories a day. It is obvious that she is not meeting her energy requirements—in fact, she is only consuming 45% of her bottom-level energy needs ([916 calories/2041 calories] × 100 = 45%). One of the roles of a sports nutrition professional is to understand the client’s perspective by determining why a client eats in a certain way. In this scenario, it is critical to determine why Lyndsi made changes to her diet in order to have a better feel for her potential risk of developing an eating disorder. For this exam- ple, assume that Lyndsi is merely ignorant of how the changes she has implemented can potentially nega- tively affect her health and performance.

3. Because her calorie intake is low, she should increase her daily calories, but gradually. The sports nutrition professional should ensure that Lyndsi’s questions, concerns, and fears are addressed prior to suggesting the revised meal plan. The revised meal plan (refer to Training Table 13.1) provides adequate nutrients for growth, development, health, and performance. Even though the revised plan is at the lower end of the recommended range, it may take a couple of weeks to gradually progress her intake to the new level. The more gradual the process, the easier it will be for Lyndsi to adapt physically and mentally to the increased number of calories. Once she reaches the minimum requirement for calories, the revised meal plan can be reevaluated and adjusted accordingly.

How can calorie needs be calculated for athletes aiming to maintain body weight while increasing strength/power? Nutrition becomes a focus for some athletes who are try- ing to bring their performance “to the next level” by opti- mizing their intake of macro- and micronutrients. Often, these athletes are satisfied with their current weight but feel something is missing in their daily dietary regimen. For these athletes, energy needs should be calculated to confirm an appropriate calorie level is being consumed, and then the focus should shift to establishing balance, variety, and moderation within the diet.

Jake’s Case Study Jake is a 25-year-old 50-meter butterfly swimmer. He

swam competitively in high school and college and now trains and competes periodically with the master’s swim team at the YMCA. During high school and college, he ate “whatever he wanted” and never gained an ounce because

he was so active. He has been at the same weight (165 pounds) since graduation, and he wants to maintain that weight. He works full time, lives alone, swims 5 to 6 days a week, and volunteers as an assistant coach for a high school team. Since he has become so busy, he has been relying more on fast food (see TRAINING TABLE 13.2 ), which he recognizes has affected his swimming performance and energy lev- els (unlike the “glory days” of his high school and collegiate career). He wants to stay fit, eat healthy, increase his energy levels, and compete at several upcoming swim meets.

Making recommendations. In this scenario, Jake has realized he needs to make some changes to his diet to keep his energy levels up, to meet his nutritional needs, to avoid weight gain, and to swim at his best. 1. The first step is to calculate his energy needs:

REE = (15.3 × BW in kg) + 679 = (15.3 × 75) + 679 = 1827

Total energy needs = REE × Activity factor = 1827 × (1.6–2.0) = 2922–3654 calories/day

Because Jake is not as active as he was in high school and college, a moderate activity factor can be used (1.6–2.0 versus 1.6–2.4).

2. The next step is to evaluate the adequacy of his cur- rent intake by analyzing a food record. An excerpt from Jake’s food record is listed in Training Table 13.2. As noted by the nutrition analysis, Jake is consum- ing an appropriate number of total calories; however, he is eating 37% of his calories from fat. Therefore, dietary recommendations for Jake should focus on substituting some of the high-fat foods with lower- fat, more nutrient-dense options.

3. Jake maintains a busy schedule, so meal planning needs to be simple and easy to follow. By making a few adjustments to his food choices, keeping meal preparation to a minimum, and taking time to plan ahead, Jake’s revised meal plan will help him main- tain his weight while also rebalancing his daily mac- ronutrient intake. See Training Table 13.2 for Jake’s revised meal plan.

How can calorie needs be calculated for athletes aiming to gain muscle mass to increase strength/ power? Strength/power athletes who are aiming to gain weight need to consume extra calories each day to support basic energy needs, the energy demands of daily training, and the nutrient support for tissue growth and development. The success of a plan for weight gain depends on both the quality and quantity of the diet as well as an appropriate strength training and conditioning program. It is essential that these two components go hand in hand; if increases in training are not accompanied by extra calories, muscle mass can potentially be used as an energy source, result- ing in weight loss, and if extra calories are consumed without the physical challenge of training, extra calories will most likely contribute to larger fat stores.

368 SECTION 2 The Practical Application of Sports Nutrition

Tissue growth of approximately 1 pound requires approximately 5–8 calories per gram.5,6 Because 1 pound of muscle weighs 454 grams, a reasonable estimate of total calories needed to produce 1 pound of muscle is a range of 2300–3600 calories. In general, no more than 1–2 pounds of weight gain is recommended per week. There- fore, an athlete would need to consume approximately 300–500 additional calories per day for a 1-pound lean weight gain per week, or 600–1000 additional calories for a 2-pound lean weight gain per week, assuming all calories are used for muscle construction. However, this assump- tion cannot always be made. Although increasing daily calories is an effective way to gain weight, researchers have found that only 30–40% of the weight gain is in the form of lean mass when study participants are consum- ing an extra 500–2000 calories per day.7 It seems reason- able to assume that the more dramatic the increase in daily calorie consumption, the greater the percentage of gained weight will be in the form of fat. The body can construct only a finite amount of muscle tissue daily; above that level, extra calories are stored as adipose tis- sue. Therefore, strength/power athletes should aim for a

modest increase in daily calorie consumption (300–500 calories/day) and be patient with gradual weight gain.

The extra calories needed for a 1-pound weight gain can be easily obtained by consuming a snack such as:

• 2 tablespoons of peanut butter on one slice of thick bread with 1 cup of milk = 370 calories

• A 6-ounce yogurt with ¼ cup of dry oatmeal and ¼ cup of mixed nuts = 310 calories

• A can of tuna with 4–6 crackers and a banana = 395 calories For individuals needing 600–1000 calories, portion

sizes should be increased at each meal and at least one or two snacks included throughout the day, such as:

• Any of the preceding snacks • A smoothie made with 12 ounces of milk, 1 cup

of frozen fruit, and a scoop of protein powder = 470 calories

• 4–6 ounces of turkey in a whole wheat pita with let- tuce and tomato = 410 calories

• A canned nutrition drink or a large energy bar (no more than one supplement item per day—focus heav- ily on whole foods) = 255–360 calories

Training Table 13.2: Jake’s Initial and Revised Meal Plans Jake’s Initial Meal Plan Jake’s Revised Meal Plan

Meal/Snack Food/Beverage Calorie content (kcal) Food/Beverage Calorie content (kcal)

Breakfast 2 pieces wheat toast with butter 245 2 pieces wheat toast 160

8 oz cranberry juice cocktail 144 with 2 tbsp peanut butter 190

16 oz 100% cranberry juice blend

265

½ cup Egg Beaters, scrambled

with 2 tbsp shredded cheddar cheese

Snack Granola bar 180 2 Granola bars 360

Lunch 2 McDonald’s cheeseburgers 640 1 McDonald’s cheeseburger 320

Small french fries 210 McDonald’s garden salad 35

12 oz Diet Coke 2 with 1 pkt of fat-free dressing

16 oz skim milk 170

Banana 108

Snack Banana 108 Orange 62

Dinner 12” Tombstone pizza 1550 2 cups instant brown rice 433

16 oz 2% milk 242 6 oz stir-fry chicken 281

2–3 cups stir-fry vegetables 98

cooked in 2 tbsp olive oil 239

16 oz skim milk 171

Snack 1 cup low-fat yogurt 258

Apple 60

Total calories = 3321 Total calories = 3377

37% of calories from fat 25% of calories from fat

Total carbohydrates = 381 g Total carbohydrates = 468 g

Chapter 13 Strength/Power Athletes 369

Leo’s Case Study Leo is a 45-year-old recreational cyclist and weight

lifter. He commutes to work on his bike daily and goes to the gym 4 to 5 days per week for weight-lifting ses- sions. His goal is to gain 5–10 pounds of muscle mass (cur- rent weight, 170 pounds), but he is having a hard time gaining any weight. He follows a well- balanced strength- training program and changes his routine every 6 to 8 weeks. He is cur- rently eating three

Gaining the Performance Edge

Strength/power athletes must be provided with a sufficient amount of calories per day to meet energy needs or performance will suffer. Total energy requirements should be calculated on an individual basis and modified according to the ath- lete’s goals and objectives. Take into consideration an athlete’s current intake before making final recom- mendations to avoid drastic and unrealistic changes.

Training Table 13.3: Leo’s Initial and Revised Meal Plans Leo’s initial meal plan Leo’s revised meal plan

Meal/Snack Food/Beverage Calorie Content (kcal) Food/Beverage Calorie Content (kcal)

Breakfast Smoothie: Smoothie:

16 oz skim milk 171 16 oz skim milk 171

½ cup nonfat yogurt 78 ½ cup nonfat yogurt 78

Banana 108 Banana 108

½ cup protein powder 180 1 packet instant breakfast mix 130

2-egg cheese omelet 284 2 small blueberry muffins 316

Snack 8 pretzel twists 183

Lunch Two 4–5 oz ham sandwiches 691 Two 4–5 oz ham sandwiches 691

Apple 81 16 oz apple juice 233

1½ cups melon balls 86 1½ cups melon balls 86

16 oz skim milk 171 16 oz skim milk 171

Snack 2 cups carrots 104 2 cups carrots 104

with 2 tbsp fat-free dressing 50 with 2 tbsp fat-free dressing 50

Pear 98 5 oz tuna 181

5 oz tuna 181

Dinner 6 oz pork chops 408 6 oz pork chops 408

1½ cups mashed potatoes 332 1½ cups mashed potatoes 332

3–4 cups salad with veggies 93 3–4 cups salad with veggies 93

3 tbsp oil/vinegar dressing 240 2 tbsp oil/vinegar dressing 121

16 oz skim milk 171 2 dinner rolls 205

16 oz skim milk 171

Snack 3 oatmeal cookies 240

8 oz skim milk 85

Total calories = 3527 Total calories = 4157

Total carbohydrates = 399 g Total carbohydrates = 612 g

meals a day and sometimes a snack. He wants to gain weight in a healthy way and not rely on candy bars and chocolate shakes to add calories to his diet. However, when he increases his intake through fruits and vegeta- bles, he experiences some gastrointestinal bloating and discomfort. He is frustrated about his inability to gain weight and is looking for advice from a professional.

Making recommendations. Leo’s complaints are com- mon among strength/power athletes—he has attempted to gain weight with little to no success. Fortunately, he is dedicated to a healthy diet by focusing not only on weight gain, but also on long-term health. However, in his attempts to add more food to his normal regimen, he has chosen the two food groups with the lowest calo- rie density—fruits and vegetables. Although whole fruits and vegetables are certainly an important part of his over- all diet, they may be contributing to his sense of fullness and discomfort, ultimately discouraging him from eating enough food to increase his total calorie intake. 1. The first step is to determine how much he is cur-

rently consuming. TRAINING TABLE 13.3 shows a typical

370 SECTION 2 The Practical Application of Sports Nutrition

power athletes add the element of repeated high-inten- sity bursts of effort throughout a typi- cal training session. This factor mandates the need for energy sources that are eas- ily digestible to avoid gastrointestinal dis- comfort. Sports bev- erages are an ideal

day for Leo. An analysis of his current intake reveals a total calorie consumption of 3527 calories. There- fore, it is obvious that he needs to eat more than 3527 calories a day to make any progress in gaining weight.

2. The next step is to calculate total energy needs based on his age and activity level. Using the formulas stated in Table 13.1, his total daily energy needs are:

REE = (11.6 × BW in kg) + 879 = (11.6 × 77.3) + 879 = 1775 Total calorie needs = REE × Activity factor = 1775 × (1.6 – 2.4) = 2840–4260 calories/day

Because he is currently consuming ~3500 calories and he is not gaining weight, the lower end of the spectrum can be eliminated. For him to gain weight gradually, he will need to consume approximately 3800–4200 calories per day. This range would provide additional calories above his current intake, while staying within the calculated estimate.

3. Leo should be congratulated on adding fruits and veg- etables to his diet. However, consuming more nutri- tious and calorie-dense foods should be the focus of his weight gain efforts. Foods that provide excellent nutrition and extra calories include items such as fruit juices, dried fruits, avocados, olives, thick breads, nuts , seeds, yogurt, instant breakfast mixes, and fruit/milk smoothies. See

TABLE 13.2 for more ideas on how athletes can gain weight in a healthy way by eating nutrient- and calorie-dense foods. Leo should maintain balance in his diet by eating items from every food group of the MyPlate food guidance system. Discourage Leo from focusing on one type of macronutrient or food group as the sole source of added calories. Balance, variety, and moderation are still his keys to success. Refer to Training Table 13.3 for Leo’s revised meal plan, which provides 4157 calo- ries per day.

How are calorie needs calculated during strength/power training and competition? Energy needs for strength/power athletes can vary greatly between a training session and a competitive event. Training sessions can last several hours, whereas perfor- mance at a competition may last only seconds or min- utes. Therefore, these two scenarios should be addressed differently.

Similar to endurance athletes, consuming appropriate amounts of energy, mainly in the form of carbohydrates, during training sessions will help to delay fatigue. Carbo- hydrate intake of 30–60 grams per hour is appropriate, pro- viding approximately 120–240 calories per hour. Strength/

Table 13.2

Gaining Weight the Healthy Way Through Nutrient- and Calorie-Dense Foods

Foods Nutrient- and calorie-dense options

Grains Oatmeal, Cream of Wheat Brown rice, quinoa Thick, dense breads Bagels Wheat germ Muffins Cornbread Quick breads (e.g., banana bread)

Fruits 100% fruit juice Dried fruit Pineapple Bananas

Vegetables Potatoes Corn Peas Squash Beets Avocados Olives

Dairy (milk alternatives) Nonfat powdered milk Cottage cheese Instant breakfast mixes Fruited yogurts Canned shakes (e.g., Ensure)

Protein foods (meat alternatives)

Beans (e.g., pinto, black, kidney), lentils Split peas Nuts and nut butters Seeds Meats

Desserts Puddings Hot cocoa made with milk Oatmeal raisin cookies Fig bars Milk shakes made with low-fat dairy products

Food for Thought 13.1

Considerations for Gaining Weight

In this exercise, you will identify the components necessary for eliciting weight gain.

Gaining the Performance Edge

A majority of required calories for strength/power activities should be consumed before or after exercise sessions to avoid gastrointestinal upset and the subsequent inter- ference with training. Consuming sports beverages throughout a prac- tice or eating a light snack during a break will provide the energy needed to fuel high-intensity performance.

Chapter 13 Strength/Power Athletes 371

source of calories and are generally well tolerated even during high-intensity exercise. The consumption of solid food should be reserved for during breaks or at the end of a training session.

For some strength/power athletes, competition day consists of only one event that lasts less than a few min- utes. In these situ- ations, it is neither practical nor nec- essary to consume calories during the event. The body will not deplete its energy reserves in such a short burst of effort, and therefore imme- diate replenish- ment is not critical to performance. The exception to this rule is when an athlete is competing in multiple events at the same meet within one day. In this situation, the length of the meet can last several hours, with a small, but progres- sive, depletion of energy stores with each event. There- fore, to sustain a high level of performance throughout the day, an athlete should plan on consuming easy-to-digest snacks, beverages, and possibly small meals in between events to keep energy levels elevated. The quantity of food consumed will depend on several factors, including time between events, length of each event, time elapsed since the last full meal, and personal preferences.

Are carbohydrate needs different for strength/power athletes? Consuming enough carbohydrates on a daily basis is crit- ical for optimal strength/power performance. Because many strength/power sports rely on anaerobic metab- olism, carbohydrates are the main fuel for these short, high-intensity bursts of energy. Anaerobic metabolism taps into glycogen stores for energy during an activity; therefore, if glycogen stores are depleted, performance will suffer.

Similar to endurance exercise, strength/power exer- cise can deplete muscle glycogen, although not to the same degree. Several studies have examined the glyco- gen-depleting effects of strength training. Tesch and col- leagues8 found a 25% decline in muscle glycogen stores after subjects performed 5 sets of 4 different leg exercises for 6 to 12 repetitions each. Other protocols involving 5 to 6 sets of 6 to 12 repetitions at 35–70% of maximal strength produced a similar reduction in glycogen stores.9,10 There- fore, it has been suggested that the ingestion of higher carbohydrate diets will improve performance through higher initial glycogen levels. Several studies have sup- ported this recommendation after examining the effects

of a high-versus low-carbohydrate diet prior to perform- ing a single bout, as well as intermittent, high-intensity activities.11–14 Strength/power athletes should strive for a moderate to high intake of carbohydrates daily to have fully loaded glycogen stores before training sessions and competitive events.

A possible exception to the rule of glycogen stores making an impact on strength/power performance is dur- ing a single sprint effort. During one sprint of about 400 meters or less, the quantity of muscle glycogen stored in the muscle is not necessarily the limiting factor in perfor- mance.15 Carbohydrates are still the main source of fuel; however, because of the short duration of the effort, gly- cogen stores will not be depleted by one burst of sprint- ing. Therefore, carbohydrate loading for one sprint is not as critical as it would be before a training session or other repeated high-intensity exercise bout. Sprint- ers may train intensely several times per week, including repeated sprints per workout, so moderate carbohydrate consumption on a daily basis is a sound dietary practice.

In addition to fueling activity, carbohydrate intake can play an indirect role in building muscle mass. Carbohy- drate ingestion stimulates the secretion of insulin. Insulin is considered an ana- bolic hormone, driv- ing nutrients into the cells for the growth and development of tissues as well as preventing normal postexercise muscle protein breakdown.16,17 Consuming adequate amounts of carbohydrates, as well as ensuring that total energy and protein needs are met, will support muscle growth in response to the demands of an appro- priate strength training and conditioning program.

How are daily carbohydrate needs calculated for strength/power athletes? Many strength/power athletes will train intensely three to five times per week; without sufficient dietary car- bohydrate intake, this could lead to glycogen depletion and decreased performance. An intake of 6–10 grams of carbohydrates per kilogram of body weight per day has been shown to replenish glycogen stores after daily train- ing sessions.18 However, based on an athlete’s training regimen, carbohydrate recommendations might range from 3–10 grams per kilogram of body weight.81 Carbo- hydrate intake should contribute approximately 55–65% of total calorie intake. This percentage can also be used to estimate carbohydrate needs based on total calorie requirements.

Estimated carbohydrate needs should be compared to total estimated energy requirements to verify that carbo- hydrate recommendations fall near the range of 55–65% of total calories. Building on the scenarios described in the last section regarding Lyndsi, Jake, and Leo, the following

anabolic A metabolic process or activity that results in tissue repair or growth. An anabolic hormone or substance is one that stimulates anabolism.

Gaining the Performance Edge

To meet calorie needs, strength/ power athletes should focus on consuming calorie-containing bev- erages and easily digestible snacks during training sessions and half-or full-day competitive meets. How- ever, during single-bout events it is neither practical nor necessary to consume any food or beverage.

372 SECTION 2 The Practical Application of Sports Nutrition

examples demonstrate the importance of fine-tuning car- bohydrate recommendations for every athlete:

• Lyndsi, the gymnast, requires 259–432 grams of car- bohydrates daily based on the 6–10 grams of carbohy- drates per kilogram of body weight recommendation (95 lbs ÷ 2.2 = 43.2 kg; 43.2 kg × 6–10 g/kg = 259–432 g). Lyndsi’s initial meal plan analysis revealed that she was consuming 66% of her total calories from car- bohydrates. Although this percentage sounds appro- priate, the absolute value of her carbohydrate intake was only 153 grams, which is only 59% of the low end of her recommended carbohydrate intake range. In addition, Lyndsi’s absolute carbohydrate intake is only slightly higher than the RDA for carbohydrates (130 grams) for adults and children based on the aver- age minimum amount of glucose utilized by the brain daily.19 In Lyndsi’s revised meal plan, the percentage of calories from carbohydrates decreased to 56%; however, the absolute value of her intake increased to 290 grams. This number is within the 259–432 recom- mended range and represents an 89% increase from her previous carbohydrate consumption.

• Jake, the swimmer, requires 450–750 grams of carbo- hydrates daily based on the 6–10 grams of carbohy- drates per kilogram of body weight recommendation (165 lbs ÷ 2.2 = 75 kg; 75 kg × 6–10 g/kg = 450–750 g). In this case, 450 grams of carbohydrates contribute 1800 calories (450 g carbohydrates × 4 calories/g car- bohydrates = 1800 calories). This quantity of carbohy- drates represents 62% of 2922 calories (the low end of his recommended calorie range) and 49% of 3654 calories (the high end of his recommended calorie range). Clearly, 450 grams of carbohydrates would be appro- priate for a calo- rie intake at the low but not the high end of his recommended range; there- fore, it is more appropriate to estimate his car- bohydrate needs through a per- centage of total calories. For example, 55–65% of Jake’s high-end calorie range (i.e., 3654 calories) equals:

([0.55–0.65] × 3654 calories)/ 4 calories per gram of car- bohydrates = 502–594 grams of carbohydrates daily

For Jake, estimating an appropriate amount of carbohydrates varies greatly depending on his total calorie intake. Therefore, a final carbohydrate recom- mendation for Jake is 450–594 grams of carbohydrates

per day. Jake’s revised meal plan provides 468 grams of carbohydrates, thus meeting his daily needs.

• Leo, the weight lifter, requires 464–773 grams of car- bohydrates daily based on the 6–10 grams of carbohy- drates per kilogram of body weight recommendation (170 lbs ÷ 2.2 = 77.3 kg; 77.3 kg × 6–10 g/kg = 464–773 g). Because Leo is attempting to gain weight and thus has higher calorie needs, the estimated carbohydrate intake based on body weight should be checked using the percent total calories method. By comparing the body weight recommendation range of 464–773 grams of carbohydrate to that of the percentage of total calories range (i.e., 522–682 grams), it is apparent an adjustment is needed for his minimum intake recommendation. In this case, the minimum value of the body weight recommendation range (i.e., 6 grams per kilogram of body weight, or 464 grams) is too low because it accounts for less than 55% of total calories. As a result, adjusting the min- imum recommendation to 522 grams is warranted. If you convert the 522 grams of carbohydrate into a gram per kilogram body weight recommendation, it would be 6.8 grams per kilogram of body weight (i.e., 522 g/77.3 kg = 6.8 g/kg). Leo’s initial meal plan was providing only 399 grams of carbohydrates per day. The revised meal plan increased his intake 53% to a total of 612 grams of carbohydrates per day. Keep in mind that these scenarios provide only three

examples of individual athlete needs. Most of these cases suggest 55–65% of total calories from carbohydrates; however, this recommendation can be raised or lowered based on the volume of training a strength/power athlete engages in daily. None of these cases recommended car- bohydrate intakes at the high end of the range—10 grams of carbohydrates per kilogram of body weight. This does not mean that 10 grams of carbohydrates per kilogram of body weight is not appropriate in some situations. Evalu- ate each athlete individually, compare estimations to cur- rent intake, and then make recommendations based on the athlete’s goals and training schedule. FIGURE 13.2 com- pares the individual carbohydrate and energy needs of the three athletes discussed here. Each of these athletes has different energy and carbohydrate needs based on his or her body weight, gender, and strength-training program.

Are carbohydrates needed before and during training and competition? The performance effects of carbohydrate ingestion imme- diately prior to and during strength/power sports are unclear. The limited research available presents evidence to support a variety of benefits and potential drawbacks. Thus, trade-offs exist, requiring recommendations and nutrition plans to be individualized based on the goals and objectives of the athlete and a consideration of the specific activity to be performed.

Gaining the Performance Edge

Carbohydrates are the master fuel for strength/power sports. Con- suming adequate amounts of car- bohydrates on a daily basis ensures glycogen stores will be sufficient to support high-intensity training and competition. Carbohydrates also act as a support crew for the construc- tion of muscle mass in response to resistance training.

Chapter 13 Strength/Power Athletes 373

Although engaging in strength/power sports gener- ally does not cause a reduction in blood glucose levels during a workout, a considerable glycogenolytic effect has been observed during either intermittent, high-intensity exercise or strength-training-type activities.8,10,20,21 If depletion of glycogen occurs, then performance suffers as a result of fatigue, and over the long term the athlete can experience muscle loss. Therefore, it appears prudent to consume carbohydrates before and also during strength/ power exercise.

A general recommendation for preactivity eating is to consume a carbohydrate-rich meal approximately 1 to 4 hours prior to the initiation of exercise. The provision of carbohydrates helps to top off the body’s glycogen stores prior to training or competition. Many athletes find that the consumption of carbohydrates before a hard train- ing session allows them to complete a tough workout without feeling fatigued prematurely. Therefore, athletes push themselves harder and gain more benefit from the workout. Furthermore, recent research has suggested that the provision of carbohydrates, as well as amino acids, prevents muscle breakdown during intense exercise, potentially leading to a maintenance or enhancement of muscle mass.17

Additional benefit has been observed when athletes supplement the preactivity meal with a supply of carbo- hydrates during the workout or competition, typically in the form of a beverage or liquid supplement. Especially for long training sessions, consuming carbohydrates peri- odically during exercise sustains energy levels and work output for longer periods of time.22,23 In a well-designed study, Haff et al.22 aimed to determine the performance effects of carbohydrate supplementation on the ability to perform resistance exercise during a second training session on the same day. Subjects performed a glycogen- depleting session of resistance training in the morning (15 sets of various lower body exercises) and then returned

to the gym 4 hours later to squat to exhaustion. The car- bohydrate-supplemented group outperformed the pla- cebo group by successfully completing a greater number of sets and repetitions. Although higher energy levels and greater strength/power outputs during a training session because of carbohydrate intake sounds like a “no-brainer,” not all research findings have yielded similar results.24,25 In fact, some athletes, coaches, and researchers are sug- gesting the exact opposite nutrition practice—avoiding carbohydrates before and during training.

This school of thought exists mainly in the world of weight lifting and body building. It is based on the prem- ise that a steady stream of carbohydrates into the blood- stream will prevent the body from tapping into other energy sources, specifically fat stores. Therefore, the rec- ommendation is to avoid eating carbohydrate-rich foods 1 to 4 hours prior to exercise. In fact, most recommend not consuming any food before a workout. The second half of the recom- mendation includes the avoidance of car- bohydrate beverages, supplements, and food during a work- out. Although this practice will cause the body to turn to fats (adipose tissue and intramuscular fats) for energy, it is well known that when glycogen and blood glucose levels begin to run low, the athlete will begin to tire, perception of effort increases, and

Gaining the Performance Edge

Trade-offs exists in the “to eat” or “not to eat” schools of thought regarding consuming carbohydrates before and during strength/power sports. Currently, most research suggests that supplying the body with car- bohydrates before and during exer- cise will lead to greater gains in strength/power performance. Ath- letes should try both methods and determine which recommendation is ideal in helping the athlete reach his or her goals and performance potential.

Figure 13.2 Lyndsi, Jake, and Leo have different energy and carbohydrate needs based on their size, sport, and training level. © Guryanov Andrey/Shutterstock © Photos.com © Photodisc

374 SECTION 2 The Practical Application of Sports Nutrition

performance levels can plunge. However, not all athletes experience extreme fatigue, particularly if their diet is adequate at other times of the day when following this practice; therefore, the final recommendation will be based on individual preference and tolerance. If an ath- lete chooses to avoid consuming food before and during a strength/power workout, a strong emphasis should be placed on consuming the required number of daily calo- ries throughout the rest of the day. Obviously, this car- bohydrate avoidance scenario is best implemented with early morning workout sessions to prevent the disruption of regular meal times throughout the day.

The final recommendation should be based on an athlete’s preference for carbohydrate consumption, the effects on performance, and the safety of the athlete. Some athletes feel they perform better on an empty stom- ach, whereas others become hungry, distracting them from performing well. In terms of safety, if blood glucose levels run too low, athletes can pass out and injure them- selves, especially during an activity such as weight lift- ing. Athletes should test both methods during practice sessions and determine which recommendation leads to improved performance, increased strength/power, overall safety of the athlete, and a feeling of well-being that they are meeting their goals. At the same time, researchers will continue to examine the effects of macronutrients on strength/power performance and eventually determine specific nutritional guidelines.

Are carbohydrates needed for recovery from strength/power activities? Similar to endurance sports, strength/power activities can deplete glycogen stores, requiring carbohydrate consump- tion after exercise. Complete replenishment of glycogen stores can take as little as 4 to 6 hours and up to 24 to 48 hours depending on exogenous carbohydrate availability. It is in the athlete’s best interest to consume carbohy- drates immediately following exercise as well as through- out the day at regular meals and snacks.

Athletes should focus on the timing and quantity of carbohydrates consumed after exercise. A source of car- bohydrates should be eaten as soon as possible—ideally within 15 to 30 minutes—after the cessation of exercise. This will ensure that the carbohydrates are digested and delivered to muscles in the window of time in which the muscles are most receptive to absorbing and storing car- bohydrates as glycogen for the next training session. Ide- ally, athletes should ingest 1.0–1.2 grams per kilogram of body weight every hour for 4 hours postexercise.81 Con- suming enough carbohydrates is more important than the exact type of carbohydrates. Fruits, vegetables, juices, whole grains, low-fat milk, and dairy products are some of the best choices to supply carbohydrates.

Although the provision of carbohydrates after high- intensity exercise is critical for glycogen replenishment, it has also been suggested that it plays a role in muscle adaptation after intense training. However, carbohydrates

cannot act alone in this role; muscle protein synthesis will be much greater when a combination of carbohy- drates and protein is consumed immediately after exer- cise.26 The quantity and timing of this macronutrient combination for muscle growth and development will be addressed in the upcoming sections on protein needs for strength/power athletes.

Carbohydrates may be important not only for the replenishment of glycogen stores and muscle construc- tion but also for the attenuation of immunosuppression observed after exercise. Many studies have reported that high-intensity exercise suppresses immune function temporarily after exercise.27–30 It has been suggested that ingestion of carbohydrates before, during, and/or after exercise may minimize the immune function changes in athletes, leading to less risk of illness.30–34 Many of the studies related to immunosuppression have been con- ducted with endurance athletes. However, Chan et al.31 researched the effects on immune function of carbohy- drate consumption before and after resistive exercises. Subjects consumed a low-carbohydrate meal 2 hours prior to the strength-training session. Ten minutes prior to exer- cise and 10 minutes after exercise, subjects drank either a carbohydrate supplement beverage (one trial) or pla- cebo (second trial). The researchers reported that carbohy- drate ingestion minimized the decrease in interleukin-2 and interleukin-5 (an indication of greater immune func- tion as compared to controls) after exer- cise. More research is needed in this area to verify these results. However, car- bohydrate consump- tion after strength/ power exercise is important for glyco- gen resynthesis and muscle construc- tion regardless of its effect on the immune system. If research does reveal that carbohydrate consumption surrounding high-intensity, short-duration exercise has a positive effect on immune function, it will be a bonus benefit to an already solid nutrition practice.

Are protein needs different for strength/ power athletes? The high intensities that strength/power athletes train at on a daily basis challenge the body and skeletal muscle. This “challenge” creates microscopic tears in muscle tis- sue, which are the stimuli for subsequent tissue repair and rebuilding. Amino acids, either synthesized by the body or obtained from the digestion and breakdown of dietary protein, are the building blocks for muscle repair

Gaining the Performance Edge

Carbohydrates are the master fuel for strength/power athletes. Each athlete should experiment with different quantities of foods and beverages to determine his or her individual “ideal” plan for before, during, and after exercise.

Chapter 13 Strength/Power Athletes 375

and rebuilding. Because of this function, protein has long been a major dietary focus for strength/power athletes. The mantra has typically been “the more protein, the better.” Although strength/power athletes do have higher protein needs than their sedentary counterparts, an over- dose of protein intake on a daily basis is not ergogenically beneficial.

How are daily protein needs calculated for strength/power athletes? Strength/power athletes have an increased requirement for dietary protein. Muscle tissue goes through a process of self-repair on a daily basis, and therefore, sufficient amounts of high-quality protein sources need to be con- sumed at every meal. Dietary proteins are digested and broken down into amino acids, which the body then uses for building blocks for all bodily tissues. Insufficient pro- tein intakes will lead to suboptimal improvements in muscle development, low energy levels, and poor perfor- mance. However, excessive protein intakes can also lead to adverse effects on performance, body composition, and overall health. Strength/power athletes need to find the right balance between these two extremes. In addition to the total protein intake, the variety of protein sources ingested is also of importance.

How do you determine the “optimal” daily dose of protein for strength/power athletes? The true “optimal” quantity of daily protein intake for strength/power athletes has been debated over the years. A few articles have reported that active individuals become more efficient at using protein on a daily basis, and therefore protein needs actually decline rather than increase in athletes.26,35 However, a majority of the cur- rent research points to protein needs in the other direc- tion, at the higher end of the scale. Some researchers suggest a range of 1.4–1.7 grams of protein daily per kilo- gram of body weight is appropriate,36 whereas others rec- ommend a higher upper limit of 2.0 grams of protein per kilogram of body weight.37,81 Magazines, coaches, prac- titioners, and athletes often push the upper limit even higher, to levels greater than 2.5–3.0 grams per kilogram of body weight. The bottom line is that strength/power athletes do have increased protein needs; however, there is a limit to the amount of protein that can be used effec- tively and ingested without adverse effects.

Since the early 1980s, studies have revealed that dietary protein plays an integral role in muscle growth and development. Although all the parameters affect- ing muscle protein synthesis have not been identified, a few factors such as increased insulin levels and availabil- ity of amino acids are obvious. A decline in intracellular amino acid concentration will inhibit protein synthe- sis. Strength/power exercise has been shown to elicit a decrease in amino acid concentrations.38,39 Therefore, it seems to follow that the ingestion of protein or amino

acids would prevent this decline and, in turn, stimulate protein synthesis. In fact, studies have shown that the consumption of dietary proteins, which increases endoge- nous amino acid availability, can stimulate an increase in muscle protein synthesis by 30–100%.26,40 Muscle growth and development are largely caused by an enhanced pro- tein synthesis, versus a decreased muscle breakdown.41 Therefore, daily and particularly pre- and postworkout provision of amino acids is of utmost importance in maxi- mizing muscle building.

Because of the essential role of protein and amino acids in the growth and development of muscle tissue, a common misconception is that by increasing protein intake, an athlete can increase muscle mass. As stated in the previous paragraphs, there is no doubt that protein is critical for muscle growth. However, once an athlete has reached the peak of protein assimilation, additional pro- tein will not be used to create even more muscle tissue. Physical training is the strongest stimulus for signaling the muscles to grow and develop. Proper nutrition acts as a support network to the training stimulus; however, it does not necessarily initiate a further stimulus when con- sumed in quantities that significantly surpass physical requirements. To increase muscle mass, the equation is simple: Train hard and eat well, but do neither in excess.

Similar to carbohydrates and fat, athletic performance and overall health can suffer if too much protein is ingested and macronutrient balance goes astray. Excessive daily protein intake is generally considered to be greater than 2.0 grams of protein per kilogram of body weight (except in cases of injury rehabilitation). At intakes above this level, protein is either used for fuel or converted and stored as fat. Second, increased protein digestion and breakdown result in greater urea production, thus causing more fluid to be excreted from the body to flush out the toxic urea, poten- tially leading to dehydration. Third, if calories remain sta- ble and protein intake increases, carbohydrate intake and glycogen replenishment generally suffer, ultimately affect- ing workouts. Finally, high-protein foods, especially animal products, tend to be high in fat, saturated fat, and cho- lesterol, all of which can negatively affect cardiovascular health. As with most nutrients, more is not always better.

How do you determine the “optimal” food sources of protein? In the world of strength/power athletes, “high-quality” and “complete” proteins receive the most attention. Although the quality of a protein is certainly important, true success is achieved with variety. It should be noted that the term incomplete protein often is misinterpreted as meaning “inadequate” or “useless” for strength/power athletes. This interpretation is erroneous and misleading. The bottom line is that all sources of protein are valuable for the strength/power athlete. To maximize the benefits of dietary protein, consider putting into practice the tips outlined in TRAINING TABLE 13.4 .

376 SECTION 2 The Practical Application of Sports Nutrition

muscle. It appears that glutamine not only prevents mus- cle catabolism, but several studies have reported that glu- tamine also is critical for protein synthesis within skeletal mus- cle.45,46 Although the current research appears promising, the long-term effects of glutamine supplementation on protein synthesis and body composi- tion have yet to be confirmed. As a result, more research is needed before conclusions can be drawn and recom- mendations made for glutamine supplementation.

The branched chain amino acids (BCAAs), particu- larly leucine, have been suggested to be positive regula- tors of muscle protein synthesis.47 However, the research on the effects of the BCAAs on exercise performance is still in its infancy. The exact actions of these amino acids before, during, and after exercise and the subsequent requirements and recommendations for intake are yet to be elucidated.

The increased secretion of growth hormone is at the center of many amino acid supple- ment claims; how- ever, study results have shown mixed conclusions. For example, Suminski et al.48 reported that 1500 milligrams of arginine and 1500 milligrams of lysine consumed at rest increased growth hormone levels 60 minutes after ingestion. However, the same quantity of amino acids provided immediately prior to weight lifting did not alter circulating growth hormone levels in males while exercising. Amino acids and their respective influence on insulin, testosterone, and cortisol have also been highlighted as potential factors in protein metabolism and synthesis. Once again, more research is needed to ascertain the connections and interactions of amino acid ingestion and hormonal responses and the subsequent effects on protein metabolism and muscle protein synthesis.

Is protein needed before and during training sessions and competitions? The benefits of consuming protein before strength/ power sports have recently received more attention in the research. Most of the studies have explored not only the effects of protein, but also the combination effect of carbohydrates and protein on muscle synthesis, catabo- lism, and performance. The influence of ingesting protein during training or competition on strength/power per- formance has received minimal attention, and therefore the relationship between these two factors is still under investigation.

Until recently, many of the recommendations related to nutrition and muscle building have focused on the recovery period. Although the 1 to 4 hours after exercise

catabolism A metabolic process or activity that results in tissue breakdown or destruction.

growth hormone A hormone produced by the pituitary gland that results in the growth of many different tissues in the body, including skeletal muscle.

Do individual amino acids have an ergogenic effect on muscle growth and development? The ingestion of specific amino acids or groups of amino acids has been purported to enhance muscle strength and development. It has been suggested that amino acids can influence muscle strength and development through the initiation of protein synthesis and/or increase the secre- tion of various anabolic hormones. The current research provides some insight into the action of various amino acids, but more research is needed to make firm conclu- sions and subsequent dietary recommendations.

Glutamine is one of the most popular amino acid sup- plement products on the market because of its touted “anticatabolic” effects in regard to skeletal muscle. It is the most abundant amino acid found in blood plasma and skeletal muscle42 and accounts for more than 60% of the total intramuscular free amino acid pool.43 However, glu- tamine is in high demand by other tissues of the body. For example, glutamine is needed by the cells of the gastro- intestinal system to support their continual high protein synthesis rates. Glutamine is also used as a fuel source for cells of the immune system and hair follicles.43,44 As a result, if glutamine levels are not sufficient to meet the body’s total needs, particularly during periods of high stress such as intense training, then glutamine is taken and/or synthesized from amino acids present in skeletal

Training Table 13.4: Tips for Maximizing the Benefits of Dietary Protein for Strength/Power Athletes

• Consume enough total calories to meet energy needs. If calorie intake declines, a higher percentage of ingested protein will be used for energy versus for muscle building and repair.

• Consume a level of protein that falls within 1.4–2.0 grams of protein per kilogram of body weight. This level of protein generally contributes 15–20% of total calories. Athletes should ensure that plenty of carbohydrates and at least minimum amounts of fat are also ingested daily.

• Include a protein source in every meal and snack. By focusing on including a protein source at every meal and snack, protein is digested gradually and continuously throughout the day. This recommendation is especially important for athletes engaging in multiple training sessions daily.

• Choose a variety of different protein sources. Lean meats, poultry, fish, and dairy products are excellent choices because of their amino acid profile and high overall protein content. Vegetarians should consume plenty of soy products, which also contain an ideal amino acid profile and high protein content. Beans, lentils, nuts, seeds, and grains supply protein in smaller amounts and with low levels of one or two amino acids. By consuming a variety of these sources on a daily basis and in larger quantities, strength/power athletes can achieve optimal intakes of protein.

• Consume protein supplements in moderation, if necessary. In general, protein needs can be met through “real” foods consumed throughout the day. Studies have shown that supplemental protein provides no added benefit over whole food sources.38 However, if an athlete is already eating a well-balanced diet but is still having a hard time obtaining optimal quantities of protein, a supplement can be used in moderation. Protein powders are an appropriate supplement to use because a powder can be added to “real” foods such as milk, yogurt, cereal, and smoothies.

Chapter 13 Strength/Power Athletes 377

are still considered a critical time for replenishment, it may not be the only time when the athlete can affect muscle and strength gains. The potential positive impact of consuming a protein–carbohydrate supplement before exercise is a relatively novel concept. The argument for consuming both protein and carbohydrates before strength/power training is based on the anabolic effects of increasing the secretion of insulin and circulating amino acids. By consuming carbohydrates before strength/power exercise, insulin levels will rise and thus decrease the nor- mal exercise-induced catabolism of muscle tissue.49,50 A supply of exogenous protein results in a greater delivery and increased concentration of intracellular amino acids in the muscle during exercise, enhancing protein synthe- sis.39 Although the action of carbohydrates and protein is the same after exercise, the reason that preactivity con- sumption is prefer- able to postactivity is related to blood flow. The theory is that when the con- centration of nutri- ents (through the digestion of a preac- tivity carbohydrate– protein source) and blood flow (caused by exercise) are both increased, the rate of nutrient uptake and utilization as well as protein synthesis is maximized.39 The positive effects of consuming carbohydrates and protein prior to exercise have been reported with as little as 6 grams of essential amino acids and 35 grams of carbohydrates.17 Therefore, large volumes of food do not need to be con- sumed to gain the anabolic benefits.

Strength/power athletes should strongly consider consuming a source of both carbohydrates and protein before a training session to maximize the ability of the body to synthesize new proteins. The benefit of consum- ing additional protein during strength/power sports still needs to be determined.

Is protein needed for recovery from strength/ power activities? High-intensity exercise and strength training stimulate protein synthesis in muscle tissue. In response to this physical stress, amino acids are released from the free amino acid pools within plasma and cellular spaces of the body.51,52 To meet the basic metabolic needs of mus- cle tissue, to repair damage from high-intensity exercise, and to build new muscle tissue, exogenous amino acids are required. Therefore, protein is a critical component of any strength/power athlete’s postexercise meal or snack.

Several studies have examined the effects of consum- ing macronutrients at various intervals after exercise to determine an ideal environment for muscle synthesis and recovery from training. It appears that the provision of

amino acids after resistance exercise stimulates greater protein synthesis, producing a net positive effect (more synthesis versus breakdown as compared to fasting after exercise).53 When a combination of essential amino acids (6 grams) and carbohydrates (35 grams) is provided, an even greater increase in protein synthesis is observed.41 The current recommendation is to consume 15–25 grams of protein, or 0.25–0.30 grams of protein per kilogram of body weight, after exercise.81 Consuming a combination of carbohydrates and protein both before and after high- intensity training will be beneficial for protein synthesis.

A study conducted by Chandler54 and colleagues reported that the combination of carbohydrates and pro- tein was more advantageous than either carbohydrates or protein alone in stimulating anabolic hormone secretion after resistance exercise. Subjects performed a standard- ized resistance training workout and then consumed an isocaloric amount of one of three supplements (carbohy- drates only, 1.5 g/kg; protein only, 1.38 g/kg; or carbohy- drates and protein, 1.06 g/kg and 0.41 g/kg, respectively) immediately and 2 hours after the session. Both the carbo- hydrates and carbohydrate–protein supplements caused an increase in circulating insulin levels. However, only the carbohydrate–protein supplement additionally caused a modest but significant increase in growth hormone levels. The results of this study reveal that the combination of carbohydrate and protein ingestion after strength train- ing can produce a hormonal environment during recovery that may be favorable to muscle growth.

A study performed by Borsheim et al.55 provided more evidence that a combination of protein and car- bohydrates after resistance training stimulates muscle protein synthesis to a greater extent than carbohydrates alone. Eight subjects engaged in resistance training on two separate occasions, and consumed either a combina- tion supplement (77.4 grams carbohydrates, 17.5 grams whey protein, 4.9 grams amino acids) or a carbohydrates- only supplement (100 grams carbohydrates) 1 hour after the exercise session while net protein balance response was measured. The results revealed the combination bev- erage not only stimulated protein synthesis at 20 to 30 minutes after ingestion (as shown in previous studies), but also caused synthesis to peak again at 90 minutes postconsumption. The authors speculate that this second round of enhanced synthesis was caused by the delayed digestion of intact proteins versus rapidly digested amino acids.

Although the optimal balance and ideal quantity of carbohydrates and protein to consume after strength/ power activities are yet to be determined, athletes can gain an edge on competitors by consuming a snack or full meal containing both carbohydrates and protein to help recover after training sessions or competitions. So the next question is: When should these macronutrients be ingested?

Similar to consuming carbohydrates immediately after endurance exercise to optimize glycogen replenishment,

Gaining the Performance Edge

Until further research is conducted to elucidate the benefits and draw- backs of consuming individual or groups of amino acids, the best way for athletes to obtain amino acids is from protein-rich, whole foods eaten daily in appropriate amounts.

378 SECTION 2 The Practical Application of Sports Nutrition

a combination of protein and carbo- hydrates should be consumed as soon as possible after s t r e n g t h / p o w e r activities. A protein– carbohydrate food or beverage should be consumed imme- diately following a training session or competition, with benefits diminishing 1 to 3 hours postex- ercise.55 This nutrition protocol will stimulate the release of insulin to prevent muscle breakdown while also sup- plying amino acids needed as building blocks for muscle tissue.

Are fat needs different for strength/power athletes? Strength/power athletes burn very little fat during the performance of their sport. The bioenergetic demands of the forceful muscle actions performed by strength/ power athletes are met by the phosphagen and anaerobic energy systems, neither of which relies on the metabo- lizing of fats for production of ATP. Does that mean that strength/power athletes do not need to consume fat? No. Essential fatty acids are needed for the general health of all bodily tissues. Fats are also attractive to the strength/ power athlete because of their caloric density. A moder- ate amount of fat should be consumed on a daily basis, with an emphasis placed on unsaturated fats. The tim- ing of fat consumption is also of importance to avoid any potential performance disturbance during training or competition.

How are daily fat needs calculated for strength/ power athletes? For strength/power athletes, the goal is to find the right balance of carbohydrate, protein, and fat intake to supply all essential nutrients and allow athletes to perform at their best. Fat is a controversial topic requiring the con- sideration of several factors, including caloric needs; the athlete’s desire to lose, maintain, or gain weight; health history; and ideal sources of fat. All strength/power ath- letes need fat; however, fat intake recommendations can vary greatly.

A general recommendation cited by Rogozkin18 sug- gests a daily fat intake of approximately 2 grams of fat per kilogram of body weight. This quantity of fat may be appropriate for most athletes; however, as always, the calculated estimate should be compared to total calo- rie needs before a final recommendation is made to the

athlete. For general health, a fat intake of 30–35% of total calories is considered an upper limit. A range of 20–25% is more appropriate for strength/power athletes who are trying to lose weight because fat is more calorically dense, and it takes less energy to digest, absorb, and assimilate fats than carbohydrates and proteins. What this means is that if excess calories from fatty foods are ingested, then more of the excess will be stored as fat than if the excess calories had come from proteins or carbohydrates. An athlete who is aiming to gain weight will generally find the 25–30% range sufficient in supplying extra calo- ries as well as decreasing the total volume of food needed to meet total energy needs. General health and specific athletic goals/objectives should be considered when esti- mating fat needs.

For example, consider two athletes who both weigh 150 pounds: one is a wrestler aiming to lose weight who consumes about 2500 calories per day, whereas the other is a shot putter with the goal of increasing muscle mass who requires 4500 calories per day. Basing their fat needs on 2 grams per kilogram of current body weight, both ath- letes would require 136 grams of fat per day. Compar- ing this recommendation to estimated calorie needs, the percentage of total calories from fat would be 49% and 27% for the wrestler and shot putter, respectively. Know- ing that the wrestler wants to lose weight, that the fat intake recommendation for overall health is no more than 30–35% of total calories, that fat is calorically dense mak- ing it easier to err on the side of overconsumption, and that fats do not increase the metabolic demands for diges- tion and absorption like proteins and carbohydrates, the 136-gram recommendation is not to the wrestler’s advan- tage. Using the range of 20–25% of total calories from fat to estimate his needs:

(2500 calories × [0.20–0.25])/9 calories per gram of fat = 55–69 grams of fat per day

Thus, 55–69 grams of fat per day will supply the wrestler with a small amount of fat to provide satiety and essential fatty acids, while minimizing the impact on total calorie intake. In contrast, the 136 grams of fat calculated for the shot putter is appropriate, providing a moderate amount of fat to allow the athlete to meet his increased energy needs while maintaining a healthy diet (see FIGURE 13.3 ).

Strength/power athletes should also consider their health history when consuming fats. Saturated and trans fats are the most detrimental to health, whereas mono- unsaturated and polyunsaturated fats are beneficial to overall health. For those who are at risk for heart disease, high cholesterol, or cancer, special attention should be placed on unsaturated fats. An intake of mainly unsatu- rated fats is also considered protective for future health problems for all athletes. Strength/power athletes should be guided toward healthy types of fats, especially those who are consuming large quantities of protein, which are often rich sources of saturated fats. Protein sources that

Gaining the Performance Edge

Strength/power athletes should aim for consuming at least 15–25 grams of protein (0.25–0.30 grams protein per kilogram body weight) and 35 grams of carbohydrates as soon as possible after training sessions and competitions. The combination of carbohydrates and protein will aid not only muscle protein synthesis, but also glycogen replenishment.

Chapter 13 Strength/Power Athletes 379

are lower in total fat and saturated fat include lean cuts of beef, chicken, turkey, fish, legumes, and soy products.

Are fats needed before and during training sessions and competitions? Although fats are important to consume on a daily basis, fat intake should be minimized in the hours leading up to, as well as during, an intense training session or competi- tion. Fats take longer to digest, leading to a sense of fullness and potentially gastroin- testinal discomfort during exercise. Very small amounts of fat can be included in a preexercise meal consumed several hours prior to the initiation of exercise to provide a feeling of satiety. However, a majority of fat intake should be reserved for after training ses- sions and competitions, spread evenly throughout the day.

Is fat needed for recovery from strength/power activities? It is not essential to replace any fat used during strength/ power exercise by consuming fat-rich foods immediately following training or a competition. Strength/power sports rely minimally on fat for energy during training sessions and competitions, and therefore fat “depletion” is not an

issue. Even if fat was used during strength/power sports, the body’s stores of fat are so great that they will not be depleted in one workout. For ath- letes aiming to lose weight and become lean, training ses- sions help to burn calories, leading to a long-term loss of fat mass, and therefore a replacement of fat postworkout would be counterproductive. Instead, the postexercise meal should consist of mainly carbohydrate- and protein-rich foods. However, fats add flavor to foods and create a sense of satiety, and therefore can be included in small amounts in the postexercise meal or snack.

Are vitamin and mineral needs different for strength/power athletes? The vitamin and mineral needs of strength/power ath- letes have not been studied extensively. As with all active individuals, nutrient needs may be slightly higher than for sedentary counterparts, but an increased intake of specific vitamins and minerals may or may not be criti- cal for optimal strength/power performance. This section reviews several of the micronutrients that have been sug- gested to be of importance, including antioxidants, boron, calcium, chromium, iron, magnesium, and zinc. As more research develops, clearer recommendations can be made.

Do strength/power athletes need to supplement with antioxidant vitamins? The main antioxidants receiving attention in the exer- cise arena are beta-carotene, vitamin C, vitamin E, and selenium. Antioxidants are touted to combat free radi- cal damage occurring during and after exercise, including strenuous and high-intensity exercise. Most of the cur- rent research conducted on the effects of antioxidants and exercise-related free radical damage has focused on endur- ance athletes. Although strength/power athletes may need more of these nutrients, a specific recommendation can- not be made at this time. The best option is to consume a variety of antioxidant-rich foods such as citrus fruits, dark green and orange vegetables, nuts, seeds, and Brazil nuts.

Should strength/power athletes supplement boron intake? Boron is a nonessential trace mineral found in foods such as fruits, vegetables, nuts, seeds, and wine. It is readily absorbed by the body, and the average dietary intake is estimated to be 1–2 milligrams a day. Boron received con- siderable attention in the world of strength/power sports after a study in 1987 reported that people taking boron supplements had elevated testosterone levels.56 Boron

Gaining The Performance Edge

Fats are an important component to an overall healthy diet for strength/ power athletes. Fat consumption should be kept within the range of 20–35% of total calories, based on total calorie needs and the athlete’s goals and objectives. Fats should be obtained from mainly unsaturated sources, while minimizing saturated and trans fat intake. The ingestion of fats before, during, and immedi- ately postexercise should be kept to a minimum. Fats should be ingested in other meals and snacks spread throughout the day.

Food for Thought 13.2

Nutrition Specifics for Gaining Weight

In this exercise, you are asked to provide and justify macronutri- ent intakes you recommend for an athlete wishing to gain weight.

Figure 13.3 Dietary fat consumed in moderation allows the strength/ power athlete to meet increased energy needs while maintaining a healthy diet. © bikeriderlondon/Shutterstock, Inc.

380 SECTION 2 The Practical Application of Sports Nutrition

supplements quickly appeared in the market, claiming the product could be used as an “anabolic steroid alter- native.” However, a review of the study reveals that the researchers’ conclusions were sorely misinterpreted and taken out of context. Nielsen and colleagues56 fed a group of postmenopausal women a boron-deficient diet, and then once hormone levels had dropped, a boron supplement was provided. After taking a 3-milligram daily dose of boron, serum testosterone and estrogen levels returned to normal levels. This study focused on older women who were not athletes, and the supplement was intended to correct a deficiency in the diet. When a study was con- ducted on young individuals engaged in the sport of body building, a boron supplement of 2.5 milligrams per day had no effect on testosterone levels, lean mass, or strength as compared to the control group.57 An RDA has not been established for boron; however, the estimated daily requirement is thought to be 1 milligram per day. A UL has been established at 20 milligrams per day for adults 19 years or older and 17 milligrams per day for ado- lescents.58 Low intake of boron, as with all nutrients, can potentially cause adverse effects; however, supplemental boron at levels higher than the 20-milligram UL have not been shown to be beneficial and can have negative effects.

Should strength/power athletes be concerned about calcium intake? Calcium is critical for optimal bone health, muscle devel- opment, and nerve transmission in both men and women. Unfortunately, many strength/power athletes are not con- suming adequate amounts of daily calcium. This defi- ciency is often caused by an avoidance of dairy products in the quest for a leaner body. Ironically, recent studies have shown that higher intakes of calcium can actually aid in weight loss and body fat loss.59 Much of this research has focused on overweight individuals placed on calorie- restricted diets with varied dairy calcium or supplemental calcium intakes. Of potential interest to strength athletes is the growing evidence that high dairy calcium intake aids not only increased weight loss, but also higher body fat losses compared to low dairy or supplemental calcium intakes.60 In addition, dairy products contain many other essential nutrients for strength/power athletes, includ- ing protein, carbohydrates, vitamin D, and riboflavin. To promote overall health and a strong body, a minimum of three to four servings of calcium-rich foods such as milk, yogurt, calcium-fortified orange juice, green leafy vege- tables, soy milk, and other soy-based dairy alternatives should be consumed on a daily basis to meet, but not necessarily to exceed, current recommendations (1000 milligrams for 19- to 50-year-old men and women).

Is chromium supplementation important for strength/power athletes? Chromium is an essential mineral involved in the regu- lation of insulin-mediated metabolism of carbohydrates, fats, and proteins. Some early chromium studies reported

positive changes in body composition,61,62 which have led to a variety of ergogenic claims, such as increased muscle mass, decreased fat mass, and enhanced mus- cular strength. However, most studies reveal no effect on body composition or muscular strength after chromium supplementation.63–66 Chromium can be easily obtained through the diet in foods such as mushrooms, prunes, nuts, whole grains, brewer’s yeast, broccoli, wine, cheese, egg yolks, asparagus, dark chocolate, and some beers.

Should strength/power athletes worry about iron? “Pumping iron” should not be reserved only for the weight room—it should also happen in the kitchen. Strength/ power athletes perform a variety of activities that often involve high-intensity, weight-bearing movements caus- ing hematuria. Hematuria is the presence of hemoglobin or myoglobin in the urine caused by a breakdown of red blood cells (i.e., hemolysis) or damage to muscle tissue, respectively. Hemolysis has been observed in weight lift- ers as a result of the mechanical stress of lifting heavy weights. As is the case for hemoglobin, iron is also essen- tial for the formation of myoglobin, which stores oxygen inside muscle cells until it is needed for chemical reac- tions and muscular contraction.

Sprint swimmers are a unique group of strength/ power athletes that have been found to have low iron levels, even though a majority of their training is non- weight-bearing. A study conducted by Brigham and col- leagues67 examined 25 female college swimmers for iron status as well as the effectiveness of iron supplementa- tion during the competitive season. The baseline tests revealed that 17 swimmers had depleted iron stores and 5 swimmers were classified as anemic. The experimental group consumed 39 milligrams of iron per day, which was successful in preventing a further decline in iron status as compared to the control group. However, the authors sug- gested that a higher dosage might be indicated to increase iron stores to a healthy range. The best line of defense is to prevent an iron deficiency from occurring by ensur- ing that athletes are consuming plenty of iron-rich foods daily. If anemia is suspected, a physician should be con- sulted before iron supplements are taken.

Chapter 13 Strength/Power Athletes 381

Strength/power athletes should focus on sources of heme iron found in foods such as beef, poultry, and fish as well as nonheme iron, which is found primarily in plant foods such as soy products, dried fruits, legumes, whole grains, fortified cereals, and green leafy vegetables. Non- heme iron’s bioavailability can be enhanced by eating nonheme foods with either a meat product or a vitamin C source.

Is magnesium supplementation important for strength/power athletes? Magnesium has become a popular supplement in the area of strength/power sports. Because of its role in muscle contraction and protein synthesis, magnesium supple- mentation has been touted to increase muscle mass and strength. However, only a few studies have demonstrated an ergogenic effect, and many of the studies have not been well controlled. Therefore, the verdict is still out on whether intake of magnesium above the RDA will provide any benefit. Until the picture becomes clearer, athletes should focus on consuming magnesium-rich foods such as whole grains, green leafy vegetables, legumes, nuts, and seafood.

Why is zinc important for strength/power athletes? Zinc has a variety of functions in the body, including roles as an antioxidant, a regulator of growth and development, and a wound healer. Strength/power athletes benefit from all these functions of zinc. Many athletes, especially those on calorie-restricted diets, may not be consuming ade- quate amounts of zinc, and thus it should become a focus of attention. Zinc is found in a variety of foods, including beef and other dark meats, fish, eggs, whole grains, wheat germ, legumes, and dairy products. Zinc supplements are generally not necessary when an athlete is consuming enough food.

Is multivitamin/mineral supplementation necessary for strength/power athletes? It is a common practice for athletes to take a multivi- tamin/mineral supplement on a regular basis. Although this may be a good practice for nutrient “insurance,” it may not be ergogenic. Sev- eral research articles have been published reporting no perfor- mance benefit from multivitamin/min- eral supplementation for athletes partici- pating in strength/ power sports.68,69 If

an athlete is look- ing for insurance, it is best to choose a brand containing no more than 100–200% of the Daily Value for each nutrient to pre- vent side effects that could be caused by ingesting large doses of vitamins and minerals.

Are fluid needs different for strength/ power athletes? Fluid consumption and hydration are important for all types of athletes. Muscle tissue is composed mainly of water, and therefore when dehydration sets in mus- cular function and performance decline. Consuming adequate amounts of fluid before, during, and after strength/power training sessions and competitions will ensure that an athlete feels energetic; has the stamina for long, intense workouts; and recovers well after each session.

What issues are of concern regarding the fluid intake of strength/power athletes? Muscle function and performance will decline when ath- letes are in a dehydrated state. To be well hydrated at the onset of any training session or competitive event, strength/power athletes should adhere to fluid consump- tion recommendations. Note that fluid losses during exercise are in addition to daily fluid recommendations. Because of the frequency, intensity, and duration of strength/power athletes’ training and competition ses- sions, maintaining euhydration is of utmost importance and should be a dietary focus every day.

One aspect of strength/power sports that often leads to a restriction of daily fluid intake and dehydration is the weight-class system. Sports such as boxing, judo, wres- tling, and weight lifting classify athletes based on body weight for competitive events. The goal for these athletes is to maximize their strength/power relative to their body weight. To gain an advantage over a competitor, many athletes will aim for weight reduction immediately prior to a weigh-in for competition so that they can compete in a lower weight category. Competing in a lower body weight category can allow the athlete theoretically to dominate an athlete who legitimately has a lower body weight and possibly also less strength and power. One of the quickest, yet unhealthiest, ways to cut weight quickly is to dehydrate the body through a variety of methods such as rubber suits, steam rooms, and the restriction of fluid intake. The magnitude of weight loss can range from a couple pounds to as high as 9.1 kilograms.70 Athletes

Gaining the Performance Edge

There is little research to support taking specific vitamins or miner- als to provide an ergogenic benefit to strength/power athletes, unless an individual is deficient in a nutri- ent. Athletes should focus on whole foods first, ensuring balance, variety, and moderation of all food groups on a daily basis.

Food for Thought 13.3

Dietary Analysis of a Power Athlete

In this exercise, you will analyze the meal plan of an athlete whose goal is to gain weight.

382 SECTION 2 The Practical Application of Sports Nutrition

may aim to lose weight on a regular basis, often weekly, during the competitive season. This continuous pattern of weight loss, and then often subsequent weight gain, leads to a pattern of weight cycling, which not only can be detrimental on a daily/weekly basis, but also can have a cumulative effect over the course of an entire season. Some of the negative effects of severe and intentional dehydration include poor thermoregulation; loss of electrolytes, thus increasing the risk for cardiac arrhyth- mias; and extra strain on the kidneys, potentially affect- ing short - term function. Because of the harmful nature of these practices, many governing bod- ies have made changes in policies and established strict guidelines to prevent the life- threatening combination of severe dehydration and high- intensity competition.

The sport of wrestling has recently received atten- tion for its efforts to prevent health-related problems caused by dehydration by changing its policies and pro- cedures related to establishing a minimum weight for all athletes. Currently, both the National Collegiate Athletic Association and the National Federation of State High School Associations have minimum weight standards in place.71,72 Minimum weight for wrestlers is established through body composition testing to ensure that athletes do not drop to unhealthy weights and body fat levels. In addition to weight and body fat testing, all colleges and many high schools are also measuring hydration through urine specific gravity, requiring a specific gravity of 1.020 or higher before assessing a minimum weight. Changes to wrestling policies and procedures are a positive step forward in safeguarding the athletes’ health and perfor- mance. The established guidelines provide an example to other sports on the importance of enforcing daily hydra- tion for athletes.

Although severe dehydration is mainly a health con- cern, it should be noted that it can also significantly decrease strength/power performance. The impact on performance for very short duration activities (< 30 sec- onds) is not as profound as for activities requiring more endurance; however, even in short bursts of effort, muscle function has been found to suffer.73 As the duration of the event increases, the impact of dehydration becomes more evident. TABLE 13.3 summarizes the known effects of dehy- dration on strength/power sports.

Another unique aspect of weight classification sports is that there typically is a period of time between weigh- ing in and the actual competition. Therefore, in between, food and fluids can be consumed in an attempt to replen- ish the body for high-intensity efforts and optimal per- formance. However, can a complete replenishment of the body actually be achieved after such a depletion?

Unfortunately, very little research exists to fully explain the physiological responses and per- formance rebounds with rehydration. Table 13.3 summa- rizes the current research examining the physiological and performance effects of rapid rehydration after dehydration.

cardiac arrhythmia A distur- bance in the normal rhythmic pattern of heart activity. Severe arrhythmias can lead to sudden death.

Table 13.3

Effects of Rapid and Moderate Rates of Dehydration and Rehydration on Physiological Function and Strength/ Power Performance

Variables Dehydration Rehydration

Cardiovascular

Blood volume ↓ ↓*

Cardiac output ↓ ?

Stroke volume ↓ ?

Heart rate ↑ ?

Metabolic

Anaerobic power (Wingate test) ↔, ↓ ↔, ↓

Anaerobic capacity (Wingate test)

↔, ↓ ↔, ↓

Buffer capacity of the blood ↓ ?

Muscle/liver glycogen ↓ ↓

Blood glucose during exercise Possible ↓ ?

Protein degradation during exercise

Possible ↑ ?

Thermoregulation and Fluid Balance

Electrolytes (muscle and blood) ↓ ↔

Core temperature ↑ ?

Sweat rate ↓ ?

Skin blood flow ↓ ?

Strength/Power Performance

Muscular strength ↔, ↓ ↔, ↓

Muscular power ? ↓†

Speed of movement ? ?

Wrestling simulation tests ↓ ↔, ↓†

↓, decrease; ↑, increase; ↔, no known change or return to normal values; ?, unknown. * From Burge et al.75

† Oopik et al.76

Modified from Wilmore JH. Weight category sports. In: Maughan RJ, ed. Nutrition in Sport. Malden, MA: Blackwell Science; 2000:637–645. Data acquired from reviews written by Fogelholm,77 Horswill,78 Keller et al.,79 and Oppliger et al.80

Gaining the Performance Edge

Strength/power athletes should make optimal hydration a top nutri- tion priority on a daily basis. Ath- letes should be educated on the harmful effects of rapid weight loss caused by dehydration and encour- aged to manage weight on a long- term basis using healthy nutrition and exercise practices.

Chapter 13 Strength/Power Athletes 383

How are fluid needs during strength/power activities determined? Maintaining euhydration during strength/power sports is similar to endurance and team sports. Athletes need to make accurate estimations of individual sweat rates, prac- tice the consumption of the estimated amounts while exercising, and overcome any logistical barriers to fluid availability.

How do you determine individual sweat rates? Coaches, athletic trainers, and dietitians working to keep athletes well hydrated during training and competitions need to be aware of the differences in sweat loss among different sports and treat each athlete individually based on his or her own sweat rate and fluid replacement needs. Not only do sweat rates need to be determined individu- ally, but athletes also need to discover the impact of vari- ous environments on their sweat rates. For example, Grant is a 200-meter sprinter. His training consists of a combi- nation of strength training indoors in an air-conditioned facility and sprint workouts on an outdoor track. His workouts are typically at 4:00 pm, and therefore the out- door track can reach temperatures of 80–95 degrees with 70–90% humidity, while the weight room is maintained at 68–72 degrees and 50–60% humidity. Performing two different sweat trials in the two different environments revealed the following :

Weight Room Sweat Trial 1. Determine body weight lost during exercise: Grant

reported that his body weight before his weight train- ing session was 171 pounds, and 170 pounds after- ward. Therefore, he lost 1 pound of water weight during his 1-hour weight-training session indoors (171 – 170 = 1 pound of water weight loss).

2. Determine the fluid equivalent, in ounces, of the total weight lost during exercise: Grant lost the equivalent of 16–24 ounces of fluid during his weight training ses- sion (1 × 16–24 ounces = an additional 16–24 ounces should have been consumed to maintain fluid bal- ance during this weight-training session).

3. Determine the actual fluid needs of the athlete during a weight room workout: Grant understands the benefits of euhydration for exercise performance, and there- fore brings a bottle to all of his workouts. However, in the weight room he often forgets to drink, consum- ing only about 8 ounces of fluid in a 1-hour work- out. Based on the amount of weight he lost in the weight-training workout, he should be consuming 24–32 ounces of fluid per hour in the weight room (8 ounces of fluid consumed + 16–24 ounces he should have consumed to establish fluid balance = 24–32 ounces of total fluid needs).

4. Determine the number of fluid ounces needed per hour of exercise: Because his sweat trial was performed for a

1-hour workout, Grant knows that he ideally needs to consume 24–32 ounces of fluid per hour to maintain hydration during weight-training workouts indoors in a climate-controlled environment.

Outdoor Track Sweat Trial 1. Determine body weight lost during exercise: Grant

reported that his body weight before his track work- out session was 170.5 pounds, and 168 pounds after- ward. Therefore, he lost 2.5 pounds of water weight during his 1-hour outdoor track workout (170.5 – 168 = 2.5 pounds of water weight loss).

2. Determine the fluid equivalent, in ounces, of the total weight lost during exercise: Grant lost the equivalent of 40–60 ounces of fluid during his track workout (2.5 × 16–24 ounces = an additional 40–60 ounces should have been consumed to maintain fluid balance during this outdoor track workout).

3. Determine the actual fluid needs of the athlete during an outdoor workout: Grant brought a bottle to his work- out; however, he consumed only a couple of sips equaling about 4 ounces. Based on the amount of weight he lost, he should be consuming 44–64 ounces of fluid per hour on the track (4 ounces of fluid con- sumed + 40–60 ounces he should have consumed to establish fluid balance = 44–64 ounces of total fluid needs).

4. Determine the number of fluid ounces needed per hour of exercise: Because his sweat trial was performed for a 1-hour workout, Grant knows that he ideally needs to consume 44–64 ounces of fluid per hour to maintain hydration during an outdoor track workout in hot, humid temperatures.

Reviewing the two sweat trials, there is a substantial difference between the two trials in different climates: 24–32 ounces of fluid are needed in a cool, dry indoor environment, whereas 44–64 ounces are required in a hot, humid, outdoor setting. Grant should ensure that he is consuming the appropriate amount of fluid for each set- ting to prevent under- or overhydration and to optimize performance.

What should athletes drink and when should they drink it? Similar to other sports, strength/power athletes should focus on water and sports beverages for fluid replacement during training sessions and competitive events. Water is appropriate for training sessions lasting less than 1 hour, whereas sports beverages are the preferred beverage for any activity lasting longer than 60 to 90 minutes.

Logistically, it is slightly more challenging for strength/ power athletes to actually ingest adequate amounts of fluid during training, but certainly not impossible. Strength/power athletes should take hydration breaks at least every 10 to 15 minutes during training sessions.

384 SECTION 2 The Practical Application of Sports Nutrition

Sufficient amounts of water or sports drinks should be consumed at each break to meet individual sweat rate requirements over the course of an hour. Athletes need to take personal responsibility for maintaining hydra- tion by bringing bottles filled with adequate amounts of water and sports beverages to every practice and drinking consistently.

How much fluid should strength/power athletes drink after training sessions and competitive events? Strength/power ath- letes can lose modest to copious quantities of fluid while train- ing and competing, which need to be replaced as quickly as possible after exer- cise. Athletes should strive to consume optimal (i.e., as deter- mined by sweat tri- als) amounts of fluids in a timely manner.

What meal-planning/event logistics need to be considered during strength/power events? The logistics for consuming fuel and fluids during strength/power sports are very manageable compared to other sports because of their intermittent nature. However, athletes still need to plan ahead to prepare snacks, water bottles, and recovery foods. The follow- ing sections include some ideas for snacks to eat in between efforts at competitive events as well as for quick snacks that provide optimal recovery after high- intensity workouts.

What are high-quality options for snacks between events at meets? For strength/power sports such as track and field or swim- ming meets, an athlete may have several events to com- pete in over the course of 1 day. These situations usually entail a hard, intense effort, and then a long recovery and wait period before the next event. Athletes need to make sure they are staying fueled and hydrated throughout the day. However, at a meet their total energy expenditure is relatively small, and therefore their nutrition intake in between events should be modest. The goal is to supply enough energy to keep blood glucose and overall energy levels up, while minimizing the risk of gastrointestinal

fullness and discomfort. The following small snacks would be appropriate to supply fuel to athletes between events at a meet:

• Whole fruit and juices • Granola or energy bars • Half a lunchmeat sandwich (access to a cooler or

refrigeration is critical) • Yogurt, cottage cheese and low-fat milk (access to a

cooler or refrigeration is critical) • Hard boiled eggs (access to a cooler or refrigeration

is critical) • Bagels or English muffins with jelly or a small amount

of peanut butter • Nuts • Fig bars • Sports bever-

ages and water Athletes should

practice consum- ing snacks during training sessions to ensure that no gas- trointestinal distress will occur on compe- tition day. Nothing new should be con- sumed on the day of a competitive event!

What are high-quality options for snacks after competition? Similar to training sessions, it is imperative that athletes feed their bodies properly after competitive events to ini- tiate the recovery process. Ideally, athletes should con- sume a snack within 15 to 30 minutes of completing their final event at a competitive meet. Often, the athlete is far from home and therefore dependent on packed items or food/fluid that can be purchased on the road. Planning ahead by packing a snack is always the best option. The following are several suggestions of snacks that can be packed, without refrigeration, to be consumed immedi- ately following a competition:

• Peanut butter and jelly sandwiches • Whole fruit • Juices and soy milk packaged in aseptic containers

(drink boxes) • Instant breakfast powders that can be mixed with

water • Energy bars containing a combination of carbohy-

drates and protein • Homemade dried fruit, dry cereal, and nut mixes

If the athlete relies on fast food or convenience store options, the best choices include:

• Cartons of low-fat milk and yogurt

Gaining the Performance Edge

Each athlete should perform sev- eral sweat trials in various indoor and outdoor environments. Sweat rates can vary dramatically, so to promote optimal hydration at all times, individual variations need to be discovered and documented, and appropriate hydration plans need to be implemented.

Gaining the Performance Edge

Strength/power athletes need to take time to plan ahead for day-long meets and competitive events. Non- perishable items should be packed for between events, focusing on carbohydrate sources and fluids. After the day’s events are complete, athletes should consume a carbo- hydrate- and protein-rich snack to begin the recovery process.

Chapter 13 Strength/Power Athletes 385

• 100% juices • Deli sandwiches • Grilled meat sandwiches and burgers (skip excessive

sauces, mayonnaise, or dips) • Granola and energy bars

Everyone’s appetite is different after hard physi- cal efforts. Athletes need to experiment with a variety of postcompetition snacks to determine what tastes the best, settles well, and can be conveniently packed in a gear bag.

It pays to plan. The nutritional value of food/fluid options on the road is typi- cally not as high quality as snacks packed at home. The benefits of having nutritious, familiar foods and bever- ages on-hand at all times far outweighs the small amount of time needed to plan ahead.

Food for Thought 13.4

You Are the Nutrition Coach

Apply the concepts from this chapter to several case studies.

386 SECTION 2 The Practical Application of Sports Nutrition

The Box Score Key Points of Chapter

n Strength athletes participate in sports that demand high levels of muscle force production. Power ath- letes participate in sports requiring the combination of great strength with speed of movement. Despite the difference, strength/power activities can be char- acterized as short, intense bouts of muscle activity.

n Short, intense bursts of muscle activity require an immediate supply of energy to the muscle. As a result, the primary system relied upon for energy during a strength/power activity is the phosphagen system. As the duration of the activity increases, the anaerobic system begins to contribute to a greater extent.

n The main dietary concern with individuals involved in strength/power sports is the consumption of ade- quate amounts of total daily calories. Adequate daily caloric intake not only ensures adequate energy for training, competition, and recovery, but also helps the athlete to conserve or build upon his or her cur- rent level of muscle mass. Low calorie intake can result in muscle tissue being metabolized to meet the body’s energy demands. Loss of muscle tissue is detrimental to strength/power athletes.

n Because many strength/power sports rely on anaer- obic metabolism, carbohydrates are the main fuel. However, because of the short duration of the effort, depletion of carbohydrate stores in the muscle is rarely the cause of fatigue in strength/power events. Therefore, carbohydrate-loading prior to competi- tion is not necessary for strength/power sports.

n A daily intake of 6–10 grams of carbohydrates per kilogram of body weight has been shown to replen- ish and maintain glycogen stores in strength/power athletes. Based on an athlete’s training regimen, car- bohydrate recommendations might range from 3-10 grams per kilogram of body weight. Carbohydrate intake should be approximately 55–65% of the day’s total calorie recommendations.

n Most research supports carbohydrate consump- tion 1 to 4 hours prior to and during strength/power sports; however, some athletes feel they perform better on an empty stomach. Because depletion of energy stores is rarely the cause of fatigue in these sports, the athlete and coach should experiment with various dietary plans and adopt one that is psychologically and physiologically compatible with the athlete.

n Ingestion of carbohydrates as soon as possible after training or sport performance is important to accel- erate the replenishment of glycogen stores, provide for muscle tissue growth, and possibly attenuate immunosuppression resulting from intense training or competition.

n Protein intake is essential to accommodate the body’s need for muscle repair and tissue building resulting from strength and power training. How- ever, there is a ceiling effect, and excessive protein intake (i.e., > 2 grams per kilogram body weight) does not promote more muscle growth than the training in and of itself stimulated. Unused amino acids are converted to fat, not muscle.

n Consuming carbohydrates and protein prior to as well as after strength/power training appears to have a positive synergistic effect in regard to protein synthesis. Consuming 15–25 grams of protein (or 0.25–0.30 grams protein per kilogram body weight) with 35 grams of carbohydrates will not only aid in muscle protein synthesis, but will also speed replen- ishment of energy reserves.

n Fats are not a major energy source during strength/ power events, and therefore special dietary consid- eration prior to, during, and immediately after train- ing or competition is not required. However, fats are critical to a strength/power athlete’s balanced diet and should be consumed in moderation (i.e., less than 35% of total daily calories), with the majority of fats being unsaturated.

n Vitamin and mineral supplementation in strength/ power athletes has not been shown to speed recov- ery from training or enhance sport performance above that provided by a balanced diet. A multivi- tamin/mineral tablet can be taken for nutritional insurance, but the doses provided should not exceed 100 to 200% of the Daily Value.

n As with any athlete, fluid intake is essential not only for normal physiologic functioning of the body, but also for survival. Because of the differences in environmental conditions in which strength/power sports may occur, performing sweat trials will help assess an athlete’s individual fluid needs.

n Rehydrating with water is appropriate for train- ing sessions lasting less than an hour; sports bev- erages are preferred for activities lasting longer than an hour. A rule of thumb for rehydration is to drink 16–24 ounces of fluid for every pound of weight lost over the course of a training session or competition.

n The logistics for consuming food and fluids during strength/power sports is very manageable because of their intermittent nature. The goal is to supply enough energy to keep blood glucose and overall energy levels up, while minimizing the risk of gas- trointestinal fullness and discomfort.

Chapter 13 Strength/Power Athletes 387

Study Questions

1. What is the difference between strength and power? Which group of competitive weight-lifting athletes relies more on power, power lifters or Olympic lift- ers? Explain.

2. What energy system provides the majority of energy during the performance of a 400-meter sprint? Which macronutrient would be most important to these ath- letes and why?

3. What energy system provides the majority of energy during the performance of a javelin throw? During recovery between throws, which energy system is most important?

4. How are the daily energy requirements of strength/ power athletes different from endurance athletes? Dis- cuss the specific nutritional needs of strength/power athletes and how this might affect their dietary plan.

5. For athletes wishing to gain weight, how many extra calories do they need to consume each week? What problems are associated with gaining weight too fast?

6. How much protein should be consumed, and when is it best to ingest protein if maximizing protein syn- thesis is the goal?

7. How would you rank the three macronutrients in order of importance to the strength/power athlete? Defend your answer.

8. How would you determine the fluid requirements for a particular strength/power athlete? What are cur- rent recommendations about the quantity and type of fluid to be used while rehydrating?

9. What are the main nutritional goals for a strength/ power athlete on the day of competition?

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69. Telford R, Catchpole E, Deacon V, Hahn A, Plank A. The effect of 7–8 months of vitamin/mineral supple- mentation on athletic performance. Int J Sports Nutr. 1992;2:135–153.

70. Steen SN, Brownell KD. Patterns of weight loss and regain in wrestlers: has the tradition changed? Med Sci Sports Exerc. 1990;22:762–768.

71. National Collegiate Athletic Association. NCAA Wres- tling Rules and Interpretations. Indianapolis, IN: National Collegiate Athletic Association; 2003:WR23–WR34.

72. National Federation of State High School Associa- tions. Wrestling Weight Management Program. India- napolis, IN: National Federation of State High School Associations; 2001:25–34.

73. Sawka MN, Pandolf KB. Effects of body water loss on physiological function and exercise performance. In: Lamb DR, Gisolfi CV, eds. Perspectives in Exercise Sci- ence and Sports Medicine. Carmel, IN: Benchmark Press; 1990:1–38.

74. Wilmore JH. Weight category sports. In: Maughan RJ, ed. Nutrition in Sport. Malden, MA: Blackwell Science; 2000:637–645.

75. Burge CM, Carey MF, Pine WR. Rowing performance, fluid balance, and metabolic function following dehydration and rehydration. Med Sci Sports Exerc. 1993;25:1358–1364.

76. Oopik V, Passkey M, Sick T, et al. Effect of rapid weight loss on metabolism and isokinetic performance capacity: a case study of two well trained wrestlers. J Sports Med Phys Fitness. 1996;36:127–131.

77. Fogelholm M. Effects of bodyweight reduction on sports performance. Sports Med. 1994;18:249–267.

78. Horswill CA. Physiology and nutrition for wrestling. In: Knotted HG, Lamb DR, Murray R, eds. Physiology and Nutrition for Competitive Sport. Carmel, IN: Cooper; 1994:131–174.

79. Keller HL, Tully SE, Freedson PS. Weight loss in adoles- cent wrestlers. Pediatr Exerc Sc. 1994;6:211–224.

80. Oppliger RA, Case HS, Hartwell CA, Landry GL, Shelter AC. Weight loss in wrestlers: an American College of Sports Medicine position stand. Med Sci Sports Exerc. 1996;28:ix–xii.

81. Thomas DT, Erdman KA, Burke LM. Position of the Acadmey of Nutrition and Dietetics, Dietitians of Can- ada, and the American College of Sports Medicine: Nutrition and athletic performance. J Am Diet Assoc. 2016;116(3):501–528.

390 SECTION 2 The Practical Application of Sports Nutrition

Additional Resources

Chesley A, MacDougall JD, Tarnopolsky MA, Atkinson SA, Smith K. Changes in human muscle protein synthesis after resistance exercise. J Appl Physiol. 1992;73:1383–1388.

Kleiner SM. Power Eating. Champaign, IL: Human Kinet- ics; 1998.

Phillips SM, Tipton KD, Ferrando AA, Wolfe RR. Resis- tance training reduces the acute exercise-induced increase in muscle protein turnover. Am J Physiol. 1999;276:E118–E124.

Chapter 13 Strength/Power Athletes 391

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Key Questions Addressed 1. What is different about athletes in team sports?

2. What energy systems are utilized during team sports?

3. How are energy needs different for team sport athletes?

4. Are carbohydrate needs different for team sport athletes?

5. Are protein needs different for team sport athletes?

6. Are fat needs different for team sport athletes?

7. Are vitamin and mineral needs different for team sport athletes?

8. What are the fluid recommendations for team sport athletes?

9. What meal-planning/event logistics need to be considered during team sport events?

You Are the Nutrition Coach Tomas is a junior in college and is a starting wing on his nationally ranked ice hockey team. He is a hard worker in practice and is highly competitive on the ice. Lately, he has been surprised that he feels fatigued during practices and has even had to come out of the most recent game because he was so out of breath. This concerned both him and his coaches. He describes being very busy in school with studying, exams, and papers. He has plans to go to medical school after graduation and knows he needs excellent grades to get accepted. The team dietitian met with him to determine whether he was meeting the nutrient, fluid, and energy requirements for his busy, active lifestyle.

Questions • What specific questions should you ask Tomas about his nutrient intake?

• How do you determine his calorie needs?

• How do you determine whether he is meeting his calorie and macronutrient needs?

Team Sport Athletes

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CHAPTER 14

What is different about athletes in team sports? For the purposes of this chapter, team sports are sports in which two or more athletes work together on a common playing area to defeat an opposing group of competitors. Some commonly identified team sports are football, baseball, ice hockey, soccer, volley- ball, and basketball. However, information from this chapter also applies to other, less-recognized team sports such as rugby, lacrosse, and field hockey. Sports in which individual ath- letes perform by themselves in an event, and their score is added to that of others to derive a team score, are not considered team sports. Examples of these individual sports are gymnastics, swimming, diving, track and field, tennis, and wrestling.

Team sports have classically been labeled as anaero- bic sports because success is often dependent on physi- cal skills that require quick bursts of intense, powerful muscle activity. Quick bursts of intense muscle activity are fueled primarily by the ATP/CP (phosphagen) and anaerobic energy systems. However, classifying team sport athletes as anaerobic athletes can be very mis- leading. Sprinting, jumping, throwing, and tackling are indeed anaerobic activities, but it must be remembered that during the less intense moments between anaer- obic bursts, the athlete’s body is trying to recover. The recovery process requires aerobic energy. During recov- ery, the body is attempting to replace the high-energy phosphates (i.e., ATP and CP) and remove any lactic acid formed during the anaerobic burst of activity. By improving aerobic fitness, an athlete is able to recover more fully between bursts of activity. During a game or practice when the intermittent bursts of activities occur over a 2- or 3-hour time period, the athletes who are not able to recover their ATP and CP levels adequately during the periods of lesser activity begin to run out of energy. Failure to recognize the importance of the aerobic energy system even in team sports traditionally labeled as anaerobic can lead to early-onset fatigue and perfor- mance disaster.

What energy systems are utilized during team sports? Participation in team sports relies upon all three of the body’s energy systems; however, the ATP/CP and aerobic systems are the major energy contributors. As depicted by the darker shaded area on the left side of region 1 in FIGURE 14.1 , the very high-intensity bursts of muscle

team sports Sports in which two or more athletes work together on a common playing area to defeat an opposing group of competitors. Examples of team sports are foot- ball, baseball, hockey, soccer, and basketball.

activity required to jump, kick, sprint, shoot, and so on are supplied predominantly by the ATP/CP system. The aerobic system comes into play during the lower-inten- sity activities that occur between the bursts of effort. These between-burst activities are performed at slower, less metabolically demanding (i.e., lower intensity) movement speeds and are depicted by shaded region 4 in Figure 14.1. The aerobic system not only is supplying most of the energy for the lower-intensity activity itself, but also is helping the athlete to recover. In other words, the aerobic system is working to replenish any ATP and CP that was used in earlier flurries of activity. Failure to com- pletely recharge the muscles’ high-energy phosphates (i.e., ATP and CP) between bouts can eventually lead to fatigue and thus decreased sport performance. A real- ization of the importance of the aerobic system for opti- mal performance in team sports dem- onstrates why ath- letes involved in what have tradition- ally been considered anaerobic sports need to include endurance train- ing in their condi- tioning program.

Figure 14.1 Team sport energetics. Participation in team sports relies on all three of the body’s energy systems; however, the phosphagen and aerobic systems are the major energy contributors. Reproduced with permission of McGraw-Hill Education LLC from Bowers RW, Fox EL. Sports Physiology, 3rd ed. Dubuque, IA: William C Brown Publishers; 1992, p. 34.

Gaining the Performance Edge

Failure to recognize the impor- tance of the aerobic energy system in team sports, traditionally thought of as anaerobic sports, can lead to early-onset fatigue and perfor- mance disaster.

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Chapter 14 Team Sport Athletes 393

Endurance training stresses the aerobic energy system, which adapts and becomes better at producing ATP. This, in turn, enables the team sport athlete to recover more quickly and thus preserves muscle ATP and CP levels over the 2 or more hours it takes to complete many team sport competitions.

How are energy needs different for team sport athletes? The most significant difference in energy requirements for the category of team sport athletes, versus endurance or strength/power sport athletes, is the huge variation in calorie needs. For an individual athlete, calorie needs can fluctuate greatly on a daily basis because of variations in training and competition schedules. Among team sport athletes, disparities in calorie requirements are caused by several factors, such as the nature of the sport, the position played by the athlete, and an individual’s body weight. These variations must be considered when cal- culating energy needs and developing a meal plan for an individual athlete.

Calorie needs can vary greatly among team mem- bers within one sport because of variations in their roles, as dictated by their position. For example, soccer play- ers generally expend 3800–3900 calories per day.1,2 How- ever, actual caloric requirements depend on a player’s position on the team. Soccer midfielders and halfbacks run most of the game, chasing the ball and playing both defense and offense. A typical soccer midfielder can run as much as 10 kilometers (6.2 miles) in one game, with a large percentage of the running performed at high intensities.3 In contrast, soccer goalies and defensive players play less than half of the field and run less than the forward players, thus using considerably less energy. When calculating energy needs for team sport athletes, the nature of the sport as well as the athlete’s position on the team should be considered before making final recommendations.

Some athletes are very heavy, such as football line- men, whereas others weigh significantly less, such as soccer and field hockey players. Larger athletes who require greater mass to optimally perform in their sport may want to increase lean body mass. Football players are getting larger every season. A comparison of NCAA Division I football players from 1987 and 2000 found sig- nificant increases in body mass for quarterbacks, running backs, tight ends, offensive linemen, and defensive line- men.4 The offensive linemen showed the largest increase in body mass (8.8%) when compared to the 1987 study. Larger size means greater calorie needs and higher energy expenditure. It is not unusual for a 300-pound linebacker to have energy needs for weight maintenance of more than 5000 calories per day. In comparison, a 190-pound wide receiver may require only 3500 calories per day for weight maintenance.

José’s Case Study José is a 22-year-old Triple-A minor league baseball

catcher whose long-term goal is to play in the major leagues. During the off-season, he diligently followed an intense training and conditioning program. As a result of his hard efforts, José successfully gained muscle mass, decreased his fat mass, and achieved a body weight of 220 pounds. His current goal is to maintain this weight and body composition throughout the competitive season.

Matching energy intake with expenditure can be challenging for competitive athletes. Hassapidou and Manstrantoni studied four groups of female athletes—vol- leyball players, swimmers, middle distance runners, and ballet dancers—in Greece during one off-season and one competitive season.5 Researchers found that mean energy intake was lower than mean energy expenditure in all four groups of athletes. Mean energy intake ranged from 1500–2350 calories per day, and mean energy expenditure ranged from 2150–2350 calories for the athletes in this study. Other studies have shown similar energy intakes and expenditures, with the average intake of female ath- letes in the range of 1600–2400 calories per day.6–8 How- ever, in the Hassapidou study, the volleyball players increased energy intake during the competitive season and attained energy balance. The other three teams in the study did not increase intake during the competitive season and were in negative energy balance in both the off- and in-season parts of the study. It is possible that the volleyball team members paid more attention to cal- orie intake during the competitive season or that their energy expenditure was reduced because they had more competition days and less intense practice. Underreport- ing of energy intake and energy expenditure could have been inaccurately estimated in all athletes in the study. Although it may be challenging for team athletes to meet energy needs, athletes can achieve energy balance with careful nutrition planning.

How are daily energy needs calculated for team sport athletes? When calculating energy needs, several things must be considered. An accurate weight should first be obtained because the primary calculation is based on body weight. A good estimate of activity level should be determined based on the sport, position played, amount of daily train- ing, days off, and intensity of training. The age of the ath- lete is also a determining factor when calculating energy expenditure. The athlete’s weight goal and recommended weight must be considered as well. If the athlete’s goal is to maintain weight, the calculations do not need to be modified. If the athlete needs or desires weight change, then daily needs should be adjusted. The equations used to determine energy needs for team sport athletes are presented in TABLE 14.1 .

394 SECTION 2 The Practical Application of Sports Nutrition

or less or events lasting 1 to 2 hours requiring intermittent efforts generally do not require calories to be consumed while exercising. In these cases, a focus on proper hydra- tion during activity will be all that is needed to keep the athlete in top form. Energy needs for shorter events can usually be met before and after games.

Other events lasting 2 to 4 hours will require extra cal- ories to be consumed during play to keep performance at its peak. Consuming fluids that contain carbohydrates will provide a small amount of calories, usually sufficient to delay fatigue during games. For example, a starting basket- ball player might play 35 of the 40 official minutes of a bas- ketball game that might take 2 hours to play. Consuming a sports drink at a rate of 8 ounces every 15 minutes during the game would provide approximately 360 calories in the 2 hours of the game. Although not a large amount of calo- ries, this level of calories, especially from a carbohydrate source, provides readily available energy and decreases the chances of depleting glycogen stores during the game.

Many team sport events have games played through- out a day or weekend, requiring careful nutrition planning for before, during, in between, and after games to ensure adequate fuel. Refer to the team sport event logistics sec- tion later in this chapter for examples of how to meet calorie needs during tournament play.

Are carbohydrate needs different for team sport athletes? As discussed earlier in this chapter, team sport athletes use all three energy systems during activity. The intense bursts of activity usually involved in team sport play depend largely on the anaerobic system for energy, with the aerobic energy system contributing during moder- ate efforts. Carbohydrates are the main source of fuel for the aerobic system and the only macronutrient that can be metabolized for energy anaerobically. Thus, in the absence of carbohydrates, sport performance deterioration is ensured.

Table 14.1 Resting Energy Expenditure (REE) Equations and Activity Factors

Gender and age Equation (BW in kilograms)

Activity factor

Males, 10 to 18 years REE = (17.5 × BW) + 651 1.6–2.4

Males, 18 to 30 years REE = (15.3 × BW) + 679 1.6–2.4

Males, 30 to 60 years REE = (11.6 × BW) + 879 1.6–2.4

Females, 10 to 18 years REE = (12.2 × BW) + 749 1.6–2.4

Females, 18 to 30 years REE = (14.7 × BW) + 496 1.6–2.4

Females, 30 to 60 years REE = (8.7 × BW) + 829 1.6–2.4

Using the equation listed in Table 14.1, José’s energy needs are calculated as follows: 1. Calculation for a 22-year-old male:

REE = (15.3 × BW in kg) + 679 2. Convert pounds of body weight to kilograms:

220 ÷ 2.2 = 100 kg 3. Determine José’s REE:

(15.3 × 100) + 679 = 1530 + 679 = 2209 calories 4. Multiply the REE by the activity factor of 1.6–2.4:

2209 × (1.6–2.4) = 3534–5302 calories per day The calorie range generated is quite wide—a differ-

ence of 1770 calories. However, as mentioned earlier, it is important to give team sport athletes a large target calorie range to allow for flexibility in daily energy needs. For example, because José is a catcher, he is involved in nearly all defensive plays on the field. The constant crouching, throwing, running between home and first base, and chasing foul balls demand significant energy. Catchers also wear protective gear that adds weight and bulk, causing less efficient movement and thus increas- ing calorie expenditure. Therefore, José could potentially burn as much as 13 calories per minute during a game.9 On days when José catches a full game or on hard train- ing days, his energy needs will be on the upper end of his calculated calorie range. On game days when he does not catch or on rest days from training, the lower end of the calorie range would be appropriate. José should be instructed on how to modify his daily intake to match the variances in his training and competition schedule to his daily energy needs, thus allowing him to maintain his current weight.

For all team sport athletes, it is important to balance energy needs with recommendations for appropriate macronutrient intake. Many team sport athletes, espe- cially those whose performance may be enhanced by a larger body size, consume excessive amounts of protein. This often is a detriment to their glycogen stores, which need to be replenished daily for optimal sport perfor- mance. Team sports require a blending of carbohydrates, protein, and fat because the energy systems utilized dur- ing activity are typically a combination of anaerobic and aerobic in nature. TRAINING TABLE 14.1 presents examples of sample meal plans for three different calorie levels com- mon for team sport athletes: 2500, 4000, and 6000 calories. The lower-calorie meal plan may be appropriate for small, female team sport athletes, whereas the higher-calorie meal plan is generally well suited for larger, heavier male athletes.

How can energy needs during an event be calculated? Calorie needs during a team sport event are based on the type of event, the length of the event, and the amount of playing time during the event. Single games lasting 1 hour

Chapter 14 Team Sport Athletes 395

Training Table 14.1: Sample Meal Plans for Various Calorie Levels 2500 4000 6000

Breakfast Breakfast Breakfast

Oatmeal, 1 cup Egg sandwich: Granola cereal, 1½ cups

Melon chunks, 1 cup Poached egg, 1 Low-fat milk, 1 cup

Low-fat milk, 1 cup English muffin, 1 whole Banana, 1 large

Brown sugar, 1 tbsp Cheddar cheese, 1 slice Pineapple juice, 1 cup

Orange juice, 1 cup Ham, 1 slice Fruit yogurt, 1 cup

Blueberry muffin, 1 small

Apple juice, 1 cup

Low-fat milk, 1 cup

Lunch Lunch Lunch

Chicken Caesar salad: Thick crust vegetarian pizza, ½ large Sandwiches, 2:

Chopped chicken, 4 oz Orange, 1 Thick whole grain bread, 4 slices

Romaine, leaf lettuce, 2 cups Cranberry juice, 8 oz Lite mayo, 2 tbsp

Egg, 1 chopped Low-fat milk, 1 cup Turkey, ham, or roast beef, 8 oz

Parmesan cheese, 2 tbsp American cheese, 2 slices

Tomato, cucumber slices, ½ cup combined Low-fat milk, 1 cup

Caesar dressing, 1 tbsp Grape juice, 2 cups

Grapes, large bunch Fig bars, 4 large

Minestrone soup, 1 cup

Water

Dinner Dinner Dinner

Tofu stir-fry with vegetables, 2 cups Grilled chicken breast, 1 (4–6 oz) Turkey, 6 oz

Steamed rice, 1½ cups Baked potato, 1 large, with skin Mashed potatoes, 2 cups

Sherbet, ½ cup Green beans, 1 cup Corn/pea mix, 2 cups

Almond cookie, 1 Carrot/raisin salad, 1 cup Chocolate pudding with topping, 2 cups

Low-fat milk, 1 cup Margarine, 1 tsp Rolls, 2

Light sour cream, 1 tbsp Honey, 2 tbsp

Brownie, 1 small Margarine, 2 tsp

Snack Snack Snack

Juice, 8 oz Whole grain crackers, 8 to 10 Apple juice, 16 oz

Graham crackers, 2 full sheets Mozzarella cheese sticks, 2 Peanuts, ½ cup

Banana, 1 Sports drink, 16 oz Raisins, ½ cup

Yogurt, 1 cup Low-fat milkshake, 12 oz Soft pretzel, 1 large

Vanilla wafers, 10 to 12 Lemonade, 16 oz

The benefits of carbohydrate ingestion during shorter-duration, high-intensity exercise are beginning to emerge in the literature. Muscle glycogen is the primary substrate used during maximal exercise performed for 30 to 60 seconds, and repeated bouts of such exercise can substantially reduce glycogen stores in short periods.10 Davis et al. studied eight trained subjects to determine the effects on fatigue of carbohydrate ingestion using high- carbohydrate drinks during intermittent high-intensity shuttle running.10 They found that the average run time to fatigue was significantly longer in trials supplemented with carbohydrates when compared to a placebo sports drink. They found a 32% increase in run time to fatigue during the performance bout. Their research findings are supported by many other studies.11,12

Ice hockey provides another example of the impor- tance of adequate daily carbohydrate intake and glyco- gen storage. For hockey players, maintaining adequate glycogen stores to perform optimally throughout a gru- eling 8-month season is imperative. A study of Swedish ice hockey players revealed that those who consistently consumed a high-carbohydrate diet versus a mixed diet during a two-game series had higher muscle glycogen concentrations.13 This increase in glycogen can translate into faster speeds on the ice, a higher number of shifts skated, and better recovery between shifts.

Team sport athletes may not consume the recom- mended amount of carbohydrates consistently. Those who consume a chronically deficient amount of carbo- hydrates may experience chronic depletion in muscle

396 SECTION 2 The Practical Application of Sports Nutrition

glycogen stores. This is especially true with repeated com- petitions seen in tournament or match play and competi- tions lasting several days. Because of the profound effect of carbohydrates on performance, one of the main goals of the sports nutrition professional is to ensure that the car- bohydrate needs of team sport athletes are met daily, as well as before, during, and after training and competitions.

How are daily carbohydrate needs calculated for team sport athletes? Team sport athletes vary greatly in their individual train- ing regimens, which influence their daily requirements for carbohydrate intake. Some team members have fairly moderate weekly protocols, whereas other athletes are completing long, intense workouts on a regular basis. The current recommendations regarding carbohydrate needs for athletes engaging in sports training programs include the following14:

• Low-intensity or skill-based training: 3–5 grams per kilogram of body weight per day.

• Moderate training (e.g., about 1 hour per day): 5–7 grams per kilogram of body weight per day.

• High-volume training (e.g., 1–3 hours per day of mod- erate to high intensity): 6–10 grams per kilogram of body weight per day.

• Extreme commitment (e.g., > 4–5 hours per day of high-intensity exercise): 8–12 grams per kilogram of body weight per day. For team sports, appropriate carbohydrate recommen-

dations span a majority of the preceding ranges. A general recommendation for carbohydrate intake for team sport athletes is 6–10 grams per kilogram body weight daily. Carbohydrate needs should be calculated on an individ- ual athlete basis, not as a team. Athletes on teams may have very different carbohydrate needs based on position played, amount of training, body weight, need to change body weight, and total calories consumed daily.15

Once a carbohydrate gram range is calculated, the recommendation should always be compared to total calorie estimations. Carbohydrates should comprise approximately 55–65% of total calories. It should be noted that for some athletes, carbohydrate recommendations fall outside of the stated ranges for grams/kilogram of body weight or percentage of total calories. For example, athletes’ consumption of carbohydrates based solely on 55–65% of total calories has been shown to fall short of recommendations if total calorie intake is low.5,6 In these cases, a double-check of carbohydrate needs by calculat- ing a grams/kilogram of body weight recommendation will reveal a shortage in total calories and carbohydrates. Conversely, some football studies have reported that players consume less than half of their calorie intake as carbohydrates, which at face value would indicate a carbohydrate deficiency.16,17 However, when carbohy- drate intake is calculated in grams per kilogram of body weight, it may be discovered that the absolute value of carbohydrate intake is well within the recommended

intake range. Bottom line—use both grams per kilogram of body weight and a comparison of carbohydrates to total calorie intake to confirm dietary recommendations. The following examples demonstrate how to calculate carbohydrate needs based on the position played by an athlete on a team.

Cassie and Allison’s Case Study Cassie plays goalie and Allison is a midfielder on a

semiprofessional soccer team. They are in the beginning of the competitive spring/summer season. Tournaments are played every weekend, with practices nearly every day of the week. Cassie is very tall and muscular. She has played the goalie position all of her life and wants to maintain her weight and muscle mass. Allison is small, trim, and muscular and wants to maintain her current weight so that she can preserve her exceptional speed and endurance on the field.

The calculation of carbohydrate needs for both play- ers should include calculations based on grams per kilogram as well as percentage of calories. The equations in Table 14.1 are used to determine energy needs.

Calculations of carbohydrate needs for Cassie—163-pound, 24-year-old female: 1. Calculate carbohydrate needs based on grams per

kilogram of body weight. 2. Convert pounds of body weight to kilograms:

163 lbs ÷ 2.2 = 74 kg 3. 74 kg × (6–8 g carbohydrates/kg) = 444–592 g car bo hydrates 4. Calculate REE using formula in Table 14.1:

REE = (14.7 × 74 kg) + 496 = 1088 + 496 = 1584 calories 5. Multiply REE by activity factors (1.6–2.4):

1584 × (1.6–2.4) = 2534–3802 calories daily 6. Calculate grams of carbohydrates as a percentage of

calorie needs based on the 6–8 grams per kilogram: • 6 g/kg: 444 g carbohydrates × 4 calories per gram =

1776 carbohydrate calories ÷ 2534 (low end) and 3802 (high end) = 70% and 47% calories from carbohydrates

• 8 g/kg: 592 g carbohydrates × 4 calories per gram = 2368 carbohydrate calories ÷ 2534 and 3802 = 93% and 62% calories from carbohydrates

Calculation of calorie needs for Allison—134-pound, 25-year- old female: 1. Calculate calorie needs based on grams per kilogram

body weight. 2. Convert pounds of body weight into kilograms:

134 lbs ÷ 2.2 = 61 kg 3. 61 kg × (6–8 g carbohydrates/kg) = 366–488 g

car bo hydrates 4. Calculate REE using the formula in Table 14.1:

REE = (14.7 × 61 kg) + 496 = 897 + 496 = 1393 calories 5. Multiply REE by activity factors (1.6–2.4):

1393 × (1.6–2.4) = 2229–3343 calories daily 6. Calculate grams of carbohydrates as a percentage of

calorie needs based on the 6–8 grams per kilogram:

Chapter 14 Team Sport Athletes 397

• 6 g/kg: 366 g carbohydrates × 4 calories per gram = 1464 carbohydrate calories ÷ 2229 (low end) and 3343 (high end) = 66% and 44% calories from carbohydrates

• 8 g/kg: 488 g carbohydrates × 4 calories per gram = 1952 carbohydrate calories ÷ 2229 and 3343 = 88% and 58% calories from carbohydrates

The amount of carbohydrates to recommend for these two athletes is determined by the differences in energy cost of their different positions on the team. Allison has high energy costs on the playing field because she is responsible for both offense and defense and runs a good portion of the playing field with few rests throughout games and prac- tices. Cassie’s position is critical to the team on defense, but she has a much lower energy expenditure defending the goal on her end. To achieve the target 55–65% of calories from carbohydrates for team sport athletes, Cassie could consume the midpoint of estimated calorie needs ([2534 + 3802] ÷ 2 = 3168 average calories), and 6 grams of carbohy- drates per kilogram body weight. This would put her calo- ries from carbohydrates at approximately 56%, meeting her carbohydrate needs for her position (6 × 74 kg = 444 grams of carbohydrates {[444 × 4] ÷ 3168} × 100 = 56%). Allison’s high energy expenditure and need for endurance and carbohydrate usage during her on-field play require more calories from carbohydrates as a percentage of calories. At the high end of Allison’s calorie range, she would need to consume 8 grams of carbohydrates per kilogram to obtain 58% of her calories as carbohydrates.

Because carbohydrates are the foundation of the soc- cer players’ diets, a daily intake of at least 6–8 grams per kilogram body weight appears appropriate. Most team sport athletes should attempt to consume a minimum of 55–65% of their total calories from carbohydrates. In times of significantly high-intensity or duration training, this percentage may go up. A lower percentage could be appropriate in times where strength training is more of a focus and protein needs are increased. However, carbohy- drates are still the primary fuel for the working muscles, and athletes should not decrease carbohydrate intake dramatically (i.e., < 50–55%).

carbohydrates per kilogram of body weight 1 to 4 hours before a game. The pregame meal can consist of solid and/ or liquid sources of carbohydrates (see FIGURE 14.2 ). Bagels, cold cereal with skim milk, watery fruits (such as oranges, watermelon, and grapes), and carbohydrate-containing fluids are all good choices.

Many team sport events occur in the late afternoon or evening, which gives athletes the additional oppor- tunity to consume several “game day” meals. In other words, the athletes should not neglect breakfast and lunch just because they know they are going to have a well-balanced pregame meal. They must understand that even the best-planned pregame meal will not erase the

Team sport athletes can easily meet their carbohy- drate needs by consuming whole grains, fruits, vegetables, and low-fat dairy products throughout the day at meals and snacks. TRAINING TABLE 14.2 provides a sample menu that contains approximately 55–65% carbohydrates.

What is the effect of carbohydrate consumption prior to team sport activities? It is well known that a high-carbohydrate meal prior to team practice or a competitive event helps “top off” gly- cogen stores and ensures adequate blood glucose levels at practice or game time. As a result, it is recommended that athletes consume approximately 1–4 grams of

Training Table 14.2: Carbohydrate-Rich Menu Menu Item (kcal) Carbohydrates (g) Calories

Breakfast

Raisin bran cereal, 1 cup 46 187

1% milk, 1 cup 12 103

Raisins, 1/4 cup 31 130

Grapefruit juice, 1 cup 28 115

Fruited low-fat yogurt, 8 oz 40 210

Subtotal 157 745

84% of calories

Lunch

Black bean soup, 2 cups 40 240

Whole grain bread, 2 slices 24 142

Green salad w/raw vegetables, 2 cups

20 112

Light salad dressing, 2 tbsp 3 138

1% milk, 1 cup 12 103

Peanut butter cookies, 2 small 14 120

Subtotal 113 855

53% of calories

Dinner

Grilled tuna steak, 6 oz 0 240

Rice pilaf, 1 cup 22 115

Broccoli spears, 3 large 15 80

Low-fat frozen yogurt, 1 cup 36 230

1% milk, 1 cup 12 103

Subtotal 85 768

44% of calories

Snacks

Banana, 1 medium 28 109

Fig bars, 2 22 110

Whole grain crackers, 8 20 126

Subtotal 70 345

81% of calories

Total 425 g 2713 calories

63% of total calories

398 SECTION 2 The Practical Application of Sports Nutrition

Figure 14.2 Pre-event meal options. A variety of foods and beverages that contain mainly carbohydrates, along with a small amount of protein, and that are low in fat are the best pre-event meal options. All photos © Photodisc

effects of prior poor nutritional habits on performance. Game day meals more than 4 hours in advance of com- petition should consist of easily digestible, familiar foods that are high in carbohydrates (i.e., 55–65% total calo- ries) and also include small amounts of protein and fat for satiety. Athletes should be cautioned to moderate the overall amount of food eaten in a single sitting prior to events to avoid gastrointestinal distress. When combined with a good breakfast and lunch, the odds of the pregame meal fulfilling its mission of topping off energy stores is enhanced.

In team sports, there may be several games or matches played on the same day or on multiple days in a row. If an event is an hour or less away, liquid carbohydrates in the form of juices or sports drinks are the best options (see FIGURE 14.3 ). Solid car- bohydrate foods tend to take long er to digest and could still be in the stomach at game time or during the event, potentially causing gas- trointestinal upset. Also, pre-event jitters close to game time may prevent an athlete from consuming solid foods.

Liquids tend to be better tolerated and thus provide the nervous athlete with an appropriate dietary option.

Is carbohydrate intake required during team sport activities? If team sport athletes have followed prudent dietary practices in the days and hours leading up to game time, then rarely are muscle carbohydrate stores exhausted by the end of a game. However, that does not mean that a team athlete’s ability to perform isn’t affected in the later periods of a game. Liver gly- cogen stores and blood glucose lev- els can decrease in later periods of a game, thus nega- tively affecting per- formance.18 Results from studies involv- ing soccer and ice hockey athletes have shown decreased perceptions of effort and an increased capability for maintaining top playing velocities during games when consuming car- bohydrates.19–21 Similar improvements in performance have been shown in studies using activities that sim- ulate team sport activity.10,11,22 As a result, time-outs

Figure 14.3 Liquid pregame meal options. Liquids may digest more quickly and feel better in the stomach prior to games than solid foods. Athletes with sensitive stomachs and pregame jitters may choose a liquid meal prior to a big game. (top left) © Photodisc; (top right) © Creatas; (bottom left) © Hemera/Thinkstock; (bottom right) © Don Farrall/ Photodisc/Getty Images

Gaining the Performance Edge

Consuming 1–4 grams of carbohy- drates per kilogram of body weight in solid and/or liquid form 1 to 4 hours before a game can help top off energy reserves and provide for optimal performance.

Gaining the Performance Edge

Ingesting carbohydrates dur- ing sport competition has been shown to decrease mental fatigue, decrease perceptions of effort, and help maintain playing velocities in team sport athletes.

Chapter 14 Team Sport Athletes 399

and halftime are excellent opportunities to supply team sport athletes with carbohydrates in the form of sports drinks or snacks.

Consumption of approximately 30–60 grams of car- bohydrates per hour should be adequate for team sport athletes. This is equivalent to ingesting approximately 120–240 calories per hour. The lower end of this range is adequate for team sports in which regular breaks, time- outs, and athlete substitutions occur. The upper level of carbohydrate ingestion is appropriate for sports in which activity levels are consistent and sustained. Ingesting 30–60 grams of carbohydrates during competition can be easily achieved if athletes consume a 6–8% carbo- hydrate sports drink in the amounts recommended for optimal hydration (i.e., 1 cup approximately every 10 to 15 minutes).

Is carbohydrate intake needed for recovery from team sport activities? As is true with any athlete who has been involved in high-intensity activity, the timely consumption of ade- quate amounts of carbohydrates following the event provides for optimal restoration of glycogen stores.23,24 Carbohydrate intake should begin as soon as possi- ble after competition or practice to take advantage of muscles’ increased ability to take up blood glu- cose after exercise. Athletes should consume at least 1.0–1.2 grams of carbohydrates per kilogram of body weight every hour for the first 4 hours after competi- tion or practice. As much as 2.0 grams per kilogram of body weight may be needed for team athletes who play in highly active sports for most of the game. For exam- ple, a 70-kilogram soccer player should try to consume a minimum of 70–84 grams of carbohydrates after exer- cise. This can be accomplished by consuming 8 ounces of fruit juice (25 grams), one granola bar (25 grams), and 1 cup of low-fat fruit yogurt (40 grams). Consum- ing adequate amounts of carbohydrates immediately after exercise is even easier if high-carbohydrate foods and fluids are made available to the ath- letes before they leave the sport facil- ity or locker room. Fortunately, many high-carbohydrate foods are readily available, easy to pack, and relatively inexpensive; there- fore, athletes should bring their favorite-tasting carbohydrate drinks or snacks for after practice/competition. This will help ensure that athletes start consuming carbohydrates as soon as pos- sible after activity before outside distractions have the potential to disrupt their dietary recovery practices.

Are protein needs different for team sport athletes? Protein is rarely used as an energy substrate during team sport activities, particularly if the athlete is meeting energy needs and carbohydrate intake is adequate. In some instances, such as during tournament play and/or long overtime games, the body can use protein for fuel. However, even in these scenarios, the reliance on protein for energy is low. The role of protein for team sport athletes focuses on the provision of daily nutrition. Protein is essential for the repair, construction, and maintenance of muscle mass throughout the season and during off-season training.

How are daily protein needs calculated for team sport athletes? Calculating protein needs for team sport athletes depends on several factors, including the quantity and methods of training, as well as current body weight and muscle mass goals. Some team sports require more endurance training, whereas others are more focused on strength training. These variations in training, time spent exercis- ing, and the intensity of training will affect protein needs. Protein needs can be determined based on current body weight. Refinement of protein need calculations can be done when change in the athlete’s muscle mass is a goal. As with carbohydrates, protein needs based on current body weight should be compared to total calorie recom- mendations. If protein needs are altered based on training or muscle mass goals, then the percentage of carbohy- drates and fat may also need to be adjusted.

Calculating protein needs should be done individually based on the sport and position played. Giving the entire team the same recommended protein intake without cal- culating the information individually could be a detriment to many players. Differences in playing and practice time, energy expenditure of various positions, and amount of contact in positions all will dictate protein needs. Abrasions, contusions, and musculoskeletal injuries all may increase protein needs for adequate healing. The athletes on a team who receive the most contact hits during play and training may need slightly higher protein intake.

Strength training during the playing season and in the off-season increases protein needs. Protein needs may increase substantially in the off-season for some team sport athletes if the focus is on muscle mass gains. As strength-training time increases, energy and protein needs will also increase.

Body weight has a significant influence on the amount of protein needed daily. Similar to calculating energy and carbohydrate needs, body weight will significantly alter the overall grams of protein needed by different athletes. If muscle mass gain is a goal, then protein needs may be increased. If weight loss is the goal, protein needs may also be increased to avoid significant losses in muscle mass.

When using body weight to determine protein needs, a range of 1.2–2.0 grams of protein per kilogram

Gaining the Performance Edge

Ingesting 1.0–1.2 grams of carbohy- drates per kilogram of body weight every hour for 4 hours after prac- tice or competition will help speed replenishment of carbohydrate stores.

400 SECTION 2 The Practical Application of Sports Nutrition

of body weight is acceptable for most team sport ath- letes. Athletes with a goal of increasing muscle mass or rehabilitating from an injury may require greater than 2.0 grams per kilogram body weight.14,25 This level of pro- tein intake could actually fall within the recommended 15–20% of daily calorie range for large athletes with high energy requirements. If a large football player weighing 110 kilograms consumes 5500 calories per day, a protein intake of 2.5 grams per kilogram body weight would mean that he is consuming 20% of his daily calories as protein.

Scott’s Case Study Scott is an 18-year-old, 210-pound freshman wing

on his college hockey team. He is highly competitive and plays the maximum number of minutes possible in each game. He works hard year-round in the weight room and trains for endurance in the off-season. His muscle mass is at the optimal level, and his goal is to maintain muscle mass during the long competitive season. The following is a sample calculation of protein needs for Scott:

Calculate protein needs based on grams per kilogram of body weight: 1. Convert pounds of body weight to kilograms:

210 lbs ÷ 2.2 = 95 kg 2. 95 kg × (1.2–2.0 g protein/kg) = 114–190 g protein/kg

Calculate energy needs using the REE calculations listed in Table 14.1: 3. REE = (17.5 × 95 kg) + 651 = 1663 + 651 = 2314 calories 4. Multiply REE by activity factors (1.6–2.4):

2314 × (1.6–2.4) = 3702–5554 calories/day

Calculate grams of protein as a percentage of calories based on grams per kilogram of body weight: 5. Using the range of 1.2–2.0 g/kg:

• 1.2 g/kg: 114 g protein × 4 calories/gram = 456 protein calories ÷ 3702–5554 = 8–12% of calories from protein

• 2.0 g/kg: 190 g protein × 4 calories/gram = 760 protein calories ÷ 3702–5554 = 14–21% of calories from protein

The preceding calculations show that for Scott to meet his protein needs and achieve an adequate percent- age of calories he must consume the higher end of the grams of protein per kilogram of body weight. This is true for both the low and high end of his estimated calorie needs range. If he consumed only 1.2 grams of protein per kilogram body weight and 3700 calories daily, he would get only 12% of his calories from protein. At the higher end of his calorie needs, only 8% of calories would come from protein. Neither of these levels reaches the 15–20% range recommended for team sports. Because Scott has a high muscle mass, strength-trains year-round, and wants to maintain his muscle mass, protein intake must reach at least 15% daily. This would be achieved if he were to consume the middle to high range of calorie needs and 2.0 grams of protein per kilogram body weight.

Many team sport athletes strive for greater muscle mass and size in attempts to improve performance. These athletes should be encouraged to consume adequate pro- tein daily, but not in excess of needs. To build muscle mass, adequate daily calories are equally as important as adequate protein intake. The extra calories consumed from carbohydrate or fat sources spare ingested protein for muscle repair, building enzymes essential for sport performance, healing, and muscle hypertrophy. The Inter- national Olympic Committee (IOC) consensus statement is clear that “a varied diet that meets energy needs will generally provide protein in excess of requirements.”26 TRAINING TABLE 14.3 gives a sample day of meals that empha-

sizes protein without being excessive.

Training Table 14.3: Sample High-Protein Menu Meal Items Protein (g) Calories

Breakfast

Buttermilk pancakes, 3 8 258

Poached eggs, 2 13 156

Grapefruit and orange sections and sliced banana, 1½ cups

2 139

1% milk, 1 cup 8 103

Subtotal 31 656

19% of calories

Lunch

Whole wheat pita, 1 whole 6 170

Chicken breast chunks, 6 oz 54 284

Light mayonnaise, 1 tbsp 0 45

Vegetable juice, 12 oz 2 69

Sprouts, onion, tomato, lettuce, 1½ cup, combined

2 50

1% milk, 1 cup 8 103

Subtotal 72 721

40% of calories

Dinner

Beef and bean burrito with cheese, 1 large 18 470

Chopped tomato and greens, 1 cup 3 60

Light ranch dressing, 1 tbsp 0 45

Soft serve ice cream, ½ cup 3 185

Subtotal 24 760

13% of calories

Snacks

Fresh strawberries, 1 cup 0 120

Graham crackers, 2 full sheets 2 120

Yogurt and fruit smoothie, 2 cups 10 347

Subtotal 12 587

8% of calories

Total 139 2724

20% of total calories

Chapter 14 Team Sport Athletes 401

As a result, it is important for the sports nutrition profes- sional to be able to determine the fat needs of each ath- lete and recommend intake levels based on the athletes’ sport’s energy requirement and/or their personal train- ing goals.

How are daily fat needs calculated for team sport athletes? Fat recommendations for most team sport athletes are the same for the general population. Fat should contrib- ute 20–35% of total calories, providing sufficient amounts of essential fatty acids and aiding in meeting calorie needs. Some studies of team sport athletes report an aver- age fat intake of 30% of total calories,6,18 whereas others have documented that athletes consume more than 30% of their calories from fat.1,5,28 Fat intake was reported to provide 37% of total calories in a study of Greek female volleyball players. This same group of athletes consumed 45.9% ± 12.5% of total calories from carbohydrates and 16.0% ± 4.9% of total calories from protein. It appears that the higher percentage of fat intake reduced the per- centage of carbohydrates in their diets to the lower end of the recommended range for most athletes. Higher fat intake, when consumed at the expense of adequate car- bohydrates in the diet, could inhibit optimal sport perfor- mance in most team sport athletes.

The level of fat in the diet should provide adequate energy to meet weight goals (maintenance, loss, or gain). For team sports, the target range for fat intake is 20–35% of total calories. Team sport athletes may need the mid- dle to high end of the range in fat intake because many of these athletes weigh more and have higher calorie needs. To meet calorie needs, 25–30% fat may be appro- priate because fat provides a concentrated source of cal- ories in less volume. The fat consumed should be low in saturated and trans fats and include heart-healthy fat sources that include omega-3 fatty acids. Fat needs can be calculated after calorie, carbohydrate, and protein needs are determined. Total energy intake, carbohydrate intake, and protein intake are more important to team sport athletes, so those values should be calculated first. This does not mean that fat is not important to team sport athletes. It just means emphasis should be placed on the macro-nutrient intake that fits best for enhanced sport performance.

Is protein recommended after exercise for recovery? There is growing evidence that protein intake after activ- ity is advantageous. Protein intake immediately following exercise or competition provides the amino acids for heal- ing of tissues and rebuilding of muscle. Contusions, abra- sions, cuts, strains, and sprains are often part of playing team sports, and adequate protein intake is necessary for speeding recuperation. The amount of protein ingested should put the recovering athlete in a state of positive nitrogen balance.

Postgame ingestion of protein, and in particular essen- tial amino acids, has been shown to improve nitrogen balance. Ingestion of essential amino acids appears to stimulate muscle protein synthesis, whereas nonessential amino acids do not have this effect. As little as 10 grams of essential amino acids postexercise can result in dra- matic elevations in muscle protein synthesis.27 To meet this guideline, athletes should consume 0.25–0.30 grams of protein per kilogram of body weight or ~15–25 grams of protein. Timing of protein intake, along with adequate consumption of carbohydrates and fat, also has an impact on an athlete’s state of nitrogen balance. As a result, it is detrimental for ath- letes to focus just on protein intake after competition, partic- ularly if it is at the expense of adequate carbohydrate and fat intake.25 In summary, consuming adequate carbohydrate along with 15–25 grams of high-quality protein immediately after hard exercise may be beneficial during recovery.

Are fat needs different for team sport athletes? Fats are a source of energy for any athlete. As a conse- quence, the fat needs of team sport athletes are in gen- eral not any different from those of other athletes. Even though carbohydrates serve as the primary energy source during the short, intense bursts of movement that are characteristic of many team sport activities, it is impor- tant to note that many games can last 1 or more hours. In other words, when considering the energetic demands of team sports, the sports nutrition professional must focus on the energy demands for the entire game, not just that of the short bursts of activity. The reason for this is that the aerobic system is working hard during the rest inter- vals between bursts to help the athlete recover. During these recovery periods both carbohydrates and fats are used for energy. If adequate fats are available for aerobic metabolism, they can help spare the use of carbohydrates.

Gaining the Performance Edge

Consumption of 10 grams of essen- tial amino acids within 1 to 2 hours after practice or competition has been shown to increase amino acid use by the body during recovery.

Joe’s Case Study Joe is a professional football offensive lineman. He

does some form of strength or aerobic training almost every day in addition to practice with the team. He com- plains that he is hungry all the time and feels like he con- stantly needs to eat to maintain his weight and muscle mass. In fact, he has lost some lean mass recently and wants to regain that lost mass. A sample calculation of Joe’s fat needs is listed below. Joe weighs 300 pounds and is 25 years old:

402 SECTION 2 The Practical Application of Sports Nutrition

Determine energy needs using the REE equations listed in Table 14.1: 1. Convert pounds of body weight into kilograms:

300 lbs ÷ 2.2 = 136 kg 2. Determine REE:

(15.3 × 136 kg) + 679 = 2080 + 679 = 2760 calories 3. Multiply REE by activity factor (1.6–2.4):

2760 × (1.6–2.4) = 4416–6624 calories

Determine carbohydrate needs using 6–7 grams per kilogram body weight: 4. (6–7 g) × 136 kg = 816–952 grams carbohydrates 5. Calculate the number of calories in 816–952 g:

(816–952 g) × 4 calories/g = 3264–3808 calories from carbohydrates

6. Determine the percentage of carbohydrates from total calories:

• (3264–3808) ÷ 4416 = 74–86% • (3264–3808) ÷ 6624 = 49–57%

Determine protein needs based on grams of protein per kilogram of body weight using 1.2–2.0 grams per kilogram body weight: 7. (1.2–2.0) × 136 kg = 163–272 g protein 8. Calculate the number of calories in 163–272 grams:

163–272 × 4 = 652–1088 calories from protein 9. Determine the percentage of protein from total calories:

• (652–1088) ÷ 4416 = 15–25% of total calories from protein

• (652–1088) ÷ 6624 = 10–16% of total calories from protein

Determine fat needs as a percentage of total calories: 10. Calculate using the highest calorie range: 100 – 57%

carbohydrates (7 g/kg) – 16% protein (2.0 g/kg) = 27% of calories left for fat intake

11. Calculate grams of fat per day: 6624 × 0.27 = 1788 calories ÷ 9 calories/g = 199 grams of fat daily In this example, the carbohydrate range was calcu-

lated using 6–7 grams of carbohydrates, which is within the high-volume training recommended range of 6–10 grams per kilogram body weight.

Because Joe is a lineman and has significant muscle mass and uses short bursts of power for his sport, a lower carbohydrate level, still within the range of recommenda- tions, is appropriate. The 57% of calories determined for carbohydrates is based on the high end of his estimated energy needs. This large amount of calories was chosen for the calculations because Joe has lost muscle mass and needs additional calories to regain that weight. At this high end of the calorie range, the protein calculated at the high end of recommendations (2.0 grams per kilogram body weight) provides 16% of his intake as protein.

The calculation of fat needs is based on carbohydrate and protein estimations and therefore was determined last. In this example, fat intake is calculated at 27% of calories, which is within the recommended range. He has reported being hungry all the time and has lost weight. Fat is more calorically dense and can help him meet his high-calorie

Figure 14.4 Healthful fat sources for athletes with high energy needs. Fat is a rich source of energy and can increase calorie intake in athletes who have high energy needs. Fats should be consumed primarily in the unsaturated form from nutrient-dense food sources. (top left) © Photodisc; (top right) © Digital Vision; (bottom left) © Digital Stock; (bottom right) © AbleStock

needs for weight gain while providing satiation to curb his hunger. FIGURE 14.4 shows some healthy sources of dietary fat. When calculating energy and macronutrient needs, con- sideration of both percentage of calories and total grams of each macronutrient is necessary to make sure appropriate levels of all three macronutrients are attained.

Although there is growing evidence that higher fat intake, especially in the form of medium-chain triglycer- ides, may be helpful for endurance and ultra-endurance athletes, there is no evidence to support the use of high- fat diets by team sport athletes. As noted earlier, fats are an essential part of any athlete’s diet; however, too much can have negative effects on performance. A study involv- ing 20 men assessed the effects of high dietary fat intake on high-intensity exercise similar to the bursts of activ- ity encountered in team sports.29 They found that after 6 weeks on a high-fat diet (i.e., 61% of total calories from fat), peak and mean power output, as determined by an anaerobic power test, significantly decreased compared to that of a control group on a 25% fat diet. In addition, performance on a 45-minute cycling work output test was also reduced compared to the controls. This study indi- cates that a high-fat diet can lead to decreases in anaero- bic exercise performance, which would be deleterious for team sport athletes.

Chapter 14 Team Sport Athletes 403

Is fat recommended after exercise for recovery? The amount of fat stored in adipose tissue, even in lean individuals, is adequate to provide replacement of fats oxidized during most bouts of intermittent-type exercise characteristic of team sport participation. Burke et al.14 reviewed the research literature on intramuscular tri- glycerides (IMTG) and noted that there is some evidence that the consumption of a high-carbohydrate (i.e., ~65% of total calories)/low-fat (i.e., ~20% of total calories) diet during recovery after prolonged exercise may not fully replenish IMTG levels in the muscle. A study investigat- ing the effects of a high-fat (~40% of total calories) versus a low-fat (~24% of total calories) diet on replenishment of IMTG in trained endurance cyclists revealed that the high- fat diet resulted in higher IMTG levels during a 48-hour recovery period.30,31 Although this might seem to indicate that a higher-fat diet would be beneficial during recovery, it is important to note that the research to date has been done with endurance athletes engaged in continuous, prolonged exercise lasting 3 hours or more. The extent to which the team athlete utilizes IMTGs during sport play and the impact depleted IMTGs may have on performance are unknown. What is clear is that carbo- hydrates are a major fuel source for the team athlete and, as a result, recovery diets for team sport athletes should still focus on replen- ishment of carbohydrates versus fats.

Are vitamin and mineral needs different for team sport athletes? Most team sport athletes have higher energy needs than their sedentary counterparts. They may also have slightly increased needs for some vitamins and minerals. How- ever, specific studies documenting increased or differ- ent vitamin and mineral needs for team sport athletes are rarely found in the literature. Much research on team sport athletes reports actual intake of energy, macronu- trients, vitamins, and minerals and compares this to the appropriate DRI levels. This section will discuss how team sport athletes may or may not meet dietary intake rec- ommendations for vitamins and minerals, how meeting calorie needs may affect vitamin and mineral intake, and whether a once-daily vitamin and mineral supplement is necessary for team sport athletes.

How does vitamin intake of team sport athletes compare to the dietary intake standards? Assessing the dietary intake of athletes is accomplished using the typical means of food intake data collection. Self-reported food frequency questionnaires, food record- ing, interviews, and dietary recalls or combinations of

these methods can be used to determine micronutrient intake. Many studies have been completed that assess the dietary intake of athletes and compare that informa- tion to recommendations for energy, macronutrient, and micronutrient intakes. Some of this research has focused on one sport; other studies contained data from a variety of sports. The vitamin intake information presented in this section relates to studies that included team sport athletes.

Hinton and colleagues studied 345 NCAA Division I male and female athletes to determine nutrient intake and dietary and weight loss behaviors. They found that the average intakes met or exceeded the RDAs for all micronutrients except vitamin E and magnesium.32 Folate intake was low in a significant proportion of some of the athletes, but average folate intake met the RDA. In this large study of athletes in a variety of sports, it appears that vitamin intakes on average were adequate with only two exceptions. Similar results were found in a study of eight elite male soccer players. Vitamin A intake was 93% of the RDA and the only vitamin found to be deficient.1 In this study, all of the water-soluble vitamins were well in excess of the RDAs. Beals studied 23 adolescent female volleyball players and found that mean micronutrient intakes met or exceeded the respective DRIs or RDAs except for folate, calcium, and/or zinc.33

Antioxidant vitamins, primarily vitamins A, E, and C, have been promoted aggressively to athletes as a means of improving performance. As noted in two of the preceding studies, vitamin E and A intakes were reported below rec- ommended levels. However, vitamin C intake was within the recommendations in each of those studies. A major- ity of studies indicate that vitamin C intake in athletes is adequate at levels of approximately 90–140 milligrams per day.34 In attempts to test the theory regarding antioxidant intake and athletic performance, Schroder et al. studied professional basketball players. The athletes were given an antioxidant supplement with 600 milligrams alpha- tocopherol, 1000 milligrams vitamin C, and 32 milligrams beta-carotene or a placebo for 32 days during a competi- tive season. The antioxidant mixture decreased oxidative stress and helped avoid marginal vitamin C status com- pared to the placebo group.35 However, improvement in sport performance using any of the antioxidant vitamins in supplemental form is still under investigation. In sum- mary, it appears that male and female athletes in a variety of team sports meet the dietary intake recommendations for most vitamins, with the exception of vitamins A, E, and folate. Sports nutritionists may want to include more foods rich in these vitamins in their athletes’ diets.

How does mineral intake of team sport athletes compare to the dietary intake standards? Much of the concern regarding athletes’ mineral intake focuses on iron, calcium, and zinc, especially for female athletes. However, iron intake is of consistent concern in the team sports arena. Mineral losses in sweat, particu- larly sodium and potassium, can be a concern for athletes

Gaining the Performance Edge

High-fat diets (i.e., >35% of total calo- ries) have not been proven to speed recovery in team sport athletes and thus are not recommended.

404 SECTION 2 The Practical Application of Sports Nutrition

in team sports that play in high heat, humidity, and out- door venues in the sun. Research assessing mineral intake and status in some team sport athletes has been done as a part of intake studies of macro- and micronutrients. This section will focus on iron, sodium, and potassium intake in team sport athletes as it compares to the RDAs.

Many studies have documented low iron intakes and poor iron status in female athletes.36–38 This research often focuses on female athletes in aesthetic sports and in endurance athletes, with less information provided about traditional team sport athletes. Iron depletion and iron- deficiency anemia can have deleterious effects on sport performance. Dubnov and Constantini39 studied the preva- lence of iron depletion and anemia in 103 male and female top-level basketball players. They found a high prevalence of iron depletion and anemia in both genders.39 Fourteen percent of the females and 3% of the males had iron-defi- ciency anemia in this study. Iron intake was not assessed in this study; however, the authors note that to prevent and help treat iron deficiency, athletes should be educated about consuming dietary sources high in iron.

The high incidence of iron depletion in athletes is usually attributed to poor energy intakes; avoidance of meat, fish, and poultry that contain iron in the readily available heme form; vegetarian diets that have poor iron bioavailability; or increased iron losses in sweat, feces, urine, or menstrual blood.24 Despite the knowledge and abundance of research showing athletes to be at greater risk for iron depletion, the condition appears to persist.

Food sources of dietary iron include meats; fortified breads, cereals, and pastas; and some vegetables. Con- suming a vitamin C–rich food with an iron-rich food, espe- cially a nonheme iron food, can enhance the absorption of iron. Team sport athletes can read the labels of foods they commonly consume to determine whether the products are iron fortified or iron enriched to increase the iron con- tent of their diets. Female athletes should have their iron status evaluated annually and follow the advice of their medical doctor if supplemental iron is recommended.

Mineral losses through sweat can be high in some sports where high levels of sweat are common. Sports played outside in the summer heat, humidity, and sun are likely to cause high levels of sweating. Athletes should be aware that minerals are lost in sweat, particularly sodium and potassium, and need to be replenished appropriately. Sports drinks with electrolytes help replenish electrolytes during and after exercise. Some energy and sports bars and gels may also contain electrolytes and are often for- tified with other vitamins and minerals. When extreme sweat loss occurs, adding salt to food and choosing higher potassium foods such as many fruits, potatoes, and toma- toes can help replace these lost electrolytes.

How does energy consumption affect vitamin and mineral intake? It is a common principle in nutrition that individuals who meet their energy requirements by consuming a variety of foods will meet their micronutrient needs as

well. Indeed, in most cases this is probably true as long as a variety of foods from all the different food groups is eaten regularly. Athletes who have higher energy needs than the general population, however, may have diffi- culty meeting energy requirements. This may lead to a reduced intake of vitamins and minerals. Athletes at the greatest risk of poor micronutrient status are those who restrict energy intake or use severe weight loss prac- tices, eliminate one or more of the food groups from their diet, or consume diets high in carbohydrates and low in micronutrient-dense foods.40

A study of Greek female volleyball players found energy intake below recommended levels.41 These ath- letes also did not meet RDA values for vitamins A, B1, B2, B6, calcium, iron, folic acid, magnesium, and zinc but had sufficient dietary intake of vitamins C, B3, and B12.41 Another study of Greek elite female athletes somewhat contradicts this study. Thirty-five female athletes (eight were volleyball players) were assessed for dietary intake and energy balance in the training and competitive sea- sons.5 All of the athletes in this study were negative in energy balance during both seasons, yet their intake of all vitamins and minerals except iron were met. The volleyball players in the study were close to meeting their energy needs in the competitive season but not in the training season. It appeared that although the energy intake was low for the athletes, their diets were nutrient dense. The authors note that this nutrient density in the diets may be related to the high intake of fruits and vegetables consistent with a traditional Mediterranean diet.

In a study by Clark et al., female soccer players in the preseason were found to have higher intakes of major vitamins and minerals, except vitamin D and biotin, than in the postseason.6 However, when energy, vita- min, and mineral intake were assessed immediately postseason, calcium, copper, iron, magnesium, selenium, zinc, vitamin E, vitamin C, and several B-complex vita- mins were significantly lower. Daily calorie intake was approximately 2300 preseason and 1800 postseason. The authors noted that both pre- and postseason average energy needs for individual players were met. Preseason energy needs were higher because of increased training demands, and postseason energy needs were signifi- cantly lower because training level, time, and intensity had greatly diminished.

This study brings up an interesting question about calorie needs as they relate to vitamin and mineral intake. Is it true that athletes who meet their energy needs will also meet their vitamin and mineral needs? Athletes need to make sure to eat a variety of nutrient-dense foods daily to get appropriate amounts of vitamins and minerals in the diet, especially when energy needs/intake are lower. Athletes who may be trying to lose weight may also be at risk for poor vitamin and mineral intake. It becomes more important in times of lowered energy intake to carefully plan a nutrient-dense diet to meet micro-nutrient as well as macronutrient needs.

Chapter 14 Team Sport Athletes 405

In the Hinton study previously discussed, the male athletes did not meet estimated energy requirements, but the female athletes did meet the average estimated requirements for their activity level.32 The majority of females in the study reported that they wanted to decrease their body weight by at least 5 pounds. Approximately 25% of these females reported that they restricted dietary fat or carbohydrates in an attempt to prevent weight gain, yet micronutrient intake was met except for vitamin E and magnesium. When comparing the males to the females in this study, the males had higher total caloric intake than females but did not meet recommended energy require- ments. When nutrient intakes were compared between genders, while controlling for energy intake, the diets of the female athletes were more nutrient dense than those of the male athletes. The male athletes that played foot- ball and basketball had lower energy intakes and greater body weights than the other male athletes in the study. This may suggest that it is difficult for these larger ath- letes with higher energy expenditure to meet caloric needs. Nutrient density appears to have at least as much influence on adequacy of team sport athletes’ diets as meeting actual energy requirements.

Are vitamin and mineral supplements recommended for team sport athletes? Athletes and the general population use a variety of dietary supplements. Many studies report that team sport athletes take vitamin/mineral supplements. Krum- bach et al. examined vitamin and mineral supplement use in NCAA Division I athletes and found that 57% of these athletes reported use of vitamin or mineral sup- plementation.42 A multivitamin/mineral supplement was most commonly used, and vitamin C, calcium, and iron supplementation were also reported. A study of several different NCAA team athletes found that 18.9% of the athletes regularly used a multivitamin supplement.43 Herbold et al. studied collegiate female athletes and found that 35.8% of these athletes took a multivitamin with iron supplement regularly, an additional 4.4% took a multivitamin/mineral without iron, and 13.5% took a multivitamin.44 Twenty-three percent of collegiate fresh- man football players reported using a vitamin or mineral supplement.45

The previous section on team sport athletes’ micro- nutrient intake reported that athletes tend to have ade- quate vitamin and mineral intake in most cases, especially when energy needs are met. Intake of micronutrients is marginal when less total calories are consumed in some cases, even if energy balance is attained. However, the studies report averages of the study participants; some individual athletes may have vitamin and mineral intakes significantly below recommended levels. Therefore, indi- vidual athletes should be assessed for adequate intake, and dietary recommendations should be made for each individual on the team, not a collective recommendation

for the whole team. The dietary focus should be on obtain- ing a nutrient-dense diet with a variety of foods that meet energy demands for exercise.

When eating a variety of foods is difficult, calorie needs are low, or total intake is restricted because an athlete is trying to lose weight, a multivitamin/mineral (MV) supplement may be indicated. The MV should con- tain close to 100% of the RDA values of all the vitamins and minerals listed on the label. Athletes should choose an MV that is designed for the individual’s age and gen- der. Female athletes may need slightly more calcium, iron, and folate than male athletes, and an MV tailored to females is likely to provide these additions. It is better to consume a once-daily MV than to consume several single vitamins or minerals in signifi- cantly higher than RDA levels. One hun- dred percent of the RDA is more than enough to provide some “insurance” that the athlete is getting an adequate supply of vitamins and minerals.

Some athletes get very nauseous for a short time after taking an MV supplement. Athletes should be encouraged to take the MV supplement with a full meal to avoid stom- ach upset. Athletes may choose to omit the MV on a com- petition day to avoid nausea. Stomach upset is more likely on game day in athletes who tend to get nervous before a game.

Team sport athletes who must make weight or who are overly concerned about weight or appearance should be encouraged to take a daily MV supplement. During times of dieting or when appetite is poor or travel sched- ules are difficult, the daily MV will help ensure that the major vitamins and minerals are consumed regularly and avoid depletion of vitamin and mineral stores. However, relying on an MV supplement instead of consuming nutrient-dense foods is not recommended. In addition, an MV supplement provides only those nutrients in the supplement. Athletes need to be reminded that vitamins and minerals do not provide energy or macro-nutrients, and energy needs should be met through adequate caloric intake.

TABLE 14.2 compares a standard once-daily MV to food options as an example of the benefits of obtaining micronutrients from healthful food intake. Notice that the MV supplement provides a wide variety of nutrients but no calories, macronutrients, or fiber. The small meal

Gaining the Performance Edge

Most team sport athletes who meet their energy needs will meet their vitamin and mineral needs. Athletes with poor appetite, difficult travel schedules where missed meals are common, or those who are trying to lose weight may have a decreased intake of some vitamins and min- erals. A once-daily multivitamin/ mineral supplement may be indi- cated for these athletes; however, it should not replace a nutrient-dense nutrition plan.

406 SECTION 2 The Practical Application of Sports Nutrition

Table 14.2 Comparison of Whole Foods to Multivitamin/Mineral Supplement

Vitamin or mineral

MV supplement

Raisin bran cereal w/milk

Orange juice, 1 cup

Nutrients in OJ + cereal meal Meal compared to MV

Vitamin A 3500 IU 1250 IU 0 1250 IU One-third of amount in MV

Vitamin C 60 mg 2 mg 72 mg 74 mg 14 mg more than MV

Vitamin D 400 IU 138 IU 0 138 IU One-third of amount in MV

Vitamin E 30 IU 0 0 0 Meal contains no vitamin E; athletes on low-fat diets may need supplemental vitamin E

Folate 400 μg 162 μg 60 μg 222 μg More than half the amount in MV

Vitamin B6 2 mg 0.6 mg 0 0.6 mg One-quarter of the amount in MV

Thiamin 1.5 mg 0.4 mg 0 0.4 mg One-third the amount in MV

Niacin 20 mg 5.2 mg 0.4 mg 5.6 mg One-quarter the amount in MV

Calcium 162 mg 327 mg 20 mg 347 mg More than twice the amount in MV

Iron 18 mg 10.8 mg 0 10.8 mg More than one-half the amount in MV

Zinc 15 mg 3.25 mg 0 3.25 mg One-fifth the amount in MV

Potassium 80 mg 738 mg 450 mg 1188 mg More than 10 times the amount in MV; athletes exercising in heat and humidity need to replace potassium with food sources

Sodium 0 mg 484 mg 20 mg 504 mg MVs typically contain no sodium; athletes exercising in heat and humidity need to replace sodium with food sources

Calories 0 289 110 399 Food provides energy, macronutrients, and fiber plus many more trace elements and phytochemicals that are not found in MVs

Protein 0 12.7 g 2 g 14.7 g

Carbs 0 58 g 26 g 84 g

Fat 0 1 g 0 g 1 g

Fiber 0 7.7 g 0 g 7.7 g

Note: The 399 calories in this small meal are only a small portion of the total calorie intake that most athletes need in 1 day. Choosing a variety of other foods to meet calorie needs should complement the nutrients not obtained in the meal, providing a balanced diet with adequate micronutrient intake.

of raisin bran cereal with orange juice p rov i d e s m o re potassium, vitamin C, and calcium and nearly two-thirds of the amount of iron found in the supple- ment. In addition, the meal provides sodium that may be necessary for ath- letes with high sweat rates, and one-third to one-half of the vitamin A, vitamin D, and folate of the MV. Choos- ing other nutrient-dense meals throughout the day sup- plies the rest of the micronutrients not found in the raisin bran and juice meal while providing a variety of other trace elements, healthful phytochemicals, and the energy needed to meet the athlete’s energy requirements.

What are the fluid recommendations for team sport athletes? Despite the intermittent nature of many team sports, maintaining hydration in team sport athletes can be a problem. Many team sports are played outside in the heat and humidity or in warm, humid gymnasiums with poor ventilation. In addition, athletes may wear heavy uniforms, protective equipment, and head gear that pre- vent heat loss and thus promote heavy sweating. Football gear is by far the worst when it comes to heat dissipation; as a result, these athletes produce as much as 1.5–2.0 liters of sweat during summer training sessions.3 Even for ice hockey, which is played in a cool environment, sweat loss can be substantial because of the amount of protec- tive gear that prevents heat dissipation. One study of ice hockey players reported a 3–10 pound weight loss attrib- uted to sweat in one game.46 Finally, mere observation of a basketball player engaged in practice or a game reveals

Food for Thought 14.1

Nutrient Needs of Team Sport Athletes

In this activity you will discuss the various factors you need to con- sider as you determine the calorie and macronutrient requirements for players of the various positions on an American football team.

Chapter 14 Team Sport Athletes 407

heavy sweating despite wearing just a jersey and shorts. Clearly, attention must be paid to the maintenance of hydration in team sport athletes.

Why are fluids critical to team sport performance? In all team sports, preventing dehydration is tantamount to optimal sport performance. Athletic performance pro- gressively declines with increasing dehydration. Not only does dehydration negatively affect thermoregulation, but it also compromises cardiovascular function and thus delivery of oxygen and nutrients to the working mus- cles. Depending upon the metabolic rate; environmental conditions such as heat, sun, and humidity; and clothing worn, exercise can induce significant elevations in body temperatures.47 As body temperature rises with exer- cise, especially in warm humid environments, the body increases blood flow to the skin and increases the sweat rate. High water and electrolyte losses in sweat can signif- icantly reduce sport performance in athletes. The inter- mittent, high-intensity outbursts of powerful movements characteristic of team sports require that the athlete be functioning at optimal levels to remain competitive. Fail- ure to maintain hydration decreases sport performance and, even worse, can endanger an athlete’s life.

How can dehydration be prevented in team athletes? Close attention must be paid to the fluid intake of ath- letes not only during practice or games, but also prior to and after these events. The following sections discuss strategies and considerations regarding hydration in team sport athletes.

What can athletes do prior to practice or competition to prevent dehydration? Adequate hydration prior to practice or a game is essen- tial, but hyperhydration prior to some sporting events is not necessary or desired. Hyperhydration immediately prior to an event will cause more frequent urination. This can become a bothersome problem in sports such as foot- ball or hockey because it is difficult and cumbersome to have to remove clothing and pads to urinate. To minimize this problem, ingesting fluids approximately 2 hours prior to practice/game time allows for adequate hydration and allows time for urine production and elimination before the athlete needs to suit up. The National Athletic Train- ers Association (NATA) suggests drinking 17–20 ounces of water or a sports drink 2 to 3 hours prior to exercise and then an additional 7–10 ounces approximately 10 to 20 minutes immediately before activity to top off fluid reserves.48

What can athletes do during practice or competition to prevent dehydration? Encouraging fluid intake and having appropriate fluids available at all times will help athletes maintain high levels of hydration. During exercise, the NATA recommends 7–10

ounces of water or sports drink every 10 to 20 minutes.48 Flavored drinks may improve fluid consumption in some athletes. Studies have shown that athletes achieve improved fluid balance when drinking flavored beverages, even after expressing a preference for water.49

Besides offering a taste advantage over plain water, carbohydrate- and electrolyte-containing drinks also benefit players by increasing blood glucose levels and decreasing utilization of muscle glycogen in addition to helping maintain hydration. Sparing muscle glycogen and maintaining blood glucose levels through ingestion of carbohydrate drinks can help prevent both mental and physical fatigue during events lasting 90 minutes or more. Reilly reported that in soccer the number of goals scored near the end of the game decreases.50 He sur- mised that both physical and mental fatigue—in other words, decreased concentration—may be the contrib- uting factors to this phenomenon. Ostojic and Mazic studied professional male soccer players to determine the effects of carbohydrate–electrolyte drinks on soc- cer performance.51 Players ingesting the carbohydrate– electrolyte drinks had lower ratings of perceived exertion during the match and completed dribble and precision tests faster than the water-only group after the match.51 They concluded that drinking a carbohydrate–electrolyte fluid throughout the game helps prevent deterioration in skill performance.

A study of collegiate hockey, rugby, and soccer play- ers found a 22% reduction in muscle glycogen utilization when compared to the control (water-only) group.28 Sim- ilar results were found in a study of soccer and basket- ball players during practices and shuttle run tests. A 6% carbohydrate and electrolyte solution ingested preprac- tice and at scheduled intervals four times throughout the practice resulted in a 37% longer run time (i.e., delayed fatigue), faster sprint time at the end of the session, and improved motor skills test performance.52 The authors concluded that carbohydrate drinks can positively affect sport performance, and their effects are independent of and additive to preventing dehydration.53 Research cer- tainly seems to indicate that carbohydrate–electrolyte drinks can offer some advantages over water alone for team sport athletes.

During competition, educating athletes on when they can get their fluids can be just as important as what they drink because lack of knowledge may prevent the athlete from ingesting fluids as often as he or she should. Hockey players have many short breaks that allow quick opportu- nities to replenish fluids. They can consume sports drinks on the bench between shifts and at intermission. Simi- larly, basketball players have the opportunity to drink dur- ing time-outs and during substitutions of players. Breaks between periods and at halftime are opportunities for most team players to replenish substantial fluids and electrolytes. In baseball and softball, quick fluid sips can be taken between the bottom and top of the innings when teams switch offensive and defensive positions. Sports

408 SECTION 2 The Practical Application of Sports Nutrition

drinks and water should occupy a highly visible position on the bench or near the players. This encourages fluid replacement by acting as a constant reminder to athletes to drink, allows for easy access, and enables trainers to keep track of fluid consumption by athletes.

What can athletes do after practice or competition to prevent dehydration and rehydrate? Athletes need to work on fully replenishing water losses from previous activity so that they arrive at the next practice/competition well hydrated. As discussed ear- lier, sweat losses can be very high in team sports, and keeping track of an athlete’s success in rehydrating is important. Rehydration should begin as soon as possi- ble after exercise. There is some concern that consum- ing large volumes of fluid to rehydrate quickly increases plasma volume, thus increasing urine output. Kovacs et al. studied the effects of both high and low rates of fluid intake on postexercise rehydration.54 They found that higher rates of fluid intake resulted in greater plasma volume increases and thus faster fluid balance restora- tion when compared to lower rates of intake. The higher rate of rehydration did increase urine output at hours 2 and 3 posthydration, but overall urine output was the same after 6 hours of rehydration in both the high and low rates of hydration.

Some team sports require athletes to compete numerous times in a 24- to 48-hour time span. Tourna- ment play and double headers in baseball are examples. Despite the fact that the athletes are resting and relatively inactive between games, it is imperative that they con- tinue to drink during the short periods of time between competitions. In extreme environmental conditions, it is unlikely that the athletes totally offset sweat loss with fluid intake; as a result, continued rehydration between games is important. Although issues of frequent urination are a concern to athletes, the inconvenience of having to go to the bathroom is more than outweighed by the posi- tive impact of preventing dehydration and its effect on sport performance.

What other special considerations or practices can help prevent dehydration? Preseason football practice is a special consideration. Twice-a-day practices begin in the late summer and are commonly conducted during times of the day in which the heat and humidity are highest. Encouraging athletes to drink may not be enough to prevent dehydration and the physical dangers associated with it. Athletes need to be educated about the importance of staying hydrated and taught the signs and symptoms of heat illness. In addition, athletic trainers and coaches should be on the lookout for any signs of heat illness in their athletes because the athletes may be too engrossed in learning and practice to drink adequately. Coaches and trainers

must adopt practices that help ensure proper hydration. For example, allowing free access to fluids at all times during practice, having good-tasting sports beverages available, and enforcing fluid intake by athletes during mandatory water breaks are excellent practices that can help prevent dehydration.55

Another strategy that is effective in preventing dehy- dration involves having athletes weigh in before practice starts and immediately after practice. Any weight that is lost during practice is the result of water loss and should be replaced prior to the next practice or game. It is rec- ommended that to rehydrate an athlete should consume enough fluid to replace 100–150% of the body weight lost because of sweat, or approximately 16–24 ounces of fluid for every pound of body weight lost.48,54 Over time, this direct monitoring of weight loss during practice and under different environmental conditions will help teach the athlete what his or her typical fluid loss is in varying environmental conditions. Athletes can thus get a better feel for how much fluid they need to ingest to prevent dehydration and thus protect their ability to perform opti- mally during games.

Acclimatization is another practice that must be taken into consideration. Athletes traveling from cooler climates to hotter, more humid envi- ronments to com- pete must be allowed some time to acclimatize to maintain their per- formance levels. At a minimum, it takes an athlete about 5 days to acclimatize to hot environments, and thus the intensity of practices should be adjusted accordingly. A case study of Eng- land’s female field hockey team preparing for the 1998 Commonwealth Games in Malaysia describes a 5-day acclimation hydration strategy.56 They underwent 5 days of low-intensity or high-intensity intermittent cycling in a similar temperature and humidity as the event just prior to leaving for the games. Body mass in the morning and pre- and postexer- cise, along with urine color measures throughout the day, were recorded. They found a significant reduction in exercising heart rate and core temperature at all time points by days 4 and 5. Urine color decreased from day 1 to day 4, suggesting an improvement in hydration status over these days.

acclimatization A process in which the body undergoes phys- iologic adjustments or adapta- tions to changes in environmental conditions such as altitude, tem- perature, and humidity. These physiologic changes enable the body to function better in the new climate.

Food for Thought 14.2

Hydration Practices for Team Sport Athletes

In this activity you will discuss ways that coaches, trainers, and dietitians can help team members stay well-hydrated during outdoor practices.

Chapter 14 Team Sport Athletes 409

Should food be consumed during an event? Depending on the length of the event, snacks may need to be consumed during an event. Many team sport com- petitions last between 1 and 3 hours. During the game, players may play only part of the time. Some players only play on offense or defense. Others will get short rest peri- ods during time-outs or substitutions for positions. There usually is a halftime or break between periods when ath- letes can rehydrate and refuel relatively easily. In most team sports, snacks do not need to be consumed during the event. However, adequate hydration is essential to all athletic endeavors, and sports drinks are recommended as the main fluid for high-intensity competitions.

Although food may not need to be consumed dur- ing the event, consumption of food and fluids is essen- tial between events. For example, in a baseball or softball doubleheader, the players will spend as much as 8 hours at the ballpark in a day. They may have pregame warm- ups; play the first game, which may last 2 to 3 hours; get less than an hour break; and then have to play another 2- to 3-hour game.

Some players will not play both games, or play all of one game. However, every athlete is expected to be ready to play at a moment’s notice. Therefore, proper hydration and fuel for all team members are essential.

What should athletes consume between games and at tournaments? Macronutrient intake at all-day or weekend events can be varied based on the timing of events, hours between events, and avail- ability of foods. Ath- letes should fuel up before an event with a meal several hours prior to the pregame warm-ups. For between-game meals, lower-fat, higher-carbohydrate, moderate-protein foods are best. Car- bohydrates are more easily digested and absorbed and gen- erally well tolerated immediately prior to events. They are also the primary fuel during activity and need to be consumed after competition to replace muscle glycogen stores. This provides energy for the muscles to use at the next event.

Protein helps athletes by providing satiation, keep- ing the athlete from becoming hungry during events and while waiting for the next game to start. Protein sources offer more selection and less boredom with eating, often encouraging enhanced nutrition intake during a long day at the event site. Lower-fat foods are necessary during

As a result, it may be helpful for teams who know they will travel to a more humid or hot environment for a major event to acclimate to these conditions before leaving. Allowing the athletes time to acclimate and get a feel for fluid losses in harsher environments will enable them to adapt their fluid intake levels accordingly.

What meal-planning/event logistics need to be considered during team sport events? Most team sports are played at scheduled times during the day or evening. Athletes or teams can bring foods and fluids with them to the playing field and often have time to consume these items during breaks in the action. Storage space is available on the sidelines, in the dugout, or in the locker rooms. Back-to-back events, tournament play, traveling, and over- night stays can be challenging for ath- letes in team sports. These team sport logistics need to be considered to obtain proper nutri- tion for top-notch sport performance.

Fortifying Your Nutrition Knowledge

How Coaches and Trainers Can Encourage Adequate Hydration

■ Provide a variety of fluid options. Have flavored sports drinks, plain water, and diluted juices available on the bench and in the locker room.

■ Keep fluids cool. Use a cooler or other refrigeration. ■ Take short fluid breaks every 15 to 20 minutes during

practices. ■ Give each player his or her own sports bottle with

ounces marked on the bottle. Monitor fluids consumed during practices and games.

■ When athletes come out of the line-up, hand them their sports bottle and encourage fluid consumption.

■ Discuss the reasons why sports drinks, in most circum- stances, are a better choice than water. Allow athletes to choose, but give them the information with which to choose wisely.

■ Weigh athletes before and after practices for several days and under different environmental conditions. Determine the average weight lost during typical practices and then encourage hydration strategies to counteract those losses.

team sport logistics The plan- ning, implementation, and coordi- nation of details in regard to team practice and competition. For exam- ple, nutrition logistics involve dietary considerations prior to, during, and after practice or competition, in addition to issues of food prepara- tion, preservation, and/or when and where to eat while on the road.

Gaining the Performance Edge

Team sport athletes need adequate fuel during long games or tourna- ment play. Consuming food and flu- ids at breaks in the action provides essential energy and hydration to continue peak performance during events. Arriving at the competition well fueled and eating for recovery after a long competitive day help athletes stay sharp throughout a several-day tournament.

410 SECTION 2 The Practical Application of Sports Nutrition

Training Table 14.4: Sample Meal Plan for a 2-Day Tournament Menu Item Calories Carbohydrates (g) Protein (g) Fat (g)

Breakfast (6:30 AM)

Frosted Mini-Wheats, 1½ cups 285 60 8 1.5

1% milk, 1 cup 105 12 8 2.5

Banana, 1 medium 112 28 0 0

Sports drink, 8 oz 50 14 0 0

Subtotal 552 114 16 4

83% of calories 11% of calories 6% of calories

First Game (8:30 AM)

Lunch (11:30 AM)

Deli turkey sandwich, no cheese 345 24 29 14

Grapes, 1 cup 62 16 0.5 0

Whole grain crackers, 8 68 10 1 3

Apple juice, 1 cup 117 29 0 0

Subtotal 592 79 30.5 17

53% of calories 21% of calories 26% of calories

Second Game (3:30 PM)

Dinner (7:00 PM)

Spaghetti w/meat sauce, 3 cups 500 67 34 15

Italian bread w/ butter, 2 slices, 1 tsp 200 30 5 5

Large tossed salad 80 10 4 0

Light French dressing, 2 tbsp 45 7 0 2

1% milk, 1 cup 109 12 8 2.5

Lemon sherbet, 1 cup 100 23 1 1.5

Subtotal 1034 149 52 26

58% of calories 20% of calories 22% of calories

Snack (10:00 PM)

Whole grain crackers, 8 175 14 5 10

Peanut butter, 1 tbsp 95 3 3 8

Orange juice, 1 cup 110 28 0 0

Subtotal 380 45 8 18

47% of calories 9% of calories 44% of calories

Total Day 1 2558 387 106.5 65

60% of calories 17% of calories 23% of calories

Breakfast (7:00 AM)

Poached eggs, 2 156 1 13 10

Whole grain bagel, 1 small 209 43 8 1.5

Jam, 2 tbsp 108 27 0 0

1% milk, 1 cup 103 12 8 2.5

Cantaloupe chunks, 1 cup 62 15 1.6 0

Subtotal 638 98 30.6 14

61% of calories 19% of calories 20% of calories

Third Game (11:00 AM)

Lunch/Snack (1:30 PM)

Soft pretzel, 1 medium, w/mustard 288 33 5 10

Fruited low-fat yogurt, 1 cup 210 40 9 2

(continued)

Chapter 14 Team Sport Athletes 411

games and tournaments. High-fat foods take longer to digest and may cause stomach upset throughout the day. After the competition is over, a moderate-fat meal can be consumed; however, carbohydrates and protein are still the macronutrients of focus in recovery nutrition. Refer to TRAINING TABLE 14.4 for sample meals and snacks that could

be used during a 2-day tournament. Access to food can be a major consideration at ball-

parks, soccer fields, ice arenas, and gymnasiums. In most cases, a food concession stand will be on-site offering a limited variety of foods. Athletes who do not bring their own food with them or who do not have storage space available may need to choose from concession offerings. This is not ideal, because concession stands often do not have much in the way of lower-fat, high-carbohydrate, moderate-protein foods.

If the concession stand is the only option, some choices are healthier than others. Athletes should avoid very-high-fat foods such as nachos with cheese sauce,

whole fat ice cream, and cookies. They should also avoid french fries, onion rings, and other fried foods. Protein sources that might be available are plain hamburgers (no cheese and little mayo), grilled chicken breast sand- wiches, deli meat sandwiches, or Italian beef. Carbo- hydrates available at most concessions include juices, lemonade, soft pretzels, fruit, frozen yogurt, and frozen treats such as Popsicles, ices, and smoothies. TABLE 14.3 provides a list of healthy food options available at con- cession stands for between-game snacks or during long tournament play.

Which foods are recommended for athletes while traveling? In most cases, athletes and their coaches, managers, or parents will be able to transport and store some food and fluids for game time and between games. Storage space and refrigeration capabilities at the competition site need to be considered. The person in charge of the team’s nutri- tion should call ahead to the event location to determine availability of space and determine whether refrigeration is available. Some sport facilities have refrigerators in the locker rooms. Others will provide large coolers with ice that teams can use during the events. If neither of these options is available, coolers, ice, and space for storage dur- ing transit to the field as well as at the field will need to be planned in advance.

TABLE 14.4 provides a list of perishable and nonper- ishable food and beverage items athletes can bring with them for meals and snacks. A variety of both perishable and nonperishable foods and fluids should be available to team members. Players have different preferences in

Table 14.3 Healthier Sports Nutrition Options at Concession Stands

Sports drinks Deli sandwiches

Juices Hamburgers

Lemonades Cheeseburgers

Smoothies Grilled chicken sandwiches

Fruit ices Vegetarian pizza slices

Frozen yogurts Soft pretzels

Frozen fruit bars Packaged pretzels

Orange, 1 medium 62 16 1 0

Lemonade, 16 oz 200 56 0 0

Subtotal 760 144 15 12

77% of calories 9% of calories 14% of calories

Finals Game (4:00 PM)

Dinner on the Road (8:00 PM)

Grilled chicken sandwich, 1 400 37 25 17

Vanilla milkshake, small 278 45 9 7.5

Side salad 70 13 1 0

Fat-free dressing 35 8 0 0

Subtotal 783 103 35 24.5

53% of calories 18% of calories 29% of calories

Total Day 2 2181 345 80.6 50.5

63% of calories 15% of calories 22% of calorie

Training Table 14.4 (continued): Sample Meal Plan for a 2-Day Tournament Menu Item Calories Carbohydrates (g) Protein (g) Fat (g)

412 SECTION 2 The Practical Application of Sports Nutrition

Table 14.4 Perishable and Nonperishable Foods and Fluids for Traveling

Perishable—keep cold/ serve cold

Nonperishable—do not need refrigeration

Sports drinks* Graham crackers

Bottled water* Vanilla wafers

Low-fat milk Low-fat whole grain crackers

Yogurt Animal crackers

Low-fat cheese sticks Gingersnaps

Deli meats Granola bars

Hard-boiled eggs Cereal bars

Bagels Sports bars

Fruit Fig or fruit bars

Juices/juice boxes Pretzels

Bread sticks

Canned fruit

Canned puddings

Dried fruit

Dry cereals

Peanut butter

Canned tuna, chicken, or salmon

* Nonperishable, but best if served cold.

taste, texture, and type of foods and fluids. Fluids can be brought to the event location already packed in ice, with additional beverages brought at room temperature. As cooled drinks are consumed, room temperature bever- ages can be added to the cooler. This saves space for the more perishable food items but still allows for cold drinks when athletes need them. Fluids should be consumed cool or cold whenever possible to help keep the athlete cool and to increase palatability, which encourages fluid intake. Having a variety of choices available to meet the individual preferences of each player will encourage con- sumption of fuel for optimal sport performance.

Overnight stays in hotels, as well as eating on the road, present additional nutrition challenges. Many hotels have small refrigerators where athletes can store fluids and perishable foods. Going to the grocery store nearby and purchasing lean deli meats, whole grain breads, fruits, juices and sports drinks, and cereal and milk can minimize the food budget while ensuring nutritious food options for the team. Athletes may be able to go to the store for themselves, or coaches, train- ers, and/or parents can do the shopping for the whole team. A mini-cooler for each athlete or a large cooler for the whole team is essential for any team that plays often on the road. When refrigeration is not available,

purchasing nonperishable snacks that can be brought to the playing field and stored in hotel rooms can improve the likelihood that athletes are consuming healthy snacks that meet sports nutrition recommendations for performance.

By the time events are over and athletes have show- ered, packed up, and are on their way home or to the next destination, fuel levels are already low. Athletes can have a small snack from the food and fluids they have brought with them to tide them over until the team can stop for a meal. Trainers and coaches should have sports drinks readily available in the locker room for postgame

Lauren’s Case Study A competitive club volleyball team has been invited

to the national championship tournament. The tourna- ment will be played 500 miles from the team’s home- town. The team will travel as a group in several vans to the weekend event and stay in a hotel close to the arena. Lauren, the setter on the team, likes to bring food with her because she has very specific food preferences. However, there will be limited space in the vans for all of the players. The hotel does have mini-refrigerators in each room that players will share. She and her room- mate plan to share a small cooler with some perishable items and bring additional nonperishable items in their packs. The following is a list of items Lauren decides to bring. Nonperishable items:

• 3 quarts of her favorite sports drink • 6 sports bars • 1 box of whole grain crackers • 1 bag of dried cherries • 1 small jar of peanut butter • 4 whole grain bagels • 1 box of cereal bars • 4-pack of chocolate pudding cups

Perishable cooler items: • 2 pints of skim milk • 6 string cheese sticks • 4 single-serving yogurt cups

Lauren can consume some of these foods while trav- eling to the event. Once the team gets to the hotel, she can transfer the perishable items to the hotel mini-refrigera- tor. Then she and her roommate can fill the cooler with ice at the hotel and use it to transport perishable items to the tournament site. The team can stop at a local gro- cery or convenience store to purchase additional items as needed throughout the weekend.

Chapter 14 Team Sport Athletes 413

hydration. Carbohydrate intake within 30 to 60 minutes after exercise or competition increases muscle glycogen replenishment, and fluids with carbohydrates can easily be transported. Full-strength 100% juices after exercise are convenient and contain the carbohydrates and fluids needed postgame.

Restaurants may not be close to the playing field, and when in unfamiliar cities it may be difficult to find a res- taurant where team members want to eat. Coaches and managers should investigate prior to travel which res- taurants are close to the competition site or are on the road to the next site and make choices ahead of time. Obtaining travel directions and restaurant menus prior to departure saves time both in deciding where to go and in finding the restaurant.

What restaurant options are recommended for teams that are traveling? Many food options in buffet-style, traditional, and fast- food restaurants can help the athletes meet their nutri- tion needs. Breakfast, lunch, and dinner buffets offer many selections that are high in carbohydrates, a good source of quality protein, and varied in nutrient compo- sition. Buffets are also excellent for large teams whose individual players may have very different food pref- erences. More traditional restaurants where players select from the menu can also offer a variety of meal options that help the athlete recover from a long tour- nament or provide fuel prior to the next competition. Most restaurants offer the option of preparing food with less fat and making substitutions of side dishes. Athletes can make these modifi- cations in the meal choices based on their own individual energy and macro- nutrient needs.

Fast food can, and in many cases has to, fit into an athlete’s nutrition meal plan. Choos- ing fast-food restau- rants while traveling to and from events can save the team significant time. The time saved may be worth the fewer optimal food choices available in fast-food establishments. There are, however, many fast-food choices that can benefit the traveling athlete.

Gaining the Performance Edge

Planning ahead is the key to ensur- ing team sport athletes will be well nourished on the road. Packing a variety of perishable and nonper- ishable foods and beverages in coolers and backpacks can keep athletes adequately fueled when restaurant stops are infrequent. Pre- planned stops at restaurants where athletes have a variety of choices to meet their personal preferences and nutrition requirements can meet the varied needs of all team members.

Emphasis should be placed on consuming carbohy- drates and protein while finding lower-fat items on fast- food menus. Grilled meat sandwiches, plain hamburgers or cheeseburgers, salads with low-fat dressing, low-fat or skim milk, yogurt, baked potatoes, chili, and juices are all typically avail- able in fast-food restaurants. Milk- shakes can be an excellent option for the athlete with high energy require- ments. Many fast- food restaurants use a low-fat milk mix, making shakes a lower-fat, high-calorie, moderate-protein option. Choosing a variety of the preceding food options can make a healthful meal for athletes when chosen in the amounts needed to meet energy and macronutrient needs. TABLE 14.5 lists some healthy food options when athletes dine out.

Food for Thought 14.3

Nutrition Travel Planning for Team Sport Athletes

In this activity you will be plan- ning meals on an extended trip to a competition, keeping in mind restaurant menus and timing of meals.

Food for Thought 14.4

You Are the Nutrition Coach

Apply the concepts from this chapter to several case studies.

Fortifying Your Nutrition Knowledge

Planning Nutrition on the Road ■ Plan food stops before leaving home. Determine res-

taurant availability on the road and at the destination. Plan stops according to anticipated budget. Get driv- ing directions from the event location to avoid delays postgame.

■ Ask athletes for input on what types of foods and fluids they prefer for snacks and pre- and postevent nutrition.

■ Purchase foods and fluids prior to leaving home. Pack a cooler with ice and load it with several nutritious food and fluid options based on athletes’ preferences.

■ Call ahead to the event location to determine storage space for coolers or refrigeration availability.

■ Contact the hotel staff to determine availability of refrig- eration in rooms. Ask if there is a restaurant on-site; if so, get a copy of its menu. Hotel staff can also provide a list of restaurants near the hotel that may be acceptable to the team.

■ Pack plenty of bottled water and sports drinks that do not require immediate refrigeration. Pack these in ice in the cooler as athletes consume already-chilled bottles.

414 SECTION 2 The Practical Application of Sports Nutrition

Table 14.5 Healthful Food Choices When Dining Out

Carbohydrate choices Protein choices Lower-fat options Buffet-style eating Low-fat or skim milk Juice Hot cocoa Low-fat chocolate milk Whole grain breads/rolls Fruit muffins Pancakes Toast Bagels Cornbread Soups: broth-based, split pea, bean,

minestrone, vegetable Thick-crust vegetable pizza Salads with corn, beets, carrots,

three-bean salad Pastas with marinara sauce Pudding

Hamburger Cheeseburger Roast beef Chicken breast Turkey Eggs Chili Meat sauce on pasta Fish Tuna or chicken salad Black, pinto, and kidney beans Lentils Tofu, bean curd stir-fry Lentil, bean, or pea soup Low-fat cottage cheese

Baked, broiled, roasted, boiled, poached, charbroiled items

Soft flour tortillas or corn tortillas Low-fat condiments, salad dressings Vinaigrette dressings Steamed instead of fried rice Salsa, picante sauce instead of sour

cream and guacamole Tomato or vegetable juice as appetizers Breads/rolls instead of chips as

appetizers

Fill one plate first with vegetables, fruit, salads, whole grain breads

Broiled, grilled, or steamed meats, fish, chicken

Avoid fried foods Avoid cheesy, creamed foods Baked potato instead of fries Limit creamy salads, buttery croutons,

extra cheese on salads Put garbanzo, kidney beans on salads Frozen yogurt or soft-serve ice cream

for dessert Eat until you are full and then stop Avoid the “get your money’s worth”

mentality

Chapter 14 Team Sport Athletes 415

The Box Score Key Points of Chapter

n Teams are made up of athletes whose energy requirements and nutritional needs vary widely. The best dietary plans for team sports are designed around the individual athlete and do not take a “one diet fits the whole team” approach.

n As with all sports, the three energy systems work together to provide energy for team sport perfor- mance; however, this does not mean that they all contribute equally. The intense, short bursts of activ- ity characteristic of team sport play make team sports more anaerobic in nature, which means that the phosphagen and anaerobic energy systems are the prime contributors during actual sport play. The aerobic system comes into play during the rest intervals between plays when the anaerobic energy stores are being replenished.

n The calorie requirements for team sport athletes vary depending on the sport, the position played by the athlete, and the length of the event. However, the energy requirements for most team sports can usually be met by following healthy dietary practices before and after the game. Consumption of signifi- cant amounts of energy during games is generally not necessary for games lasting 1 to 2 hours.

n The carbohydrate needs of athletes can be deter- mined based on calculated energy requirements or body weight. In most cases, carbohydrate, protein, and fat intake should range from approximately 55–65%, 15–20%, and 20–35%, respectively. It should be realized that carbohydrates are the primary energy fuel for team sports and that their dietary intake should not be decreased at the expense of higher protein or fat diets.

n Pregame meals should consist primarily of car- bohydrates and be consumed 3 to 4 hours prior to competition.

n After practice or a game, carbohydrate levels in the liver and muscle must be restored. The recommen- dation of consuming 1.0–1.2 grams of carbohydrates per kilogram of body weight every 1 hour for 4 hours after practice or competition helps to ensure that recovery will be optimal.

n Indiscriminant protein supplementation, par- ticularly at the expense of carbohydrate intake, is neither warranted nor recommended. In many instances the athlete’s diet supplies enough protein to meet the body’s needs.

n The timing of protein intake rather than high-dosage protein supplementation itself may be more impor- tant to the athlete. Ingestion of complete protein

sources immediately before and after training or practice has been shown to increase cellular uptake and increase protein synthesis, which, in turn, may speed tissue healing, rebuilding, or adaptation.

n Dietary fat intake for team athletes is no different from a heart-healthy diet. The current recommenda- tion states that 20–35% of total daily calories should come from fats.

n Vitamin and mineral supplementation at high dos- ages has not been shown to enhance athletic perfor- mance. Although intense training can increase the needs for certain micronutrients, the normal diet of most athletes is adequate in supplying the daily micronutrient needs. Although mega-dosing is not recommended, taking a once-a-day multivitamin/ mineral tablet as insurance is generally accepted as a prudent dietary practice.

n Preventing dehydration is tantamount to good sport performance. Hydration must be maintained in all- day or weekend tournaments; otherwise, the ath- letes’ performance will deteriorate. A minimum of 3–4 liters should be consumed to meet basic needs, with additional water intake occurring prior to, dur- ing, and immediately after competition.

n Based on changes in body weight, 16–24 ounces of water should be consumed for every pound of body weight lost. Drinking fluids containing carbohy- drates within 1 to 2 hours after practice or games will not only help in rehydration, but also assist in the restoration of muscle glycogen levels.

n Macronutrient intake at all-day or weekend tour- naments can be varied based on the timing of events, the number of hours between events, and the availability of foods. In general, foods or snacks eaten before or between games should be com- posed primarily of carbohydrates because they are more rapidly digested and absorbed. High-fat foods or snacks are not recommended because they take longer to digest and may cause stomach upset.

n During tournaments where multiple games are played over the course of 1 to 2 days, snacks and small meals should consist primarily of carbohy- drates. Athletes should pack food and beverages for the trip if there is room for storage and refrigeration. If packing items is not feasible, then making smart choices at fast-food restaurants and/or the conces- sion stand can serve as the alternative. Educating athletes about making smart nutrition choices when dining out will positively affect their performance in away games.

416 SECTION 2 The Practical Application of Sports Nutrition

Study Questions

1. Even though team sports tend to be classified as anaerobic sports, why is it important for the athletes to also engage in aerobic conditioning?

2. What information is needed to calculate the daily energy needs for a team sport athlete? What are some of the hurdles encountered by team sport athletes who are trying to meet their energy needs?

3. Which of the macronutrients is the prime source of energy for the interval type of activity encountered in most team sports?

4. What role do proteins play in the diet of team athletes?

5. Once the athlete’s energy needs have been estimated, how are carbohydrate and protein needs determined? In other words, what are the recommended daily intake levels of carbohydrates and proteins for team sport athletes? Provide your answer in a percentage

of total calories as well as grams per kilogram of body weight.

6. Should team sport athletes take vitamin and min- eral supplements? Defend your answer as to why or why not.

7. Discuss strategies that could help team athletes who practice and compete in hot and humid conditions to stay well hydrated.

8. Discuss strategies that coaches or sports nutrition professionals can employ to increase the chances of athletes adequately hydrating themselves.

9. When a team is on the road what are some healthy foods to pack for the trip?

10. What are several healthy food choices for athletes when buying food from a concession stand or fast- food restaurant?

References

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8. Myerson M, Gutin B, Warren M. Resting metabolic rate and energy balance in amenorrheic and eumen- orrheic runners. Med Sci Sports Exerc. 1991;23:15–22.

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13. Akermark C, Jacobs I, Rasmusson M, Karlsson J. Diet and muscle glycogen concentration in relation to physical performance in Swedish elite ice hockey players. Int J Sport Nutr. 1996;6(3):272–284.

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15. Hawley J, Dennis SC, Noakes TD. Carbohydrate, fluid, and electrolyte requirements of the soccer player: a review. Int J Sport Nutr. 1994;3: 221–236.

16. Kreider R, Ferreira M, Wilson M, et al. Effects of creatine supplementation on body composition, strength, and sprint performance. Med Sci Sports Exerc. 1998;30(1):73–82.

17. Short S, Short WR. Four-year study of univer- sity athletes’ dietary intake. J Am Diet Assoc. 1983;82:632–642.

18. Schokman C, Rutishauser IHE, Wallace RJ. Pre- and postgame macronutrient intake of a group of elite Australian football players. Int J Sport Nutr. 1999;9:60–69.

19. Leatt PB, Jacobs I. Effects of glucose polymer ingestion on glycogen depletion during a soccer match. Can J Sports Sci. 1989;14:112–116.

20. Simard C, Tremblay A, Jobin M. Effects of carbohy- drate intake before and during an ice hockey game on blood and muscle energy substrates. Res Q Exerc Sci. 1988;59:144–147.

21. Zeederberg L, Lambert EV, Noakes TD, Dennis SC, Hawley JA. The effect of carbohydrate ingestion on the motor skill performance of soccer players. Int J Sports Nutr. 1996;6:348–355.

Chapter 14 Team Sport Athletes 417

22. Nicholas CW, Tsintzas K, Boobis L, Williams C. Car- bohydrate-electrolyte ingestion during intermit- tent high-intensity running. Med Sci Sports Exerc. 1999;31:1280–1286.

23. Shepard RJ. Meeting carbohydrate and fluid needs in soccer. Can J Sports Sci. 1990;15:165–171.

24. Hargreaves M. Carbohydrate and lipid requirements of soccer. J Sports Sci. 1994;12(suppl):13S–16S.

25. Tipton K, Wolfe RR. Protein and amino acids for ath- letes. J Sports Sci. 2004;22:65–79.

26. International Olympic Committee. IOC consen- sus statement on sports nutrition 2010. J Sports Sci. 2011;29(S1):S3–S4.

27. Tipton KD. Exercise, protein metabolism, and muscle growth. Int J Sport Nutr Exerc Metab. 2001;11(1):109–132.

28. Nicholas C, Tsintzas K, Boobis L, Williams C. Car- bohydrate-electrolyte ingestion during intermit- tent high-intensity running. Med Sci Sports Exerc. 1999;31(9):1280–1286.

29. Fleming J, Sharman MJ, Avery NG, et al. Endurance capacity and high-intensity exercise performance responses to a high-fat diet. Int J Sport Nutr Exerc Metab. 2003;13(4):466–478.

30. Van Loon LJ, Greenhaff PL, Constantin-Teodosiu D, Saris WH, Wagenmakers AJ. The effects of increas- ing exercise intensity on muscle fuel utilization in humans. J Physiol. 2001;536(Pt 1):295–304.

31. Van Loon LJ, Schrauwen-Hinderling VB, Koopman R, et al. Influence of prolonged endurance cycling and recovery diet on intramuscular triglyceride con- tent in trained males. Am J Physiol Endocrinol Metab. 2003;285(4):E804–E811.

32. Hinton PS, Sanford TC, Davidson MM, Yakushko OF, Beck NC. Nutrient intakes and dietary behaviors of male and female collegiate athletes. Int J Sport Nutr Exerc Metab. 2004;14:389–405.

33. Beals KA. Eating behaviors, nutritional status, and menstrual function in elite female adoles- cent volleyball players. J Am Diet Assoc. 2002;102: 1293–1296.

34. Peake JM. Vitamin C: effects of exercise and require- ments with training. Int J Sport Nutr Exerc Metab. 2003;13(2):125–151.

35. Schroder H, Navarro E, Tramullas A, Mora J, Galiano D. Nutrition antioxidant status and oxidative stress in professional basketball players: effects of a three compound antioxidative supplement. Int J Sports Med. 2000;21(2):146–150.

36. Greydanus DE, Omar H, Pratt HD. The adolescent female athlete: current concepts and conundrums. Pediatr Clin N Am. 2010;57:697–718.

37. Robertson S, Benardot D, Mountjoy M. Nutritional recommendations for synchronized swimming. Int J Sport Nutr Exer Metab. 2014;24:404–413.

38. McClung JP, Gaffney Stromberg E, Lee JJ. Female ath- letes: a population at risk of vitamin and mineral

deficiencies affecting health and performance. J Trace Elem Med Biol. 2014;28(4):388–392.

39. Dubnov G, Constantini NW. Prevalence of iron deple- tion and anemia in top-level basketball players. Int J Sport Nutr Exerc Metab. 2004;14(1): 30–37.

40. American Dietetic Association. Position of the American Dietetic Association, Dietitians of Can- ada, and the American College of Sports Medicine: nutrition and athletic performance. J Am Diet Assoc. 2000;100:1543–1556.

41. Papadopoulou S, Papadopoulou SD, Gallos GK. Macro- and micro-nutrient intake of adolescent Greek female volleyball players. Int J Sport Nutr Exerc Metab. 2002;12:73–80.

42. Krumbach CJ, Ellis DR, Driskell JA. A report of vita- min and mineral supplement use among university athletes in a Division I institution. Int J Sport Nutr. 1999;9(4):415–425.

43. Jacobson B, Sobonya C, Ransone J. Nutrition practices and knowledge of college varsity athletes: a follow- up. J Strength Cond Res. 2001;15(1): 63–68.

44. Herbold N, Visconti B, Frates S, Bandini L. Traditional and nontraditional supplement use by collegiate female varsity athletes. Int J Sports Nutr Exerc Metab. 2004;14(5):586–593.

45. Jonnalagadda S, Rosenbloom C, Skinner R. Dietary practices, attitudes, and physiological status of col- legiate freshman football players. J Strength Cond Res. 2001;15(4):507–513.

46. Burns J, Dugan L. Working with professional athletes in the rink: the evolution of a nutrition program for an NHL team. Int J Sport Nutr. 1994;4(2): 132–134.

47. American College of Sports Medicine. Position stand: exercise and fluid replacement. Med Sci Sports Exerc. 2007;39(2):377–390.

48. Casa D, Armstrong LE, Hillman SK, et al. National Athletic Trainers’ Association position state- ment: fluid replacement for athletes. J Athl Train. 2000;35(2):212–224.

49. Minehan M, Riley MD, Burke LM. Effect of flavor and awareness of kilojoule content of drinks on prefer- ence and fluid balance in team sports. Int J Sport Nutr Exerc Metab. 2002;12:81–92.

50. Reilly T. Energetics of high-intensity exercise (soc- cer) with particular reference to fatigue. J Sports Sci. 1997;15(3):257–263.

51. Ostojic S, Mazic S. Effects of a carbohydrate-electro- lyte drink on specific soccer tests and performance. J Sports Sci Med. 2002;1:47–53.

52. Welsh R, Davis JM, Burke JR, Williams HG. Carbo- hydrates and physical/mental performance during intermittent exercise to fatigue. Med Sci Sports Exerc. 2002;34(4):723–731.

53. Murray R. Rehydration strategies—balancing sub- strate, fluid, and electrolyte provision. Int J Sport Med. 1998;19:133S–135S.

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54. Kovacs E, Schmahl RM, Senden JMG, Browns F. Effect of high and low rates of fluid intake on post-exercise rehydration. Int J Sport Nutr Exerc Metab. 2002;12:14–23.

55. Coris E, Ramirez AM, Van Durme DJ. Heat illness in athletes. Sports Med. 2004;34(1):9–16.

56. Dabinet J, Reid K, James N. Educational strategies used in increasing fluid intake and enhancing hydration status in field hockey players preparing for competi- tion in a hot and humid environment: a case study. Int J Sport Nutr Exerc Metab. 2001;11:334–348.

Additional Resources

Braakhuis A, Meredith K, Cox GR, Hopkins WG, Burke LM. Variability in estimation of self-reported dietary intake data from elite athletes resulting from cod- ing by different sports dietitians. Int J Sport Nutr Exerc Metab. 2003;13: 152–165.

Oppliger R, Bartok C. Hydration testing of athletes. Sports Med. 2002;32(15): 959–971.

Smart L, Bisogni CA. Personal food systems of male college hockey players. Appetite. 2001;37:57–70.

Chapter 14 Team Sport Athletes 419

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Key Questions Addressed 1. What is a “special population”?

2. What are the special considerations for athletes with diabetes?

3. What are the special considerations for athletes who are pregnant?

4. What are the special considerations for child and teen athletes?

5. What are the special considerations for college athletes?

6. What are the special considerations for masters athletes?

7. What are the special considerations for vegetarian athletes?

You Are the Nutrition Coach Ryan is a cross-country athlete running for one of the top collegiate teams in the country. He is a sophomore in college and is living in an apartment with two other runners on the team. He lived in a dorm as a freshman and decided on a more vegetarian style of eating last year because his room- mate was vegetarian. A variety of vegetarian dishes that he liked were available in the dorm cafete- ria, and he found eating there to be convenient after long practices.

Ryan is 5’ 8” and weighs around 135 pounds. He trains hard daily for 1 to 2 hours at the track or on the road and lifts weights twice a week with the team. He eats some dairy, mainly yogurt and soy milk, and occasionally eggs. He eats no meat or fish, but he does consume some beans, legumes, and frozen veggie burgers. Grocery shopping, meal planning, and vegetarian cooking are all new to Ryan, and therefore he schedules an appointment with the athletic department’s sports nutritionist for guidance with eating vegetarian style in his apartment.

Questions • What nutrients would you be most concerned about being insufficient in Ryan’s daily diet?

• What questions should you ask about his typical food intake to help you determine a nutrition plan for Ryan?

• What recommendations, both nutritional and educational, would you give Ryan to help him be successful in sport while practicing a vegetarian diet?

Special Populations

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CHAPTER 15

What is a “special population”? The best dietary plans are those designed around the needs of each individual athlete. In a sense, each dietary plan is special. The meal plan must be designed to meet not only the basic metabolic needs of the athlete, but also the unique energetic demands of training, sport partici- pation, and recovery. Although each athlete is certainly “special,” the dietary practices followed are basic in regard to nutrition.

The “special populations” discussed in this chap- ter require nutritional consideration beyond the usual adjustments made to meet individual basic dietary needs. The popularity of sport participation, the advancement of training and conditioning, and the increased sporting opportunities for children and women have expanded the pool of athletes and thus increased the physical diversity of today’s athletes. For example, there are athletes who are playing sports with metabolic diseases such as dia- betes. The number of older or masters-level athletes is increasing as advances in training and conditioning are keeping athletes in competitive shape later in life; the number of masters-level competitions also is increasing, creating more opportunities for masters athletes to com- pete. Children are participating in sports at young ages, thus requiring nutritional planning for athletes under- going growth and development. Title IX has expanded the number of sporting opportunities for women, which, in turn, has made dealing with the pregnant athlete a

growing issue. In the following sections, the nutritional considerations required for these and other special popu- lations are discussed.

What are the special considerations for athletes with diabetes? According to the American Diabetes Association, there are approximately 29.1 million people with diabetes mellitus (diabetes) in the United States. Of these, approximately three-quarters have been diagnosed and the other one- quarter are unaware they have diabetes. Diabetes is a metabolic disorder that affects carbohydrate availability and utilization by the cells of the body.1 Because carbohy- drates are one of the main sources of energy for the body, particularly during exercise, diabetes severely alters nor- mal energy metabolism in the body.

Consumed carbohydrates ultimately appear as glu- cose in the bloodstream; however, for the blood glucose to be used by cells, it must be carried across the cell mem- branes by special transporter molecules. Activity of the glucose transporters is increased by the hormone insulin, which is produced by the pancreas. In response to rising blood glucose levels after a meal, the pancreas secretes insulin. Insulin activates the cell membrane transport- ers, thus increasing glucose uptake into the cell (see FIGURE 15.1 ), lowering blood glucose levels back to normal. In diabetes, there is a disruption of insulin release by the

Figure 15.1 Regulating blood glucose levels. In response to high blood glucose levels, the pancreas releases insulin, which increases the uptake of glucose by cells.

High blood glucose

Blood glucose Blood glucose

Insulin stimulates liver and muscle cells to store glucose as glycogen.

Insulin released.

Pancreas Insulin stimulates cells to take up glucose from the blood.

Chapter 15 Special Populations 421

pancreas and/or a decreased response of the cells to any insulin that is secreted. In either case, the end result is the inability of cells to uptake glucose.

Because the cells are incapable of uptaking glucose, hyperglycemia, or high blood glucose, results. Despite the fact that blood glucose levels are high, without the increased activity of the cell transporters, the cells of the body are

robbed of energy. The body is fooled into thinking the cells are starving for carbohy- drates and then, iron-

ically, the liver starts to release its stored glucose into the blood. This makes matters worse, raising the glucose levels in the blood even higher. The high blood glucose levels cause sugar to spill into the urine, causing another com- mon symptom of diabetes—frequent urination.

When the body is unable to use glucose as energy, it turns to other sources, namely proteins and fats. In times of energy deficit, proteins can be converted to glucose via gluconeogenesis. The body resorts to breaking down protein from muscle in an attempt to meet its energy demands. The end result is muscle wasting, muscle weakness, and loss of body weight, which are three other prominent symptoms of diabetes.

With diabetes, the body also attempts to increase fat utilization, which can also cause problems. When exces- sive fat is used as an energy source in the absence of glu- cose, intermediate products of fat metabolism can build up, forming compounds known as ketone bodies. The increased production of ketone bodies is known as keto- sis and can lead to a serious clinical condition called keto- acidosis. In ketoacidosis, body fluids, which are normally

slightly alkaline, become very acidic, and if left uncor- rected can be life threatening and result in coma.

There are many long-term conse- quences of high blood glucose lev- els that result from uncontrolled diabe- tes. The increased blood glucose con- centrations can cause damage to many body tissues.

Blood vessels in the eyes, kidneys, and heart, along with the cells that make up nerves, are all damaged by high levels of blood glucose. As a result, diabetes can cause blindness, kidney dysfunction, heart disease, and nerve degeneration.2 Amputations of the lower limbs are a com- mon complication of diabetes because of the nerve and tissue damage caused by diabetes. In fact, statistics from

the American Diabetes Association indicate that diabetes is responsible for 60% of all lower extremity amputations and 44% of all new kidney failure cases in adults.

What are the main types of diabetes? There are two types of diabetes, each requiring different treatment regimens. In type 1 diabetes, the pancreas stops producing insulin, and exogenous insulin injections

are required. Type 1 diabetes is most often diagnosed in children or young adults and previ- ously was termed “insulin-dependent diabetes.” In type 1

diabetes, the pancreas fails to produce enough insulin, so the blood glucose has no mechanism to enter the cells. Approximately 5% of people with diabetes have type 1 diabetes. The treatment regimen for type 1 diabetes is primarily insulin injections combined with a healthful diet and regular exercise to control blood glucose levels.

In type 2 diabetes, the pancreas produces sufficient amounts of insulin—it actually may overproduce insu-

lin—but the body’s cells are not respon- sive. The cells are less responsive to insulin because the number of cell recep- tors responsible for binding insulin is decreased. If insulin cannot bind to recep-

tors on the cell membrane, then it cannot activate the glucose transporters, and uptake of glucose is affected. Approximately 95% of the people with diabetes in the United States have type 2 diabetes. The treatment for type 2 diabetes will depend on the individual’s blood glucose levels, amount of endogenous insulin production, and other factors. Some oral medications can enhance insulin sensitivity, helping blood glucose be transported more effectively into the cells for energy. It is interesting to note that exercise can also help in the management of type 2 diabetes. Exercise has been shown to increase the activity level of some of the glucose transporters in the active muscles independent of insulin, thereby increasing the uptake of blood glucose and subsequently lowering blood glucose levels. Exercise also plays a role in weight loss, which in overweight individuals with type 2 diabetes is also effective in treating some of the diabetic symptoms.

Prediabetes is a condition in which blood glucose levels are elevated but are

hyperglycemia An abnormally high blood glucose level; usually a feature of diabetes.

ketone bodies Molecules that are formed from fat metabolic byproducts. Ketone bodies are formed when insufficient carbohy- drates are available for complete metabolizing of fats.

ketosis A condition that arises from abnormally high levels of ketone bodies in the tissues and body fluids.

ketoacidosis Acidification of the blood caused by a buildup of ketone bodies.

type 1 diabetes A type of dia- betes in which the pancreas stops producing insulin. Type 1 diabet- ics require exogenous insulin injections to help maintain normal blood glucose levels.

type 2 diabetes A type of diabetes in which the pancreas still secretes insulin but the cells are not as responsive to it, resulting in elevated blood glucose levels. Individuals who are obese and over the age of 35 are at increased risk for this disease.

prediabetes A condition in which blood glucose levels are elevated but are not high enough to meet the criteria for a diagnosis of diabetes.

422 SECTION 2 The Practical Application of Sports Nutrition

not high enough to meet the criteria for a diagnosis of diabetes. Most individuals who develop type 2 diabetes have had glucose levels in the prediabetes range for some time prior to their type 2 diabetes diagnosis. The fasting plasma glucose level that typically signifies prediabetes is 100–125 milligrams per deciliter (mg/dL).3 The early iden- tification of prediabetes is essential to the prevention of type 2 diabetes and the complications that occur with this disease.

The diagnostic criteria for diabetes mellitus are as follows:3

• Diabetes symptoms plus casual plasma glucose con- centration ≥ 200 mg/dL (11.1 mmol/L), or

• Fasting plasma glucose ≥ 126 mg/dL (7.0 mmol/L), or • 2-hour plasma glucose ≥ 200 mg/dL (11.1 mmol/L)

during an oral glucose tolerance test The diagnostic criteria are the same for type 1 and

type 2 diabetes. Physicians can determine which type of diabetes has developed by reviewing the length of onset of symptoms, age at onset, and patient and family history, as well as by performing additional laboratory tests and a physical examination. A list of common symptoms of diabetes is provided in TABLE 15.1 .

What are the considerations related to exercise for athletes with diabetes? Regular exercise is one of the main recommendations for managing diabetes and blood glucose levels. Regular exer- cise can decrease insulin resistance and thereby improve blood glucose control. Athletes who are newly diagnosed with diabetes need to consider the effect that training and competition have on their blood glucose levels. More fre- quent self-monitoring of glucose levels before and after exercise is necessary to avoid complications of low blood glucose levels. As noted earlier, muscular contractions can improve glucose uptake by increasing glucose transporter activity, thereby allowing glucose to enter the cells inde- pendent of insulin. This enhanced transport can continue for several hours after exercise and thus can have a pro- longed impact on blood glucose levels. Therefore, moni- toring of glucose 2 to 3 hours after exercise may also be necessary because abnormal lows in glucose levels could occur postexercise.

Table 15.1

Common Symptoms of Diabetes Mellitus

Excessive thirst Blurred vision

Excessive urination Unexplained weight loss

Dehydration Excessive hunger or eating

Dizziness Poor or slow wound healing

Headache

Athletes with type 1 diabetes have to be even more cautious than type 2 diabetic athletes because they have to inject insulin in appropriate amounts and at the proper times to help control their blood glucose. Type 1 diabetic athletes must be very regimented and possess good self- management skills to safely and effectively participate in sports. They must closely monitor the effect of exercise on their blood glucose levels and thus make adjustments in the timing of insulin injections and dosage levels administered. Despite the extra hassle, studies indicate that athletes and active individuals with type 1 diabetes have a decreased risk for cardiovascular disease, which is a major health issue for diabetics. The bottom line is that athletes with type 1 diabetes can safely participate in all sports activities as long as they have learned how to control their blood glucose levels, there are no medi- cal complications that would be exacerbated by athletic participation, and they have adopted consistent lifestyle strategies for dealing with their disease.4

How can athletes manage their diabetes and excel in sports? Athletes who manage their diabetes well can excel in their sport and exercise activities. The main objective in managing diabetes is good blood glucose control on a daily basis. Maintaining a fasting glucose level of 70–100 mg/dL on a regular basis is the primary focus of con- trolled diabetes.3 This will prevent the two complications of most concern to diabetic athletes: hyperglycemia and hypoglycemia. Preventing hyperglycemia will help keep the athlete from developing some of the chronic diseases defined earlier in this chapter that are related to high cir-

culating glucose lev- els. Hypoglycemia can be extremely dangerous at any time but is more

likely to occur in athletes during and after exercise. To manage diabetes well, athletes need to be very disci- plined in the consumption of healthy foods and the tim- ing of food intake and insulin administration relative to exercise. Frequent self-monitoring of glucose levels prior to, during, and after exercise is a must.

How do athletes self-monitor glucose levels? Self-monitoring of glucose levels in the blood and urine is essential to any person with diabetes. Self-monitoring on a frequent basis helps individuals determine whether they need to make changes in their diet, exercise pro- gram, and/or medications. Athletes should self-moni- tor more frequently than nonathletes so that they can learn how their sport activity and diet affect their glucose levels. Testing the urine for glucose is one way of self- monitoring. Urine glucose testing consists of placing a small amount of urine on a chemically treated test strip. A change in the color of the test strip indicates a high

hypoglycemia A condition in which blood glucose levels fall below normal.

Chapter 15 Special Populations 423

level of glucose in the urine. Urine tests are less infor- mative to the athlete than blood tests, however, because they only indicate that glucose is spilling over into the urine because blood levels are high. It does not provide the actual blood glucose level.

The monitoring of blood glucose levels is more impor- tant to the athlete than urine glucose testing. Athletes can use portable blood glucose testing devices to accu- rately determine blood glucose levels. Information from this type of self-monitoring is essential to athletes with diabetes because it gives specific information about the actual level of glucose in the blood. The athlete pricks a finger and places a small droplet of blood on a chemi- cally treated test strip. The test strip is inserted into the testing device, which reads the blood glucose level and provides a digital readout of the actual glucose level. This type of monitoring should be done regularly, usually at least once in the morning and several times throughout the day, particularly for individuals who are taking medi- cations for diabetes. Athletes need additional testing prior to exercise, immediately after exercise, and several hours after exercise. Athletes are at risk for hypoglycemia not only during exercise, but also after exercise, when the risk for hypoglycemia may actually be increased. Decisions regarding the safety of initiating exercise and whether to make any adjustments to carbohydrate intake and insu- lin amounts are based on the preexercise monitoring of blood glucose (see TABLE 15.2 ).4

If the glucose level is greater than 250 mg/dL prior to exercise, the athlete should test the urine for ketones. To test the urine for ketones, a small amount of urine is placed on a chemically treated test strip. These test strips will change color if ketones are present. If ketones are present, exercise should not be initiated until the glucose level is lowered and ketones are not present. A combina- tion of high blood glucose with ketones in the urine can

Table 15.2

Preexercise Glucose Guidelines

Preexercise glucose level Recommendation < 100 mg/dL Ingest additional carbohydrates

prior to initiating exercise: 15–40 g carbohydrates (or more) depending on actual glucose level and athlete's typical response to added carbohydrates.

100–250 mg/dL Safe to initiate exercise

> 250 mg/dL Test urine for ketones.

> 250 mg/dL, with ketones Do not exercise. Make insulin or medication adjustments and then retest glucose and ketones.

> 250 mg/dL, without ketones present

Exercise can be initiated.

> 300 mg/dL, without ketones present

Exercise with caution.

be dangerous and lead to ketoacidosis. Athletes with type 1 diabetes and those with type 2 taking insulin are more prone to this condition and should take additional insu- lin. It is important that the athlete allow enough time for blood glucose levels to fall before exercise starts. If the glucose level is greater than 300 mg/dL without ketones present, the athlete should exercise with caution. Table 15.2 describes the considerations for these adjustments based on the level of glucose in the blood and ketones in the urine.

When glucose levels are low prior to exercise, then adjustments in insulin dosage and carbohydrate intake must be made or exercise delayed until blood glucose lev- els are in a safe range (see Table 15.2). In general, a glucose level of less than 100 mg/dL indicates that some adjust- ments should be made in either insulin injections or car- bohydrate intake prior to exercise. Consuming a small amount of carbohydrates immediately prior to exercise when blood glucose levels are below 100 mg/dL will help bring blood glucose up to a level that will be safe to ini- tiate exercise. The amount of carbohydrates to consume at this time varies and depends on the individual athlete. Generally between 15 and 40 grams of carbohydrates will be adequate to bring the blood glucose level up enough to safely initiate exercise.

Monitoring blood glucose levels during exercise, espe- cially exercise lasting greater than 60 minutes, is crucial to the diabetic athlete. It provides the athlete with ongo- ing information about how the exercise is affecting blood glucose levels and what adjustments need to be made. Any time significant changes in the type, intensity, or duration of exercise are made, close self-monitoring of blood glucose should occur. Once the athlete has a clear picture of how his or her body responds to the change, less frequent monitoring will be necessary. The athlete’s physician or a Certified Diabetes Educator (CDE) should help with adjusting insulin or medication doses in

response to exercise. These professionals can also make sug- gestions for adjust- ing preexercise and during-exercise car- bohydrate intakes. Athletes may also want to meet with a

registered dietitian to devise guidelines for total daily car- bohydrate adjustments, as well as formulate specific dietary strategies to better prepare for training and/or competition.

What are the nutrition recommendations for the athlete with diabetes? Dietary recommendations for people with diabetes are very similar to healthy recommendations for the general population. Athletes with diabetes should make dietary selections based on their individual food preferences,

Certified Diabetes Educator (CDE) An allied health profes- sional who has passed a rigorous certification exam documenting his or her advanced knowledge and skills related to dealing with diabetes mellitus.

424 SECTION 2 The Practical Application of Sports Nutrition

athletes, low glycemic index foods are recommended before exercise, high glycemic snacks/drinks during exer- cise, and moderate to high glycemic index foods after exer- cise. However, the current research regarding the benefits of using the glycemic index for glycemic control with indi- viduals with diabetes is inconclusive. Once again, it is the total amount of carbohydrates ingested and the timing of ingestion that are crucial.

What should athletes with diabetes eat during long exercise bouts? Athletes with type 1 diabetes should have carbohydrates available during and after exercise. During exercise last- ing more than 30 minutes, athletes with type 1 diabe- tes should consume 15–30 grams of carbohydrates every

cultural food choices, metabolic needs (e.g., glucose and lipid levels), training goals, and lifestyle. The current position statement from the American Diabetes Asso- ciation states that there is no single eating pattern that is best for all individuals with diabetes. Therefore, it is appropriate for athletes with diabetes to follow the cur- rent sports nutrition recommendations. Carbohydrate intake can range from 45–65% of total calories, prefer- ably consumed in the form of fruits, vegetables, whole grains, legumes, and dairy products. Athletes with diabe- tes should limit or avoid sugar-sweetened beverages and processed foods containing added sodium, fat, and sug- ars. Protein intake in the range of 15–20% of total calories should be adequate for athletes with diabetes.5 Total fat intake can range from 20–35% of total calories with an emphasis on the unsaturated fats. As noted earlier, the athlete may want to consult with a physician, a CDE, and/or a registered dietitian (RD) to help formulate the best diet based on his or her needs and the demands of his or her sport.

Athletes with diabetes should eat at approximately the same time each day and eat a similar amount of food in each meal or snack. There is no need to have a rigid sched- ule of food intake; however, eating at approximately the same time each day, not varying carbohydrate intake drasti- cally from meal to meal, and pairing a carbohydrate source with a protein-rich food will help to maintain blood glucose levels in the recommended range. If more carbohydrates than usual are eaten, then adjustments in insulin dosage, for diabetics using insulin, can be made. However, deter- mining how much to increase insulin dosage is a learning process, and it will initially require the athlete to test regu- larly and often to determine how his or her body responds to higher-than-normal carbohydrate intake. Athletes with diabetes requiring insulin also need to learn how to match their carbohydrate intake and insulin dosages to ensure appropriate blood glucose levels are attained at the begin- ning of exercise. A sample meal plan for a female basketball player with diabetes is listed in TRAINING TABLE 15.1 .

Athletes need to be aware of the amount of carbo- hydrates they are ingesting in a meal or snack. The type of carbohydrate (i.e., simple or complex, high or low gly- cemic index) is not as important as the total amount con- sumed. This gives athletes with diabe- tes freedom to choose various sources of carbohydrates in their diet as long as they pay attention to the amount of car- bohydrates being eaten.6

Glycemic index has received considerable attention in both the scientific and popular press. For nondiabetic

Training Table 15.1: Sample Meal Plan for a Type 1 Diabetic Athlete

Breakfast Serving Size

Oatmeal 1 cup

Whole grain toast 2 slices

Peanut butter 2 tbsp

Orange 1 medium

Milk, 1% 1 cup

Total carbohydrates: 81 grams Total calories: 650

Lunch Serving Size

Grilled chicken sandwich:

Whole wheat bun 1

Chicken breast 4 oz

Tomato ½ raw

Light mayo 1 tbsp

Salad 1 cup

Salad dressing, fat free 1 tbsp

Apple, raw 1 medium

Milk, 1% 1 cup

Total carbohydrates: 80 grams Total calories: 609

Dinner Serving Size

Pork chop, loin, lean 3 oz

Red-skinned potatoes 2 small

Steamed asparagus 1 cup

Margarine 2 tsp

Pineapple chunks, water-packed 1 cup

Water or noncaloric beverage 2 cups

Total carbohydrates: 82 grams Total calories: 685

Snack Serving Size

Pudding, vanilla, sugar-free 1 cup

Sliced strawberries ½ cup

Total carbohydrates: 30 grams Total calories: 161

Daily total carbohydrates: 273 grams (52% of total calories)

Daily total calories: 2105

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Gaining the Performance Edge

Blood glucose response in dia- betic athletes depends on the amount of carbohydrates ingested, not the type. When planning meals and snacks for before, dur- ing, or after exercise, carbohydrate content should be the primary consideration.

to release too little glucose into the circulation. This results in too much glucose uptake into the cells and too little left circulating in the blood. The signs and symp- toms of hypoglycemia are listed in Table 15.3. Carbohy- drate foods should be available during and after exercise in case low blood glucose occurs. Consuming carbohy- drates as needed during and immediately after exercise, and continuing intake for several hours after exercise, is the best prevention for hypoglycemia. Carrying a food bag that contains glucose tablets, juice, and regular soda for emergencies is essential for any diabetic athlete. Glucose tablets are particularly helpful to have on hand because they are small, can be carried in a small pouch on the athlete, and are convenient for times when emergency glucose is needed. The athlete’s physician, RD, or CDE can provide guidelines for amounts of carbohydrates to ingest in a hypoglycemic emergency.

Sports professionals, friends, parents, and teammates can all help the athlete manage the diabetes. All of these

individuals should know the warning signs and symp- toms that are typi- cal of low and high blood glucose levels so that they can help recognize and prop- erly address symp- toms during training or competition. This is important because in some situations the diabetic athlete may not be aware or

30 to 60 minutes. This can be accomplished by consum- ing sports drinks, sports gels, diluted juices, sports bars, and/or dried fruit. The following examples all provide the 15–30 grams of carbohydrates appropriate for consump- tion during exercise:

• 8 oz sports drink, containing 6–8% carbohydrates • 1 single-serving sports gel • 1 fig bar • 8 oz diluted juice, mixed in a 1:1 ratio of juice to water

Another question often asked by endurance diabetic athletes is whether it is appropriate to carbohydrate load. The answer is yes. The modified version of carbohydrate loading, which consists of eating a mixed diet of slightly lower carbohydrates (50% carbohydrates, 30% fat, 20% pro- tein) 4 to 7 days prior to an event and then increasing car- bohydrate intake 3 days prior to the event (up to 60–65% carbohydrates), would be the recommended method of carbohydrate loading. Because this method avoids drastic changes in carbohydrate intake, athletes who self-monitor regularly are better able to adjust their insulin or medica- tion levels to maintain their blood glucose levels while car- bohydrate loading. Before trying this method or any other dietary manipulation, however, the athlete should consult with a physician or endocrinologist to ensure good glucose control prior to carbohydrate loading.

How can athletes recognize, treat, and prevent diabetic emergencies during exercise? Athletes with diabetes can exercise safely if they manage their diabetes well. In type 2 diabetes, with no medica- tions, there should be very little concern of either hypo- or hyperglycemia during exercise. Conversely, athletes who use insulin or type 2 diabetics who take oral medications for their diabetes may be at risk for experiencing low or high blood glucose levels that could constitute a diabetic emergency. Hyperglycemia can occur as a result of severe insulin deficiency during exercise. This deficiency, when combined with the actions of other hormones that cause the liver to release more glucose into the bloodstream, can cause blood glucose levels to rise precipitously. The signs and symptoms of hyperglycemia are presented in TABLE 15.3 .

To be prepared in case of hyperglycemia, the athlete must keep insulin and syringes readily available. The stor- age and transport of insulin and syringes can be chal- lenging because insulin needs to be kept cool, requiring a refrigerator or portable cooler. Syringes need to be kept secure and in a container to maintain hygiene and to avoid accidental needle sticks to other individuals. Medi- cation adjustments based on high blood glucose levels should be established with the assistance of the athlete’s physician.

Hypoglycemia can occur if too much insulin is cir- culating at the time of exercise. Excess insulin enables cells to uptake more glucose while also causing the liver

Table 15.3

Signs and Symptoms of Hypoglycemia and Hyperglycemia

Hypoglycemia signs/ symptoms

Hyperglycemia signs/ symptoms

Sweating Nervousness

Pounding heart Restlessness

Hunger Thirst

Shakiness Fatigue

Confusion Blurred vision

Lethargy Muscle cramps

Incoordination Nausea

Slurred or difficult speech Abdominal pain

Irritability

Headache

Nausea

426 SECTION 2 The Practical Application of Sports Nutrition

Gaining the Performance Edge

With careful glucose monitoring, regular exercise, and a healthful eating plan, athletes with type 1 or type 2 diabetes should be able to lead an active, competitive life. Reg- ular visits with medical personnel to monitor long-term glucose levels and to make adjustments in treat- ment regimens will help the ath- lete with diabetes remain healthy and active.

recognize the symptoms on his or her own. The athlete’s support group (and the athlete) should also know what to do in case of a diabetic emergency. Athletes should keep additional carbohydrate foods on hand before, dur- ing, and after exercise to prevent, and treat when neces- sary, low blood glucose levels. The athlete should inform the coach, athletic trainer, sports nutritionist, and team- mates about where he or she keeps the food bag, glu- cose tablets, insulin, and syringes. In both hypoglycemia and hyperglycemia, call- ing emergency per- sonnel to the scene may be necessary if self-monitoring and administration of either carbohydrates or insulin does not appear to be effective in alleviating the athlete’s symptoms.

What are the special considerations for athletes who are pregnant? When athletes become pregnant, some may choose to continue training and competing throughout a major- ity of their pregnancy. For example, Regan Scheiber, an All-American swimmer from Penn State, continued her training postcollege in pursuit of swimming the English Channel. In August 2001, she successfully completed this feat while in her 11th week of pregnancy.7 This example may be on the extreme end of the spectrum; however, it demonstrates that athletes can continue to train dur- ing many months of pregnancy. Many athletes who are pregnant will choose to stay active but decrease their training level and intensity and may not compete, espe- cially in the last two trimesters of pregnancy. Athletes who choose to stay active should be followed closely by their physicians, make modifications to their exercise regimens as medically indicated, and adjust their daily nutrition intake. Fetal growth and development require adequate energy and proper nutrition. When an indi- vidual becomes an athlete, calorie, macronutrient, and micronutrient needs rise. If an athlete becomes preg- nant, overall nutrient needs increase again, requiring a renewed focus on a well-balanced and appropriately planned diet.

Although all nutrients are important for the growth of a fetus, several dietary components are of special concern to active mothers. Specifically, pregnant athletes need to ensure the daily consumption of adequate calories, pro- tein, B vitamins (especially folate), vitamin C, vitamin A, magnesium, and iron. The following sections provide the rationale for these increased requirements and sugges- tions for the development of an individualized nutrition plan for pregnant athletes.

How are an athlete’s caloric requirements affected by pregnancy? In general, athletes will require an additional 300 calories a day as compared to their prepregnancy diet, especially during the second and third trimesters. Because many athletes struggle to meet their own calorie needs, it can be challenging for some to meet the extra caloric demands of pregnancy. However, because training duration, intensity, and frequency often simultaneously, and appropriately, decrease throughout pregnancy, the increase in daily cal- ories required may not be as great. However, special care should be taken to ensure that pregnant athletes are in fact consuming enough calories. Adequate calories from a well-balanced diet will prevent exercise-induced hypo- glycemia, which can result in a multitude of problems for both the mother and fetus.

Calorie needs for endurance, strength, and team sport pregnant athletes should be calculated just as they would for nonpregnant athletes and then an additional 300 calories added. Note that 300 calories is an estimate and may vary among athletes. Similar to nonpregnant athletes involved in heavy training and competition, standard calculation estimates may need to be adjusted based on the individual’s response and progression. Research has revealed that calorie needs during preg- nancy can range from 25 calories per day up to 800 calo- ries per day above prepregnancy values.8 This is a huge range! If 300 calories a day is used across the board for all pregnant athletes, some women may gain too much weight, whereas others may fail to gain enough weight. Therefore, one of the best indicators of adequate calo- rie consumption is appropriate weight gain throughout pregnancy. In general, athletes should gain 25–35 pounds during the duration of a pregnancy, with variations based on prepregnancy weight (athletes with a BMI < 20 should aim for a gain of 28–40 pounds), height (shorter athletes should aim for a gain at the low end of the range), and age (teen athletes should aim for the high end of the weight gain range).9

The increase in calorie needs during pregnancy can be met by increasing portion size slightly at meals or adding one to two small snacks throughout the day. For example, drinking a 12-ounce glass of skim milk and eating a 6- to 8-ounce yogurt would provide approximately 300 calories. Many athletes are unaware of the energy value of foods and therefore need assistance in understanding the total quantity of food to consume to obtain 300 calories to pre- vent under- or overestimation.

The athletes at highest risk for not meeting the energy demands of pregnancy are those in weight-restricted sports, those who were restricting calories with the inten- tion of weight loss before pregnancy, and individuals with disordered eating. These high-risk athletes should work closely with a dietitian to ensure that calorie needs, as well as other macronutrient and micronutrient require- ments, are being met. The dietitian should work as a team with the athlete’s obstetrician/gynecologist to confirm

Chapter 15 Special Populations 427

Food for Thought 15.1

Dealing with a Diabetic Athlete

Understand the guidelines and emergency procedures for work- ing with a diabetic athlete.

any one of the following would provide 20–25 grams of protein:

• 24 oz skim milk • 3 oz beef, chicken, or fish • 1½ cups beans, lentils, or other legumes • 3 oz nuts

A pregnant athlete’s success in meeting protein needs is often directly correlated to her energy intake; if calorie intake is low, protein intake is typically low. By increas- ing total food consumption, from a variety of different food groups, protein needs can be met. Pregnant athletes should not rely on protein supplements to meet daily requirements. Supplements often will provide large quan- tities of protein, vitamins, and/or minerals that can inter- fere with the absorption of other nutrients. By focusing on a variety of whole foods, protein needs can be met while also encouraging the athlete to continue meal planning, which will be a critical skill for the whole family once the baby is born.

Inadequate protein intake will affect the mother as well as the developing fetus. Similar to nonpregnant ath- letes, low protein intake will affect muscle development, immune function, and recovery from exercise. If protein, as well as caloric, intake is low, muscle tissue will be used for energy, altering the athlete’s body composition and affecting her ability to maintain fitness. A lower immune function can endanger the mother’s health, thus affect- ing the health and continued development of the fetus. Low protein intake can also negatively affect the recovery process after exercise sessions, increasing muscle sore- ness and overall fatigue.

Although protein requirements increase during preg- nancy, carbohydrate and fat needs remain proportion- ately the same. Carbohydrates are still the main source of energy for the mother and fetus. In fact, the respiratory exchange ratio (RER) for active women has been shown to increase during pregnancy, hovering around 1.0.12–14 This RER value represents a preferential use of carbohydrates versus fats. Therefore, it is important for pregnant ath- letes to continue eating a moderate- to high-carbohydrate diet (50–65% of total calories) to provide energy for the growth of the fetus, provide energy for maternal exercise, and prevent ketosis, which can be harmful to the develop- ing fetus.12 Adequate fiber intake is especially important in preventing constipation and hemorrhoids, which are common during pregnancy. Fat is a good source of con- centrated calories and essential fatty acids and allows for the absorption of fat-soluble vitamins during pregnancy. Overall, a well-balanced diet, with increased calories and protein, will provide the nutrients an athlete needs to pro- duce a healthy baby.

How are an athlete’s B vitamin requirements affected by pregnancy? B vitamins are critical for energy production and tis- sue development in both the pregnant woman and the developing fetus. Thiamin, riboflavin, and niacin needs

that the athlete’s current consumption level is resulting in the proper growth and development of the fetus.

Inadequate calorie consumption can have sev- eral adverse consequences. In the first trimester, low energy intake is associated with a higher risk of pre- mature delivery, fetal death, and malformation of the fetal central nervous system. In the second and third trimesters, poor fetal growth and development are the main consequences of inadequate intake. In relation to an athlete’s maintenance of fitness, low energy intakes will also lead to fatigue and the inability to recover from even light to moderate workout sessions. If athletes cannot continue to exercise and maintain fitness dur- ing pregnancy, making a comeback in their sport after the baby is delivered will be a challenging and poten- tially lengthy process.

How are an athlete’s protein requirements affected by pregnancy? An athlete’s protein needs are increased slightly during pregnancy. Protein is critical for the development of fetal organs and tissues, as well as the maintenance of mater- nal tissues. In general, an additional 20–25 grams of pro- tein should be consumed daily. The RDA for nonpregnant women is 46 grams per day (based on 0.8 grams of protein per kilogram of body weight), which increases to 71 grams during the second half of pregnancy (requirements in the first half of pregnancy remain equivalent to nonpregnant women).10,11 Keep in mind that these are baseline require- ments, designed mainly for sedentary women. The differ- ence in the baseline requirement is 25 grams; therefore, athletes can use this recommendation to increase their estimated protein needs for their activity level by about 25 grams when pregnant. As with calorie needs, if train- ing duration, intensity, and frequency decline during pregnancy, protein needs may actually stay the same or increase minimally.

An additional 25 grams of protein can easily be obtained through a balanced diet. The consumption of

428 SECTION 2 The Practical Application of Sports Nutrition

are slightly increased for athletes and increase again dur- ing pregnancy to aid in energy production. Vitamin B12 is involved in DNA and red blood cell synthesis, and vitamin B6 aids in the metabolism of amino acids; daily require- ments of both of these nutrients increase slightly during pregnancy. However, the B vitamin deserving the most attention before and during pregnancy is folate.

Folate, or folic acid, plays a role in DNA synthesis, red blood cell production, and the development of the nervous system. Athletes who are thinking about becom- ing pregnant should begin to monitor their folate intake months before conception to ensure that adequate stores are available at the onset of fertilization. The reason for this focus on meeting folate requirements relates to the development of the fetal nervous system. Adequate intake of folate has been shown to dramatically decrease the risk of neural tube defects in children. The critical stages of neural tube formation occur within the first month after conception—which is typically before a woman knows she is pregnant. If a woman waits to change her eating habits until after she has confirmation of fertilization, she will have missed the window of opportunity to positively affect her baby’s health. A focus on folate should occur early and continue throughout pregnancy.

The folate requirements for pregnant women increase from a prepregnancy guideline of 400 micrograms to 600 micrograms during pregnancy.11,15 Folate can be obtained by consuming a balanced diet containing plenty of fruits, vegetables, and legumes as well as through fortified foods and folic acid supplements. Some of the richest sources of folate are orange juice, strawberries, green leafy veg- etables, beans, lentils, and fortified grains. For example, 1 cup of cooked lentils contains about 320 micrograms of folate, which is slightly over half of a pregnant athlete’s daily requirement.

Low folate intake will also begin to affect the mother. Active moms need folate for DNA synthesis in relation to red blood cell development. If folate intake is low, mega- loblastic anemia can occur, causing the pregnant athlete to feel weak and fatigued. Other signs and symptoms of low folate include depression, irritability, and disturbed sleep. A fatigued athlete will not have the energy to keep up with workouts, grocery shop, prepare meals, and continue other healthy behaviors for both the mother and fetus.

How are an athlete’s vitamin C requirements affected by pregnancy? Vitamin C requirements increase minimally during preg- nancy. Vitamin C plays a role in collagen formation, hor- mone synthesis, and proper immune function. Increased vitamin C intake also positively affects the absorption of iron—another nutrient critical for a healthy baby. Vita- min C requirements increase from 75 milligrams to 80–85 milligrams during pregnancy.11,16 Athlete mothers also benefit from this increase because the antioxidant func- tions of vitamin C aid in recovery from exercise sessions.

Vitamin C is found in foods that conveniently are also good sources of folate: orange juice, strawberries, green leafy vegetables, and some fortified cereals. In general, a strong focus on fruits and vegetables will help the preg- nant athlete achieve her daily vitamin C needs. For exam- ple, 1 cup of orange juice contains about 80 milligrams of vitamin C—nearly the entire daily requirement! There- fore, vitamin C supplements are not necessary during pregnancy unless a dietary deficiency exists.

Pregnant athletes should be aware of the maternal signs of low vitamin C, such as swollen, bleeding gums or fatigue, and work to reverse any deficiencies as soon as possible. Because of its independent and supportive roles (nonheme iron absorption) for both the mother and fetus, a focus on vitamin C should ideally begin before, and continue throughout, pregnancy. Because the increased requirement during pregnancy is small, and vitamin C can easily be obtained through a well-balanced diet, there should be no reason why a pregnant athlete cannot meet her needs.

How are an athlete’s vitamin A requirements affected by pregnancy? Vitamin A requirements increase slightly during preg- nancy to assist in cell differentiation and proper immune function. Because vitamin A is a fat-soluble vitamin and therefore can be stored in the body and become toxic, pregnant athletes should focus on food sources of vitamin A and avoid supplements.

Vitamin A requirements increase from the pre-preg- nancy level of 700 micrograms (RAE) to 750–770 micro- grams (RAE) during pregnancy.11,17 Similar to vitamin C and folate, vitamin A is most concentrated in fruits and vegetables. Specific foods considered to be excellent sources of vitamin A include spinach, broccoli, tomato juice, carrots, and sweet potatoes.

Beta-carotene, a provitamin form of vitamin A, has also been shown to have antioxidant effects in the body. Active mothers will benefit from adequate vitamin A intake through a stronger immune system, enhanced recovery from exercise, and optimal bone health. How- ever, it should be emphasized that “more” is not necessar-

ily “better” in relation to vitamin A intake; excessive amounts can actually be detri- mental to the health of both the mother and fetus. An exces- sive intake of vita- min A can cause urogenital abnor- malities, ear mal-

formations, cleft palate, and neural tube defects in the fetus.18 By focusing on whole foods, overdoses of vitamin A are generally avoided.

Chapter 15 Special Populations 429

Gaining the Performance Edge

There is quite a bit of overlap in the foods that are rich in nutrients important for active mothers. For example, fruits and vegetables are good sources of carbohydrates, fiber, folate, vitamin C, and vitamin A.

How are an athlete’s magnesium requirements affected by pregnancy? Magnesium has garnered attention in the athletic world because of its roles in enzyme and ATP production, bone development and maintenance, and protein synthesis and muscle contraction. For these same reasons, magne- sium requirements increase slightly for women during pregnancy. Once again, there is an overlap of foods that are good sources of magnesium as well as other macro- and micronutrients important during pregnancy.

For women 19 to 30 and 31 to 70 years of age, the basic requirement for magnesium is 310 and 320 milligrams per day, respectively. During pregnancy, the requirement increases 40 milligrams a day for all ages.11,19 Magne- sium is generally found in protein-rich foods, providing a two-for-one bonus for pregnant women because protein needs are also increased. The following foods are good to excellent sources of magnesium: whole wheat bread, yogurt, tofu, dried beans, almonds, cashews, peanut but- ter, and some fish species. Spinach is also an excellent source, providing a four-for-one punch because it is also a good source of folate, vitamin C, and vitamin A. Hali- but is an example of a fish that is rich in magnesium—a 6-ounce serving provides about 180 milligrams, which is about 50% of the daily needs for pregnant women of all ages.

If pregnant athletes have low magnesium levels, they may experience several types of symptoms. The first signs are generally loss of appetite, nausea, and weak- ness. However, these signs are also similar to morn- ing sickness, and therefore symptoms may or may not be caused by low magnesium intake. Morning sickness can indirectly cause low magnesium levels if mothers are chronically vomiting, which can lead to magnesium deficiency over time. Therefore, a consultation with a physician is warranted if morning sickness is severe or continues for an extended period of time. If a true mag- nesium deficiency develops, the later stages will cause symptoms such as irritability and muscle cramps. Mus- cle cramps may be experienced more by athletes than sedentary mothers, especially during normal training or exercise sessions. Muscle cramps are another symptom with multiple potential causes, such as dehydration, and therefore pregnant athletes should consider all options to ensure that the symptoms are addressed appropriately. If an athlete believes she is low in magnesium, whole foods versus supplements should be the focus. Excessive doses of magnesium can become toxic and lead to respiratory paralysis and death.

How are an athlete’s iron requirements affected by pregnancy? Iron requirements for athletes increase substantially during pregnancy. Iron contributes to fetal development through energy metabolism, the production of red blood cells, and overall normal growth. Similar to total calories, female athletes generally struggle to meet iron needs

before pregnancy; therefore, the increased requirements with pregnancy pose an extra challenge.

Before pregnancy, women should aim for 18 mil- ligrams of iron per day; during pregnancy the goal is boosted up to 27 milligrams per day.11,17 This quantity of iron can be difficult but not impossible for women to actu- ally achieve with consistency on a daily basis. Because of this challenge, iron-deficiency anemia is one of the most common nutrient deficiencies during pregnancy. Iron-rich foods that should be eaten daily include beef, chicken, turkey, fish, legumes, and iron-fortified grains.

As always, the focus should be on iron-rich whole foods first to meet daily needs; however, even with a bal- anced diet, supple- mental iron is often indicated. Iron is typ- ically present in pre- natal and pregnancy multivitamins/min- erals. Some pregnant athletes may need even more iron than the amount supplied in a standard mul- tivitamin/mineral, requiring an individ- ual iron supplement. However, pregnant athletes should con- sult with their phy- sician before taking iron supplements because an over- dose of iron can be as harmful as a defi- ciency. High iron intakes can result in diarrhea, con- stipation, nausea, decreased absorp- tion of other critical nutrients, and, for those with hemo- chromatosis, organ damage or death.

Nonheme iron’s bioavailability is enhanced by eat- ing other foods or products containing vitamin C. For example, drinking a glass of orange juice with an iron-forti- fied cereal will aid in the absorption of the iron in the cereal. Iron absorption can be inhibited by cal- cium, tannins in tea, phytic acid in grains, or excessive fiber. Therefore, preg- nant athletes should consume foods rich in these nutri- ents in small amounts when consuming a good source of iron (see TRAINING TABLE 15.2 ).

Food for Thought 15.2

The Pregnant Athlete

Describe how to assist a pregnant athlete who is losing weight and has become anemic.

430 SECTION 2 The Practical Application of Sports Nutrition

Gaining the Performance Edge

In addition to increased calorie, pro- tein, and certain vitamin and min- eral requirements, pregnant athletes should also ensure adequate con- sumption of fluids, especially during exercise, to aid in thermoregulation. By staying hydrated and cool, the risk for congenital abnormalities resulting from high core body tem- perature will decrease.20

Gaining the Performance Edge

All nutrients are important during pregnancy; however, a special focus should be placed on total calories, protein, folate, vitamin C, vitamin A, magnesium, and iron from whole food sources. See Table 15.4 for an overview of these specific nutrient requirements during pregnancy.

Training Table 15.2: Power-Packed Pregnancy Burritos 2 tbsp olive oil

1 tbsp minced garlic

5 oz frozen spinach (½ box), thawed and drained

2 cups fresh broccoli, chopped

½ medium red onion, diced

1–2 cups canned black beans

1 lb lean sirloin steak, cut into strips, or firm tofu, cut into half-inch squares

1 tbsp chili powder

1 tsp ground cumin

½ tsp garlic salt

8 whole-wheat tortillas

1. Place 1 tbsp of olive oil in a large skillet and add garlic, spinach, broccoli, and onions. Cook 3 to 5 minutes over medium heat or until tender.

2. If using steak, remove vegetables from the skillet, place in a bowl, and cover with aluminum foil to keep warm. Then place 1 tbsp olive oil and the steak strips in the skillet, cover, and cook 8 to 10 minutes until cooked through, stirring occasionally. When the steak is done, add the vegetables back to the skillet, add the beans and spices, stir to mix, and cook over low heat for several minutes until warm. Fill one tortilla with one-eighth of the mixture and serve.

3. If using tofu, add the beans, tofu, and spices to the vegetables, stir to mix, and cook over low heat for several minutes until warm. Fill one tortilla with one-eighth of the mixture and serve. Makes 4 servings.

Nutrition Information (per serving):

Steak Tofu

Calories 810 kcal 640 kcal

Protein 64 g 28 g

Folate 107 μg (18% RDA) 122 μg (20% RDA)

Vitamin C 45 mg (53–56% RDA) 45 mg (53–56% RDA)

Vitamin A 510 REA (66–68% RDA) 510 REA (66–68% RDA)

Magnesium 70 mg (18–20% RDA) 83 mg (21–24% RDA)

Iron 10 mg (37% RDA) 7 mg (26% RDA)

Table 15.4 Differences in Nutrient Needs for Pregnant and Nonpregnant Women

Nutrient Nonpregnant recommendation

Pregnant recommendation

Protein 46 g/day 71 g/day

Folate 400 μg/day 600 μg/day

Vitamin C 14 to 18 years: 75 mg/day 19 to 50 years: 75 mg/day

14 to 18 years: 80 mg/day 19 to 50 years: 85 mg/day

Vitamin A 14 to 18 years: 700 RAE μg/day

19 to 50 years: 700 RAE μg/day

14 to 18 years: 750 RAE μg/day

19 to 50 years: 770 RAE μg/day

Magnesium 14 to 18 years: 360 mg/day 19 to 30 years: 310 mg/day 31 to 70 years: 320 mg/day

14 to 18 years: 400 mg/day 19 to 30 years: 350 mg/day 31 to 70 years: 360 mg/day

Iron 18 mg/day 27 mg/day

What are the special considerations for child and teen athletes? Children are participating in sports at very young ages— from organized peewee football and soccer leagues to a variety of school, club, and other organized sports. Sports provide children and teens with excellent opportunities to build strong muscles and bones as well as confidence and self-esteem. Participation in athletics at a young age can promote health and fitness, establish lifelong healthy activity patterns, and provide for personal development skills in youngsters. In regard to nutrition, child and teen athletes require adequate daily intake to support a healthy rate of growth and maturation while also meet- ing the increased energy demands for sport and exercise activities. For the purposes of this chapter, child or teen athletes are defined as those 9 to 18 years of age.

How does nutrition affect growth and maturation in the child or teen athlete? Energy needs and caloric intake are of primary impor- tance in supporting growth in children participating in competitive or recreational sports. The growth and mat- uration process should follow a linear progression with age. Ensuring adequate nutrition to keep growth on the correct progressive track is essential for child and ado- lescent athletes.

Evaluation of growth is most often accomplished by performing height and weight assessments at regular intervals. This information is compared by age to stan- dardized tables; most U.S. medical facilities use the 2000 Centers for Disease Control and Prevention (CDC) growth charts and BMI charts. The CDC charts are a revised edi- tion of the 1977 National Center for Health Statistics growth charts that were in use prior to the 2000 release of the CDC charts. The newer versions revised the previous

14 charts and consist of 16 charts (8 for boys and 8 for girls) plus two new BMI-for-age charts for boys and girls ages 2 to 20.21 FIGURE 15.2 shows a sample weight-for-age chart for boys from 2 to 20 years of age. The CDC growth charts are used to identify growth patterns as the child ages by comparison to his or her peers, or the “norm.” Height, weight, and head circumference measures at regular intervals should be plotted on these charts for each child. This provides a way to determine the trends of growth patterns and aids in health assessment if there is a substantial increase or decrease in the percentiles.

Children older than 2 years of age usually maintain their height and weight growth between the same percen- tiles (such as 50th to 75th) during the preschool and early

childhood years.22 This consistent he ight- to-weight growth pattern is often referred to as the growth channel. During puberty, the

growth channel The normal height-to-weight growth pattern/ relationship. It is used to assess a child's growth trends and to screen for any potential growth abnormalities.

Chapter 15 Special Populations 431

Figure 15.2 Boys tend to have a marked increase in stature and weight between the ages of 12.5 and 14 years. Reproduced from the National Center for Health Statistics in collaboration with the National Center for Chronic Disease Prevention and Health Promotion (2000). http://www.cdc.gov/growthcharts/clinical_charts.htm.

2 to 20 years:Boys Stature-for-Age and Weight-for-Age Percentiles

NAME

RECORD #

W E I G H T

S T A T U R E

kg 10

100

105

110

115

120

125

130

135

140

145

150

155

150

155

160

165

170

175

180

185

190

100

110

120

130

140

150

160

170

180

190

200

210

220

230

kg 10

105

100

2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

12 13 14 15 16 17 18 19 20

AGE (YEARS)

S T A T U R E

160

cm 113 4 5 6 7 8 9 10

Date Age Weight Stature BMI*

Mother’s Stature Father’s Stature

76 in

6262

432 SECTION 2 The Practical Application of Sports Nutrition

growth pattern may not follow as clear of a linear path because of the radical growth spurts that occur at this time. It is cause for investigation if the child’s height or weight falls significantly above or below the growth chan- nel. There is cause for concern of potential nutritional inadequacy or other medical or genetic anomalies if the infant or child is below the 5th percentile or above the 95th percentile on the growth charts.

Growth trends can help determine the nutrition sta- tus of a child. Weight in relation to height assesses cur- rent nutritional status and growth. This measure is better for assessing current nutrition status than weight-for-age because body weight is dependent on total body size, not age. The height measure at a given age is an indicator of previous nutrition status and growth status. A reduction in the height trend develops more slowly than a reduc- tion in the weight trend and thus can be an indicator of chronic undernutrition. The most important way to assess the child or adolescent athlete’s growth is through the trend of growth pattern. This may also reflect the ade- quacy of energy intake for that athlete’s physical activity level.

Growth in adolescence occurs in spurts, with signifi- cant growth and leveling off throughout the adolescent years. Height growth is linear, with boys growing approxi- mately 8 inches and girls 6 inches during puberty.23 Sig- nificant weight increases in adolescence often occur after the major height growth spurt; however, they can occur throughout the adolescent growth period as well. The main growth spurt in girls occurs approximately 1 year prior to menarche, or the onset of menstruation. Weight gains can be concerning for young athletes. These ath- letes need to be reassured that height and weight gains are normal and a healthy part of their development.

As mentioned, growth rates are closely related to sex- ual maturation in adolescence. Development of sex organs, pubic hair, breast tissue (girls), and voice changes (boys) are all signs of sexual growth and maturation. Typi- cal growth spurts begin at approximately 10.5 to 11 years of age in girls, with peak in the rate of growth at age 12. For boys, growth spurts typically begin around 12.5 to 13 years and peak at age 14.24 Children who are tall prior to sexual maturation have a higher predicted adult height. A shorter child who already possesses sexual maturation characteristics is likely to be a shorter adult as well. Growth of the skeleton is complete when the epiphyses

(growth plates) at the long ends of the bones close. A poorly nourished athlete who is small of stat- ure at the point of

epiphyses closure may not achieve his or her full potential adult height.

Youngsters competing in gymnastics, wrestling, and other sports that emphasize strict weight standards may be at greater risk of growth disorders. Paying close

attention to growth trends in child athletes in these types of sports can help prevent growth delays and potential reduction in adult height. Female adolescent gymnasts are consistently found to be shorter of stature, weigh less, and have lower body fat percentages than same-age controls or female athletes participating in less strenuous sports. A study of female gymnasts and swimmers conducted over a 2- to 3-year interval found that gymnasts had sig- nificantly lower growth velocities than swimmers.25 The gymnasts trained for 22 hours each week compared to 8 hours each week for the swimmers. A different study also found slower growth velocities in adolescent female gymnasts.26 The girls in this study did not have the typi- cal pubertal growth spurt seen in the inactive controls, and 27% of the gymnasts had less than expected adult heights.

Moderate activity is associated with cardiovascu- lar benefits, positive changes in body composition, and development of bone density. However, excessive physical activity during childhood and adolescence may negatively affect growth and adolescent development.27 High levels of intense physical activity, as seen in the Theintz study,25 appear to have effects on growth in some athletes. The nutritional intake of young athletes may also have posi- tive or negative effects on growth. When energy intake matches energy needs, then continued maturation and growth are likely to occur. However, restrictive eating and dieting behaviors in young athletes are likely to negatively affect their growth. Restricting dietary intake to main- tain a thin appearance at a time when adequate intake is essential to growth (especially around puberty) not only can restrict growth, but may also decrease the nutrients needed for bone mineral accrual. With dietary energy restriction, calcium, vitamin D, iron, and other nutrients necessary for bone density may be limited as well.

For young athletes, the bottom line is to eat enough calories and protein to support growth and enough variety to maintain a wide base of nutrients in the diet. Dietary intake of adequate energy, using the MyPlate food guid- ance system food groups and serving sizes, will help the young athlete consume adequate energy and nutrients to support all growth functions. Emphasis on complex carbohydrates, adequate protein sources, and moderate fat intake with a variety of foods will provide a comple- ment of nutrients for muscle and bone development. Eat- ing the minimum number of servings per day in each of the food groups, consuming a variety of foods within the food groups, and meeting calorie demands with addi- tional foods from the food groups and some discretion- ary calories should provide adequate nutrition for growth and development. There is enough flexibility within each food group to allow even the most finicky child to find a choice he or she likes. Calorie needs are based on each individual’s hunger and growth. As a child goes through a growth spurt, hunger increases, and he or she should be encouraged to eat more to satisfy hunger. Providing higher-calorie, nutrient-dense meals and snacks during

epiphysis A cartilaginous plate found near the ends of bones that enables bone to grow in length; also known as the growth plate.

Chapter 15 Special Populations 433

high-growth and high-exercise times will help the child athlete maintain appropriate growth and nutrient intake. Conversely, when growth is slow, hunger and total dietary intake may not be as high.

Establishing a regular meal schedule and providing snacks before practice or after school allow the young ath- lete to eat when needed to maintain energy levels. The parents or caregivers are responsible for ensuring that a nutrient-rich diet with adequate energy is available for the child. Children can be finicky eaters, and it may be difficult to get them to eat enough nutritious foods dur- ing mealtime to meet energy demands. Providing nutri-

ent-dense snacks can help picky eaters consume adequate nutrients even when meal consumption is not optimal. A list of snack options is found in TABLE 15.5 . These snacks can be made available in the home; carried with the child for a

postschool, prepractice snack; and packed for traveling to sporting events.

Are fluid needs for young athletes different from those of adult athletes? Athletes of any age need proper hydration before, dur- ing, and after exercise. Adequate hydration is especially important for child and adolescent ath- letes for several rea- sons. Children are less tolerant of heat than adults. Their body surface area is greater as it relates to body weight and

Table 15.5

Healthy Snack Options for Young Athletes

Pudding cups Yogurt Smoothies Cheese cubes String cheese Milk/chocolate milk Soy milk 100% fruit juices Dried cherries, peaches,

apricots, apples Raisins

Peanut butter and whole grain crackers

Peanut butter and jelly sandwiches

Hard-boiled eggs Trail mix Graham crackers Whole grain cereal or granola

bars Dry cereals Fig bars

absorbs heat from the environment more readily than adults.28 Children also produce more heat during exercise while sweating less than adults. Because of these factors, special attention should be placed on ensuring that youth and teen athletes are adequately hydrated.

Children may not drink enough fluid even when it is offered frequently, especially in the heat. To prevent dehy- dration in young athletes, several strategies can be imple- mented. Giving each athlete his or her own sports bottle is a way of measuring intake and encouraging adequate hydration. Frequent fluid breaks during practices and competitions along with encouragement from coaches and parents help increase overall fluid consumption. Chil- dren should be asked to consume fluids when they are thirsty and until thirst is quenched. Children younger than age 10 may need more reminders to drink adequately than older children. Providing palatable beverages can enhance a child’s willingness to drink.29 Sweet-tasting beverages, such as sports drinks, are often preferred by children; however, as with any athlete, specific flavor preferences will occur. Children should test out a variety of flavors, and parents, coaches, and other sport staff should ensure that these drinks are available and that ample hydration

breaks are offered to consume these beverages. Similar to adults, weigh- ing before and after practices and com- petitions can help determine whether young athletes are consuming adequate amounts of fluids. Athletes who consis- tently lose 1–2% of body weight during

practice should be encouraged to consume more fluids and monitored more carefully by coaches and parents.

Do young athletes require higher vitamin and mineral intake? In general, children who meet energy needs for growth and maturation will consume adequate vitamins and minerals in their daily diets. However, iron and calcium are two minerals that have been identified as being defi- cient in the diets of children and teens, particularly in young female athletes.28 Active young female athletes are likely to require more energy and macronutrients to meet the higher demands of sports participation. It is likely that female athletes also have increased needs for calcium and iron, especially during peak growth spurts around puberty and sexual maturation periods. Physical activity and ade- quate nutrition in younger years allow for optimal bone development during adolescence and adulthood.

The RDA for calcium in males and females aged 9 to 18 years is 1300 milligrams per day, compared with 1000 milligrams per day for most adults.30 The requirement

434 SECTION 2 The Practical Application of Sports Nutrition

Gaining the Performance Edge

Young athletes need to consume adequate calories to achieve proper height and weight growth. Estab- lishing a regular meal schedule and providing snacks throughout the day will help the child or teen ath- lete meet his or her dietary needs.

Gaining the Performance Edge

Child athletes are at higher risk for dehydration and heat illness dur- ing exercise than adults. Offering fluid breaks often, monitoring fluid intake during practice and compe- titions, and providing flavored bev- erages during and after practices or competitions will help the young athlete maintain fluid balance.

Food for Thought 15.3

Hydration and the Young Athlete

Discuss why young athletes are at greater risk for dehydration and what steps can be taken to avoid it.

of 1300 milligrams per day is a rather large amount for children and teens to consume on a daily basis. Children who consume dairy products are likely to meet this level of calcium intake. They should be encouraged to consume at least three servings of dairy daily. Additional calcium intake can be achieved with consumption of calcium-for- tified orange juice, fortified cereals and breads, and forti- fied soy milk. Adequate calcium in the diet is essential for future bone health because peak bone mass is likely to be achieved in the late 20s or early 30s. Calcium, vitamin D, and magnesium are minerals that are needed regularly in the diet of young people to help achieve peak bone mass. Weight-bearing physical activity in youth also positively affects bone development and achievement of maximal bone mineral density.

Iron requirements are increased during puberty. Iron is essential for the development of muscle and bone for all children, and needs are increased for the active young athlete. The RDA for iron for girls and boys aged 9 to 13 years is 8 milligrams per day.17 For teens aged 14 to 18, the RDA is 11 milligrams per day for males and 15 milligrams per day for females.17 Females require more

iron to account for blood lost dur- ing menstruation. The increased need for iron between the ages of 14 and 18 correlates with the timing of sex- ual maturation and accelerated growth rates. Increased iron intake sup- ports the increase in body mass, blood volume to maintain the additional mass, and hemoglobin and

myoglobin in the cells. Poor iron status was found in nonendurance athletes such as gymnasts, tennis play- ers, and table tennis players, and male gymnasts were found to be particularly prone to nonanemic iron defi- ciency in a study of elite young athletes aged 12 to 18 years.31 Although true anemia is rare in most young ath- letes, iron deficiency can produce consequences such as fatigue and impaired growth, which can significantly affect sport performance.

Teen athletes can meet dietary iron recommenda- tions by consuming a wide variety of foods with iron and consuming adequate calories. Iron-fortified cereals, breads, bagels, granola bars, and sports bars are excel- lent options that kids typically enjoy eating. A once-daily multivitamin/mineral for teens may help supplement the dietary iron consumed in foods. This can also help with calcium ingestion. The UL for iron for teens aged 14 to 18 years is 45 milligrams per day. Parents should be careful to instruct their young athletes to take only a once-daily

supplement to avoid overconsumption of iron from both the diet and supplements.

What are the special considerations for college athletes? For many athletes, college presents the first opportunity to live life “on their own.” Therefore, athletes are sud- denly in charge of food selection, meal planning, and even grocery shopping. Individuals need to learn how to make healthy food choices and balance their intake to meet the increased energy demands from highly competitive prac- tices and competitions. Collegiate athletes also need to navigate the social aspects of college that may involve the use of alcohol, including its deleterious effects on their nutrition status and sport performance.

Are college athletes’ energy needs higher than their precollege needs? Many college athletes participated in three sports and trained year-round in high school. Depending on the level and intensity of training, those multiple-sport high school athletes had extremely high calorie needs and, therefore, becoming a collegiate athlete will not increase calorie demands dramatically. Other collegiate athletes focused on one sport in high school, training and competing sea- sonally, with long off-seasons and preseason training regimens. When these athletes enter college, a change in training regimens to fewer days off, more competitions, and potentially higher daily activity levels could drasti- cally increase their energy needs.

Daily walking on campus and busy class schedules may increase baseline energy expenditure. Often, incom- ing freshmen are not allowed to have cars on campus, so they may have to walk or bike to classes. Some campuses are very large and buildings are spread out over several miles. Practice facilities and playing fields may also be far from residence halls, apartment complexes, and class- rooms where college athletes spend most of their time. Getting to and from all of these places is likely to increase energy expenditure and thus energy needs.

Compared to most high school programs, college ath- letic programs represent a major leap in athleticism and, as a result, incorporate more rigorous strength and con- ditioning requirements. Although strength and condition- ing at the high school level may have been an integral part of some of the more traditional contact sports (e.g., football, wrestling, basketball, hockey), it may not have been as common in other competitive sports (e.g., ten- nis, swimming, baseball, softball). As a result, the phys- ical demands on the high school athlete transitioning into college may increase substantially, thereby requiring additional calories. Furthermore, increased training usu- ally results in larger muscles, which also increases energy expenditure. As discussed previously, muscle is metaboli- cally active tissue, and thus any increases in muscle mass will increase one’s total daily energy expenditure.

Chapter 15 Special Populations 435

Gaining the Performance Edge

Calcium and iron deserve a special focus in the diets of youth and teen athletes. Through the consump- tion of calcium- and iron-rich foods and beverages, nutrient needs can easily be met. For extra nutritional insurance, a once-daily multivita- min/mineral can be taken; how- ever, exceeding the upper limit for calcium and iron from both foods and supplements should be closely monitored and avoided.

with breakfast, and should focus on a wide variety of foods. Athletes should eat breakfast daily, “breaking the fast” from the overnight sleep. Typical breakfast foods are high in nutrients and provide the athlete with the energy needed to start the day. Breakfast can top off glycogen levels and provide the energy needed to get to early eight o’clock classes or team workouts. It can be tempting to sleep in and wake up just in time to rush to early classes without breakfast. A common reason college athletes give for skipping breakfast is the lack of time. However, break- fast does not have to be time consuming. Many nutri- tious breakfast items can be kept right in the dorm room

The physical demands of high-level competition dic- tate that athletes continue to work on improving—or at a minimum, maintaining—physical conditioning throughout the year. This means that athletes have only brief periods of time off from training. Even in the off-season, most coaches provide their athletes with strength and conditioning pro- grams. The intent is to ensure continued athletic devel- opment, even when not under the direct auspices of the sport coach. The physical rigor of being a competitive ath- lete demands ongoing training, increased energy expendi- ture, and attention to good nutritional practices.

The combination of higher-intensity training, strength training, daily energy expenditure, and year-round train- ing may equate to high total daily calorie needs for col- lege athletes. Most athletes will find themselves hungry often and will increase caloric intake by eating more at meals and snack times. Many residence-hall cafeterias and training tables for athletes offer unlimited buffet- style eating at each meal. College athletes should have the selection and amount of food available to meet addi- tional energy demands in dorm cafeterias. For example, André is a freshman football player at a Division II college. He is 6 3 tall and weighs 245 pounds. His estimated calo- rie needs are 4700 per day. He eats in his dorm cafeteria for breakfast and lunch, and with the team at the train- ing table for his evening meal. He is allowed to “carry out” snacks from the training table cafeteria to consume dur- ing the day or in the evening. A sample 1-day meal plan for André is shown in TRAINING TABLE 15.3 .

André is able to meet his calorie needs by increas- ing calorie- and nutrient-dense beverages (milk, choco- late milk, juices), entrées and side dishes (honey-glazed chicken, baked beans, vegetarian pizza, scrambled eggs), and snacks and desserts (pudding, smoothies, muffins, and crackers). It is important for André to focus on nutri- ent-rich foods that also have a higher calorie level rather than choosing high-sugar, high-fat, or fried foods and snacks that are high in calories but low in nutrient density.

What are practical tips for the implementation of a college athlete’s meal plan? Most freshman college athletes are choosing for the first time when, how much, where, and what they will eat all day long. This can be a challenge in a college cafeteria envi- ronment where huge varieties, and portions, of food are available daily. However, there are many nutritious offer- ings in a college cafeteria setting. The variety and flexibil- ity of a cafeteria are essential for athletes who have busy practice schedules and demanding academic schedules to juggle. For athletes in apartments, the challenge can be shopping and preparing meals that meet energy and nutri- ent needs. This needs to be accomplished on an often- times limited budget, especially for athletes not on full scholarships.

Making a plan for eating, whether in a cafeteria, at a training table, or in an apartment, is necessary for all athletes’ good nutritional health. The plan should include meals and snacks at regular intervals, starting

Training Table 15.3: André’s 1-Day Meal Plan Food Item Calories

Breakfast

3 scrambled eggs 188

2 slices whole grain toast 147

2 tsp margarine 67

16 oz orange juice 189

1 cup milk, 1% 105

Total breakfast: 696

Snack

1 small blueberry muffin 242

16 oz bottle cranberry juice cocktail 258

Total snack: 500

Lunch

2 personal size vegetarian pizzas 1099

Raw vegetables with 2 tbsp Ranch dressing 150

12 oz chocolate milk, 1% 215

Total lunch: 1464

Prepractice Snack

12 oz low-fat yogurt fruit smoothie 345

1 granola bar 219

Total snack: 564

Dinner

2 honey-glazed chicken breasts 436

1½ cups baked beans 314

1½ cups cooked corn 241

1 cup butterscotch pudding 159

1 cup milk, 2% 125

Total dinner: 1275

Snack

Crackers, 12 whole grain 140

2 oz cheese 165

Total snack: 305

Daily calorie total: 4804

436 SECTION 2 The Practical Application of Sports Nutrition

college athletes and how excessive alcohol consumption may have negative effects on nutrient intake and athletic performance.

Several studies of college student drinking found that alcohol use is higher in athletes than nonathlete college students.32–34 Binge-drinking episodes have been most commonly researched. Excessive use of alcohol, or a “binge-drinking episode,” is considered five or more drinks at a time for men and four or more drinks for women. One study of college athletes stated that 57% of male athletes and 48% of female athletes reported a heavy drinking episode within the past 2 weeks.33 This is com- pared to 49% of males and 40% of females who were not

or apartment for quick breakfast meals. A few breakfast options include:

• Bagel with 2 tbsp peanut butter or cream cheese • Yogurt cup and 1 cup juice • Cold cereal, 1 cup milk, and a banana • Oatmeal packet, raisins, and 1 cup milk • Cereal or granola bar and 1 cup milk • Whole grain toast, 1 cup cottage cheese, 1 cup juice

A refillable cup or mug with a tight-fitting lid and a box of zipper sandwich bags can help athletes make a portable breakfast. Juice and milk can go in the mug, and bagels, dry cereal, and raisins can be placed in the bags for a fast and portable breakfast on the way to class.

Lunch and dinner can also be easy to compile, whether preparing at home or choosing from a cafeteria buffet. Salad or sandwich bars provide a variety of nutri- ent-dense foods that are rich in carbohydrates and pro- tein. Hot entrées can make the base of the meal; however, they should not be considered the entire meal. Adding a vegetable or salad, soup, milk, or yogurt can round out the meal. For athletes preparing their own meals, the same concepts can be applied. Frozen or prepared entrées can be cooked conveniently, and canned or frozen vegetables, soups, baked beans, and other side dishes can be added for more variety in nutrients and taste. TABLE 15.6 lists quick meal ideas that are easy to prepare, relatively inex- pensive, and nutrient dense.

For athletes in apartments for the first time, grocery shopping and cook- ing can be a chal- lenge in terms of time and finances. Athletes should stock the kitchen with a few favorite foods that are easy to prepare when time is limited. Dietitians working with col- lege athletes should be prepared to teach very basic cooking techniques and help athletes plan meals

that meet energy and nutrient needs. TABLE 15.7 provides a grocery list by food category that may be helpful for college athletes. This list is compiled by food category to help athletes understand the different food groups and to encourage the purchase of a variety of foods.

How does alcohol consumption affect college athletes’ nutrition? Alcohol consumption on college campuses is always a top priority on the list of concerns for academic admin- istrators. Tailgate parties, celebratory occasions, weekend festivities, and other scenarios have led to a surprisingly high consumption of alcohol by collegiate athletes. This section discusses the incidence of alcohol consumption in

Table 15.6

Quick Preparation Meal and Cooking Ideas

Convenience items such as frozen and canned foods can be part of a healthy sports nutrition diet. A nutritious, well- balanced meal should contain at least three different food groups.

Canned soups • Add a can of vegetables or leftover cooked vegetables to the soup.

• Serve with whole grain crackers.

• Add a sandwich and/or fruit.

Hamburgers • Serve with thick slices of tomato, lettuce, pickle, and onion.

• Serve with baked frozen fries.

• Accompany with milk or juice.

Marinated chicken breast • Serve with a microwaved baked potato.

• Add canned or frozen vegetables.

Macaroni and cheese • Slice or cube ham and mix into the macaroni and cheese.

• Add a can of tuna or cooked chicken and heat thoroughly.

Noodles or rice-in-sauce packets

• Serve with canned or frozen vegetables.

• Add a can of tuna, some cooked chicken, or a can of beans.

Any frozen entrée • Serve with a salad or vegetable.

• Include a roll or bread on the side.

• Serve fresh fruit for dessert.

Baked potato • Melt cheese on top.

• Top with broccoli or another vegetable (precooked).

• Cottage cheese mixed with picante or salsa is also a tasty topping.

Pancakes or waffles • Top with sliced fruit or berries.

• Serve with one or two eggs.

• Juice is a healthy beverage choice.

Bean and cheese burrito • Serve with salad or precut raw vegetables.

• Chop fresh fruit for a side salad.

Chapter 15 Special Populations 437

Gaining the Performance Edge

Upon entering college, athletes may be required to plan, purchase, and prepare their own meals and snacks for the first time in their lives. Planning and implementing a healthful sports nutrition diet can be accomplished by using the basic principles of good nutrition combined with adequate intake to meet the demands of training and competition.

athletes in the study. Another study found that almost 81% of varsity athletes had used alcohol in the 12 months prior to the survey.35 Although not all athletes consume alcohol, when they do, many tend to do so to excess.

Gender differences in alcohol consumption are prevalent in the collegiate athlete population. Male ath- letes have higher rates of binge-drinking episodes than female athletes. Female athletes typically have the lowest amount of alcohol consumption in both the athlete and nonathlete populations.34 The National Collegiate Athletic

Table 15.7

Grocery List for Active Individuals

Grocery shopping is the first step to healthful eating. The items athletes purchase at the grocery store will dictate the foods/beverages consumed before, during, and after practices and competitive events, as well as throughout the day. Athletes should develop the habit of making a shopping list to ensure that the kitchen will be stocked until the next shopping trip. Foods should be purchased from all of the food groups to achieve balance, variety, and a wide complement of nutrients. The following is a sample grocery list that includes a wide variety of items.

Fruits Vegetables Dairy products

Bananas Different-colored veggies Low-fat yogurt

Berries Broccoli Low-fat or skim milk

100% fruit juice Cauliflower String cheese

Juice boxes Carrots Cheese chunks

Raisins Dark greens Cheese slices

Dried fruits Salad or cabbage mix Nonfat dry milk powder

Canned fruits (in own juice) Potatoes Pudding

Fresh fruits Sweet potatoes Cottage cheese

Frozen fruits Peppers

Green and yellow beans

Asparagus

Grains Proteins

Whole grain cold cereal Tuna, water-packed

Oatmeal Fish, frozen or fresh

Whole grain breads Eggs

Whole grain bagels Chicken breasts, boneless, skinless

Pasta Ground beef, 80–95% lean

Brown, wild, or white rice Lean cuts of pork or beef

Popcorn Tofu

Granola bars Deli or sliced chicken, turkey, roast beef, or ham

Quinoa Peanut butter

Graham crackers Nuts

Whole grain crackers Starchy beans (black, kidney, pinto, soy)

Frozen Foods Desserts and Snacks

0p3.9 Frozen fruit juice or yogurt bars

Lasagna Sherbet or frozen yogurt

Veggie burgers Frozen fruit pieces (berries, grapes, melons)

Flash-frozen chicken breasts Peanut butter with crackers

Frozen vegetables Cereal or granola with milk

Stir-fry meals Yogurt and fruit or granola

Whole grain toaster waffles Fig bars

Association (NCAA) has developed programs addressing the issue of alcohol and other drug use in college athletes. Many college and university athletic departments bring NCAA or other sponsored speakers to their schools annu- ally to discuss alcohol issues with their athletes.

Alcohol, namely ethyl alcohol, is an organic com- pound that holds a unique standing in regard to nutri- tion. Alcohol is considered to be a food because it provides energy (7 calories per gram) to the body; however, it is not considered a nutrient because of the fact that the body

438 SECTION 2 The Practical Application of Sports Nutrition

does not need it to survive. It is interesting to note that alcohol is also considered a drug because of its effects on the central nervous system. When ingested, alcohol is very rapidly absorbed into the bloodstream compared to the rate of other foods. Some absorption of alcohol occurs within the mouth, esophagus, and stomach, with the majority of absorption occurring in the small intes- tine (see FIGURE 15.3 ).

Alcohol, unlike carbohydrates, fats, and proteins, is not stored in the body. Instead, once it is ingested, the body begins to metabolize alcohol in an attempt to quickly eliminate it from the body. As shown in FIGURE 15.4 , alco- hol is converted to acetyl coenzyme A (CoA) and either metabolized further for energy or converted to fat and stored in the body. Increased body fat is not a desirable outcome for most athletes, and thus is a negative aspect associated with alcohol consumption.

Alcoholic beverages can be calorically dense with neg- ligible nutrient content. Alcohol contains 7 calories per gram but virtually no vitamins or minerals. Some alco- holic beverages contain significant calories as a result of the mixers used to make the drinks. Sweet drinks, drinks containing sweet liqueurs, and those with whipped cream or sugar toppings add to the caloric content of the drink without adding nutrients. Alcoholic beverages have been labeled as “empty calories” for good reason!

TABLE 15.8 lists the calorie and carbohydrate content of some common alcoholic beverages. Although athletes may be able to consume the additional calories because

Figure 15.3 Alcohol absorption. Alcohol easily diffuses into and out of cells, so most alcohol is absorbed unchanged.

The primary site of alcohol absorption is the upper small intestine.

Small amounts of alcohol are absorbed in the mouth and esophagus.

Alcohol is readily absorbed in the stomach, but food will dilute the alcohol and delay gastric emptying.

of their high caloric expenditure, it is better to meet addi- tional calorie needs with nutrient-dense foods.

Some athletes do not consume food before drinking alcohol and/or do not eat anything while they are drink- ing. Many male and female athletes are conscious of their weight and total caloric intake. In an attempt to “save” calories, they practice this abstinence-from-food strategy before and during drinking. Unfortunately, this strategy makes little sense nutritionally or physiologically. Nutri- tionally speaking, abstaining from eating nutrient-dense foods while replacing them with nutritionally empty cal- ories from alcohol is not a good idea for many reasons. Second, absorption of alcohol is much slower if con- sumed with food. Drinking on an empty stomach leads to rapid absorption of alcohol. Because alcohol affects the central nervous system (i.e., the brain), judgment skills are more quickly affected. As a result, the athlete often

Figure 15.4 Metabolizing alcohol. Alcohol is converted to acetyl CoA and either metabolized further for energy or converted to fat and stored in the body. © Glenda M. Powers/Shutterstock, Inc,

METABOLIZING SMALL TO MODERATE AMOUNTS OF ALCOHOL

Alcohol (ethanol)

Fat (triglycerides)

Acetaldehyde

Fatty acids

Citric acid cycle

Alcohol dehydrogenase

Acetyl CoA

Acetaldehyde dehydrogenase

Little acetyl CoA enters citric acid cycle.

Small amounts of alcohol

Chapter 15 Special Populations 439

ends up drinking more than he or she had intended, thus defeating the purpose of the food-abstinence strategy.

Alcohol also has the potential to affect calorie intake because of its effect on appetite. Although alcohol as a drug is a depressant, it appears to stimulate appetite. Appetite is not necessarily physical hunger; it is the desire to eat food. Many individuals who drink alco- hol also end up eating either during or after the drink- ing episode. Hetherington reported that individuals who consumed a preload of alcohol (beer) 30 minutes prior to a test meal consumed more calories than those who consumed a nonalcohol preload.36 Even when the addi- tional calories from the alcohol preload were taken into account, subjects in the study consumed 30% more at lunch than the nonalcohol-preload controls. A common occurrence reported by many college athletes is the “late- night munchies.” The foods are consumed after an eve- ning of drinking and are likely calories in excess of the athlete’s needs. Typical food choices are less nutritious (pizza, nachos, ice cream, chips) and calorically dense. Athletes who need to maintain weight for optimal sport performance could end up gaining weight if this occurs often. It may not only be the excess calories from the alcoholic beverages, but also the “munchies” that lead to weight gain in some college athletes.

Drinking alcohol after a big game or competitive event is commonplace in college athletics. Athletes who have competed with high intensity have used up their glycogen stores. Postgame nutrition should include nutrient-dense carbohydrates to replenish stores lost during the event. However, athletes who drink alcohol after games or hard practices are less likely to consume adequate amounts of complex carbohydrates from nutrient-dense sources and therefore may not fully replenish glycogen stores. Thus,

athletic performance during the next practice or compe- tition will suffer.

A common misconception is that beer is a rich source of carbohydrates because it is made from grains. Actu- ally, one regular domestic beer contains, on average, 10–12 grams of carbohydrates, a small amount of protein, and zero fat calories; the rest of the calories come from alcohol. Alcohol contains 7 calories per gram. An example of calcu- lating the alcohol content of one regular beer is shown here:

Calorie content of a 12 oz beer: 143 total calories Carbohydrate content: 10.8 g × 4 kcal/g =

43.2 calories from carbohydrates Protein content: 1.2 × 4 = 4.8 calories from protein

Fat content: 0 calories Carbohydrate and protein calories combined:

43.2 + 4.8 = 48 calories Total beer calories: 143 – 48 carbohydrate and

protein calories = 95 calories from alcohol Alcohol calories: 95 ÷ 7 calories/g of alcohol = 13.6 g

of alcohol

A beer contains significantly more calories derived from alcohol than from carbohydrates. Beer is not a good source of carbohydrates for the replenishment of glyco- gen stores after exercise.

An increase in binge drinking is also associated with an increased likelihood of alcohol-related harms. Aca- demic achievement can suffer when social drinking interferes with studying. Missing classes because of a morning hangover can add to the already huge demand on class time for the traveling athlete. Driving while under the influence or riding in a car with a driver under the influence has potential for both injury and legal conse- quences. Nelson and Wechsler studied college athlete drinking behavior and found that more athletes than nonathletes missed classes, fell behind in school work, forgot where they were/what they had done, and either drove or rode with another driver while under the influ- ence of alcohol.33 In summary, the consumption of alco- hol by collegiate athletes can be detrimental to overall health, nutrition status, academics, and personal safety, and therefore is not recommended.

What are the special considerations for masters athletes? Masters athletes are generally defined as athletes older than age 40 or 50 years. Nutrition guidelines for seden- tary individuals within this age group are different from their younger counterparts.37 Add regular exercise and high-intensity training into the mix, and those changes in recommendations become even more important because of the extra nutrition demands of physical activity. Mas- ters athletes need to consider the changes to individual nutrient recommendations, the required diet adaptations resulting from chronic disease and medication use, as well as the nutrient needs of their sport.37

Table 15.8

Calorie and Carbohydrate Content of Alcoholic Beverages

Beverage Calories Carbohydrates (grams)

12 oz regular beer 139 12.6

12 oz light beer 95 4.4

16 oz (1 pint) beer 186 6.8

60 oz pitcher, regular beer

697 63

4 oz wine 77 0.9

1.5 oz shot of liquor 97 0.0

6 oz mixed drink 129 12

7 oz piña colada 526 61

5 oz martini 316 0.5

Data From: Pennington JAT, Douglass JS. Bowes and Church's Food Values of Portions Commonly Used. 18th ed. Baltimore, MD: Lippincott, Williams & Wilkins; 2005. Nutrition Analysis Tools and System. 2004. Nutrition Analysis Tool. Available at: http://nat.crgq. com. Accessed August 20, 2004.

440 SECTION 2 The Practical Application of Sports Nutrition

How do the nutrient needs of masters athletes change? For apparently healthy masters athletes, total calorie, chromium, iron, calcium, vitamin D, and magnesium needs change. Total calorie, chromium, and iron recom- mendations decrease, whereas calcium, vitamin D, and magnesium needs increase. By making slight dietary modifications, all of these changes can be easily managed.

How do total calorie requirements change with age? As athletes age, total calorie needs decrease slightly.10,11,38 For all aging individuals, several factors contribute to lower energy needs with progressing age, including the loss of calorie-burning muscle mass.39 Masters ath- letes are at an advantage over their sedentary counter- parts because physical activity helps to maintain muscle mass, keeping their metabolic rate higher; however, some change in calorie needs is inevitable. The result of this decline can be realized when using the resting energy estimation (REE) equations.

For example, an active 25-year-old man weighing 160 pounds (72.7 kilograms) will require about 138 fewer cal- ories when he is 50, even if his total weight and activity level remain the same:

REE at age 25: (15.3 × BW) + 679 = (15.3 × 72.7 kg) + 679 = 1791 calories

Total energy needs: 1791 × 2 (activity factor) = 3582 calories

REE at age 50: (11.6 × BW) + 879 = (11.6 × 72.7 kg) + 879 = 1722 calories

Total energy needs: 1722 × 2 (activity factor) = 3444 calories

Difference in total daily energy needs based solely on age = 138 calories

Although this difference may seem to be insignifi- cant, over time it can make a huge impact. If this 50-year- old man continued to eat the same number of calories he required when he was 25, he would gain about 14 pounds in 1 year, even if physical activity remained constant! Eat- ing an extra 138 calories per day for 365 days leads to a calorie excess of 50,370 in 1 year, which is equivalent to 14 pounds of fat mass:

138 extra calories/day × 365 days/year = 50,370 extra calories in 1 year

50,370 calories ÷ 3500 calories in 1 lb of fat = 14 lbs of fat weight gain per year

Fat mass gain not only can be detrimental to athletic performance, but also is a risk factor for many chronic diseases, including heart disease and diabetes. Although masters athletes need to ensure adequate calo- rie consumption to meet the energy requirements of their sport, they will not need to consume as much as they did earlier in their athletic career. Incongruently, several vita- min and mineral needs increase with age, creating the

challenge of eating less but requiring more. As athletes age, it becomes progressively more important to focus on the consumption of nutrient-dense foods while minimiz- ing the intake of “empty” calories.

The proportion of macronutrients should remain rel- atively constant for masters athletes. Carbohydrates are still the main source of fuel, requiring an intake of 50–65%

of total calories. Pro- tein needs remain above the RDA due to decreased protein synthesis efficiency and impaired insu- lin action in older adults. Thus, it is recommended that

masters athletes intake a minimum of 1–1.3 grams of pro- tein per kilogram of body weight.39 Fat should be kept at a moderate level, ranging from 20–35% of total calories. The key words balance, variety, and moderation still hold true for masters athletes.

How do chromium requirements change with age? The daily requirements (AI) for chromium decrease from 35 to 30 micrograms after the age of 50.17 Chromium plays a role in blood glucose regulation, possibly by maintaining insulin sensitivity and insulin-mediated uptake of glucose into cells. This action has been suggested to be critical in the prevention of diabetes, which, in turn, promotes overall health. Chromium’s role is also recognized in the world of athletics because cells are dependent on insulin to deliver glucose and other nutrients for fuel and repair. Therefore, masters athletes should strive for adequate intakes of chromium, with the goal decreasing slightly after age 50.

However, even if masters athletes were to consume more than 30 micrograms of chromium per day, they would probably not experience any adverse effects. Cur- rently, no upper limit has been set for chromium because toxic effects from food sources are uncommon. Therefore, masters athletes should focus on chromium-rich foods such as mushrooms, dark chocolate, nuts, prunes, whole grains, and wine and avoid individual chromium supple- ments. Chromium-containing multivitamin/minerals are safe to continue taking as long as the chromium con- tent does not exceed 85–100% of the Daily Value. Because the change in the daily recommendation for chromium is small, and there is little risk of overdosing on chro- mium, this should not be an area of major concern for masters athletes.

How do iron requirements change with age? As mentioned previously in this chapter, iron is important for a variety of bodily functions related to overall health and athletic performance. Although iron remains a criti- cal nutrient throughout the lifespan, women’s needs for iron change after menopause. Postmenopausal women require the same amount of iron as men—8 milligrams a day.17 This change in recommendations represents

Chapter 15 Special Populations 441

Gaining the Performance Edge

Maintenance of protein intake is critical for the master athlete, requir- ing a minimum daily ingestion of 1.0–1.3 g/kg per day.

contraction, and cellular metabolism—all of which are crit- ical for overall health and optimal athletic performance.

Unfortunately, young adults generally do not consume enough calcium, leading to an older population with the same poor habits. Twelve hundred milligrams of calcium can be consumed through foods alone; however, it does require the consumption of four or more calcium-rich serv- ings each day. For example, a glass of skim milk consumed at each meal (providing a total of about 900 milligrams) plus one container of yogurt as a snack (providing another 300–350 milligrams) supplies the daily requirement. Cal- cium is also found in fortified soy products, green leafy vegetables, legumes, and fortified cereals and juices.

Vitamin D requirements for both men and women increase after age 70 from 600 to 800 IU per day.30 Vitamin D is unique in that it is found in a very narrow selection of foods. Cow’s milk and fortified milk alternatives are the best choices, providing approximately 100 IU per 8 fluid ounces. Some breakfast cereals, orange juices, and even a few yogurts are fortified with vitamin D, although in lower quantities as compared to milk. Canned salmon and sar- dines, with the bones, can also be a significant source of vitamin D. Most of these foods are also rich sources of calcium, providing a two-for-one deal.

Vitamin D can also be synthesized in the body by spending approximately 15 minutes in direct sunlight each day. However, several factors make sunlight an unreliable source for masters athletes. With age, the body becomes less efficient at synthesizing vitamin D from sunlight. In addition to this impaired function, the application of sun- screen further blocks the body’s ability to use sunlight as a precursor to vitamin D. With a stronger emphasis on preventing skin cancer, many masters athletes are wear- ing, and should be wearing, sunscreen while training and competing outdoors. Thus, sunlight cannot be considered a good source of obtaining a daily dose of vitamin D.

Both calcium and vitamin D are key players in the fight against osteoporosis. These nutrients may also aid in the prevention of cancer and hypertension. By meeting daily needs, masters athletes can keep their bones strong and decrease their risk for chronic disease.

How do magnesium requirements change with age? Magnesium is a critical nutrient for enzyme activity and energy production. Magnesium intake is generally suboptimal in the typical Amer- ican diet, but can be compounded by several factors that may lead to greater magnesium losses or poor absorption. Individuals who

a significant decrease from the 18 milligrams women require throughout their childbearing years.17

From a practical standpoint, the change in iron requirements creates a major shift in a woman’s ability to meet daily requirements. Most female athletes strug- gle to meet their needs for iron, especially pregnant ath- letes. Being iron challenged, younger women are generally urged to eat plenty of iron-rich foods and take iron sup- plements through a multivitamin/mineral and/or individ- ual iron pill. Once the tables are turned and requirements plunge to only 8 milligrams, postmenopausal women should stop taking supplemental iron and focus solely on iron-rich foods to prevent iron toxicity. Iron-rich foods include beef, poultry, fish, legumes, nuts, and enriched whole grains. The upper limit for iron is 45 milligrams per day, which should not be exceeded through foods and especially supplements. Several multivitamin/mineral manufacturers have developed “senior” or “silver” formu- las that contain little to no iron. These specialty formulas are the best choice for postmenopausal women.

Men should continue to aim for 8 milligrams of iron per day. Men are 5 to 10 times more likely than women to suffer from iron overload and the genetic disorder hemochromatosis. Similar to postmenopausal women, men should focus on whole-food sources of iron, keep- ing intake well below the upper limit of 45 milligrams per day, and avoid iron-containing supplements.

How do calcium and vitamin D requirements change with age? Calcium requirements increase from 1000 to 1200 milli- grams per day for women older than 50 and men older than 70 years.30 Calcium is important for the maintenance of bone health, nerve function, blood clotting, muscle

442 SECTION 2 The Practical Application of Sports Nutrition

Gaining the Performance Edge

Masters athletes need to focus on "getting more for less"—more nutri- tion in fewer calories. Each meal and snack should be centered on nutri- ent-dense foods while being mindful of decreasing "unnecessary" calories. Both men and women should take a multivitamin/mineral without iron for extra nutrition insurance.

In addition to the actual disease state, medications prescribed for the treatment of chronic disease can have their own effects on an athlete’s dietary intake. Specific foods and beverages can alter the function, effective- ness, or absorption of various medications. Athletes should consult with their physician, pharmacist, and dietitian to determine whether any dietary modifica- tions are required when starting a new medication. Refer to TABLE 15.10 for some common examples of food–drug interactions.

What are the special considerations for vegetarian athletes? Vegetarianism is becoming more popular in both sed- entary and active populations (see FIGURE 15.5 ). Individu- als convert to a plant-based diet for a variety of reasons, including long-term health, animal rights, world hunger, finances, and religious beliefs. Many national organiza- tions endorse a vegetarian lifestyle because of a plethora of research revealing a myriad of health benefits, such as lower risk of coronary artery disease, hypertension, dia- betes, some cancers, and renal disease.40 However, these health benefits can be realized only when the switch from an omnivorous diet to a vegetarian diet is planned

have chronic diarrhea or are taking diuretic medica- tions are at higher risk for magnesium deficiency. As athletes age, the incidence of health problems such as high blood pressure increases, often requiring the daily use of medications. Diuretics are a common prescription given to individuals with hypertension. A common side effect of many different medications is diarrhea. There- fore, athletes taking daily diuretic medications, or drugs that cause diarrhea, should ensure an adequate intake of magnesium.

Fortunately, magnesium is found in a large variety of foods, with whole grains, vegetables, and legumes topping the list. The daily requirement for magnesium increases slightly after age 31 to 420 milligrams per day for men and 320 milligrams per day for women.19 These require- ments are easily met through whole foods. For example, 1.5 cups of black beans contain about 190 milligrams of magnesium, providing 45% and 59% of total daily needs for men and women, respectively. Other specific foods rich in magnesium include cheeses, fish, almonds, spin- ach, and peanut butter. If masters athletes fail to meet magnesium needs, loss of appetite, weakness, and muscle cramps can occur. If a deficiency is left untreated, heart rhythm can be disrupted. Fortunately, many magnesium- rich foods are also good sources of iron and calcium, pro- viding a three-for-one punch.

How does the presence of chronic disease affect nutrient needs of masters athletes? The presence of chronic disease generally requires adjust- ments to daily nutrient intake, regardless of whether the individual is sedentary or an athlete. Increasingly, nutri- tion is being implicated in the prevention, as well as the treatment, of chronic disease. The incidence of chronic disease increases with age, so older athletes need to con- sider not only the nutrient needs of their sport, but also the therapeutic benefits of proper nutrition.

A full explanation of the relationship between nutri- tion and chronic disease extends beyond the scope of this text. However, there are general nutrition recom- mendations that should be incorporated into the nutri-

tion plans of masters athletes who have been diagnosed with various conditions. It is important to note that each individ- ual’s diagnosis and precipitating factors leading to the dis- ease are different, requiring an indi- vidualized approach

to each client. TABLE 15.9 presents the general recommen- dations for various chronic diseases; these recommenda- tions should be used as general guidelines and adapted according to the needs of the individual athlete.

Table 15.9

Potential Dietary Modifications Required for Various Chronic Diseases

Disease Possible dietary modifications Atherosclerosis Decrease total fat, saturated fat, and cholesterol;

increase complex carbohydrates, fiber, and antioxidants from fruits, vegetables, and vitamin E–rich foods.

Cancer Decrease total fat, some meats, alcohol, and salty and cured foods; increase complex carbohydrates, fiber, unsaturated fats, and fruits and vegetables.

Arthritis Decrease total caloric intake if overweight; increase unsaturated fats, particularly omega-3 fatty acids.

Osteoporosis Increase calcium, vitamin D, and vitamin K; decrease phosphorus.

Diabetes Decrease total caloric intake if overweight; decrease total fat and refined sugars; increase fiber and protein; monitor total carbohydrate intake.

Hypertension Increase calcium, potassium, protein, magnesium, and fiber; decrease sodium, total fat, and saturated fat.

Stroke Decrease total caloric intake if overweight; decrease total fat and saturated fat; increase complex carbohydrates, fiber, and antioxidants from fruits, vegetables, and vitamin E–rich foods.

Chapter 15 Special Populations 443

Gaining the Performance Edge

Masters athletes have the chal- lenge of modifying their nutrition based on their age, medical history, and medication use as well as their sport. All modifications are manage- able through a well-balanced, calo- rie-appropriate diet.

Table 15.10

Examples of Food–Drug Interactions

Drug Foods that interact Effect of the food What to do Analgesic

Acetaminophen (Tylenol) Alcohol Increases risk for liver toxicity Avoid alcohol.

Antibiotics

Tetracyclines Dairy products; iron supplements Decreases drug absorption Do not take with milk. Take 1 hour before or 2 hours after food or milk.

Amoxicillin, penicillin Food Decreases drug absorption Take 1 hour before or 2 hours after meals.

Zithromax, erythromycin Food Decreases drug absorption Take 1 hour before or 2 hours after meals.

Nitrofurantoin (Macrobid) Food Decreases GI distress, slows drug absorption

Take with food or milk.

Anticoagulant

Warfarin (Coumadin) Foods rich in vitamin K Decreases drug effectiveness Limit foods high in vitamin K: liver, broccoli, spinach, kale, cauliflower, and Brussels sprouts.

Antifungal

Griseofulvin (Fulvicin) High-fat meal Increases drug absorption Take with high-fat meal.

Antihistamine

Diphenhydramine (Benadryl), chlorpheniramine (Chlor-Trimeton)

Alcohol Increases drowsiness Avoid alcohol.

Antihypertensive

Felodipine (Plendil), nifedipine Grapefruit juice Increases drug absorption Consult physician or pharmacist before changing diet.

Anti-inflammatory

Naproxen (Naprosyn) Food or milk Decreases GI irritation Take with food or milk.

Ibuprofen (Motrin) Alcohol Increases risk for liver damage or stomach bleeding

Avoid alcohol.

Diuretic

Spironolactone (Aldactone) Food Decreases GI irritation Take with food.

Psychotherapeutic (MAO inhibitor)

Tranylcypromine (Parnate) Foods high in tyramine: aged cheeses, Chianti wine, pickled herring, brewer's yeast, fava beans

Risk for hypertensive crisis Avoid foods high in tyramine.

Note: Grapefruit juice contains a compound not found in other citrus juices. This compound increases the absorption of some drugs and can enhance their effects. It is best not to take medications with grapefruit juice. Grapefruit juice should be consumed at least 2 hours before or after taking a medication. People who often drink grapefruit juice should talk with their pharmacist or doctor before changing their routine.

Reproduced from Bobroff LB, Lentz A, Turner RE. Food/Drug and Drug/Nutrient Interactions: What You Should Know About Your Medications. Gainesville, FL: University of Florida; March 2013. Publication FCS 8092 in a series of the Department of Family, Youth and Community Sciences, Florida Cooperative Extension Service, Institute of Food and Agricultural Sciences. http://edis.ifas.ufl.edu/pdffiles/HE/HE77600.pdf accessed 7/11/12. Reprinted by permission.

appropriately. The Vegetarian & Vegan Diet Pyramid has been developed to educate individuals on how to plan a balanced plant-based diet (see FIGURE 15.6 ). This section reviews the various types of vegetarianism and the spe- cial nutrient needs of vegetarian athletes.

What are the various types of vegetarianism? Although all vegetarians follow a plant-based diet, the inclusion or exclusion of specific foods can vary greatly based on the type of vegetarianism practiced. Often, individuals who are exploring the idea of becoming

444 SECTION 2 The Practical Application of Sports Nutrition

is considered lacto-vegetarianism or ovo-vegetarianism. The final progression to what some call “true” vegetari- anism is to follow a vegan diet that excludes all animal products, including any animal flesh, dairy, eggs, honey (because it is made by bees), and products made with an animal derivative (such as whey or casein from dairy). See TABLE 15.11 for a summary of the various types of veg- etarian diets. The special nutrition considerations for vegetarians follow the same progression as the dietary practices—the greater the exclusion of foods from the diet, the more special considerations exist.

It should be noted that these special considerations are mainly focused on helping individuals discover the wide variety of protein foods and dairy alternatives avail- able. Vegetarianism is often erroneously viewed as being insufficient for supporting the training and competitive demands of athletics. The reality is that vegetarianism is just a different pathway to the same destination. An analogy can be made to coaching techniques: Two foot- ball coaches may have very different training/condition- ing practices based on what they view as the best way to prepare for a winning season; likewise, an omnivore and a vegetarian will have very different dietary practices based on their beliefs, both with the intention of supporting over- all health, training, and competition. Therefore, athletes should consider vegetarianism as a healthy alternative to mainstream eating. The major mistake that athletes make when converting to a vegetarian diet is the exclusion of foods from the protein foods and/or dairy group without

a vegetarian begin as a semi-vegetarian, eating dairy, eggs, poultry, and fish but avoiding beef and sometimes pork. The next step is to exclude poultry, thus becom- ing a pesco-vegetarian (pesco = fish). Lacto-ovo-vegetar- ians include dairy and eggs but have made the choice to exclude any animal flesh (including fish). Vegetarians can choose to also exclude either dairy or eggs, which

Figure 15.5 Past and present vegetarian athletes and coaches. Data from Happy Cow's Famous Vegetarians. Available at: www.happycow. net. Accessed April 19, 2016.

Figure 15.6 Vegetarian & Vegan Diet Pyramid. With careful planning, a diet that lacks animal products can be nutritionally complete. © elenabsl/Shutterstock

The following athletes and coaches follow or have followed a vegetarian diet:

Hank Aaron, Baseball Legend

Danny Garcia, Professional Skateboarder

Venus Williams, Professional Tennis Player

Tony LaRussa, Professional Baseball Coach

Marv Levy, NFL Coach

Carl Lewis, Track/Field Olympian

Edwin Moses, Olympic Hurdler

Martina Navratilova, Professional Tennis Player

Dave Scott, Ironman World Champion

Bill Walton, NBA Basketball Player

Hannah Telter, Olympic snowboarder

Chapter 15 Special Populations 445

Which vegetarian foods are rich in protein? Protein is critical for tissue growth and repair, the forma- tion of hormones and enzymes, and proper immune func- tion in athletes. Protein can be found in a variety of meat and dairy alternative foods. Beans, nuts, seeds, and soy products fit into the protein foods group, providing not only protein, but also iron, zinc, magnesium, and calcium. Semi-, lacto-, and ovo-vegetarians are the least likely to experience a challenge in meeting protein needs; vegans can meet protein needs with a little extra meal planning and creativity, particularly when traveling. Overall, vege- tarians can meet their protein needs, positively affecting athletic performance in a similar fashion to omnivores.41

Vegetarians should aim to consume a variety of meat alternative sources each day to meet essential amino acid requirements. Soy protein is the only plant protein that contains high amounts of all essential amino acids, making soy foods convenient and complete. Nuts, seeds, legumes, and grains provide all the essential amino acids; however, they may contain low levels of one or more of these amino acids, thus requiring a combination of pro- tein sources throughout the day. FIGURE 15.7 presents the various combinations of plant proteins that provide com- plementary essential amino acids. These combinations do not need to occur within one meal; a variety of plant proteins can be consumed throughout the day to provide all essential amino acids. See TABLE 15.12 for a descrip- tion of commonly used vegetarian protein sources and associated meal-planning ideas. FIGURE 15.8 lists several organizations and their associated websites where more information on vegetarian protein sources can be found.

The greatest challenge for vegetarians, especially veg- ans, is finding protein sources while traveling and when dining out. Ideally, athletes should seek out vegetarian restaurants in their area, on the road, and at their final travel destination (see FIGURE 15.9 ). Vegetarian restaurants will provide a large variety of protein sources, along with whole grains, fruits, and vegetables. Unfortunately, veg- etarian restaurants are not found on every street corner,

introducing plant-based substitutions. Simply cutting out the meat and dairy choices in the MyPlate food guid-

ance system causes “the plate to break” because of poor planning and the exclusion of many nutrients. Instead, vegetarians advocate finding alternatives that are equivalent to the foods found in the MyPlate food groups, thus creat-

ing a well-balanced, appropriately planned diet. The protein foods and dairy/milk alternative groups

are rich in protein, iron, zinc, calcium, vitamin D, and vita- min B12. Therefore, vegetarians need to substitute plant- based foods that are rich sources of these nutrients.

Table 15.11

Types of Vegetarian Diets

Type Animal Foods Included

Foods Excluded

Semi-vegetarian Dairy products, eggs, poultry, fish

Red meats (beef, pork)

Pesco-vegetarian Dairy products, eggs, fish

Beef, pork, poultry

Lacto-ovo-vegetarian Dairy products, eggs Beef, pork, poultry, fish

Lacto-vegetarian Dairy products Beef, pork, poultry, fish, eggs

Ovo-vegetarian Eggs Beef, pork, poultry, fish, dairy products

Vegan None All animal products and animal derivatives

Figure 15.7 Complementary proteins for vegetarians. Because animal and soy products contain high levels of all essential amino acids, they can be consumed with any grain, legume, or nut/seed. Grains are complemented by legumes, and legumes are complemented by nuts/seeds. Grains are not a complementary match to nuts/seeds, but the two make a tasty combina- tion in recipes.

Nuts and Seeds (i.e., peanuts, almonds, walnuts, flaxseeds, sunflower seeds)

Legumes (i.e., kidney, black or pinto beans, lentils, split peas)

Animal products (i.e., meat, dairy, eggs)

Soy products (i.e., tofu, tempeh, soy milk)

Grains (i.e., whole grain bread, cereal, rice, pasta)

446 SECTION 2 The Practical Application of Sports Nutrition

Gaining the Performance Edge

Athletes seeking information about becoming vegetarian will find the following websites helpful: The Vegetarian Resource Group, www. vrg.org; Vegetarian Times, www. vegetariantimes.com; and VegWeb, www.vegweb.com.

and therefore athletes need to improvise at other types of dining establishments. The following is a listing of com- mon restaurants and the vegetarian protein sources typi- cally found on the menu:

• American: Mainly steakhouses, these restaurants will typically have fish and pasta dishes with cheese on the menu.

• Casual dining: Mainly “chain” restaurants, veggie burg- ers are now commonly found in the burger section of the menu.

• Chinese: Chicken and fish can typically be substituted in any dish for beef. Tofu is found in the vegetable sec- tion of the menu.

• Greek: Fish dishes, lentil soup, and hummus (made from chickpeas) are traditional Greek foods.

• Italian: For semi-vegetarians, many dishes will be served with chicken. For lacto-vegetarians, dishes

Figure 15.8 Many organizations provide information, recipes, and research briefs on the benefits of vegetarian protein sources.

Table 15.12

Vegetarian Protein Sources

Product Description Meal planning ideas and uses for cooking

Edamame Green soybeans; beans are harvested early and are therefore more sweet than mature soybeans.

Edamame can be boiled and lightly salted for a snack or side dish. Edamame are also perfect in pasta dishes, stir-fries, and cold summer salads.

Legumes Kidney, black, or pinto beans, lentils, split peas, black-eyed peas, and other legumes.

Can be used in soups, stews, and chili; as a side dish; or in salads.

Nuts Whole almonds, peanuts, walnuts, pecans, cashews, and other nuts.

Nuts can be sprinkled over salads, oatmeal, or yogurt and used in trail mixes.

Nut butters Peanut, almond, and cashew butter are common.

Can be spread on toast, pancakes, English muffins, fruit or vegetables (i.e., apple slices, celery, carrots, etc.). Also great in smoothies.

Quinoa An ancient grain that is rich in protein.

Can be used as a side dish, in grain and bean salads, and as a hot cereal.

Seeds and seed butter

Sesame, sunflower, flax, hemp, chia, other seeds, and sunflower butter.

Seeds can be added to salads, yogurt, or cottage cheese. Sunflower butter can be used just like nut butters noted above.

Soy crumbles

Soy crumbles are the vegetarian version of ground beef. They are typically found in the freezer section of a grocery store.

Use soy crumbles in any recipe that calls for ground beef, such as sloppy joes, chili, lasagna, or tacos.

Soy milk Soy milk is an alternative for cow's milk made from whole soybeans. Soy milk comes in low- fat and nonfat versions as well as vanilla and chocolate flavors.

Soy milk can be consumed by the glass, on cereal, and in smoothies, as well as in any recipe calling for milk. Many coffeehouses carry soy milk to make delicious soy lattes and mochas.

Soy yogurt Made from soy milk instead of cow's milk.

Soy yogurt can be served at breakfast in a parfait, at lunch with a sandwich, or as a snack with dried fruits, nuts, or granola.

Tempeh Whole soybeans, often mixed with a grain, are fermented into a soybean cake with a nutty flavor.

Tempeh's firm texture makes it perfect for marinating and grilling. Tempeh also works well in soups, stews, casseroles, or cubed for BBQ sandwiches.

Tofu Made in a similar fashion as cottage cheese, tofu is formed by mixing soy milk with a coagulant. Tofu comes in silken, soft, firm, and extra-firm varieties.

Silken tofu is used as a replacement for sour cream in recipes such as vegetable dip or as a replacement for cream cheese in recipes. Firm and extra-firm tofu are best for stir-fries, soups, stews, chili, burritos, casseroles, grilling, etc.

Veggie burgers

Burgers made from soy protein and/or tofu as well as other ingredients such as vegetables.

Veggie burgers can be warmed in the microwave, in a skillet, or on the backyard grill for a quick lunch.

Figure 15.9 Vegetarian athletes who travel throughout the United States and abroad can obtain information about vegetarian restaurants and their locations online.

secruoseR nietorP nairategeV

Organization Website

Vegetarian Resource Group www.vrg.org Soyfoods Association

of America www.soyfoods.org

U.S. Dry Bean Council www.usdrybeans.com Almond Board of California www.almonds.com California Walnuts www.walnuts.org Whole Grains Council www.wholegrainscouncil.org

secruoseRgniniDnairategeV

The following resources can be provided to vegetarian athletes to locate vegetarian restaurants across the country:

WebsiteName

Online Vegetarian Journal’s Guide to Natural Foods Restaurants in the U.S. and Canada

www.vrg.org

Online Guide to Vegetarian Restaurants Around the World

www.vegdining.com

Online Vegetarian Restaurants Guide

www.vegguide.org

Vegetarian Travel Sites www.happycow.net

Chapter 15 Special Populations 447

from plant sources, the RDA for iron intake for vegetar- ians is increased nearly 80% above the recommendation for individuals consuming an omnivorous diet. Male veg- etarians should aim for 14 milligrams per day; female vegetarians (of childbearing age) should consume 33 mil- ligrams per day.17

Iron is found in calcium-processed tofu, legumes, nuts, seeds, and iron-fortified cereals. For example, 1 cup of fortified corn flakes provides 9–10 milligrams of iron, supplying 68% and 29% of the daily requirement for men and women, respectively. Blackstrap molasses is also a good source of iron and can be consumed as a spoonful dose or mixed with hot cereals. Semi-vegetarians can eas- ily meet iron needs through several servings of chicken, fish, and plant foods each day.

Consuming a source of vitamin C at every meal will help vegetarians absorb the nonheme iron from foods. For example, a glass of orange juice will aid in the absorp- tion of iron from a bowl of fortified corn flakes. Green peppers and tomatoes, which are packed with vitamin C, are a tasty match to tofu in burritos or spaghetti sauce. Every vegetarian meal should include a source of iron (iron-rich foods typically also contain a solid dose of protein) and fruits and vegetables, which are excellent sources of vitamin C.

If vegetarian athletes fail to meet their iron needs, low serum ferritin levels and iron-deficiency anemia can ensue.45–47 Symptoms include fatigue, decreased toler- ance of cold, and decreased physical stamina, which all obviously impair athletic performance. By making wise food selections, iron needs can generally be met and iron- deficiency anemia avoided. In fact, studies have shown that even though iron stores may be low, vegetarians are no more likely to develop iron-deficiency anemia than nonvegetarians.48 However, for insurance, vegetarian ath- letes should be followed by a physician to monitor for low iron stores and iron-deficiency anemia.

Which vegetarian foods are rich in zinc? Zinc is critical to the health, performance, and well-being of an athlete in many ways. Zinc is required for gene expression, cell growth and development, immune func- tion, hormone production, protein and fat metabolism, and proper vision. The content and absorption of zinc from plant products are slightly lower than from animal products (mainly because of phytic acid, an inhibitor of zinc absorption), so vegetarians need to ensure their well- balanced diet includes plenty of rich sources of zinc.42

For the general population, daily zinc requirements for men and women have been set at 11 milligrams and 8 milligrams, respectively.17 However, vegetarians may require up to 50% more zinc daily because of the lower availability of zinc from plant sources.17 Vegetarian

with pasta, vegetables, and cheese are easy to find. Vegans will most likely need to eat a protein source before heading to the restaurant because legumes, nuts, and soy products are hard to find in these restaurants.

• Mexican: Bean burritos can be made at any Mexican restaurant. Refried beans are typically served with main entrées. If available, ask for whole beans in dishes and as a side instead of refried beans, which are often prepared with lard or oil.

• Pizzeria: Chicken and shrimp can be found on the menu in gourmet pizzerias. Lacto-vegetarians can easily order a vegetable supreme pizza. Similar to Ital- ian restaurants, vegans will typically need to eat more protein at breakfast, lunch, and as snacks if a pizzeria is the restaurant of choice for the evening.

• Thai: Similar to Chinese restaurants, chicken, fish, and tofu are commonly included in main entrée options, catering to all types of vegetarians. The protein needs of athletes can be met by plant

protein sources. More attention to protein substitu- tions is necessary as an athlete progresses from a semi- vegetarian to a vegan. However, the food industry has made it very easy to substitute nearly any animal prod- uct with a vegetarian product. Because of the American meat-focused society, it can take some time to adjust to a plant protein–based diet, but after some education and experimentation with foods, athletes can discover the health, performance, and taste benefits of being vegetarian.

Which vegetarian foods are rich in iron? Athletes need iron for the synthesis of red blood cells and enzymes, as well as for proper immune and brain function. Iron is concentrated mainly in foods within the meat and protein foods group. There are two forms of iron found in foods: heme (animal sources) and nonheme (plant sources). Nonheme iron is not absorbed as readily as heme iron, therefore justifying a special focus on iron for vegetarians.42 Vegetarians can beat the iron challenge by consuming sufficient quantities of iron-rich foods, and possibly supplements, each day and pairing those foods with a source of vitamin C.

The main issue with iron in vegetarian diets is not necessarily the total quantity of iron obtained from plant foods, but the bioavailability of the iron ingested. Several studies have shown that vegetarian diets con- tain as much, if not more, total iron as compared to car- nivorous diets.40,43,44 However, because of the chemical form of iron (nonheme) and other constituents that may enhance or inhibit iron absorption, less iron from food may be absorbed into the bloodstream for use by the body. To compensate for the lower bioavailability of iron

448 SECTION 2 The Practical Application of Sports Nutrition

sources of zinc include whole grains, fortified cereals, legumes, nuts, seeds, and dairy products. For example, 1 cup of fortified bran flakes provides 4–5 milligrams of zinc, supplying about 40% and 55% of the daily require- ment for men and women, respectively. These foods are often high in iron as well, providing the convenience of obtaining two critical nutrients in one food.

Zinc deficiency can cause a variety of problems, including an increased risk of infections, loss of appe- tite, diarrhea, and decreased thyroid hormone synthesis. Infections can take athletes out of training and compe- tition for several days to weeks while healing and recu- perating. Loss of appetite and diarrhea can cause failure to fuel the body properly, poor recovery, and malabsorp- tion of nutrients. Decreased thyroid hormone synthesis can cause fatigue, weakness, and diminished capacity for high-intensity training. Athletes should focus on food sources of zinc because high doses via supplementation can cause decreased absorption of other nutrients, vom- iting, and cramping.

Which vegetarian foods are rich in calcium and vitamin D? Calcium and vitamin D are often thought of as being syn- onymous only with dairy products, so these two nutrients are often cited to be of special concern to vegetarians,

especially vegans. However, because of the food indus- try and calcium-rich plant foods, calcium and vitamin D needs can easily be met on a vegetarian diet.

There has been an explosion of dairy/a l ternat ive products produced by the food indus- try, giving vegetar- ians many choices

for calcium- and vitamin D–rich foods. Most common dairy products, such as milk, yogurt, and cheese, can be found in a “veggie” form, typically made from soy, nuts, seeds, or grains. Most of these alternatives are for- tified with calcium and vitamin D, providing equivalent amounts as compared to dairy products. Some varieties are not fortified, however, so vegetarians should read food labels to choose dairy alternatives that contain added calcium and vitamin D. Calcium is also found in dark green leafy vegetables, calcium-fortified cereals,

legumes, and some nuts (e.g., almonds). The calcium availability from green leafy vegetables, legumes, and nuts is lower than from dairy products and other forti- fied foods and therefore should not be considered the sole source of calcium in the diet.49 Calcium-fortified orange juice is widely available in supermarkets, with a few newer varieties fortified with vitamin D as well. In addition to fortified dairy/alternatives and orange juice, vitamin D is found in eggs and fortified cereals. Athletes ages 19 to 50 years require 1000 mg of calcium and 600 IU of vitamin D each day.

The largest problem related to calcium and vitamin D deficiency in vegetarian athletes is the long-term effect on bone health. Osteoporosis has been linked to low intake of these nutrients, as well as other dietary, lifestyle, and genetic factors. By maintaining adequate intakes of these nutrients, athletes can prevent bone-related athletic inju- ries and osteoporosis later in life.

Which vegetarian foods are rich in vitamin B12? Vitamin B12 is produced by microorganisms, bacteria, fungi, and algae; animals and plants cannot produce this nutri- ent. Animal foods are a rich source of vitamin B12 because animals can absorb the vitamin B12 produced by bacteria in the intestinal tract. Because plant foods do not have an “intestinal tract” with vitamin B12–producing bacteria,

plant foods do not contain any vitamin B12. Semi-, pesco-, lacto-, and ovo-veg- etarians generally, but not always, con- sume plenty of vita- min B12. Vegans can fall short in this cat- egory because their diets are devoid of any animal products, potentially caus- ing vitamin B12 defi-

ciency and associated ramifications.50 However, vegans and other vegetarians can consume more than adequate amounts of vitamin B12 through the wide range of fortified foods and multivitamin/mineral supplementation.

Athletes need vitamin B12 for metabolizing folate, which prevents megaloblastic anemia, and for maintain- ing the myelin sheath surrounding all nerves, allowing for proper functioning of the nervous system. Symptoms of vitamin B12 deficiency can include decreased sensation, loss of bowel and bladder control, depression, and gen- eral weakness. Long-term vitamin B12 deficiency can lead to irreversible nerve damage. Therefore, vitamin B12 is of

Chapter 15 Special Populations 449

Gaining the Performance Edge

Legumes, nuts, and fortified soy products are powerhouses of nutri- tion for vegetarians. These three food categories provide all the nutrients that are of special concern to vegetarians—protein, iron, zinc, calcium, vitamin D, and vitamin B12. Vegetarians should aim to consume foods within these three categories every day.

Gaining the Performance Edge

Sports supplements, such as protein powders, energy bars, and recovery drinks, are generally fortified with most, if not all, vitamins and min- erals. Vegetarians should consider these supplements a source of essential nutrients, keeping in mind, however, that whole foods should remain the main focus of the diet.

great importance to athletes and deserves special atten- tion, especially for vegans.

The daily requirement of vitamin B12 for both men and women is 2.4 micrograms per day. For vegetarians eating fish and dairy, a full daily dose of vitamin B12 can be obtained by eating 3 ounces of salmon or 1 cup of yogurt plus 1 cup of milk. For vegans, 2 cups of fortified soy milk or 1.5 cups of fortified cereal will pro- vide 100% of the daily requirements. Therefore, it is not difficult to consume adequate amounts of vitamin B12; it just requires an awareness of wise food choices.

Most multivitamin/mineral supplements will also supply 100% of the daily value for vitamin B12. Many sport-specific supplements also contain significant quan-

tities of vitamin B12. As always, vegetar- ian athletes should focus on whole foods first, and then use vitamin/mineral and sport supplements as extra insurance. A sample meal that contains a variety of nutrients essential to a healthful vegetar- ian diet is shown in TRAINING TABLE 15.4 .

Training Table 15.4: Example of Vegetarian Dinner Meal

This dinner can be prepared and on the table in less than an hour, with leftovers ready for the rest of the week. The veggie burgers and greens should be served with an 8- to 12-ounce glass of fortified soy milk to create a well-balanced meal, representing four different food groups. The entire dinner provides a significant source of protein, iron, zinc, calcium, vitamin D, and vitamin B12.

Homemade Veggie Burgers Good-for-You Greens

1¼ cups water ½ cup lentils, rinsed and drained 1 15 oz can of kidney, black, or

garbanzo beans, drained and rinsed

1/3 cup wheat germ ¼ cup finely chopped pecans or

walnuts ¼ cup chili sauce ½ tsp ground cumin ¼ tsp garlic salt 2 tsp dried parsley Cooking spray 4 whole-wheat hamburger buns Lettuce, tomato, cucumber, and

avocado slices (optional) 1. In a small saucepan, combine

the water and lentils and bring to a boil over high heat. Reduce the heat to low-medium, cover, and cook for 20 to 25 minutes, or until tender. Drain the lentils if all the water has not been absorbed.

2. Place lentils and beans in a food processor and process until smooth.

3. Place the lentil/bean mixture in a medium bowl. Add the wheat germ and next five ingredients; mix to combine.

4. Form four patties with the mixture. Grill the burgers in a shallow frying pan coated with cooking spray for 5 minutes on each side. Burgers that will not be eaten at the meal can be stored (uncooked) in an airtight container for several days and cooked when desired.

5. Place each burger on a bun with your choice of toppings.

1 lb kale, washed and chopped coarsely

2 tbsp olive oil ½ lb mushrooms, washed and

sliced ¼ tsp salt ¼ tsp ground black pepper ½ tsp dried oregano or basil 1. Place about a quarter-inch

of water in the bottom of a Dutch oven or other large pot. Place all the kale in the pot, cover, and cook over medium- high heat for 5 to 8 minutes or until slightly tender. Drain the water, but keep the kale in the pot.

2. Add the olive oil and mushrooms to the pot, sautéing the kale and mushrooms over medium heat. Add the spices.

3. Cook the kale and mushrooms about 5 minutes or until mushrooms are soft. Serve immediately with Homemade Veggie Burgers and a glass of fortified soy milk.

Makes 4 servings. Nutrition information for entire

meal, consisting of one Homemade Veggie Burger, one serving of Good-for-You Greens, and 12 ounces of fortified soy milk:

Calories: 800 kcal Protein: 39 g Iron: 12 mg (86% men, 36%

women RDA) Zinc: 5 mg (45% men, 63%

women RDA) Calcium: 705 mg (71% AI) Vitamin D: 150 IU (25% RDA) Vitamin B12: 1.2 μg (50% RDA)

Adapted from Rosensweig L. and the food editors of Prevention magazine. New Vegetarian Cuisine. Emmaus, PA: Rodale Press; 1994.

450 SECTION 2 The Practical Application of Sports Nutrition

Gaining the Performance Edge

Vegetarianism can be a healthy alternative to mainstream eating for athletes. By following a well-bal- anced diet and focusing on nutri- ent-dense protein foods and dairy/ alternatives, vegetarians can con- sume all required nutrients in ade- quate amounts, leading to optimal health and athletic performance.

Food for Thought 15.4

You Are the Nutrition Coach

Apply the concepts from this chapter to several case studies.

The Box Score Key Points of Chapter

n Special populations are those groups of athletes who find themselves in unique situations, physiologi- cal or otherwise, that impose nutritional demands beyond those of their sport alone.

n Diabetes is a metabolic disorder affecting the body’s ability to regulate blood glucose levels. Athletes with diabetes must learn to regulate their blood glucose levels through the consumption of healthy food choices, the regular monitoring of blood glucose, and the coordinated timing of food intake, physical activity, and administration of medications.

n Diabetic athletes should consume diets similar in composition to the healthy nutrition recommenda- tions for the general population with the exception of a special focus on the total quantity and timing of carbohydrate consumption. Athletes with diabetes should follow a consistent meal pattern in regard to time of meals, caloric content, and number of carbo- hydrates in each meal.

n Athletes with type 1 diabetes should check their blood glucose level prior to exercise and adjust food or insulin accordingly. During exercise last- ing longer than 30 minutes, 15–30 grams of carbo- hydrates in simple form should be consumed every 30 to 60 minutes. Sports drinks, gels, and/or bars are excellent sources of carbohydrates for the diabetic athlete.

n Pregnancy demands that the female athlete consider not only her own nutrient requirements, but also those necessary to support the normal growth and development of a fetus. Pregnant athletes need to ensure the daily consumption of adequate calories (approximately 300 extra calories per day), protein (20–25 grams extra per day), B vitamins, vitamins A and C, as well as magnesium and iron.

n Young athletes must follow a nutrition plan that meets the needs of their sport and at the same time allows for normal growth and maturation of body tissues. Parents and dietitians can follow the growth trends of a young athlete to help determine nutri- tion status over time.

n Child athletes are at a higher risk for dehydration and heat illness. As a result, monitoring fluid intake during practice and competitions and encouraging fluid intake will help maintain their fluid balance.

n Iron and calcium are two minerals that have been identified as being deficient in the diet of young athletes, particularly female athletes. Consumption of dairy products and/or calcium and iron-fortified foods along with a once-daily multivitamin/mineral supplement will help ensure that the vitamin and mineral needs of young athletes are being met.

n College athletes find themselves in the unique situ- ation of being on their own for the first time in their lives and must learn how to take responsibility for their own nutritional practices. Poor eating and drinking habits, along with the added demands of college life, can spell disaster for a college athlete. Dietitians must do more than provide a meal plan to college athletes. They must also educate them about grocery shopping, meal planning, food preparation, and other healthy dietary practices to help ensure their overall health and athletic success.

n The number of masters athletes over the age of 40 is growing. Masters athletes need to consider their individual nutrient requirements, the needs of their sport, and any other special considerations resulting from chronic diseases or medication use. The rule of thumb is that masters athletes need to work on get- ting “more for less” from their diet via consumption of nutrient-dense foods and decreasing “unneces- sary calories.”

n Vegetarianism is being practiced by a growing num- ber of athletes. It can be a healthy alternative to a traditional diet as long as substitutions are made. Depending on the type of vegetarian diet being fol- lowed, food choices may vary greatly. If planned appropriately, vegetarians and vegans can obtain the nutrition they need from whole foods and forti- fied products. One multivitamin/mineral per day can provide extra insurance that all micronutrient needs are being met.

Chapter 15 Special Populations 451

Study Questions

1. What is the difference between type 1 and type 2 dia- betes? Which type is most prevalent in athletes?

2. What nutritional habits should diabetic athletes adopt to enhance their ability not only to perform, but also to cope with their disease?

3. What are some of the nutritional concerns associated with the pregnant athlete? How many extra calories should a pregnant athlete consume daily?

4. What is a growth channel, and how might a nutrition expert use it?

5. Which sports tend to increase the chances of dehy- dration in young athletes? What recommenda- tions should be given to young athletes to prevent dehydration?

6. Discuss the various factors that contribute to college athletes being considered as a “special population” in regard to nutrition.

7. What impact does alcohol have on one’s diet and overall energy consumption?

8. Discuss how the nutrient needs of the young athlete differ from those of the masters athlete.

9. What is meant by “complementing proteins”? Which special population needs to be concerned most with complementing protein sources? Give two examples of food sources providing complementing proteins.

10. What are the different types of vegetarianism? What nutritional considerations must be taken into account when dealing with vegetarian athletes?

11. What suggestions for protein source alternatives would you give a vegetarian athlete who dines out frequently at nonvegetarian restaurants?

References

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18. Bernhardt IB, Dorsey DJ. Hypervitaminosis A and congenital renal abnormalities in a human infant. Obstet Gynecol. 1974;43:750–755.

19. Institute of Medicine. Dietary Reference Intakes for Cal- cium, Phosphorus, Magnesium, Vitamin D, and Fluoride. Food and Nutrition Board. Washington, DC: National Academies Press; 1997.

20. Wiggins DL, Wiggins ME. The female athlete. Clin Sports Med. 1997;16(4):593–612.

21. Centers for Disease Control, National Center for Health Statistics. CDC Growth Charts: United States. 2001. Available at: www.cdc.gov/nchs/about/major/ nhanes/growthcharts/background.htm. Accessed March 13, 2005.

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22. Berning JR, Steen SN. Nutrition for Sport and Exercise. 2nd ed. Gaithersburg, MD: Aspen Publishers; 1998.

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26. Lindholm C, Hagenfeldt K, Ringertz BM. Pubertal devel- opment in elite juvenile gymnasts: effects of physical training. Acta Obstet Gynecol Scand. 1994;73:269–273.

27. Rogol AD, Clark PA, Roemmich JN. Growth and pubertal development in children and adolescents: effects of diet and physical activity. Am J Clin Nutr. 2000;72(suppl):521S–528S.

28. Petrie HJ, Stover EA, Horswill CA. Nutritional concerns for the child and adolescent competitor. Nutrition. 2004;20:620–631.

29. Bar-Or O. Children’s responses to exercise in hot cli- mates: implications for performance and health. Gatorade Sports Sci Exchange. 1994;7(2):1–5.

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31. Constantini NW, Eliakim A, Zigel L, Yaaron M, Falk B. Iron status of highly active adolescents: evidence of depleted iron stores in gymnasts. Int J Sports Nutr Exerc Metab. 2000;10:62–70.

32. Leichliter JS, Meilman PW, Presley CA, Cashin JR. Alco- hol use and related consequences among students with varying levels of involvement in college athlet- ics. J Am Coll Health. 1998;46(1):257–262.

33. Nelson TF, Wechsler H. Alcohol and college athletes. Med Sci Sports Exerc. 2001;33(1):43–47.

34. Wilson GS, Pritchard ME, Schaffer J. Athletic status and drinking behavior in college students: the influ- ence of gender and coping styles. J Am Coll Health. 2004;52(6):269–273.

35. Green GA, Uryasz FD, Petr TA, Bray CD. NCAA study of substance use and abuse habits of college student athletes. Clin J Sport Med. 2001;11:51–56.

36. Hetherington MM, Cameron F, Wallis DJ, Pirie LM. Stimulation of appetite by alcohol. Physiol Behav. 2001;74:283–289.

37. American Dietetic Association. Position of the Ameri- can Dietetic Association: nutrition, aging and the con- tinuum of care. J Am Diet Assoc. 2000;100(5):580–595.

38. McGandy RB, Barrows CH, Spanias A, Meredith A, Stone JL, Norris AH. Nutrient intake and energy expenditure in men of different ages. J Gerontol. 1966;21:581–587.

39. Paddon-Jones D, Short K, Campbell W, Volpie E, Wolfe R. Role of dietary protein in the sarcopenia of aging. Am J Clin Nutr. 2008;87(suppl):1562S–1566S.

40. American Dietetic Association. Position of the Ameri- can Dietetic Association: vegetarian diets. J Am Diet Assoc. 1997;97:1317–1321.

41. Haub MD, Wells AM, Tarnopolsky MA, Campbell WW. Effect of protein source on resistive-training-induced changes in body composition and muscle size in older men. Am J Clin Nutr. 2002;76:511–517.

42. Hunt J. Bioavailability of iron, zinc and other trace minerals from vegetarian diets. Am J Clin Nutr. 2003;78(suppl):633S–639S.

43. Calkins BM, Whittaker DJ, Nair PP, Rider AA, Turjman N. Diet, nutrition intake, and metabolism in popula- tions at high and low risk for colon cancer. Am J Clin Nutr. 1984;40(suppl):896–905.

44. Craig WJ. Iron status of vegetarians. Am J Clin Nutr. 1994;59(suppl):1233S–1237S.

45. Alexander D, Ball MJ, Mann J. Nutrient intake and haematological status of vegetarians and age-sex matched omnivores. Eur J Clin Nutr. 1994;48:538–546.

46. Anderson BM, Gibson RS, Sabry JH. The iron and zinc status of long-term vegetarian women. Am J Clin Nutr. 1981;34:1042–1048.

47. Hua NW, Stoohs RA, Facchini FS. Low iron status and enhanced insulin sensitivity in lacto-ovo vegetarians. Br J Nutr. 2001;86:515–519.

48. National Research Council, Food and Nutrition Board. Diet and Health: Implications for Reducing Chronic Dis- ease Risk. Washington, DC: National Academies Press; 1989.

49. Weaver CM, Proulx WR, Heaney R. Choices for achiev- ing adequate dietary calcium with a vegetarian diet. Am J Clin Nutr. 1999;70(suppl):543S–548S.

50. Herrmann W, Schorr H, Obeid R, Geisel J. Vitamin B12 status, particularly holotranscobalamin II and meth- ylmalonic acid concentrations and hyperhomocyste- inemia in vegetarians. Am J Clin Nutr. 2003;78:131–136.

Chapter 15 Special Populations 453

Additional Resources

American College of Sports Medicine. ACSM’s Guidelines for Exercise Testing and Prescription. 7th ed. Philadelphia, PA: Lippincott, Williams & Wilkins; 2006.

Colberg SR. The Diabetic Athlete: Prescriptions for Exercise and Sports. Champaign, IL: Human Kinetics; 2001.

Hammill PVV, Drizd TA, Johnson CL, Reed RB, Roche AF, Moore WM. Physical growth: National Center for Health Statistics percentiles. Am J Clin Nutr. 1979;32:607–629.

454 SECTION 2 The Practical Application of Sports Nutrition

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Key Questions Addressed 1. Why should you consider becoming a registered dietitian?

2. What are the steps to becoming a registered dietitian?

3. Is continuing education required once the RD credential is obtained?

4. What is the Board Certified as a Specialist in Sports Dietetics credential?

5. Is licensure necessary for registered dietitians?

6. How can students and professionals obtain practical experience in the field of sports nutrition?

7. What are the potential job markets in sports nutrition?

You Are the Nutrition Coach Caroline will finish her dietetic internship and master’s in nutrition in 1 month. She has been in com- petitive sports all of her life and is interested in pursuing a career in sports nutrition. She completed a 2-week rotation in a sports medicine clinic during her internship and did nutrition assessment and counseling with a variety of athletes in the clinic. Her master’s thesis research included pre- and post- body composition assessments of middle-aged women in a 12-week strength-training program. During her job search, she finds there are a lot of jobs in hospitals and clinics and one job opening for a sports dietitian at the university close to her home.

Questions • What education and experience does Caroline need to land the university sports dietitian job?

• How could her master’s thesis help her compete with other dietitians applying for the univer- sity job?

• What can Caroline do to help her be more competitive for a similar sports dietitian job that might come up in the future?

Jobs in Sports Nutrition

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CHAPTER 16

Why should you consider becoming a registered dietitian? A registered dietitian (RD) or registered dietitian nutri- tionist (RDN) is a healthcare professional trained to provide food and nutrition information to the public. Approximately 90,000 RDs work in the United States in a variety of settings, including hospitals, public health organi- zations, universities, research facilities, food service venues, corporations, consulting practices, fit- ness and wellness centers, and nonprofit businesses. The registered dietitian credential is the only one recognized nationally in the nutrition field. Therefore, RDs are the experts in the nutri- tion profession, pro- viding the link between dietary advice and optimal health. Regardless of the professional set- ting, becoming an RD is essential for work- ing in the nutrition field because most, if not all, positions require the creden- tial for employment.

Sports nutrition is a relatively new specialty area for registered dietitians. The field of sports nutrition is growing exponentially because of the recognition that proper nutrition is paramount for optimal performance. The explosion of dietary supplements marketed to ath- letes has also created a need for these knowledgeable pro- fessionals who can help individuals decipher fact from fiction. Sports dietitians, who are also registered dieti- tians, provide the unique expertise in planning a practi- cal, individualized meal plan for training and competition and educating athletes on the science behind nutrition recommendations for sport, while also determining the pros and cons of incorporating supplements for improv- ing athletic performance.

The definitions and differences between a dietitian and a nutritionist warrant explanation. A dietitian is an individual who has successfully completed the require- ments for the nationally recognized RD credential. A nutritionist may or may not have the same background as a dietitian. Any- one can claim to be a nutritionist without proving background, degrees, or certifica- tions. In the job mar- ket, including the area of sports nutrition, employers look

for individuals who are RDs. Likewise, athletes are seeking out credentialed registered dietitians versus self-pro- claimed nutritionists for nutrition guidance.

What are the steps to becoming a registered dietitian? There are three main requirements to becoming a reg- istered dietitian. The first requirement is to obtain a 4-year degree at an accredited col- lege or university. The undergraduate coursework must meet the Didactic Program in Dietetics (DPD) requirements set by the Accredi- tation Council for Education in Nutri- tion and Dietetics (ACEND) within the Academy of Nutri- tion and Dietet- ics (AND). Students can receive a 4-year degree in a variety of nutrition practice areas, but the core DPD requirements must be met as the first step in becoming an RD.

The second requirement for obtaining the RD creden- tial is to complete a required amount of postbaccalaure- ate experience in nutrition. This is completed in one of two ways: either an 8- to 12-month dietetic internship at an accredited facility or acceptance into a coordinated undergraduate program. On either pathway, at least 1200 hours of experience and practice supervised by registered dietitians are required.

After the internship or coordinated program is com- pleted, the individual is then eligible to take the national board exam for dietitians. Successfully passing this exam is the third and final step in becoming a registered dieti- tian. All of these steps must be completed in the order described before the RD credential can be awarded. Each step is explained in greater detail in the following sections.

What are the curriculum requirements for an undergraduate degree in dietetics? Students who are striving to become registered dietitians must complete specific coursework at an accredited 4-year educational institution. The required curriculum must meet the ACEND standards set by the AND. To maintain accreditation, the college or university must be accredited

registered dietitian (RD) or registered dietitian nutrition- ist (RDN) Individual trained to pro- vide food and nutrition information to the public and who has suc- cessfully passed the national reg- istration examination for registered dietitians.

nutritionist Individual who may or may not have the same background as a registered and/or licensed dietitian.

Gaining the Performance Edge

The educational background and professional recognition of becom- ing a registered dietitian are critical for succeeding in a sports nutrition career.

Academy of Nutrition and Dietetics (AND) Organization of more than 90,000 dietetic practitio- ners that oversees dietetic accredi- tation and provides timely and accurate nutrition information to the public.

Accreditation Council for Education in Nutrition and Dietetics (ACEND) Agency of the Academy of Nutrition and Dietet- ics that oversees educational pro- grams preparing students for careers in dietetics.

Didactic Program in Dietetics (DPD) Core academic course require- ments to obtain a 4-year degree in dietetics.

456 SECTION 2 The Practical Application of Sports Nutrition

by a body for higher education; integrate the DPD admin- istratively and fiscally into the college structure; pro- vide the required didactic instruction, which culminates in a baccalaureate degree; and designate a director who is credentialed as a registered dietitian and has earned at least a master’s degree. The various accredited insti- tutions provide similar coursework; however, they may have different departmental or major names. A majority of universities use the term Dietetics as the major name, and it can be housed in the College of Health and Applied Sciences, Consumer and Family Sciences, or Agriculture. Completion of the program culminates in a 4-year bach- elor of science (BS) degree.

The curriculum is designed to teach students the sci- ence and practical application of food and nutrition for long-term health. The curriculum is demanding and pro- vides a challenging academic experience starting in the first year of college. Students should be interested in and prepared for coursework involving several levels of chem- istry, including biochemistry, microbiology, beginning and advanced medical nutrition, food sciences, communica- tion, business management, food service, and research. Didactic program curricula are based on the foundation knowledge, skills, and competency statements for dieti- tians. There are five categories of knowledge require- ments that are required to maintain ACEND accreditation to ensure students’ competency in the field. The founda- tions are in the following areas:

• Scientific and evidence base of practice. • Professional practice expectations. • Clinical and customer services. • Practice management and use of resources. • Support knowledge.

In addition to the knowledge requirements, curric- ulum variations are allowed, including recommended electives, which are typically based on the direction of the individual university and the faculty advisors for the dietetics program. One of the fastest-growing additions to the dietetics core curriculum is a course in sports nutri- tion. Several universities have even created a major or minor in sports nutrition. The sports nutrition courses are often open to exercise science, athletic training, and physical therapy students as well. The dietetic under- graduate student who is interested in becoming a sports dietitian would also benefit from taking electives in the exercise sciences. Classes in exercise physiology, kinesiol- ogy, sports management, and sports psychology will help prepare students for a sports nutrition career.

Do individuals need a graduate degree to be a sports dietitian? Graduate degrees are not yet required to obtain the RD credential. However, because sports nutrition is a spe- cialty area that requires significant knowledge of general nutrition, plus exercise physiology, body composition, and eating disorders, a graduate degree is helpful. In addi- tion, many jobs in sports nutrition will require a master’s

degree for employment. Therefore, to be competitive in the sports nutrition job market, a master’s degree is likely a necessity. Graduate degrees can be obtained in several areas, including advanced human nutrition, sports nutri- tion, exercise science, kinesiology, sports management, athletic training, and sports medicine. Any of these grad- uate programs provide a perfect complement to under- graduate studies for registered dietitians who work with recreational through elite athletes.

What do the dietetic internships entail, and how does the experience relate to becoming a dietitian? As mentioned previously, students have two main options for completing the second phase of becoming a registered dietitian: complete an accredited dietetic internship after undergraduate work or apply for a coordinated program that combines undergraduate and graduate work and the internship. There are approximately 250 accredited internship programs and about 55 coordinated programs available in the United States. As shown by the num- bers, most students complete their postbaccalaureate experience through an accredited dietetic internship. A third internship option is the Individualized Supervised Practice Pathways (ISPPs). Approximately 11 sites in the United States offer this option in which interns go to the sponsor site for some of the internship experience but also gain their practice-hour experiences in their home geographic region with approved registered dietitian pre- ceptors. As with the undergraduate DPD and coordinated programs, internships must also maintain ACEND accred- itation through the AND.

If a student chooses the popular route, after complet- ing undergraduate work, the student applies for a dietetic internship. The application process works on a computer matching system, requiring students and internship sites to rank their preferences on sites and applicants, respectively. The computer system matches preferences on both ends and then notifies students of their place- ment. Dietetic internships are competitive, and many students who complete the 4-year DPD and gain a BS in Dietetics do not get into an internship program. There are not enough internship spaces available for the num- ber of graduating students each year. Maintaining high grades throughout the entire 4-year undergraduate pro- gram, gaining volunteer or work experience in nutrition or food science, excelling in other academic areas, and showing leadership in extracurricular activities will help students during the internship matching process. Dietetic internship sites must meet the requirements established by the ACEND,1 including:

• The internship must be housed in a college or univer- sity, healthcare facility, federal or state agency, busi- ness, or corporation located in the United States. In addition, only individuals who have a 4-year BS and have completed all of the DPD requirements can be admitted.

Chapter 16 Jobs in Sports Nutrition 457

• Interns must complete at least 1200 hours of super- vised practice experience, which must be completed within 2 years of starting the experience.

The sponsoring organization must designate a director who has at least a master’s degree and is credentialed as a registered dietitian. Preceptors working with the interns must also be registered dietitians.

Coordinated programs in dietetics require only one application process. This pathway offers undergraduate coursework and internship practicum hours intermixed throughout the program. There are limited spaces avail- able in the coordinated programs as well, and therefore students need to shine academically coming out of high school. Some students prefer this pathway because of the streamlined nature of the experience and guaranteed internship hours.

There is a long list of competencies that individuals are required to master before completing the dietetic internship or coordinated program. The competencies are designed to ensure that all entry-level dietitians will possess core knowledge, skills, and abilities in a variety of nutrition-related areas prior to employment in the field. The competencies presented in broad categories include individual/group education and counseling, regulations, food service, program and material development, interpret- ing medical/scientific data and applying them in clinical settings, medical nutrition therapy, advanced nutrition support, and competency in working with diverse cultures. Only after students have successfully met the core com- petency standards can graduation occur, making them eligible to take the RD examination.

Dietetic internships and coordinated programs can also offer an emphasis area in addition to the core com- petencies. Sites are required to develop their own set of com- petencies to estab- lish an emphasis area for their program. These areas include advanced nutrition therapy, commu- nity nutrition, sports nutrition, food ser- vice management, b u s i n e s s , a n d research. Emphasis areas are considered a “bonus”; therefore, time spent in the specialty area is in addition to time allot- ted to mastering core competencies.

Dietetic internships and coordinated programs are standardized and regulated to provide each potential registered dietitian with similar background knowledge, skills, and abilities. The training is rigorous and demand- ing; however, because the RD credential is the only one recognized in the field, the profession demands a high

level of knowledge, skill, and analytical ability from each dietitian. This process helps ensure that the profession maintains its high level of credibility in the healthcare, food science, education, and research fields.

How is the board exam taken, and what topic areas are covered? After successfully completing a dietetic internship or coor- dinated program, each individual is then eligible to take the RD board exam. This is a standardized test taken on a computer at various sites across the nation. The exam tests the student’s knowledge and practical application of all of the core competency areas from the DPD and internship, including clinical nutrition, food service management, and community nutri- tion. Scoring of the exam occurs imme- diately following the test. Successful scores are sent to the AND Commission on Dietetic Registration (CDR). Shortly there- after, the commis- sion issues a registration card that allows the dietitian to use the RD credential.

Is continuing education required once the RD credential is obtained? All registered dietitians must obtain continuing edu- cation credits to update their knowledge and skills in their area of practice. The continuing education pro- cess for RDs includes developing a professional devel- opment portfolio plan following guidelines set by the CDR of the AND. This plan guides the registered dieti- tian in selection of continuing education activities that will enhance, update, and provide new knowledge in the primary practice area in which they work. Registra- tion renewal occurs every 5 years, requiring 75 hours of continuing education. Completion of these hours can be obtained through various means including, but not limited to, the following:

• Attending continuing education seminars and conferences.

• Completing dietetics-related academic coursework. • Conducting research. • Attaining CDR-approved certification such as the Cer-

tified Specialist in Sports Dietetics (CSSD). • Participating in journal clubs and study groups.

Requiring continuing education for RDs encourages and ensures that each dietitian will regularly maintain a high level of knowledge in the area in which he or she works. The portfolio system allows each dietitian to choose several areas of nutrition for professional develop- ment based on his or her current career path.

Gaining the Performance Edge

The process of becoming a regis- tered dietitian includes obtaining an undergraduate degree in dietet- ics from an accredited university, successfully completing postbac- calaureate work through a dietetic internship or coordinated program, and passing the RD board exam. The RD credential is essential for individuals interested in the field of sports nutrition.

Food for Thought 16.1

Registered Dietitian Requirements

Describe the three main require- ments to become a registered dietitian.

458 SECTION 2 The Practical Application of Sports Nutrition

What is the Board Certified as a Specialist in Sports Dietetics credential? Specialty board certification for registered dietitians is offered by the CDR in the areas of sports dietetics, pedi- atric nutrition, renal nutrition, oncology nutrition, and gerontological nutrition. The Board Certified as a Special- ist in Sports Dietetics credential (CSSD) was first offered as a specialty certification in 2006. Certification is granted in recognition of the applicant’s documented practice experience in sports nutrition and successful completion of a computerized examination. Sports dietetics practi- tioners are defined as registered dietitians who are expe- rienced in applying evidence-based nutrition knowledge in exercise and sports. They assess, educate, and coun- sel athletes and active individuals. They design, imple- ment, and manage safe and effective nutrition strategies that enhance lifelong health, fitness, and optimal perfor- mance. 2

To be eligible for the CSSD, applicants must: • Be a registered dietitian for a minimum of 2 years. • Document a minimum of 1500 hours of practice

directly in the sports nutrition area within the past 5 years.

• Submit an application and a $350 application fee.2

Once the application is reviewed and accepted, the applicant can select a test site in his or her geographical area and then schedule and take the computerized exam- ination. If a passing exam grade is achieved, the applicant can use the credential RD, CSSD for the 5-year certifica- tion period. At the end of the 5-year period, specialists can apply for recertification by successfully submitting the application, application fee, and achieving a passing grade on the CSSD examination.

Is licensure necessary for registered dietitians? Forty-six states have laws regulating dietitians and/or nutritionists through registration, certification, or licen- sure. Certification and registration are much less strict than licensure; they limit the use of some titles for dietetic practice and/or may require a state examination but do not limit the practice of nutrition for nonregistered or uncertified persons. Licensure is the strictest of the state regulations, and 38 states and Puerto Rico currently have licensure laws.3 Licensure laws regulate both the defini- tion of titles that can be used and the scope of practice for the profession. The licensure process was initiated in many states to ensure that only qualified professionals, with proof of adequate education and experience, pro- vide nutrition services or advice to individuals seeking nutrition care. Non-licensed professionals are subject to prosecution for practicing without a license. The licensure process is similar to other allied health professionals such as pharmacists, physical therapists, athletic trainers, and

nursing professionals. Consumers, especially athletes, should inquire about the RD and CSSD credentials and licensure before choosing a dietitian to provide them with nutrition education.

In states where licensure is required, dietitians can obtain a license if they are a registered dietitian in good standing with the AND. Licensure requires proof of dietetic registration and a fee. Some differences in the licensing laws and fees occur from state to state. The license usually indicates who is allowed to practice as a dietitian in the state. This includes allowing only licensed dietitians to use the name “dietitian” and most often means the title “nutri- tionist” is not a recognized dietetic professional. Licensed dietitian (LD) and licensed dietitian nutritionist (LDN) are two common examples of how the licensure laws distin- guish the titles of licensed nutrition professionals. Con- tinuing education is also required to maintain licensure, which is renewed on an annual or biannual basis. The continuing education that dietitians maintain for their dietetic registration usually can also be used for the licensure continuing education requirement.

What if you are not an RD and don’t have a license—can you still give nutrition advice to athletes? There are many times when an athletic program does not have a dietitian available to provide all of the sports nutri- tion education. Sports professionals other than dietitians can provide some nutrition education; however, there are limitations. It is important for non-RDs to understand these limitations and recognize when a referral to an RD is appropriate.

The non-RD professionals that athletes typically obtain nutrition information from include athletic train- ers, strength and conditioning coaches, team coaches, and physicians. Non-RD sports professionals can do a great job of imparting nutrition information because they often have an excellent rapport with the athlete, which encourages good communication of nutrition needs, prac- tical applications, and goals for improving athletic perfor- mance. However, these non-licensed individuals need to be careful not to break licensure laws by providing specific nutrition counseling or medical nutrition therapy. Medical nutrition therapy, individualized nutrition assessment, and development of nutritional plans are functions that registered dietitians and CSSDs are specifically trained (and in 38 states licensed) to do. Non-RD sports profes- sionals can provide athletes with general nutrition infor- mation that is considered “public domain.” Examples of public domain information include the MyPlate food guidance system, dietary guidelines, hydration recom- mendations, and precautions for training/competing in

licensed dietitian (LD) and licensed dietitian nutritionist (LDN) Dietitian who has obtained a state license to practice dietetics following the state-regulated prac- tice guidelines.

Chapter 16 Jobs in Sports Nutrition 459

the heat. This information is easily accessible from large government, business, and educational or professional organizations.

It is important that non-licensed nondietitians have a good working knowledge of nutrition before convey- ing advice to athletes. Several nondietetic undergradu- ate programs, such as athletic training, require at least one course in nutrition. Any non-RD who is interested in providing some nutrition guidance to athletes is encour- aged to take additional nutrition courses in college as well as attend continuing education seminars. These professional development oppor- tunities will help non-RDs understand the science behind recommendations as well as methods for communicating the practical application of concepts in the sport setting.

When athletes need more information and coun- seling beyond the public domain information, a referral should be made to an RD. Referrals should be made, at minimum, when:

• An athlete presents with an eating disorder. • An athlete has a medical condition, such as diabetes,

high cholesterol, or hypertension, that requires nutri- tion education and treatment.

• Medical information such as laboratory data, medi- cal history, and consultation with medical providers is needed to accurately educate the athlete.

• Nutrition assessment and a nutritional care plan need to be developed.

• The athlete needs specific nutrition information that the professional does not have the knowledge and expertise to provide. The sports professional and RD will then work

together as a team to ensure that the nutrition plan matches the athlete’s training regimen and addresses health or performance concerns.4 One of the most important aspects of a team approach is the delivery of a consistent message from all sports professionals working with the athlete to ensure consistency and to increase the likelihood of success.

How can students and professionals obtain practical experience in the field of sports nutrition? For any student or sports professional who is interested in pursuing a career in sports nutrition, practical expe- rience is of the utmost importance. Sports nutrition is a specialty area and therefore requires a solid educa- tional background as well as practical experience in a “real-world” setting. Even a registered dietitian cannot

be an “expert” in sports nutrition without the experience of applying nutrition knowledge specifically to athletes. Practical experience can be obtained in a variety of ways including, but not limited to, the following:

• Teaching/graduate assistantships. Both undergraduate and graduate students can pursue opportunities on campus for assistantship positions. These assign- ments may involve teaching a sports nutrition course, counseling student athletes in a campus wellness center, or working with a specific athletic team.

• Research. Professors in nutrition and exercise science departments are usually looking for eager students to assist with gathering and analyzing data for research projects. Students should inquire about current proj- ects as well as potential upcoming data collection related specifically to sports nutrition and athletic performance.

• Hospitals. Many local hospitals have a sports medi- cine department that employs sports physicians, ath- letic trainers, physical therapists, and possibly also a sports dietitian. These sports medicine or perfor- mance departments are a great way to observe a wide variety of professionals working as a team to assist athletes. These centers often can provide the oppor- tunity to work with athletes in endurance, strength/ power, and team sports, ensuring a well-balanced experience.

• Health clubs. Depending on the size and extent of a health club or fitness center, a dietitian may be on staff and work with a variety of recreational athletes. Many people who are fitness enthusiasts are also interested in working on their nutrition to enhance their workouts. For most sports dietitians, a major- ity of their clients are recreational athletes (versus elite or professional), so experience working with this population will be valuable regardless of your final career path.

• Internships. Many businesses and nonprofit organiza- tions will offer short-term internship programs for students and/or professionals in the areas of nutri- tion, exercise physiology, or other sport sciences. Typically 12 to 16 weeks in length, these part-time or full-time positions allow an individual to have the experience of what happens on a daily basis in the world of sports nutrition. Often these positions will provide a wide range of opportunities and responsibil- ities, giving an individual a well-rounded experience.

• Volunteer work. One of the best ways to get experience and to network is to volunteer within a professional organization. Working on a committee, assisting at regional or national conferences, writing book reviews, or giving student presentations on campus are excellent opportunities for gaining sports nutri- tion/science knowledge while also learning the art of organization, planning, and facilitating. Students should begin seeking opportunities for prac-

tical experience in their sophomore and junior years in

Food for Thought 16.2

Licensure

Describe the purpose of state licensure for dietitians and research licensure laws in your state.

460 SECTION 2 The Practical Application of Sports Nutrition

college. Dietetic and other sports science students should continue to search for positions throughout college, aim- ing for variety, to allow for an educated decision on a final career path.

What are the potential job markets in sports nutrition? Once an individual has acquired the necessary educa- tional background and practical experience, the next step is to look for a permanent position in the field of sports nutrition. Dietitians and other sports professionals can be involved in counseling fitness enthusiasts, as well as recreational, elite, or professional athletes, through a variety of venues. A full-time position performing only sports nutrition duties is becoming more common; how- ever, professionals should be prepared to bring other skills to the table in order to be qualified for an existing posi- tion or to create a new job in an established facility. The following are a sampling of the most likely places to find a career in sports nutrition:

• Clinical settings. Mainly associated with a hospital, these positions may be incorporated into an outpa- tient dietitian position or as part of a sports medicine clinic. In the outpatient setting, athletes are typically referred to a dietitian for a non-sports-related medical issue. In a sports medicine clinic, athletes are gener- ally counseled on sports injury treatment/prevention or techniques for improving overall performance. A sports medicine clinic is one of the most likely places to find a full-time sports nutrition position.

• Sport performance companies. These relatively new companies or programs with sports medicine facili- ties provide team and individual coaching to improve speed, agility, power, and overall sport performance.

• Fitness/wellness facilities. There are many fitness cen- ters, park districts, and wellness centers in private companies that hire sports dietitians. Opportunities to teach group nutrition classes and provide one-on- one sports nutrition counseling, wellness education, and clinical nutrition management are abundant in these settings.

• College sport teams. Many athletic departments now hire a full-time or part-time sports dietitian to pro- vide nutrition assessment and education for a spe- cific team or all teams in the athletic department.

• Academics and research. Universities provide a wealth of opportunities to be involved in sports nutrition (see FIGURE 16.1 ). One option is to teach a sports nutri- tion class for undergraduate or graduate students in a dietetics or exercise science department. Several universities and colleges have a unique pairing of the health center and recreation center, which lends itself perfectly to therapeutic and preventive nutri- tion education, including sports nutrition. Many pro- fessors are now concentrating their research in the

Figure 16.1 Nutrition education in action. Sports dietitians provide education to athletes in many different settings, includ- ing on the field, in the athletic training room, in the class- room, or in private consultation offices.

area of sports nutrition, providing another possibility for a full-time position on a university campus.

• Professional teams. Working with a professional sport- ing team can be one of the most challenging jobs to obtain because so few positions actually exist. Although there are some exceptions, most of the dietitians who work with professional teams do so on a part-time, consultant basis. These positions are generally filled by sports dietitians who have worked in the field for many years and have extensive expe- rience counseling athletes.

• Corporations/food industry. Companies who either pro- duce or market sports nutrition products often prefer to hire a dietitian over a general research or sales pro- fessional to have the experts working on their prod- ucts. These jobs can include research, development, marketing, and sales responsibilities.

• Private consulting. Currently one of the most popu- lar avenues for sports dietitians, a private consulting business allows an individual to “create” his or her own position. As mentioned previously, sports nutri- tion is a relatively new field, and therefore permanent positions are not abundant. Often, the best option for a dietitian is to open a private practice that can cater to local and regional athletes. Dietitians should be prepared to include other areas of nutrition and well- ness in their business plan because sports nutrition will typically not generate enough revenue to com- pletely sustain a business, at least not initially. There are several ways to keep abreast of job open-

ings and opportunities in sports nutrition. Networking with sports dietitians and viewing job postings at profes- sional conferences are a couple of targeted ways to find a job. Often, superior performance during an internship

Chapter 16 Jobs in Sports Nutrition 461

Fortifying Your Nutrition Knowledge

About the Author: Heather Hedrick Fink, MS, RD, CSSD How did I become a sports dietitian?

My passion and enthusiasm for food and nutrition began in junior high. I had an excellent home economics teacher who sparked my interest in proper nutrition and cooking. I continued to register for food and nutrition courses throughout high school, finding my interest deepening with each class. In my senior year of high school, there was no question in my mind of what my major would be in college—I was determined to be a dietitian.

I graduated from the University of Illinois in Urbana/Champaign with a bachelor of science degree in dietetics. While in my undergradu- ate program, I began to discover another area of interest that was a perfect match to dietetics—exercise physiology. I took one class in my undergraduate work in the exercise science department, but continued to focus mainly on obtaining the RD credential. After graduating, I spent a year at the University of Wisconsin, Madison, Hospital and Clinics successfully completing my dietetics internship. Several months into the internship I realized that clinical nutrition was not my passion. It was then that I decided to go back to school for a graduate degree in exercise science. I returned to the University of Illinois after receiving an offer for an assistantship that would combine several experiences: performing individual nutrition consultations (after I passed the RD exam) in the student health center, working within the nutrition department as a teaching assistant for a communication and sports nutrition course, and conducting a variety of programs and services through the student recreation center in a facility called SportWell. My duties within SportWell consisted of facilitating a weight management class, performing body composition measurements on students and faculty, presenting peer review sessions around cam- pus on body image and healthy eating, and working with athletes. The assistantship gave me an ideal opportunity to begin practicing as a dietitian under two incredible mentors, while also working on my master of science degree in a different academic area.

During my graduate work but outside my assistantship, I had one of the most valuable experiences of my education. I volunteered to be the dietitian for the 70 + Team who competed in the Race Across America (RAAM). I compiled the nutrition plans for all four riders and accompanied the men on their journey across the United States, preparing food, monitoring hydration status, and ensuring that they were fueled at all times. Although I was not paid, this position gave me another opportunity for hands-on, practical experience in sports nutrition.

During my last semester in graduate school, I attended the Sports, Cardiovascular, and Wellness Nutrition (SCAN) professional con- ference. While networking at the conference, I learned of a full-time dietitian position at the National Institute for Fitness and Sport (NIFS) in Indianapolis, Indiana. I applied, interviewed, and was hired within 2 weeks of the conference. My educational background and the practical, hands-on experience I had gained during my graduate assistantship and volunteer opportuni- ties made my résumé well balanced and my qualifications a perfect match for the job.

What paths has my career taken over the years?

For 15 years, I worked at NIFS as the Assistant Director of Educational Services. My roles and responsibilities included nutrition, fitness, and wellness programming. I presented wellness sem- inars to corporations, schools, churches, and other professional groups. I coordinated the team- building program, helping groups come together to work as a cohesive team. I supervised and

Sports, Cardiovascular, and well- ness Nutrition (SCAN) Dietetic practice group of nutrition profes- sionals with expertise and skills in promoting the role of nutrition in physical performance, cardiovascu- lar health, wellness, and disordered eating.

or other practical experience in a professional setting can lead to a permanent position. Several websites are also helpful in the search for a job in sports nutrition:

• www.eatright.org: Academy of Nutrition and Dietetics, CareerLink

• www.acsm.org: American College of Sports Medicine • www.jobsindietetics.com: Jobs in dietetics career

finder • www.hpcareer.net: Health promotion career finder • www.nsca.com: National Strength and Conditioning

Association • www.higheredjobs.com: Higher education career

finder

Sport nutrition is an ever-evolving pro- fession with grow- ing opportunities and excellent earn- ings potential.5 To gain insight into the responsibilities of a practicing sports dietitian, refer to the Fortifying Your Nutrition Knowl- edge feature about Heather Fink.

Food for Thought 16.3

Finding Sports Nutrition Jobs

Find and review two sports nutrition jobs posted online.

Food for Thought 16.4

You Are the Nutrition Coach

Apply the concepts from this chapter to several case studies.

(continues)

462 SECTION 2 The Practical Application of Sports Nutrition

coordinated the NIFS student internship program. I also facilitated a large-scale half-marathon training program that ran for 15 weeks every spring. Specific to the area of sports nutrition, I educated individuals and groups in a variety of ways. I conducted one-on-one nutrition consultations with athletes, ranging from the fitness enthusiast to the elite athlete. Most of my nutrition clients were triath- letes, duathletes, swimmers, and runners because I also trained and competed in these sports. I provided group presentations on sports nutrition and dietary supplements to athletes, parents, athletic trainers, and coaches at local high schools, universities, medical centers, and club teams. I wrote informational articles for publications such as the NIFS newsletter, the National Federation of State High School Association’s publications, as well as other local magazines/newsletters on a variety of sports nutrition topics. I was routinely interviewed regarding sports nutrition topics by local television stations and newspapers as well as national magazines and periodicals. During my time at NIFS, in addition to the valuable practical experience gained, I also advanced my career by obtaining the CSSD credential. This designation has enhanced my credibility, visibility, and marketability in the local community and nationwide.

In the fall of 2012, I decided to open my own private practice in the Indianapolis area. My business has focused on several practice areas: ■ Individual nutrition consulting. I work with athletes to help them optimize their daily nutrition as well as their game- or race-day

nutrition and hydration. I will also work with individuals who are interested in weight management, cholesterol lowering, diabe- tes management, and eating disorders. My referrals come from past clients, coaches, doctors, therapists, my website, and social media platforms.

■ Collegiate sports nutrition. I work with a local university’s athletic department several days per week. I am available to consult with individual athletes, provide team presentations, develop travel menus, create athlete educational materials, and serve as a resource for the entire athletic department.

■ Sports nutrition educational services. I work with various companies and club teams to provide sports nutrition education to their athletes. Services may include team presentations, individual consultations, writing projects, and event appearances.

■ Corporate wellness services. I have partnered with a few local doctors, wellness companies, and insurance providers to provide programming for corporations and public service entities. Contracts may include group presentations, health fair booths, writing projects, and individual consultations.

Running my own business has allowed me to focus on my areas of passion: sports nutrition and wellness. Being in private practice is exciting, challenging, and rewarding. It has given me the opportunity to learn more about business management and marketing. Each day is filled with new adventures!

What are my three key pieces of advice for individuals pursuing a career in sports nutrition?

I have three key pieces of advice for individuals who wish to pursue a career in sports nutrition: 1. Gain practical experience. Anyone interested in sports nutrition needs to seek out opportunities to put knowledge into practice. Volun-

teering, finding part-time jobs, writing articles, performing book reviews, helping conduct research, or taking advantage of any other means of getting hands-on experience will be vital to future success.

2. Keep current. Our knowledge of sports nutrition is always changing and expanding. Join professional organizations, read peer- reviewed journals, attend conferences, and take courses in sports nutrition to keep your knowledge up-to-date.

3. Be active in athletics. Athletes relate best to other athletes. If you are truly interested in sports nutrition, get involved in a sport and be active. A dietitian who not only talks the talk, but also walks the walk, will be highly respected and regarded in the athletic community.

(continued)

Chapter 16 Jobs in Sports Nutrition 463

The Box Score Key Points of Chapter

n Registered dietitians have to obtain a minimum of 1200 hours of supervised experience after obtaining a bachelor’s degree before they can take the registra- tion exam for dietitians.

n Non-nutrition-credentialed professionals should check licensure laws in their state to be sure they

are not providing nutrition services outside of the law. Much public domain information is available for all professionals to educate athletes in order to help them with performance nutrition.

Study Questions

1. What, if any, are the differences between a sports nutritionist and a dietitian?

2. In what job settings can registered dietitians be found? 3. What are the three required steps that must be com-

pleted in order to become a registered dietitian? 4. What academic coursework should students be pre-

pared to take when pursuing a BS degree in dietetics? 5. Discuss the various ways in which a registered dieti-

tian may obtain continuing education credits. 6. Discuss some of the various ways that students inter-

ested in sports nutrition can get field experience.

7. What are some of the daily roles and responsibilities of a registered dietitian involved in sports nutrition?

9. Explain the qualification requirements for the CSSD credential. Why is this credential important in the sports nutrition field?

References

3. Commission on Dietetic Registration. State Licen- sure. Available at: http://cdrnet.org/state-licensure. Accessed April 25, 2016.

4. Driskell JA, Wolinsky I. Nutritional Assessment of Ath- letes. Boca Raton, FL: CRC Press; 2002.

5. Rogers D. Dietetics trends as reflected in various pri- mary research projects, 1995–2011. J Acad Nutr Diet. 2012;112(suppl 1):64S–74S.

464 SECTION 2 The Practical Application of Sports Nutrition

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Chapter 1 Jennifer has several top priorities—the first consists of her athletic goals/objectives and the second relates to her cholesterol levels. As mentioned in this chapter, the stated athletic goals/objectives are often the main reason why an athlete seeks advice regarding nutrition. If these objectives are not addressed, the athlete will leave the appointment frustrated and disappointed, and may disregard other topics that were discussed (although they may be valid issues). Second, because high cholesterol levels put an individual at high risk for heart disease, it is important to discover how successful she has been at lowering her blood cholesterol lev- els to an appropriate and healthy range.

As Jennifer struggles with maintaining her weight, she may be cutting out nutrients her body needs to maintain energy levels and to recover quickly from exercise. A quick assessment of her overall calorie intake and a review of the types of foods she is consuming should help reveal whether she is missing out on valuable nutrients needed for health and exercise per- formance. To address her concerns regarding her constant hunger, she may need to eat more often or choose foods that provide satiation for longer periods of time. Often, when individuals start a weight loss plan, they decrease intakes of fat and protein. Both protein and fat provide satiety, and if they are decreased too drastically, hunger can result. She should be encouraged to include a variety of foods, balance the food choices within all of the food groups, and eat all foods in moderation. This pattern of eating will aid in weight maintenance, curb her hun- ger, provide adequate calories to sustain daily energy levels, and decrease her recovery time.

Chapter 2 Kay is making a bad decision. Although it is true that fats are a more energy-dense macronu- trient than proteins or carbohydrates, that does not mean that they are the fuel of choice for all activities. Intense sprint events lasting up to 3 minutes in length rely very heavily on the anaerobic energy system, with strong support from both the phosphagen and aerobic energy systems. As a result, Kay’s decision to switch to a high-fat, high-protein, low-carbohydrate diet is not an appropriate one for the following reasons:

• Fats cannot be metabolized for energy anaerobically. • If not closely monitored, high-fat diets can result in excess calories and increased body fat. • Proteins rarely are used for energy in short running events. • Proteins cannot be metabolized for energy anaerobically. • Excess protein intake can lead to increased body fat. • Carbohydrates are the only macronutrient that can be metabolized anaerobically.

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• Low-carbohydrate diets do not restore muscle carbo- hydrate stores between training sessions.

• Low-carbohydrate diets combined with training can significantly reduce or deplete muscle carbohydrate stores, which are the sole source of energy for anaero- bic metabolism. Kay should be advised to follow a well-balanced daily

diet consisting of adequate amounts of carbohydrates and moderate amounts of protein and fat.

Chapter 3 It appears that consuming a low-carbohydrate diet could be causing Meggan’s fatigue. In an attempt to lose weight, Meggan mistakenly lowered her total carbohydrate intake to a level below the minimum requirements for health and endurance performance. Instead, she should focus on slightly lowering her total calorie intake while maintain- ing the percentage of total calories from carbohydrates at 45–65%. Carbohydrates are the main fuel for her sport; therefore, if Meggan’s glycogen stores are low at the onset of a soccer session, she will fatigue quickly.

Second, as an alternative to a sports beverage, Meg- gan chose to drink juice during practice. Juices typically have a carbohydrate concentration of 10–14%, which is well above the recommended range of 6–8%. Highly con- centrated fluids consumed during exercise delay gastric emptying, thus affecting the absorption of fluids and carbohydrates into the bloodstream; they can also cause gastrointestinal cramping, diarrhea, and nausea. Meg- gan should experiment with various flavors and brands of sports drinks, supplying 6–8% carbohydrates, to dis- cover one that tastes appealing and digests well. Meggan’s endurance and performance will be positively affected by consuming an appropriate amount of fluids and carbo- hydrates during her soccer practices and competitions.

Chapter 4 Because of the extremely cold water temperature of the English Channel, it would behoove Shelley to gain a small amount of fat weight to protect and insulate her body dur- ing the swim. However, to prevent a decline in her mara- thon performance, Shelley should gain a small amount of weight gradually over the upcoming year. To gain weight, Shelley will need to consume more calories than she expends daily. To gain weight gradually and in a healthy way, she should increase her calorie intake by approx- imately 300 calories per day through the consumption of nutrient-dense foods. Shelley should be deterred from eating candy bars, chips, and sodas to obtain her extra calories. Calorie-dense and nutrient-dense foods that are rich in unsaturated fats such as nuts, seeds, olives, and avocados, as well as other low-fat foods such as fruit juices, thick breads, and low-fat milk/yogurt shakes are excellent choices.

As with all sports, a small amount of fat can be included in her preswim meal for flavor and satiety. Min- imal amounts of fat should be consumed during the chan- nel swim to prevent gastrointestinal distress; however, if practiced and tolerated during training, a small amount of fat can be consumed to prevent flavor fatigue from the sweet foods and beverages traditionally consumed while swimming. Fat should also be kept to a minimum after the swim to leave plenty of room in the postswim meal for carbohydrates and proteins.

Chapter 5 Based on what Jamar has revealed about his diet, it appears that he could be consuming excessive amounts of protein. To confirm this suspicion, a calculation of his daily protein needs and an estimation of his current pro- tein intake should be determined.

For athletes with the goal of gaining weight, 1.6 to 2.0 grams of protein per kilogram of body weight daily are rec- ommended. Jamar weighs 175 pounds, which is approxi- mately 80 kilograms; therefore, his protein requirements range from approximately 128–160 grams of protein per day. Based on his diet recall, Jamar is consuming approxi- mately 160 grams of protein just from his snacks and pro- tein supplements. When additionally accounting for his protein intake at breakfast, lunch, and dinner, the suspi- cion that he is overconsuming protein is confirmed.

It should be explained to Jamar that consuming pro- tein above daily requirements does not directly cause an increase in muscle mass; challenging the muscles through an appropriately planned training regimen cou- pled with consuming calories slightly above his daily needs from a balance of carbohydrates, proteins, and fats will ultimately lead to muscle mass gains. Jamar should also understand that protein not used by the body is con- verted to fat, which can be detrimental to his sport perfor- mance because increasing body fat can negatively affect his speed and quickness.

A meal plan should be developed for Jamar that pro- vides adequate calories to support his current training regimen plus additional calories for gradual weight gain. The plan should focus on whole food sources of protein versus supplements, because whole foods will provide a variety of nutrients for a lower cost than supplements.

Chapter 6 The first step is to determine Roger’s typical daily intake. Because his energy intake is below recommended levels for his high activity level, he needs to eat more to meet his energy requirements. Performing a quick diet history that includes questions about the frequency of fruit, veg- etable, and grain intake is beneficial to help determine why vitamins A and C and folate are low. Asking about

466 APPENDIX A

his daily routine, how he plans for meals and snacks, and if he carries food with him on campus will help establish his typical food intake and the best time during the day to add some nutrition breaks.

Roger should eat three to five meals and/or snacks daily. This will increase his energy intake, providing fuel for practices and adequate recovery nutrition. Because of his low intake of vitamins A and C and folate, Roger should strive for a minimum of five daily combined serv- ings of fruits and vegetables, which will supply vitamins A and C, as well as folate. At least three servings of low- fat dairy products should be included in Roger’s daily diet, especially milk, which is vitamin A–fortified.

The following tools will help Roger to implement the preceding recommendations:

• A shopping list to stock his apartment with a variety of foods including fresh, frozen, or canned fruits and vegetables

• Suggestions for including more dairy products in his meals and snacks, such as milk/yogurt smoothies and creamy soups made with milk

• Advice on how to choose wisely at the training table meals that are provided to him at dinner by the team

• A list of local eateries with examples of entrées and side options that include a variety of foods, as well as general information about dining out healthfully to help him plan balanced meals when the team plays on the road

Chapter 7 The magnesium content of the sports beverage she is using could have caused the nausea, intestinal cramp- ing, and diarrhea. In one 8-ounce serving of the beverage, the magnesium content, as well as the other macro- and micronutrients, are present in appropriate amounts. How- ever, considering that she consumed 100 ounces of the beverage during the bike portion of the race, she actu- ally drank 12.5 servings of the product within a couple of hours (100 oz ÷ 8 oz/serving = 12.5 servings). When multi- plying all of the nutrients present in the beverage by 12.5, it becomes apparent that the magnesium content exceeds the daily upper limit of magnesium (12.5 servings × 30 mg of magnesium = 375 mg consumed during the race; the UL for magnesium is 350 mg). All of the other nutrients remain within reasonable limits in the quantities she con- sumed during the race. Side effects of high doses of mag- nesium include nausea and diarrhea.

In the future, Anne should consider using a differ- ent sports beverage with lower quantities of magnesium. The most important factors to consider when evaluat- ing a sports beverage include the carbohydrate, sodium, and potassium content of the product. Other minerals included in the beverage formula should be in small amounts that will not exceed the daily upper limit when consumed in the quantities required to maintain proper hydration during long-duration activities.

Chapter 8 The athletes’ complaints of fatigue, lethargy, and light- headedness can stem from several things, including dehydration. The following suggestions would help the athletes make sure they are on the right track with their hydration protocol:

• Each athlete should perform a sweat test to ensure he is consuming enough fluid per hour during long practices.

• After determining their individual sweat rates, the athletes should bring their own water bottles to prac- tice, knowing the total volume of the bottle. In this manner the athletes can drink according to their sweat losses by measuring their intake by the num- ber of water bottles consumed during practice.

• The athletes should take full advantage of the fluid breaks during practices. Based on the number of breaks per hour, athletes can calculate how much fluid should be consumed at each break to match their sweat losses.

• Challenging the beliefs of the coach regarding water versus sports beverages is not an easy task, and must be approached with respect and tact. A few options for discussing this topic with the coach include asking the coach for a more thorough expla- nation of when he or she will and will not permit the consumption of sports beverages and why, inquir- ing about the athletic department’s guidelines or rules regarding the provision of sports beverages for athletes, and asking for the opportunity to provide a sports beverage on a short-term basis to deter- mine whether it will improve or hinder the team’s performance.

Chapter 9 Jason should first focus on taking time to plan and prepare a healthful breakfast and lunch as well as several snacks. Eating regularly throughout the day will enable him to comfortably consume the total calories, carbohydrates, protein, and fat required to help him gain muscle mass, strength, and power. Through thoughtful snacking, he can also optimize the timing of his protein intake. Snacking will enable him to take advantage of the increases in pro- tein assimilation that research has shown can be caused by protein intake prior to and after training.

Boron, ornithine, and arginine supplementation, as well as supplemental chromium picolinate, have not been shown to deliver on their claims as ergogenic aids for increasing muscle mass, strength, or power. Likewise, mega-dose vitamin and mineral supplements have not been shown to have an ergogenic effect. He would be better served to save some money by purchasing only a basic once-daily multivitamin/mineral tablet as a nutri- tion insurance policy.

You Are the Nutrition Coach—Answers 467

Protein supplementation may not be needed, depend- ing on his current protein intake. For athletes, protein intake of up to 2 g/kg of body weight has been shown to provide benefits above that provided by the RDA rec- ommendation. Protein consumption above 2 g/kg of body weight will provide little additional benefit and possibly increase fat mass, which is not desirable for an athlete wanting to increase speed. Jason should focus on foods first, and then include moderate amounts of protein supplements if indicated.

Chapter 10 It would be helpful if Jennifer brought a 3-day food record to the initial consultation. This information can be used to understand Jennifer’s usual dietary patterns and assess her basic nutrient intake. Jennifer should also be asked to complete a basic questionnaire that includes at least her demographic details, contact information, medical his- tory, current medications, and questions about dietary supplement use.

Assessing readiness to change can be determined by asking a few questions about past nutrition experiences and expectations of dietary changes needed to meet her current goals. Simply asking Jennifer, on a scale of 1 to 10, how likely she is to increase her calorie intake will help the dietitian determine Jennifer’s level of motivation and readiness to make the effort needed to change dietary habits. With some experience working with athletes, it becomes fairly clear which individuals are ready for change and which ones are not. An athlete who is engaged in the conversation, asks questions about how to make changes, and is able to detail how the recommended changes will be implemented is one who is ready for behavior changes. It is important to assess readiness for change and gear the education provided to Jennifer according to her level of readiness.

Follow-up appointments should be scheduled approximately every 2–4 weeks for the first 2 months. This will allow enough time for Jennifer to make dietary changes to increase caloric intake that will help facilitate weight gain. Follow-up appointments should include a weight check. Body composition assessments could be conducted once every 3–4 months as a way of monitor- ing progress toward increasing muscle mass. Jennifer should be encouraged to keep food records each week and bring them to each appointment. The dietitian can review these to determine any needed changes in food intake. Follow-up appointments can conclude when an appropriate weight is reached and maintenance of that weight has occurred for several weeks.

Chapter 11 Accurate measures of height, weight, and body composition are important first steps in assessing Ian’s weight. Of these measurements, body composition is the most important

because it provides information on Ian’s fat mass and lean mass. If Ian’s body composition falls within the healthy range for teenage gymnasts, he may be encouraged to maintain his current weight. If his level of body fat is above the recommended ranges, Ian could attempt weight loss.

Assuming that Ian may benefit from some weight loss, a healthful eating plan should be developed. Rest- ing metabolic rate and total energy expenditure should be calculated based on his body weight, level of activity, and duration and intensity of exercise. A low-fat, high- fiber eating plan that contains adequate carbohydrates and protein is recommended for any athlete perform- ing high-intensity exercise daily. Protein is essential for maintenance of muscle mass, and carbohydrates will help replenish glycogen stores needed for daily exercise. A low- fat diet is recommended because fat is more calorically dense than carbohydrates or protein, thus providing an easy way to cut calories from the daily diet. Sample meal plans should be provided to help Ian translate nutrition recommendations into actual food selections.

Because Ian participates in a sport that places athletes at higher risk for disordered eating, an additional concern is that Ian could develop disordered eating patterns. He reports he wants to lose weight to improve sport perfor- mance. However, if the weight loss diet is taken too far, he could potentially develop an obsession about food intake and body weight. Ian should be monitored for his food intake and his feelings about his body, weight loss program, and sport performance. The coach, parents, and sports nutrition professional working with Ian on his weight loss plan need to be aware of the warning signs of eating disor- ders with athletes and watch for these signs in Ian.

Chapter 12 To determine Adam’s daily calorie needs, use the energy estimation calculations presented in Table 12.1:

For a 14-year-old male, REE = (17.5 × BW) + 651 Adam’s REE = (17.5 × 63.6 kg) + 651 = 1764 × activity factor (1.6–2.4) Adam’s daily calorie needs = 2822–4234 calories per day

Adam does not need to increase his intake of ice cream, candy bars, and other “junk” foods to meet his calorie needs. It would be better for Adam’s health and swimming performance to consume calorie- and nutri- ent-dense foods. Desserts and snack foods will certainly add calories, but very little nutrition.

Suggestions for calorie- and nutrient-dense foods from each food group include:

• Grains: Thick-cut, dense breads; hot whole grain cere- als; granolas

• Fruits: Dried fruits, juices • Vegetables: Avocados, olives, and starchy vegetables,

such as potatoes, corn, peas, and squash

468 APPENDIX A

• Milk/alternatives: Fruited yogurts, cottage cheese, instant breakfast mixes added to low-fat milk

• Meat and beans/alternatives: Mixed nuts, seeds, nut butters Adam was losing about 1 pound per week, which

means his intake was deficient by approximately 500 calories per day. The first step is to determine how many calories Adam is currently eating. After establishing a baseline, compare his current intake to the recommenda- tions calculated above (2822–4234 calories per day). Adam should strive to consume 500 extra calories a day from his baseline, aiming for a total intake within the calculated recommendations, to keep his weight stable.

Chapter 13 Robert is having trouble controlling his body weight because he is consuming more calories than he is expending. His information indicates that he has a sedentary office job, and his weight training and mile walks do not burn that many calories. Using Table 13.1 to estimate his total daily calories and using a low activity factor (i.e., 1.6 or 1.7), his total daily calories should be closer to the 2950 to 3150 range.

The most glaring concerns about his diet are its high- protein (i.e., 250 grams per day), high-fat, and low-carbohy- drate content. His protein consumption is the equivalent of 3 grams per kilogram of body weight (250 grams / 82 kilograms = 3 grams/kilograms). This is well above the rec- ommended 1.2 to 2.0 grams per kilogram of body weight for athletes. It is important to note that excess protein converts to fat in the body, and this could certainly be contributing to his body fat changes. Given that his caloric intake from protein is 1000 calories (250 grams × 4 kilo- calories per gram = 1000 calories), or about 30% of his total calories, carbohydrate consumption is low; thus the fat composition of his diet is approximately 40%. Forty percent is higher than the recommended fat intake of 30–35% or less of total calories. Finally, low-carbohydrate intake is detrimental to strength/power athletes. Strength and power athletes rely on the phosphagen and anaero- bic energy systems during training and competition. It is important for athletes to understand that carbohydrates are the only energy nutrient that can be metabolized anaerobically. As a result, carbohydrates should predom- inate fats and proteins in Robert’s diet, not the reverse.

Chapter 14 Many factors could be at play with Tomas’s fatigue in the game. He is a busy college student trying to make great grades to get accepted into medical school. He is on a nationally ranked hockey team and has added the pres- sure of maintaining a high caliber of competitiveness.

Some questions that should be asked of Tomas to determine whether his nutrition is a factor in his fatigue include:

• Have you changed your diet recently? Are you follow- ing any particular diet?

• Have you lost or gained weight recently? • How many times per day do you eat? • What is an example of 1 day’s worth of meals and

snacks? • How much fluid on average do you consume daily?

Has this amount changed recently? To determine Tomas’s calorie needs, use the energy

calculations listed in Table 14.1:

Tomas is 20 years old and weighs 185 lbs (185 lbs = 84 kg) REE = (15.3 × BW) + 679 Tomas’s REE = (15.3 × 84 kg) + 679 = 1964 = activity factor (1.6–2.4) Tomas’s daily calorie needs = 3142–4714

The answers to the preceding questions will help determine whether Tomas is meeting his daily calorie needs. If he has changed his diet recently, the nutrition coach must determine whether the amount of calories and/or types of nutrients have decreased. The 1-day dietary recall, along with interview questions to deter- mine specific types of foods consumed, will provide this information. His fatigue could simply be related to nega- tive energy balance. He may not be eating meals at regu- lar times, could be skipping meals to study, or might not be preparing enough food to eat at his meals and snacks. Adequate fluid intake can be determined from an inquiry of his daily fluid choices as well as from the dietary recall. Many athletes can become severely fatigued if they are not meeting fluid requirements. Once the answers to these questions are compared to Tomas’s daily energy and fluid needs for his sport, the nutrition coach can help him modify his diet to prevent future fatigue.

Chapter 15 Ryan may be obtaining adequate levels of all nutrients if he is consuming a varied diet supplying sufficient daily calories. Because he is not well versed in planning and preparing vegetarian meals, he needs to ensure the inclu- sion of protein, calcium, and iron-rich foods. Protein can easily be consumed in adequate amounts without the consumption of animal products; however, it does take some planning. At least two servings of yogurt and cal- cium-fortified soy milk will help him meet both protein and calcium needs. Two to three servings from nonmeat protein sources such as dried beans, peas, lentils, veggie burgers, tofu, and other soy products will also contribute to his protein intake. Good sources of iron-rich nonmeat foods include fortified cereals and breads, spinach, broc- coli, legumes, and some dried fruits.

The nutrition professional should ask several ques- tions about Ryan’s intake to help understand his regular eating patterns. A 24-hour recall or dietary assessment will provide information about his current intake and where he may be deficient in nutrients or energy. Asking

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how often he grocery shops, what he purchases, and inquiring about his food preparation knowledge is impor- tant for the development of an example grocery list and/ or meal plan.

Education on how to improve nutrition intake can be provided to Ryan based on current dietary intake and the information he gives about his shopping and cook- ing abilities. It is helpful to provide a grocery list of staple items to purchase that are high in protein, calcium, and iron as well as nutrient dense. Suggestions for quick, easy vegetarian meals and cooking techniques will encourage Ryan to eat a greater variety of whole foods.

Chapter 16 Caroline has completed her undergraduate degree in dietetics, which provides assurance that she has a good balance of knowledge in a variety of nutrition therapy and education areas. As soon as she completes her internship she is eligible to take the Registered Dietitian exam. In most cases, the university sports dietitian job will require the RD credential and they will look for a dietitian with an advanced degree. Because Caroline will be finished with her master’s degree in nutrition at the same time as her internship, she is likely to meet the minimum education requirements for the job. She may, however, lack experi- ence when compared to other potential candidates. She did gain experience in the 2-week sports medicine rota- tion, but other dietitians applying for the job may have much more experience.

One thing that potentially sets Caroline apart from the other candidates is her research thesis related to body composition and physical activity. This shows that she has worked for the better part of 2 years on a research project that looks at two major parts of athletics—body composition and strength training. She can use this thesis as a topic of discussion in her application and cover letter and in an interview for the sports dietitian job. It is quite likely that her competitors for the position will not have this type of research experience.

If she is not offered the university sports dietitian job immediately following her internship, Caroline can do several things to help her compete for the next similar job opening. She should try to find a job where she will be able to work with athletes in some capacity on a regular basis. This could happen in a hospital dietitian position that has a rehabilitation or sports medicine clinic. She might even go back to the sports medicine clinic where she did her 2-week rotation and ask if they need a part- time RD to perform sports nutrition consulting. She needs to get the practical hours working with athletes and active people so that she will be eligible to obtain the board cer- tification as a Specialist in Sports Dietetics (CSSD) creden- tial. Completing the 1500 hours necessary in consultation with athletes and maintaining the RD credential for a minimum of 2 years will allow Caroline to take the CSSD exam. Once certified, she will have excellent credibility and the credential to show potential employers that she is knowledgeable and experienced in providing nutrition education and therapy to athletes.

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Mouth In the mouth, food is broken up by chewing with the teeth and tongue. Saliva lubricates food and makes swallowing easier. Salivary amylase begins the digestion of starch. The mouth warms or cools the food so that it is closer to body temperature. When the food bolus (a fairly liquid ball of food) is ready, swallowing is consciously initiated.

Tongue The tongue is a mobile mass of muscle that helps teeth tear food into pieces by forcing it against the bony palate. The tongue contains receptors for sweet, salty, sour, and bitter tastes. Umami, a fifth taste elicited by monosodium glutamate, is a meaty, savory sensation. Flavor is a complex combination of taste, smells (the nose has about 6 million olfactory receptor cells), physical sensations (e.g., spicy foods), and food texture.

Salivary glands The three pairs of salivary glands produce saliva. The water in saliva helps dissolve food particles, facilitating taste sensations. The mucus in saliva lubricates food for swallowing and transport. Digestive enzymes in saliva begin breaking down foodstuffs. Salivary amylase begins the chemical breakdown of starches into simple sugars. Lingual lipase initiates the breakdown of fat. The mineral sodium and the enzyme lysozyme in the saliva act as disin- fectants, destroying bacteria and other microorganisms in food.

Epiglottis The epiglottis is a flap of tissue that acts as a valve during swallowing. It closes the entrance to the larynx and prevents food from entering the respiratory passages.

Trachea This tube allows air to pass to and from the lungs.

Esophagus The esophagus is the tube that connects the mouth to the stomach. Wavelike muscle action (peristalsis) moves food through the esophagus to the stomach. The upper one-third of the muscles of the esophagus are under voluntary control, the middle third are a mixture of vol- untarily controlled muscle and automatically controlled smooth muscle, while the lower third is smooth muscle alone.

The Gastrointestinal Tract

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Inferior esophageal sphincter The inferior esophageal sphincter is a muscular valve at the lower end of the esophagus. This control valve relaxes to allow food to pass into the stomach. When contracted,

it prevents backflow (reflux) of stomach contents into the esophagus. A malfunction can cause painful esophageal reflux (heartburn), which can be so severe that it is mis- taken for a heart attack.

Salivary glands

Tongue

Mouth

Esophagus

Inferior esophageal sphincter

Epiglottis

Trachea (to lungs)

Stomach

Pancreas

Pancreatic duct

Small intestine (duodenum, jejunum, ileum)

Gallbladder

Diaphragm

Liver

Pyloric sphincter

Bile duct

Ileocecal valve

Cecum

Appendix

Large intestine (colon)

Rectum

Anus

472 APPENDIX B

Stomach The upper baglike portion of the stomach acts as a hop- per to receive and hold the food prior to delivery to the lower two-thirds. Three layers of smooth muscle surround this lower portion of the stomach. Muscular contractions churn the food, so the solids can ferment and mix with acids, fluid, and protein-splitting enzymes. The result is a sticky semi-liquid, called chyme, that is gradually released into the duodenum (the first part of the small intestine). Stomach acid halts the digestion of starch, but the stomach also produces gastric lipase, an enzyme that begins the digestion of fat.

Pyloric sphincter The pyloric sphincter is a muscular valve that controls passage of chyme from the stomach to the small intes- tine. When contracted, it prevents backflow from the small intestine into the stomach.

Liver The liver is the body's chemical factory and detoxification center. It has many functions in controlling metabolism and deactivating hormones, drugs, and toxins. It also pro- duces bile—a mixture of bile salts, phospholipids, cho- lesterol, pigments, proteins, and inorganic ions such as sodium. The detergent-like action of bile emulsifies fat, facilitating fat digestion.

Gallbladder The gallbladder stores and concentrates bile. The arrival of fatty food in the duodenum stimulates the release of the duodenal hormone CCK, which signals the gallbladder to contract. The bile is then released into the duodenum, where it aids fat digestion.

Bile duct The bile duct carries bile from the gallbladder to the duodenum.

Pancreas The pancreas is a complex gland that produces a pan- creatic juice rich in bicarbonate and enzymes. The pan- creatic juice is released into the duodenum, where it does its work. Pancreatic amylase breaks down starch into maltose. Lipase splits fats into monoglycerides, fatty acids, and glycerol. The pancreatic proenzyme trypsino- gen is converted to the enzyme trypsin. Trypsin splits polypeptides and proteins into amino acids. Bicarbon- ate produced by the pancreas neutralizes the acid chyme that enters the small intestine. In addition, the pancreas produces insulin and glucagon—hormones that have important roles in regulating carbohydrate metabolism and blood glucose.

Pancreatic duct The pancreatic duct carries pancreatic juice from the pan- creas to the duodenum.

Small intestine The small intestine is a tube approximately 10 feet long that is divided into three parts: the duodenum (the first 10 to 12 inches), the jejunum (about 4 feet), and the ileum (about 5 feet). Whereas the duodenum is mainly respon- sible for breaking down food, the jejunum and ileum pri- marily deal with the absorption of food. The duodenum secretes mucus, enzymes, and hormones to aid digestion. Most digestion and absorption occur in the small intestine. Intestinal cells secrete disaccharidases and peptidases to help complete carbohydrate and protein digestion. The intestinal lining is highly folded to increase its surface area and is richly supplied with circulatory vessels that carry absorbed nutrients away in the blood and lymph. Undi- gested material is passed on to the large intestine.

Ileocecal valve (sphincter) The ileocecal valve is the sphincter at the lower end of the small intestine. When open, it permits food residue to move from the small intestine to the large intestine. When closed, it prevents backflow from the large intestine.

Large intestine The large intestine is made up of the appendix, cecum, colon, rectum, and anus. The colon is about 2.5 inches in diameter and about 4 feet long. In the large intestine, bacteria break down dietary fiber and other undigested carbohydrates, releasing acids and gas. The large intes- tine absorbs water and minerals while dehydrating and processing the remaining undigested material into solid feces. The colon walls secrete a viscous mucus to help lubricate and mold the feces. This mucus also helps pro- tect the colon wall from mechanical damage.

Appendix The appendix is a fingerlike appendage attached to the cecum, the first part of the colon. The appendix has no known function.

Cecum The cecum is the pouch-like beginning of the large intes- tine. The small intestine's ileum empties into the cecum.

Rectum The rectum stores waste prior to elimination.

Anus The anal sphincter holds the rectum closed. Either vol- untary or involuntary control may open it to allow elimination.

The Gastrointestinal Tract 473

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• Glycolysis • Beta-Oxidation Pathway • Citric Acid Cycle • Electron Transport Chain • Urea Cycle

Major Metabolic Pathways

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APPENDIX C

Glycolysis Glycolysis is the first step in metabolizing glucose and other monosaccharides for energy. Unlike the reaction that converts blood glucose to glucose 6-phosphate, the reaction that converts glucose from glycogen to glucose 6-phosphate does not require ATP. Thus the glycolysis of glucose from glycogen directly yields 3 ATP as com- pared to the 2 ATP from blood glucose. Additional ATP is produced from glycolytic NADH in the electron trans- port chain.

The reactions that convert fructose to fructose 6-phosphate require ATP, so fructose produces the same amount of ATP as blood glucose. The same is true for galactose, which enters at glucose 6-phosphate.

O C CH

H H H OH

OH OH

OH HO C

C C C H

O C CH

H H H O P

OH OH

OH HO C

C C C H

H C C

H H H O P

OH OH

O HO C

C C C H

H C C

H H H O P

OH OH

O HO C

C C C H

O P

H H O P

OH C C C H

H H O P

P OH

C C C H

H H O P

OH C C C H

H2O

O–

H H OH

PO C C C H

O–

H PO

C C C H

O–

O COO–

C CH3

P O

CH C C H

Pyruvate (two)

ADP

ATP

ADP

ATP

ADP

ATP

Glucose

Glucose 6–phosphate

Fructose 6–phosphate

Fructose 1,6–biphosphate

Hexokinase or

Glucokinase

Phosphoglucose isomerase

Phosphofructo- kinase

Aldolase

Triose phosphate isomerase

Glyceraldehyde 3–phosphate

dehydrogenase

Phosphoglycerate kinase

Phosphoglycerate mutase

Enolase

Pyruvate kinase

Dihydroxyacetone phosphate

Glyceraldehyde– 3–phosphate (two)

1,3–Biphosphoglycerate (two)

3–Phosphoglycerate (two)

2–Phosphoglycerate (two)

Phosphoenolpyruvate (two)

NADH + H+

NAD+ Pi

ADP

ATP

Major Metabolic Pathways 475

Beta-Oxidation Pathway Beta-oxidation reactions repeatedly clip the two-carbon end off a fatty acid until it is degraded entirely. Beta-oxi- dation of 18-carbon stearic acid produces 9 acetyl CoA, 8 FADH2, and 8 NADH.

The final two-carbon link becomes part of acetyl CoA without a transfer of electrons

The chain is clipped another seven times, making acetyl CoA while transferring electrons

The two-carbon link becomes part of acetyl CoA as electrons are transferred to shuttle molecules

Enzymes clip a two-carbon link from the end of the chain

Electron transport chain

Beta-oxidationCitric acid cycle

Acetyl CoA

CoA

CoA +++

H O

bH H

+ H+

+ 7H++ 7+ 77

e–e–

NADH

NAD+FAD

Carnitine

BETA-OXIDATION

Repeated beta-oxidation cycles

Activated Stearic Acid (an 18-carbon fatty acid)

e–e– FADH2

e–e–

NADH

e–e– FADH2

CoA

CoAH a

bH H

CoA

476 APPENDIX C

Citric Acid Cycle

COO–

CH2

COO–

Succinate

NADH + H+

H3C H2O +

Acetyl CoA

FAD

COO–

CH2

Citrate

COO–

CH2

CHO

IsocitrateIsocitrate dehydro- genase

COO–

CH2

cis–Aconitate

Aconitase

Citric acid cycle

NAD+

NADH + H+

FADH2

NAD+

CO2CO2

NAD+

CO2

NADH + H+

H2O

Succinyl CoA

Succinyl CoA synthetase

Succinate dehydrogenase

Malate dehydrogenase

Fumarase

CH2

COO–

S CoA

COO–

CH2

α–Ketoglutarate

α–Ketoglutarate dehydrogenase complex

Oxaloacetate

Citrate synthase

COO–

CH2

COO–

Malate

HHO

COO–

CH2

COO–

Fumarate

ATP

ADP + Pi

GTP

GDP + Pi

Major Metabolic Pathways 477

Electron Transport Chain

(Site of oxidative phosphorylation) 1. NADH: A pair of electrons from NADH enters the

chain at complex I (NADH-Q reductase). The flow of electrons from NADH to ubiquinone leads to the pumping of 4 H+ from the matrix to the intermem- brane space. The flow of electrons from ubiquinone to cytochrome c through complex III (cytochrome reduc- tase) pumps another 2 H+ into the intermembrane space. As complex IV (cytochrome oxidase) catalyzes the transfer of electrons from cytochrome c to O2, it pumps another 4 H+. (Complex IV actually uses 4 elec- trons to produce 2 H2O from a single O2.) The tran- sit of the NADH electron pair through the electron transport chain pumps a total of 10 H+ into the inter- membrane space. Each 3 H+ returning to the matrix through the ATP synthase produces 1 ATP. Another H+ is consumed in transporting ATP from the matrix to the cytosol. Thus the two electrons from NADH pro- duce about 2.5 ATP (10 pumped / 4 = 2.5).

2. FADH2: A pair of electrons from FADH2 enter the chain at complex II (succinate-Q), which is the nonpump- ing complex. The flow of electrons from FADH2 to

ubiquinone does not pump any protons to the inter- membrane space. The flow of electrons through com- plexes III and IV is the same as for NADH. Thus the transit of the two FADH2 electrons through the elec- tron transport chain pumps a total of 6 H+ into the intermembrane space and produces about 1.5 ATP (6 / 4 = 1.5).

3. Cytosolic NADH: Glycolysis forms NADH in the cyto- sol, but the outer mitochondrial membrane is imper- vious to NADH. How can NADH deliver its electrons to the electron transport chain? NADH transfers its pair of electrons to special carriers that can cross the mitochondrial membrane. One carrier, glycerol 3-phosphate, shuttles the electrons to the matrix and delivers them to FAD, thereby forming FADH2. This FADH2 delivers the electrons to the chain where they form 1.5 ATP. In the heart and liver, malate shuttles the electrons

from cytosolic NADH to the matrix. Malate crosses the mitochondrial membrane and delivers the electrons to NAD+, thereby forming NADH inside the mitochondrion. This NADH delivers the electron pair to the chain where they form 2.5 ATP.

Depending on the carrier, cytosolic NADH may pro- duce 1.5 or 2.5 ATP.

Mitochondrial matrix

Complex I Complex II Complex III Complex IV

Complexes I, III, and IV are proton (H+) pumps. Complex II does not pump protons. The three proton pumps are linked by the mobile electron carriers ubiquinone and cytochrome c.

NADH–Q reductase Succinate–Q reductase Cytochrome reductase Cytochrome oxidase

Cytosol

e–

ADP + Pi

ATP synthase

1 ATP

ATP

Inner mitochondrial membrane

Intermembrane space

Outer mitochondrial membrane

NADH + H+

NAD+

H2O 1/2O2

FAD

FADH2 + H+

e–

Ubiquinone

Mobile electron carriers

Cytochrome c

4H+ 2H+

4H+

4H+2H+ 3H+ H+

3H+

1 2

Complex II

Complex I

Complex IV

Complex III

478 APPENDIX C

Urea Cycle Some NH4+ from the breakdown of amino acids is used for biosynthesis of nitrogen compounds. Excess NH4+ is converted to urea and excreted.

CO2

CH2NH3+

CH2 CH2 CH NH3+

H2N C

O O

O– P O–

COO–

L–Ornithine

CO2 + NH4+

NH4+

2Mg–ATP

2Mg–ADP + Pi

N–Acetyl– glutamate

Carbamoyl phosphate synthase I

Ornithine transcarbamoylase

Argininosuccinic acid synthase

L–Aspartate

L–Citrulline

Arginase

Urea cycle

Argininosuccinase Carbamoyl phosphate Pi

CUrea O NH2

NH3+

NH3+H

L–Arginine

Fumarate

Argininosuccinate

NHCH2 CH2 CH2 C COO–

COO–

–OOC CH

NH2 H2O

NH3+

NH CH CH2CH2

CH2 CH2 CH

Mg–ATP AMP + Mg–PPi

COO–

COO– CH2

C HH2N

NH2

NHCH2 CH2 CH2

NH3+CH

C O

NH4+ from the breakdown of amino acids

Major Metabolic Pathways 479

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Energy from food

Total energy intake = sum of energy from macronutrients grams carbohydrate × 4 kcal/g grams protein × 4 kcal/g grams fat × 9 kcal/g grams alcohol × 7 kcal/g

Example Carbohydrate 275 g × 4 kcal/g = 1100 kcal Protein 64 g × 4 kcal/g = 256 kcal Fat 60 g × 9 kcal/g = 540 kcal Alcohol 15 g × 7 kcal/g = 105 kcal Total Energy 2001 kcal

Calculating the percentage of calories for each Carbohydrate (1100 kcal/2001 kcal) × 100 = 54.97% (55%) Protein (256 kcal/2001 kcal) × 100 = 12.79% (13%) Fat (540 kcal/2001 kcal) × 100 = 26.99% (27%) Alcohol (105 kcal/2001 kcal) × 100 = 5.25% (5%) 1 kilocalorie = 4.184 kilojoules 1 kilojoule = 0.239 kilocalories

Body mass index (BMI)

U.S. formula BMI = [weight in pounds / (height in inches)2] × 703

Example A 154-pound man is 5'8" (68 inches) tall

BMI = [154/(68 in × 68 in)] × 703 BMI = (154 / 4624) × 703 BMI = 23.41

Calculations and Conversions

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APPENDIX D

Metric formula BMI = weight in kilograms / [height in meters]2 or BMI = [weight in kilograms / (height in cm)2] × 10,000

Example A 70-kg man is 1.75 meters tall

BMI = 70 kg / (1.75 m × 1.75 m) BMI = 70 / 3.0625 BMI = 22.86

Metric prefixes giga- G 1,000,000,000

mega- M 1,000,000

kilo- k 1000

hector- h 100

deka- da 10

deci- d 0.1

centi- c 0.01

milli- m 0.001

micro- μ 0.000001

nano- n 0.000000001

Length: metric and U.S. equivalents 1 centimeter 0.3937 inch

1 decimeter 3.937 inches

1 foot 0.3048 meter

1 inch 2.54 centimeters

1 meter 39.37 inches

1.094 yards

1 micron 0.001 millimeter

0.00003937 inch

1 millimeter 0.03937 inch

1 yard 0.9144 meter

Food measurement conversions: U.S. to metric

Capacity 1/5 teaspoon 1 milliliter

1 teaspoon 5 milliliters

1 tablespoon 15 milliliters

1 fluid ounce 30 millileters

1/5 cup 47 milliliters

1 cup 240 milliliters

2 cups (1 pint) 473 milliliters

4 cups (1 quart) 0.95 liter

4 quarts 3.8 liters

Weight 1 ounce 28 grams 1 pound 454 grams

Food measurement conversions: metric to U.S.

Capacity 1 milliliter 1/5 teaspoon

5 milliliters 1 teaspoon

15 milliliters 1 tablespoon

100 milliliters 3.4 fluid ounces

240 milliliters 1 cup

1 liter 34 fluid ounces

4.2 cups

2.1 pints

1.06 quarts

0.26 gallon

Weight 1 gram 0.035 ounce

100 grams 3.5 ounces

500 grams 1.10 pounds

1 kilogram 2.205 pounds

35 ounces

Calculations and Conversions 481

Conversion factors To change To Multiply by centimeters inches 0.3937

centimeters feet 0.03281

cubic feet cubic meters 0.0283

cubic meters cubic feet 35.3145

cubic meters cubic yards 1.3079

cubic yards cubic meters 0.7646

feet meters 0.3048

gallons (U.S.) liters 3.7853

grams ounces (avdp) 0.0353

grams pounds 0.002205

inches millimeters 25.4000

inches centimeters 2.5400

inches meters 0.0254

kilograms pounds 2.2046

liters gallons (U.S.) 0.2642

liters pints (dry) 1.8162

liters pints (liquid) 2.1134

liters quarts (dry) 0.9081

liters quarts (liquid) 1.0567

meters feet 3.2808

meters yards 1.0936

millimeters inches 0.0394

ounces (avdp) grams 28.3495

ounces pounds 0.0625

pints (dry) liters 0.5506

pints (liquid) liters 0.4732

pounds kilograms 0.4536

pounds ounces 16

quarts (dry) liters 1.1012

quarts (liquid) liters 0.94

482 APPENDIX D

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A complete set of growth charts is available at www.cdc.gov/growthcharts. There are three sets, each with a different set of percentiles. Each set includes the following charts for girls and boys:

• Weight-for-age percentiles: birth to 36 months • Length-for-age percentiles: birth to 36 months • Weight-for-length percentiles: birth to 36 months • Head circumference-for-age percentiles: birth to 36 months • Weight-for-age percentiles: 2 to 20 years • Stature-for-age percentiles: 2 to 20 years • Weight-for-stature percentiles • Body mass index-for-age percentiles: 2 to 20 years

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APPENDIX E

Growth and Body Mass Index Charts

484 APPENDIX E

Growth and Body Mass Index Charts 485

486 APPENDIX E

Growth and Body Mass Index Charts 487

The Food and Nutrition Board of the National Academy of Sciences determines recommended nutrient intakes that apply to healthy individuals. Beginning in 1997, the Food and Nutrition Board (with the involvement of Health Canada) began releasing updated recommendations under a new framework called the Dietary Reference Intakes (DRIs). In these revisions, tar- get intake levels for healthy individuals in the U.S. and Canada are listed as either Adequate Intake (AI) levels or Recommended Dietary Allowances (RDAs). Also, the DRI values include a set of Tolerable Upper Intake Levels (ULs), which are levels of nutrient intake that should not be exceeded due to the potential for adverse effects from excessive consumption.

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APPENDIX F

Dietary Reference Intakes

Dietary Reference Intakes 489 Dietary Reference Intakes 489

Life stage

group

Infants

0-6 mo 400* 400* 4* 2.0* 0.2* 0.3* 2 * 1.7* 5* 0.1* 65* 0.4* 40* 125* 0.12* 6-12 mo 500* 400* 5* 2.5* 0.3* 0.4* 4 * 1.8* 6* 0.3* 80* 0.5* 50* 150* 0.37*

Children

1-3 y 300 600 6 30* 0.5 0.5 6 2* 8* 0.5 150 0.9 15 200* 1.0* 4-8 y 400 600 7 55* 0.6 0.6 8 3* 12* 0.6 200 1.2 25 250* 1.2*

Males

9-13 y 600 600 11 60* 0.9 0.9 12 4* 20* 1.0 300 1.8 45 375* 1.5* 14-18 y 900 600 15 75* 1.2 1.3 16 5* 25* 1.3 400 2.4 75 550* 1.5* 19-30 y 900 600 15 120* 1.2 1.3 16 5* 30* 1.3 400 2.4 90 550* 1.5* 31-50 y 900 600 15 120* 1.2 1.3 16 5* 30* 1.3 400 2.4 90 550* 1.5* 51-70 y 900 600 15 120* 1.2 1.3 16 5* 30* 1.7 400 2.4 7 90 550* 1.3* >70 y 900 800 15 120* 1.2 1.3 16 5* 30* 1.7 400 2.4 7 90 550* 1.2*

Females

9-13 y 600 600 11 60* 0.9 0.9 12 4* 20* 1.0 300 1.8 45 375* 1.5* 14-18 y 700 600 15 75* 1.0 1.0 14 5* 25* 1.2 400 6 2.4 65 400* 1.5* 19-30 y 700 600 15 90* 1.1 1.1 14 5* 30* 1.3 400 6 2.4 75 425* 1.5* 31-50 y 700 600 15 90* 1.1 1.1 14 5* 30* 1.3 400 6 2.4 75 425* 1.5* 51-70 y 700 600 15 90* 1.1 1.1 14 5* 30* 1.5 400 2.4 7 75 425* 1.3* >70 y 700 800 15 90* 1.1 1.1 14 5* 30* 1.5 400 2.4 7 75 425* 1.2*

Pregnancy

≤18 y 750 600 15 75* 1.4 1.4 18 6* 30* 1.9 600 2.6 80 450* 1.5* 19-30 y 770 600 15 90* 1.4 1.4 18 6* 30* 1.9 600 2.6 85 450* 1.5* 31-50 y 770 600 15 90* 1.4 1.4 18 6* 30* 1.9 600 2.6 85 450* 1.5*

Lactation

≤18 y 1,200 600 19 75* 1.4 1.6 17 7* 35* 2.0 500 2.8 115 550* 1.5* 19-30 y 1,300 600 19 90* 1.4 1.6 17 7* 35* 2.0 500 2.8 120 550* 1.5* 31-50 y 1,300 600 19 90* 1.4 1.6 17 7* 35* 2.0 500 2.8 120 550* 1.5*

This table presents Recommended Dietary Allowances (RDAs) and Adequate Intakes (AIs). An asterisk (*) indicates AI. RDAs and AIs may both be used as goals for individual intake. 1 As retinol activity equivalents (RAE). 2 As cholecalciferol. 3 As a-tocopherol. 4 As niacin equivalents (NE). 5 As dietary folate equivalents (DFE). 6 In view of evidence linking folate intake with neural-tube defects in the fetus, it is recommended that all women capable

of becoming pregnant consume 400 mg of folic acid from supplements or fortified foods in addition to intake of food folate from a varied diet.

7 Because 10 to 30% of older people may malabsorb food-bound vitamin B12, it is advisable for those older than 50 years to meet their RDA mainly by consuming foods fortified with vitamin B12 or a supplement containing vitamin B12.

8 The AI for water represents total water from drinking water, beverages, and moisture from food.

Sources: Data compiled from Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride. Washington, DC: National Academies Press; 1997. Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline. Washington, DC: National Academies Press; 1998. Dietary Reference Intakes for Vitamin C, Vitamin E, Selenium, and Carotenoids. Washington, DC: National Academies Press; 2000. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academies Press; 2000. Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate. Food and Nutrition Board. Washington, DC: National Academies Press; 2005. Dietary Reference Intakes for Calcium and Vitamin D. Washington, DC: National Academies Press; 2011. These reports may be accessed via http://nap.edu.

Vitamin A (µg/d)1

Vitamin E (mg/d)3

Vitamin D (IU/d)2

Vitamin K (µg/d)

Dietary Reference Intakes (DRIs)

Thiamin (mg/d)

Riboflavin (mg/d)

Niacin (mg/d)4

Biotin (µg/d)

Sodium (g/d)

Choline (mg/d)

Folate (µg/d)5

Vitamin B6 (mg/d)

Vitamin C (mg/d)

Vitamin B12 (µg/d)

Pantothenic Acid (mg/d)

Life stage

group

Infants

0-6 mo 0.4* 0.18* 200* 100* 30* 0.27* 2* 15* 110* 200* 0.003* 0.01* 0.2* 2* 0.7* 6-12 mo 0.7* 0.57* 260* 275* 75* 11 3* 20* 130* 220* 0.6* 0.5* 5.5* 3* 0.8*

Children

1-3 y 3.0* 1.5* 700 460 80 7 3 20 90 340 1.2* 0.7* 11* 17 1.3* 4-8 y 3.8* 1.9* 1,000 500 130 10 5 30 90 440 1.5* 1* 15* 22 1.7*

Males

9-13 y 4.5* 2.3* 1,300 1,250 240 8 8 40 120 700 1.9* 2* 25* 34 2.4* 14-18 y 4.7* 2.3* 1,300 1,250 410 11 11 55 150 890 2.2* 3* 35* 43 3.3* 19-30 y 4.7* 2.3* 1,000 700 400 8 11 55 150 900 2.3* 4* 35* 45 3.7* 31-50 y 4.7* 2.3* 1,000 700 420 8 11 55 150 900 2.3* 4* 35* 45 3.7* 51-70 y 4.7* 2.0* 1,000 700 420 8 11 55 150 900 2.3* 4* 30* 45 3.7* >70 y 4.7* 1.8* 1,200 700 420 8 11 55 150 900 2.3* 4* 30* 45 3.7*

Females

9-13 y 4.5* 2.3* 1,300 1,250 240 8 8 40 120 700 1.6* 2* 21* 34 2.1* 14-18 y 4.7* 2.3* 1,300 1,250 360 15 9 55 150 890 1.6* 3* 24* 43 2.3* 19-30 y 4.7* 2.3* 1,000 700 310 18 8 55 150 900 1.8* 3* 25* 45 2.7* 31-50 y 4.7* 2.3* 1,000 700 320 18 8 55 150 900 1.8* 3* 25* 45 2.7* 51-70 y 4.7* 2.0* 1,200 700 320 8 8 55 150 900 1.8* 3* 20* 45 2.7* >70 y 4.7* 1.8* 1,200 700 320 8 8 55 150 900 1.8* 3* 20* 45 2.7*

Pregnancy

≤18 y 4.7* 2.3* 1,300 1,250 400 27 12 60 220 1,000 2.0* 3* 29* 50 3.0* 19-30 y 4.7* 2.3* 1,000 700 350 27 11 60 220 1,000 2.0* 3* 30* 50 3.0* 31-50 y 4.7* 2.3* 1,000 700 360 27 11 60 220 1,000 2.0* 3* 30* 50 3.0*

Lactation

≤18 y 5.1* 2.3 1,300 1,250 360 10 13 70 290 1,300 2.6* 3* 44* 50 3.8* 19-30 y 5.1* 2.3 1,000 700 310 9 12 70 290 1,300 2.6* 3* 45* 50 3.8* 31-50 y 5.1* 2.3 1,000 700 320 9 12 70 290 1,300 2.6* 3* 45* 50 3.8*

Potassium (g/d)

Calcium (mg/d)

Chloride (g/d)

Phosphorus (mg/d)

Magnesium (mg/d)

Iron (mg/d)

Zinc (mg/d)

Iodine (µg/d)

Water (L/d)8

Molybdenum (µg/d)

Manganese (mg/d)

Copper (µg/d)

Chromium (µg/d)

Fluoride (mg/d)

Selenium (µg/d)

490 APPENDIX F

Dietary Reference Intakes 491 Dietary Reference Intakes 491

Daily Values for Food Labels

The Daily Values are standard values developed by the Food and Drug Administration (FDA) for use on food labels.

Nutrient Amount

Protein1 50 g Thiamin 1.5 mg Riboflavin 1.7 mg Niacin 20 mg Pantothenic Acid 10 mg Biotin 300 mg Vitamin B6 2 mg Folate 400 mg Vitamin B12 6 mg Vitamin C 60 mg Vitamin A2 5,000 IU Vitamin D2 400 IU Vitamin E2 30 IU Vitamin K 80 mg Chloride 3,400 mg Calcium 1,000 mg Phosphorus 1,000 mg Magnesium 400 mg Iron 18 mg Zinc 15 mg Selenium 70 mg Iodine 150 mg Copper 2 mg Manganese 2 mg Chromium 120 mg Molybdenum 75 mg

1 The Daily Values for protein vary for different groups of people: pregnant women, 60 g; nursing mothers, 65 g; infants under 1 year, 14 g; children 1 to 4 years, 16 g.

2 The Daily Values for fat-soluble vitamins are expressed in International Units (IU), an old system of measurement.

Food Component Amount Calculation Factors

Fat 65 g 30% of kcalories Saturated fat 20 g 10% of kcalories Cholesterol 300 mg Same regardless of kcalories Carbohydrate (total) 300 g 60% of kcalories Fiber 25 g 11.5 g per 1,000 kcalories Protein 50 g 10% of kcalories Sodium 2,400 mg Same regardless of kcalories Potassium 3,500 mg Same regardless of kcalories

Note: Daily Values were established for adults and children over 4 years old. The values for energy-yielding nutrients are based on 2,000 kcalories a day.

Dietary Reference Intakes (DRIs) for Carbohydrates, Fiber, Fat, Fatty Acids, and Protein

Life stage Carbohydrate Fiber Fat Linoleic Acid a-Linolenic Acid Protein1 group (g/d) (g/d) (g/d) (g/d) (g/d) (g/d)

Infants 0-6 mo 60* ND 2 31* 4.4* 0.5* 9.1* 7-12 mo 95* ND 30* 4.6* 0.5* 11 Children 1-3 y 130 19* ND 7* 0.7* 13 4-8 y 130 25* ND 10* 0.9* 19 Males 9-13 y 130 31* ND 12* 1.2* 34 14-18 y 130 38* ND 16* 1.6* 52 19-30 y 130 38* ND 17* 1.6* 56 31-50 y 130 38* ND 17* 1.6* 56 51-70 y 130 30* ND 14* 1.6* 56 > 70 y 130 30* ND 14* 1.6* 56 Females 9-13 y 130 26* ND 10* 1.0* 34 14-18 y 130 26* ND 11* 1.1* 46 19-30 y 130 25* ND 12* 1.1* 46 31-50 y 1ss30 25* ND 12* 1.1* 46 51-70 y 130 21* ND 11* 1.1* 46 > 70 y 130 21* ND 11* 1.1* 46 Pregnancy ≤ 18 y 175 28* ND 13* 1.4* 71 19-30 y 175 28* ND 13* 1.4* 71 31-50 y 175 28* ND 13* 1.4* 71 Lactation ≤ 18 y 210 29* ND 13* 1.3* 71 19-30 y 210 29* ND 13* 1.3* 71 31-50 y 210 29* ND 13* 1.3* 71

An asterisk (*) indicates AI. RDAs and AIs may both be used as goals for individual intake. 1 Based on 1.52 g/kg/day for infants 0-6 mo, 1.2 g/kg/day for infants 7-12 mo, 1.05 g/kg/day for 1-3 y, 0.95 g/kg/

day for 4-13 y, 0.85 g/kg/day for 14-18 y, 0.8 g/kg/day for adults, and 1.3 g/kg/day for pregnant women (using pre-pregnancy weight) and lactating women.

2 ND = Not determinable due to lack of data on adverse effects in this age group and concern with regard to lack of ability to handle excess amounts. Source of intake should be from food only to prevent high levels of intake.

Source: Data compiled from Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids. Food and Nutrition Board. Washington, DC: National Academies Press; 2005. This report may be accessed via http://nap.edu.

This table presents Recommended Dietary Allowances (RDAs) and Adequate Intakes (AIs).

24-hour dietary recall A method of collecting food intake information that requires the athlete to remember all foods and beverages consumed within the past day (i.e., 24 hours). Although not the most accurate way of collecting food intake information, it can provide an idea of an athlete’s nutritional intake in the first consultation session if other types of food records are not available.

Academy of Nutrition and Dietetics (AND) Organization of more than 90,000 dietetic practitioners that over- sees dietetic accreditation and provides timely and accurate nutrition information to the public.

acceptable daily intake (ADI) The FDA-established safety limit for food additives and artificial sweeten- ers. The ADI is set at approximately 100 times below the level required for toxic or adverse effects.

acclimatization A process in which the body undergoes physiologic adjustments or adaptations to changes in environmental conditions such as altitude, tempera- ture, and humidity. These physiologic changes enable the body to function better in the new climate.

Accreditation Council for Education in Nutrition and Dietetics (ACEND) Agency of the Academy of Nutri- tion and Dietetics that oversees educational programs preparing students for careers in dietetics.

active transport An energy-requiring means of cellular absorption in which substances are carried across membranes by protein molecules. Active transport is not dependent on concentration gradients.

adenosine diphosphate (ADP) A chemical compound that contains two phosphate groups attached to an adenosine molecule. ADP, when phosphorylated, becomes ATP.

adenosine monophosphate (AMP) A chemical com- pound that contains a single phosphate group attached to an adenosine molecule.

adenosine triphosphate (ATP) A chemical compound that contains three phosphate groups attached to an adenosine molecule. ATP is the direct source of energy for all biological processes.

adenosine triphosphate (ATP) The molecule that serves as the body’s direct source of energy for cellular work.

Adequate Intake (AI) A reference intake for nutrients that is used instead of the Recommended Dietary Allowance. When insufficient scientific evidence is available to calculate an Estimated Average Require- ment (EAR), then an AI is used. Similar to the EAR and

the Recommended Dietary Allowance (RDA), the AI values are based on intake data of healthy individuals.

adipocyte A single fat cell.

aerobic power The rate of aerobic ATP production. It is usually represented by the fastest pace or rate of physical activity an athlete can sustain and is an indi- cator of cardiorespiratory fitness.

aerobic system The energy system that relies upon the presence of oxygen to make ATP. Of the three energy systems, it is the slowest at producing ATP but has an almost unending capacity to make ATP.

air displacement plethysmography A technique that measures the volume of air displaced by an object or body. In body composition assessment, air displace- ment plethysmography is used to determine the vol- ume of the body so that the density of the body can be determined.

amenorrhea The absence or abnormal cessation of men- struation; defined as fewer than four cycles per year.

amino acid A molecule that serves as the basic building block for proteins. Amino acids are composed of atoms of carbon (C), hydrogen (H), oxygen (O), and nitrogen (N).

amino acid pool The collection of amino acids found in body fluids and tissues that is available for protein synthesis.

amylase A digestive enzyme that breaks down carbohy- drates into simple sugars.

anabolic A metabolic process or activity that results in tissue repair or growth. An anabolic hormone or sub- stance is one that stimulates anabolism.

anabolic pathway A metabolic pathway that requires energy and results in the formation of more complex molecules.

anabolic process A metabolic function that involves the building of more complex structures or chemical mol- ecules and is associated with the storage of energy.

anaerobic A term used to describe a condition in which oxygen is not present.

anaerobic system (anaerobic glycolysis) The energy system that has the capability to generate ATP in the absence of oxygen. The anaerobic system results in the formation of ATP and lactic acid.

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GLOSSARY

anorexia athletica A subclinical condition in which indi- viduals practice inappropriate eating behaviors and weight control methods to prevent weight gain and/ or fat increases. Anorexia athletica does not meet the criteria for a clinically defined eating disorder, but the behaviors exhibited are on a continuum that could lead to the more severe clinically recognized eating disorders.

anorexia nervosa A clinical condition manifested by extreme fear of becoming obese, a distorted body image, and avoidance of food. Anorexia nervosa can be life-threatening and requires medical and psychi- atric treatments.

anticatabolic A nutritional compound that slows the breakdown processes in the body (catabolism), thus tilting the metabolic balance toward increased tissue building (anabolism).

antioxidants Compounds that protect the body from highly reactive molecules known as free radicals.

appetite A psychological or emotional desire for food.

atherosclerosis The progressive narrowing of the lumens of arteries caused by fatty deposits on their interior walls. Over time these fatty plaques can block blood supply to vital tissues, causing poor delivery of oxygen; complete blockage results in cell death.

ATP pool The muscle cell’s inventory of readily avail- able ATP.

basal metabolic rate (BMR) The minimum amount of energy required to sustain life at the waking state. BMR is usually measured in the laboratory under very rigorous conditions.

beta cells Specialized cells within the pancreas that secrete the hormone insulin.

beta-oxidation The first metabolic pathway of fat metabolism, which cleaves off two carbon molecules each time a fatty acid chain cycles through it.

bioelectrical impedance analysis (BIA) A body composition assessment technique that measures the resistance to flow of an insensible electric current through the body; percent body fat is then calculated from these impedance measurements.

bioenergetics The study of energy transfer within a bio- logical system.

body mass index (BMI) An indicator of nutritional sta- tus that is derived from height and weight measure- ments. Body mass index has also been used to provide a rough estimate of body composition even though

the index does not account for the weight contribu- tions from fat and muscle.

bone mineral mass (BMM) The weight of the mineral content of bone.

bonking A condition in which the endurance ath- lete experiences extreme fatigue and an inability to maintain the current level of activity. It is also known as “hitting the wall” and results when the body has depleted muscle and liver glycogen levels.

branched chain amino acids (BCAAs) A group of amino acids whose carbon side chain, unlike other amino acids, is branched. The BCAAs are leucine, isoleucine, and valine.

brush border disaccharidases Digestive enzymes pro- duced by cells of the intestinal wall that break disac- charides into simple sugars.

bulimia nervosa A clinical condition characterized by repeated and uncontrolled food bingeing in which a large number of calories are consumed in a short period of time followed by purging methods, such as forced vomiting or use of laxatives or diuretics.

calcitriol The active form of vitamin D in the body. It plays a vital role in calcium regulation and bone growth.

carbohydrate loading A high-carbohydrate dietary plan commonly used by endurance athletes that is designed to engorge muscle cells with glycogen.

cardiac arrhythmia A disturbance in the normal rhyth- mic pattern of heart activity. Severe arrhythmias can lead to sudden death.

cardiac drift A progressive increase in heart rate in the absence of an increase in exercise intensity. It is the result of a loss in blood volume.

cardiorespiratory endurance The ability of the cardio- vascular and respiratory systems to deliver blood and oxygen to working muscles, which, in turn, enable the working muscles to perform continuous exercise. It is an indicator of a person’s aerobic or cardiovascular fitness.

carnitine A compound that transports fatty acids from the cytosol into the mitochondria, where they undergo beta-oxidation.

carotenoids A class of colorful phytochemicals that give plants and their fruit the deep colors of orange, red, and yellow. There are hundreds of different carot- enoids; however, the ones most identified as vital to health include alpha- and beta-carotene, lycopene, lutein, zeaxanthin, and cryptoxanthin.

catabolic pathway A metabolic pathway that degrades complex compounds into simpler ones and in the process gives off energy.

catabolic process A metabolic function that involves the breakdown of structures or molecules and is associ- ated with energy being released.

Glossary 493

catabolism A metabolic process or activity that results in tissue breakdown or destruction.

cell membrane The membrane that makes up the outer boundary of a cell and separates the internal contents of the cell from the external substances.

Certified Diabetes Educator (CDE) An allied health pro- fessional who has passed a rigorous certification exam documenting his or her advanced knowledge and skills related to dealing with diabetes mellitus.

cholecystokinin (CCK) A hormone produced by cells of the small intestine that stimulates the release of bile salts and pancreatic enzymes.

chylomicron A droplet made of resynthesized triglyc- erides wrapped in lipoproteins that is produced by the intestinal cells. Chylomicrons are passed from the intestinal cells where they then enter into the lym- phatic system.

CINAHL The acronym used for the Cumulative Index to Nursing & Allied Health, which is a reference data- base that provides authoritative coverage of the lit- erature related to nursing and allied health.

cis A type of molecular configuration in which the atoms surrounding a double bond are arranged on the same side of the molecule. Most naturally occurring unsat- urated fatty acids exist in the cis configuration.

coenzymes An organic molecule, usually a B vitamin, that attaches to an enzyme and activates or increases its ability to catalyze metabolic reactions.

collagen A fibrous protein found in connective tissues of the body, such as tendons, ligaments, cartilage, bones, and teeth.

complementing proteins A group of two or more incom- plete protein foods that when eaten together provide the full complement of essential amino acids.

complete protein A protein source that supplies the body with all of the essential amino acids in high amounts.

complex carbohydrate A carbohydrate composed of three or more linked simple sugar molecules.

condensation A chemical process that results in the formation of water molecules. Condensation occurs when peptide bonds are formed between amino acids.

conditionally essential amino acid An amino acid that under normal conditions is not considered an essen- tial amino acid, but because of unusual circumstances (e.g., severe illness) becomes essential because the body loses its ability to make it.

creatine kinase The enzyme that catalyzes the reaction transferring phosphate from creatine phosphate to adenosine diphosphate to make ATP.

creatine monohydrate A dietary supplement that can help improve an athlete’s anaerobic strength and power by increasing levels of creatine phosphate in muscles.

creatine phosphate (CP) A high-energy phosphate stored inside muscle cells.

crossover point The point on an increasing contin- uum of exercise intensity where fats and carbohy- drates each contribute 50% of the needed energy and beyond which carbohydrates become the predomi- nant energy source.

cytoplasm The interior of the cell. It includes the fluid and organelles that are enclosed within the cell membrane.

cytosol The watery or fluid part of the cytoplasm.

deamination The metabolic pathway that is responsible for removing the nitrogen or amine group from the carbon structure of amino acids.

defecation The physical process of excreting feces from the rectum.

dehydration A condition resulting from a negative water balance (i.e., water loss exceeds water intake).

denaturation A process by which proteins lose their three-dimensional shape and as a consequence their enzymatic activity.

deoxyribonucleic acid (DNA) The molecular compound that makes up the genetic material found within the nuclei of cells.

diabetes A medical disease that is characterized by high blood glucose levels. Diabetes results when either the beta cells of the pancreas do not produce enough insulin or the body’s tissues do not respond normally to insulin when it is produced.

Didactic Program in Dietetics (DPD) Core academic course requirements to obtain a 4-year degree in dietetics.

diet history The most comprehensive form of dietary intake data collection. It involves an interview pro- cess that reviews recorded dietary intake, eating behaviors, recent and long-term habits of food con- sumption, and exercise patterns. A skilled and trained interviewer is needed to take the diet history.

dietary fiber A complex carbohydrate obtained from plant sources that is not digestible by humans. Although dietary fiber provides no energy for cellular

494 Glossary

activity, it does help maintain a healthy digestive system, lower blood cholesterol levels, and regulate blood glucose levels.

Dietary Reference Intakes (DRIs) A newer way to quan- tify nutrient needs and excesses for healthy individ- uals. The DRI expands on the older Recommended Dietary Allowance (RDA) and takes into consideration other dietary quantities such as Estimated Average Requirement (EAR), Adequate Intake (AI), and Toler- able Upper Intake Level (UL).

dietary supplement A product (other than tobacco) that is not intended to be used as a food or a sole item of a meal or diet. To be considered a dietary supple- ment, the product must contain one or more of the following dietary ingredients: vitamin, mineral, herb or other botanical, amino acid, dietary substance to supplement the diet by increasing the total dietary intake, or a concentrate, metabolite, constituent, extract, or combination of any of these ingredients.

Dietary Supplement Health and Education Act (DSHEA) A legislative act passed in 1994 to help reg- ulate the dietary supplement industry. DSHEA broad- ened the regulatory definition of dietary supplements and altered the federal government’s oversight of supplement products.

digestion The process of breaking down ingested foods into their basic units in preparation for absorption by the cells of the gastrointestinal tract.

diglyceride A lipid that is composed of a glycerol mol- ecule with two attached fatty acids.

dipeptide A simple protein consisting of two amino acids linked via peptide bonds.

disaccharide A simple carbohydrate that consists of two linked sugar molecules.

doping The practice of enhancing performance through the use of foreign substances or other artificial means.

dual-energy X-ray absorptiometry (DEXA) A method of body composition assessment that involves scanning the body using radiography technology to distinguish between fat and lean body tissue.

eicosanoids A group of localized, hormone-like sub- stances produced from long-chain fatty acids.

electrolytes Positively or negatively charged ions found throughout the body. The body uses the electrolytes to establish ionically charged gradients across mem- branes in excitable tissues such as muscle and nerves so that they can generate electrical activity. The most well-known electrolytes are sodium (Na+), potassium (K+), and chloride (Cl−).

electron transport chain (ETC) The final metabolic path- way of the aerobic energy system. It is responsible for transferring hydrogens from one chemical to another and in the process making ATP and water.

emulsifier A substance that breaks lipids into very small globules so that they are more manageable in watery fluids.

endocytosis A means of cellular absorption in which substances are encircled by the cell membrane and internalized into the cell.

endurance athlete An athlete who participates in sports involving continuous activity (30 minutes to 4 hours, as defined in the chapter) involving large muscle groups.

energy balance A state in which energy intake is equal to energy expenditure.

energy continuum A continuum of activity levels span- ning from lowest to maximum, with all points in between requiring slightly increasing rates of energy production.

energy nutrients Carbohydrates, proteins, and fats serve as the body’s source of energy and are consid- ered the energy nutrients.

enrichment The addition of vitamins and minerals to refined/processed products to increase their nutri- tional value.

enzymes A group of complex proteins whose function is to catalyze biochemical reactions in the body.

epiphysis A cartilaginous plate found near the ends of bones that enables bone to grow in length; also known as the growth plate.

ergogenic aid Anything that enhances a person’s ability to perform work, or in the case of athletics, to perform better in sport.

esophagus The segment of the digestive system that connects the oral cavity to the stomach.

essential A nutrition descriptor referring to nutrients that must be obtained from the diet.

essential amino acid An amino acid that must be obtained from the diet because the body is unable to make it on its own.

essential body fat Fats found within the body that are essential to the normal structure and function of the body.

essential fatty acids Fatty acids that must be obtained from the diet. Linoleic acid and linolenic acid are con- sidered essential fatty acids.

Estimated Average Requirement (EAR) The estimated daily intake level of a vitamin or mineral needed to meet the requirements, as defined by a specified indi- cator of adequacy, of half of the healthy individuals within a given life stage or gender group.

euhydration A state of fluid balance in which water loss has been replaced by adequate water intake.

eumenorrhea A term used to describe normal men- struation consisting of at least 10 menstrual cycles per year.

Glossary 495

evidence-based practitioner An individual whose pro- fessional practice is based upon information, guide- lines, or interventions that have been shown through research to be safe and effective.

extracellular A term used to describe structures, fluids, or other substances found outside of the cell.

extracellular water Body water that is found outside of cells that make up the various tissues of the body. Exam- ples of extracellular water are saliva, blood plasma, lymph, and any other watery fluids found in the body.

facilitated diffusion A means of cellular absorption in which protein carrier molecules are required to move substances across membranes driven only by differ- ences in concentration gradient.

fat loading The dietary practice of eating a diet high in fats (i.e., > 60% of total daily calories) 3 to 5 days prior to competition.

fat mass (FM) The portion of body composition that is fat. Fat mass includes both fat stored in the fat cells and essential body fat.

fat substitutes Artificial fats derived from carbohy- drates, proteins, or fats that provide foods with the same texture and taste functions of fat but with fewer calories.

fat-free mass (FFM) The weight of all body substances except fat. Fat-free mass is primarily made up of skel- etal muscles and bone and includes minerals, protein, water, and fat-free organ weight.

fat-soluble vitamins A group of vitamins that do not dissolve easily in water and require dietary fat for intestinal absorption and transport in the blood- stream. The fat-soluble vitamins are A, D, E, and K.

fatigue A physical condition marked by the point in time at which the work output or performance cannot be maintained.

Federal Trade Commission (FTC) A government agency whose mission is to ensure truth in advertising on supplement labels, in print advertising, and in com- mercials, thereby preventing unfair competition and protecting consumers from unfair or deceptive prac- tices in the marketplace.

female athlete triad A group of three interrelated con- ditions, typically diagnosed in young female ath- letes: disordered eating, menstrual irregularities, and osteopenia/osteoporosis.

flavin adenine dinucleotide (FAD) One of two electron carriers that is responsible for shuttling hydrogens from one metabolic step or pathway to another.

fluorosis A condition resulting from the overconsump- tion of fluoride that can lead to pitting and discolor- ation of the teeth and/or bone and joint problems.

Food and Drug Administration (FDA) The governing body responsible for ensuring the safety of foods sold

in the United States. This includes oversight of the proper labeling of foods.

food frequency questionnaire A nutritional analysis survey tool that asks an athlete or client to record how often common foods are eaten on a daily, weekly, monthly, or even yearly basis.

food record The most common method for collecting food intake data. It requires the direct recording of all food and beverage intake over a 1-, 3-, or 7-day period. Documentation of intake should occur at the time of consumption or as soon as possible afterward to obtain the most accurate information.

fortification The process of adding vitamins or miner- als to foods or beverages that did not originally con- tain them.

free fatty acid Compounds composed of long hydrogen- carbon chains that have a carboxyl group on one end and a methyl group at the other. Free fatty acids can be formed when a fatty acid is cleaved from a triglyc- eride molecule.

free radicals Highly reactive molecules, usually con- taining oxygen, that have unpaired electrons in their outer shell. Because of their highly reactive nature, free radicals have been implicated as culprits in dis- eases ranging from cancer to cardiovascular disease.

fructose A simple sugar known for its sweet taste that is commonly found in fruits.

functional fiber Isolated, non-digestible carbohydrates that have beneficial physiological effects in humans.

galactose A simple sugar found in milk.

gastric lipase A fat-digesting enzyme secreted by cells of the stomach.

gastrointestinal tract (GI tract) The regions of the diges- tive system that include the stomach, small intestine, and large intestine.

gene A specific sequence of DNA found within cell nuclei that contains information on how to make enzymes or other proteins.

Generally Recognized as Safe (GRAS) Substances that have not been conclusively proven to be safe but are generally accepted by experts as being safe for human consumption and therefore can be added to foods by manufacturers.

gluconeogenesis The formation of glucose from non- carbohydrate sources such as proteins.

glucose One of the most commonly occurring simple sugars in nature. It is the carbohydrate that humans rely upon for cellular energy.

glucose transporters (GLUT) Specialized membrane car- rier proteins that are responsible for the active trans- port of glucose into cells.

glycemic index (GI) An index for classifying carbohy- drate foods based on how quickly they are digested

496 Glossary

and absorbed into the bloodstream. The more quickly blood glucose rises after ingestion, the higher the gly- cemic index.

glycemic load A way of assessing the overall glycemic effect of a diet based on both the glycemic index and the number of carbohydrates provided per serving for each food ingested.

glycerol A three-carbon molecule that makes up the backbone of mono-, di-, and triglycerides.

glycogen The storage form of carbohydrates in animal cells. Glycogen consists of intricately branched chains of linked glucose molecules.

glycolysis A metabolic pathway that is responsible for the breakdown of glucose. It is unique in that it can function with or without the presence of oxygen.

goiter A clinical condition resulting from iodine defi- ciency. Goiter causes enlargement of the thyroid gland and results in an observable enlargement of the lower neck.

good manufacturing practices (GMPs) A set of quality control measures adopted by the United States Phar- macopeia that establishes guidelines for personnel, facilities design and cleanliness, equipment, testing, storage, production and process controls, yield, pack- aging, and shipping of products.

growth channel The normal height-to-weight growth pattern/relationship. It is used to assess a child’s growth trends and to screen for any potential growth abnormalities.

growth hormone A hormone produced by the pituitary gland that results in the growth of many different tis- sues in the body, including skeletal muscle.

health claim A description placed on a food label that describes potential health benefits of a food or nutrient.

health history questionnaire A survey that includes a variety of questions about current health, past medical history, and other daily health and wellness topics. The information collected in the health his- tory questionnaire about chronic diseases, current or past injuries, surgeries, and regular medications help nutrition professionals make a thorough assess- ment of the athlete’s needs and subsequently develop a sound nutritional program.

hematuria The presence of hemoglobin or myoglobin in the urine. Hematuria is an indicator of hemolysis.

hemochromatosis A clinical condition associated with the accumulation of iron in the body’s tissues, particu- larly the liver, which can result in liver failure or cancer.

hemolysis The breakdown of red blood cells in the body. This, in turn, results in the release of hemoglobin into body fluids.

high-quality protein Source of protein that contains a full complement of all the essential amino acids, has

extra amino acids that are available for nonessential amino acid synthesis, and has good digestibility.

hormone releaser A substance or substances that stimulate an increased quantity and/or frequency of release of hormones within the body.

hunger A physical cue such as gurgling or growling of the stomach that prompts an individual to eat.

hydrogenation A chemical process in which hydrogen atoms are added to unsaturated fatty acids. Hydroge- nation of fatty acids leads to the formation of trans fatty acids, which are a growing health concern in regard to cardiovascular disease.

hydrolysis A chemical process that requires utilization of water to break the chemical bond between ele- ments or molecules. Hydrolysis is required to break peptide bonds between amino acids.

hydrolyzed protein A source of protein that is usu- ally in supplement form and contains proteins that have undergone a predigestion process, breaking the more complex proteins into smaller di- and tripep- tide complexes.

hydrophobic Term used to describe molecules or com- pounds that are water insoluble. Lipids are hydropho- bic substances.

hyperaminoacidemia A condition describing abnor- mally high levels of amino acids in the blood.

hypercalcemia A clinical condition in which blood cal- cium levels are above normal.

hyperglycemia An abnormally high blood glucose level; usually a feature of diabetes.

hyperhydration A condition resulting from a positive water balance (i.e., water intake exceeds water loss).

hyperkeratosis A clinical condition resulting from the overproduction of the skin protein known as kera- tin. Overproduction of keratin plugs skin follicles, thickens the skin surface, and causes skin to become bumpy and scaly. Vitamin A deficiency is related to hyperkeratosis.

hypoglycemia A condition in which blood glucose levels fall below normal.

hyponatremia A rare condition resulting from the dilu- tion of sodium levels in the body. Endurance and ultra- endurance athletes who drink copious amounts of water without regard to sodium replacement increase their risk for hyponatremia.

hyponatremia Low blood sodium levels resulting from sodium deficiency and/or the intake of large volumes of water.

immediate energy system The energy system com- posed of the high-energy phosphates ATP and cre- atine phosphate; as a result it is also known as the phosphagen system. Of the three energy systems, it is capable of producing ATP at the fastest rate.

Glossary 497

inadvertent doping A situation resulting from an athlete ingesting a dietary supplement that unbeknownst to him or her can result in a positive test for a banned substance.

incomplete protein Sources of proteins that do not con- tain the full complement of essential amino acids.

inorganic A descriptor given to a compound that does not contain carbon atoms in its molecular structure.

insensible perspiration Loss of water from the body via seepage through tissues and then eventual evapora- tion into the air. It is labeled as insensible because, unlike sweating, the water loss via seepage through the skin or respiratory passageways occurs relatively slowly and thus goes unnoticed.

insoluble fiber A type of non-digestible plant carbohy- drate that does not dissolve in water. Insoluble fiber sources are primarily whole grain products, nuts, seeds, and some vegetables.

insulin A hormone secreted by specialized cells within the pancreas that lowers blood glucose levels after snacking or meals.

International Units (IU) An outdated system used to measure vitamin activity.

intracellular A term used to describe structures, fluids, or other substances found inside the cell.

intracellular water Body water that is found inside the cells. Approximately 66% of the total amount of water in the body is located inside the cells.

iron-deficiency anemia A clinical condition commonly resulting from poor iron intake that affects the red blood cells and their ability to transport oxygen.

isomer Compounds like unsaturated fats that may have the exact same molecular makeup as another com- pound but exist in a different geometric shape.

ketoacidosis Acidification of the blood caused by a buildup of ketone bodies.

ketone bodies Molecules that are formed from fat met- abolic byproducts. Ketone bodies are formed when insufficient carbohydrates are available for complete metabolizing of fats.

ketosis A condition that arises from abnormally high levels of ketone bodies in the tissues and body fluids.

kilocalories (kcals) The unit of measure for energy. It is the amount of heat energy required to raise the tem- perature of 1 liter of water 1 degree centigrade.

lactase A digestive enzyme that breaks lactose into the simple sugars galactose and glucose.

lactose The disaccharide found in milk that is composed of the simple sugars glucose and galactose.

large intestine The terminal portion of the gastroin- testinal tract, which receives undigested, partially digested, and unabsorbed contents from the small

intestine. It is in the large intestine that the forma- tion of feces occurs. The large intestine consists of the colon, rectum, and anal canal.

lean body mass (LBM) The portion of a body’s makeup that consists of fat-free mass plus the essential fats that comprise those tissues.

licensed dietitian (LD) and licensed dietitian nutritionist (LDN) Dietitian who has obtained a state license to practice dietetics following the state-regulated prac- tice guidelines.

limiting amino acid The essential amino acid that is in short supply in an incomplete protein source.

lingual lipase An enzyme for fat digestion that is secreted by cells located at the base of the tongue.

lipid peroxidation A chemical reaction in which unsta- ble, highly reactive lipid molecules containing excess oxygen are formed.

lipids A class of organic compounds that is insoluble in water and greasy to the touch. Lipids are commonly referred to as fats and exist in the body primarily as triglycerides.

lipophilic Substances that are fat soluble.

lipoprotein lipase (LPL) A specialized enzyme that breaks down triglycerides into glycerol and free fatty acids.

lipoproteins Substances that transport lipids in the lymph and blood. These substances consist of a cen- tral core of triglycerides surrounded by a shell com- posed of proteins, phospholipids, and cholesterol. Various types of lipoproteins exist in the body and differ based on size, composition, and density.

macronutrients These include carbohydrates, proteins, and fats and are classified as such because they have caloric value and the body has a large daily need for them.

major minerals The minerals required by the body in amounts greater than 100 milligrams per day. The major minerals include calcium, phosphorus, mag- nesium, sodium, chloride, potassium, and sulfur.

maltase A digestive enzyme that breaks down maltose into two glucose molecules.

maltose A disaccharide made up of two linked mole- cules of glucose.

mastication The process of chewing.

medium-chain triglycerides (MCTs) A glycerol molecule with three medium-chain fatty acids attached.

MEDLINE/PubMed The U.S. National Library of Medi- cine’s premier bibliographic database that provides information from the following fields: medicine, nursing, dentistry, veterinary medicine, allied health, and preclinical sciences.

messenger ribonucleic acid (mRNA) A type of nucleic acid that carries the genetic instructions for protein

498 Glossary

synthesis from the cell nucleus to the ribosomes located in the cell cytoplasm.

metabolic factory The cellular enzymes, organelles, and metabolic pathways responsible for the production of energy within the cells.

metabolic pathways Sequentially organized metabolic reactions that are catalyzed by enzymes and result in the formation or breakdown of chemicals within the body.

metabolism The sum total of all the energy required to power cellular processes and activities.

micelles Tiny bubbles made up of monoglycerides and long-chain fatty acids that are wrapped in bile salts. Micelles help transport digested fats to the intestinal wall for absorption.

micronutrients Vitamins and minerals are classified as micronutrients because the body’s daily require- ments for these nutrients are small.

mitochondrion A specialized cellular organelle respon- sible for the aerobic production of ATP within the cell.

monoglyceride A lipid composed of a glycerol molecule with one attached fatty acid.

monosaccharide A single sugar molecule. Monosac- charides are the building blocks for more complex carbohydrates.

monounsaturated fatty acid (MUFA) A fatty acid whose hydrocarbon chain contains one double bond.

muscle dysmorphia A type of distorted body image in which individuals have an intense and excessive pre- occupation and/or dissatisfaction with body size and muscularity. Muscle dysmorphia is most prevalent in male body builders and weight lifters.

muscular endurance The ability of a muscle or group of muscles to repeatedly develop or maintain force without fatiguing.

negative energy balance A state in which the total daily calories consumed are less than the total daily calo- ries expended. A negative energy balance will result in weight loss.

nicotinamide adenine dinucleotide (NAD) One of two electron carriers that is responsible for shuttling hydrogens from one metabolic step or pathway to another.

nitrogen balance A way of monitoring nitrogen status in the body. When dietary input of nitrogen (i.e., protein gain) equals the output of nitrogen (i.e., protein loss), then nitrogen balance has been achieved.

nonessential A nutrient descriptor referring to nutri- ents that can be made within the body.

nonessential amino acid A type of amino acid that can be made by the body from other amino acids or com- pounds and thus does not need to be supplied by diet.

nonessential body fat Fat found in adipose tissue. Non- essential body fat is also called “storage fat.”

nonessential fatty acid A fatty acid that can be made by the body and thus does not have to be consumed in the diet.

nutrient content claims Nutrition-related claims on food labels that highlight certain characteristics of the food.

nutritionist Individual who may or may not have the same background as a registered and/or licensed dietitian.

oligomenorrhea A condition in which the female men- strual period is irregular, with cycles occurring only four to six times per year.

oligopeptide A protein molecule made up of 4 to 10 amino acids that are linked via peptide bonds.

oligosaccharide A complex carbohydrate made up of 3 to 10 linked simple sugars.

oral cavity Another name for the mouth, which makes up the first segment of the gastrointestinal tract.

organelles Specialized structures found inside cells that perform specific functions. For example, the mito- chondria are organelles responsible for the aerobic production of energy for the cell.

osmolality An indicator of the concentration of dissolved particles per kilogram of solvent (mOsm/kg). Osmolal- ity affects the movement of water across membranes when the concentrations on either side of the mem- brane are different. A beverage with a high osmolality tends to draw water to it rather than be absorbed.

osmolarity Similar to osmolality, it is an indicator of the concentration of dissolved particles per liter of a sol- vent (mOsm/L). The higher the osmolarity, the greater the tendency to attract water rather than be absorbed.

osteoporosis A clinical condition that can result from inadequate calcium intake and is characterized by a significant decrease in bone mass. The result is weak bones that can be easily fractured.

outcome-oriented goal The final outcome or end result that an athlete would like to achieve as a result of changing dietary habits. For example, a slightly over- fat athlete may have an outcome-oriented goal of losing 3 pounds of body fat in 6 weeks. Outcome-ori- ented goals help guide the athlete and dietitian to develop a nutrition plan, revise the plan as needed, and continue behavior change toward meeting the desired end result.

pancreatic amylase An enzyme secreted by the pan- creas into the duodenum that assists in the diges- tion of starches.

pancreatic lipase A digestive enzyme secreted by the pancreas into the duodenum that breaks down triglycerides.

Glossary 499

passive diffusion A means of cellular absorption in which the movement of molecules through perme- able cell membranes is driven only by differences in concentration gradient.

peptidases A group of protein-digesting enzymes that are released from cells of the small intestine. Pepti- dases work on breaking the chemical bonds of short- chain proteins (i.e., three or fewer amino acids), thereby yielding single amino acids.

peptide bond A type of chemical bond that links the amine group of one amino acid to the acid group of another amino acid when forming a protein.

percent body fat (%BF) The amount of fat mass found on the body expressed as a percentage of total body weight.

phosphagen system The energy system composed of the high-energy phosphates ATP and creatine phos- phate. It is also known as the immediate energy sys- tem. Of the three energy systems, it is capable of producing ATP at the fastest rate.

phosphocreatine A high-energy phosphate stored inside muscle cells. It is also known as creatine phosphate.

phospholipid A type of lipid that consists of a glycerol backbone, two fatty acids, and a phosphate group. Phospholipids are derived from both plant and ani- mal sources and are both water and fat soluble. Phos- pholipids constitute the cell membranes of tissues throughout the body.

photosynthesis An energy-requiring process in which plants capture light energy from the sun and use the energy to combine carbon dioxide and water to form carbohydrates.

phytochemicals A large class of biologically active plant chemicals that have been found to play a role in the maintenance of human health.

polyols A class of food sweeteners that are found natu- rally in some plants but are not easily digested and thus yield fewer calories. Polyols, also known as sugar alcohols, include xylitol, sorbitol, and mannitol and often are added to sweeten products such as mints, candy, and gum.

polypeptide A protein molecule made up of more than 10 amino acids that are linked via peptide bonds.

polysaccharide A complex carbohydrate composed of 11 or more linked simple sugars. Starches and glycogen are examples of polysaccharides.

polyunsaturated fatty acid (PUFA) A fatty acid whose hydrocarbon chain contains two or more double bonds.

positive energy balance A state in which the total daily calories consumed are greater than the total daily cal- ories expended. A positive energy balance will result in weight gain.

prediabetes A condition in which blood glucose levels are elevated but are not high enough to meet the cri- teria for a diagnosis of diabetes.

process-oriented goal An achievement based on fol- lowing or complying with procedures designed to cause a specific outcome. Process-oriented goals are focused on the steps required to reach the desired outcome and not so much on the final outcome itself. For example, an athlete wishing to lose weight may formulate a process-oriented goal of training 30 min- utes longer 4 days of the week. The end result is to lose weight, but the goal is to meet the additional exercise requirements.

prohormone A molecule or substance that can be read- ily converted to a biologically active hormone.

proteases A class of protein-digesting enzymes that break the chemical bonds holding amino acids together.

pyruvate The end product of glycolysis.

reactive oxidative species (ROS) Free radical molecules that contain oxygen in their molecular formula and that are formed during aerobic metabolism. Com- monly occurring reactive oxidative species in the human include superoxidases, hydroxyl radicals, and peroxyl radicals.

Recommended Dietary Allowance (RDA) The average daily dietary intake level that is sufficient to meet the nutrient requirements of the overwhelming majority (i.e., 98%) of a healthy population.

registered dietitian (RD) or registered dietitian nutri- tionist (RDN) Individual trained to provide food and nutrition information to the public and who has suc- cessfully passed the national registration examina- tion for registered dietitians.

retinol activity equivalent (RAE) A unit of measure of the vitamin A content in foods. One RAE equals 1 microgram of retinol.

ribosomes Cellular organelles that are responsible for protein synthesis.

500 Glossary

salivary glands Glands of the mouth that produce and secrete saliva.

satiation The feeling of fullness that accompanies food intake and signals the time to end a meal.

satiety The feeling of fullness that maintains after a meal and helps determine intervals between meals.

saturated fatty acid A fatty acid in which all hydrogen- binding sites are filled, and thus no double bonds exist in its hydrocarbon chain.

secretin A hormone released from the duodenum that stimulates the release of bicarbonate from the pancreas.

simple carbohydrate A form of carbohydrate that exists as a monosaccharide or disaccharide.

simple sugars Another name for simple carbohydrates. These are sugars that exist as single sugar molecules (i.e., monosaccharides) or two linked simple sugar molecules (i.e., disaccharides).

skinfold calipers An instrument used to measure the thickness of skinfolds in millimeters.

small intestine The portion of the gastrointestinal system where the bulk of digestion and absorption occurs. The small intestine is divided into three seg- ments: duodenum, jejunum, and ileum.

social physique anxiety A feeling of personal uneasi- ness or nervousness about how other people view or perceive the athlete’s body shape or fatness level.

sodium bicarbonate A chemical compound found in the blood that helps maintain the body’s normal acid– base balance. Sodium bicarbonate is considered the blood’s most potent chemical buffer.

soluble fiber A type of indigestible plant carbohydrate that dissolves in water. Soluble fiber has been shown to help lower blood cholesterol levels in some individ- uals. Sources of soluble fiber are oats, barley, legumes, and some fruits and vegetables.

speed-strength This term is synonymous with power.

SportDiscus A reference database of citations, books, conference proceedings, dissertations, reports, mono- graphs, journals, magazines, and newsletters covering information in the following areas: sports medicine, exercise physiology, biomechanics, psychology, train- ing techniques, coaching, physical education, physi- cal fitness, active living, recreation, history, facilities, and equipment.

sports anemia A condition caused by the combination of intense training and poor protein intake; it results in reduced levels of hemoglobin in the blood.

sports nutrition A specialty area of study and practice within the field of nutrition.

Sports, Cardiovascular, and Wellness Nutrition (SCAN) Dietetic practice group of nutrition profes- sionals with expertise and skills in promoting the role

of nutrition in physical performance, cardiovascular health, wellness, and disordered eating.

starch The major plant storage form of carbohydrates. Starch is composed of long chains of linked glucose molecules.

steady state exercise Any level or intensity of physical activity in which the energy demand for ATP is met by the aerobic production of ATP.

steatorrhea An abnormal condition in which large amounts of fat are found in the feces.

sterols A category of lipids that possess carbon rings in their structure rather than carbon chains. Cholesterol is the most commonly known sterol.

stomach The distensible, pouch-like portion of the gastrointestinal system that receives foods from the esophagus. It has muscular walls that mechan- ically churn food and assist in the digestive pro- cess. Ingested foods pass from the stomach into the duodenum.

strength The ability of a muscle or group of muscles to generate force. Strength is purely a measure of how much weight can be successfully lifted by an athlete. It is highly dependent on the amount of muscle tis- sue an athlete possesses.

sucrase A digestive enzyme that breaks down sucrose into glucose and fructose molecules.

sucrose A commonly consumed disaccharide also known as table sugar. It is composed of linked glu- cose and fructose molecules.

sweat glands Specialized glands located in the deep layer of the skin responsible for the production of sweat and its delivery to the surface of the skin for the purpose of evaporative cooling.

tapering A scheduled decrease in the volume and inten- sity of training 6 or more days prior to competition. The purpose is to allow for recovery from training and replenishment of glycogen stores in the liver and muscle.

team sport logistics The planning, implementation, and coordination of details in regard to team practice and competition. For example, nutrition logistics involve dietary considerations prior to, during, and after prac- tice or competition, in addition to issues of food prep- aration, preservation, and/or when and where to eat while on the road.

team sports Sports in which two or more athletes work together on a common playing area to defeat an opposing group of competitors. Examples of team sports are football, baseball, hockey, soccer, and basketball.

thermic effect of activity (TEA) The amount of energy required to meet the energy demands of any physi- cal activity.

Glossary 501

thermic effect of food (TEF) The increase in energy expenditure associated with food consumption.

Tolerable Upper Intake Level (UL) The highest level of daily nutrient intake that poses no adverse health effects for almost all individuals in the general population.

total fiber The sum of dietary and functional fiber.

trace minerals Minerals required by the body in quanti- ties less than 100 milligrams per day. The trace min- erals include iron, zinc, chromium, fluoride, copper, manganese, iodine, molybdenum, and selenium.

trans A type of molecular configuration in which the atoms surrounding a double bond are arranged on opposite sides of the molecule. Trans fatty acids are not common in nature but are formed during the pro- cess of hydrogenation.

transcription The process of copying genetic informa- tion from a specific DNA sequence through the for- mation of messenger RNA.

transfer ribonucleic acid (tRNA) A type of ribonucleic acid that is responsible for delivering specific amino acids to the ribosome during production of protein.

translation The process in which proteins are produced by ribosomes as they read the genetic instructions found on messenger RNA.

Transtheoretical Model A conceptual model of how humans go about changing their behaviors. It involves six stages, each of which represents a different mind- set toward change. Knowing which change stage an athlete or client is in can be helpful in developing strategies for altering his or her health or nutrition behaviors.

triacylglycerols A category of lipids composed of a glyc- erol molecule with three attached fatty acids; more commonly referred to as triglycerides.

triglyceride A lipid that is composed of a glycerol mol- ecule with three attached fatty acids.

tripeptide A protein molecule made up of three amino acids linked via peptide bonds.

type 1 diabetes A type of diabetes in which the pan- creas stops producing insulin. Type 1 diabetics require exogenous insulin injections to help maintain normal blood glucose levels.

type 2 diabetes A type of diabetes in which the pancreas still secretes insulin but the cells are not as respon- sive to it, resulting in elevated blood glucose levels. Individuals who are obese and over the age of 35 are at increased risk for this disease.

ultra-endurance athlete A subgroup of endurance ath- letes who engage in extremely long bouts of con- tinuous activity lasting more than 4 hours. Ironman triathletes and ultra-marathoners are examples of this group of endurance athletes.

underwater weighing The gold standard of body com- position determination that involves weighing a per- son while he or she is totally immersed in water.

United States Anti-Doping Agency (USADA) A national- level nongovernmental organization that serves as an extension of the World Anti-Doping Agency. Its mis- sion is to educate athletes about doping, reinforce the ideal of fair play, and sanction those who cheat.

United States Pharmacopeia (USP) A nonprofit organi- zation that establishes and verifies standards for the quality, purity, manufacturing practices, and ingredi- ents in supplement products.

unsaturated fatty acid A fatty acid whose hydrocarbon chain contains one or more double bonds.

villi Small rod-shaped projections that cover the walls of the small intestine.

waist circumference A measure of abdominal girth taken at the narrowest part of the waist as viewed from the front.

waist-to-hip ratio (WHR) A comparison of waist girth to hip girth that gives an indication of fat deposition patterns in the body.

water balance Term used to describe the body’s state of hydration. If water intake equals water loss, then water balance has been achieved. If water loss exceeds water intake, then negative water balance results. The converse is positive water balance.

water intoxication A condition resulting from the exces- sive intake of water. The end result can be a clinical condition known as hyponatremia.

water-soluble vitamins A class of vitamins that dissolve in water and are easily transported in the blood. The water-soluble vitamins are the B vitamins, vitamin C, and choline.

weight cutting The practice of losing weight, usually in preparation for a competitive event in hopes of making a lower weight class and thus improving performance.

World Anti-Doping Agency (WADA) An international, nongovernmental organization whose mission is to foster a doping-free culture in sports. WADA was established in 1999 and is headquartered in Montreal, Canada.

502 Glossary

A absorption

of dietary fats, 31–34, 33f fluid intake during exercise and,

224 mechanisms for, 30f of minerals, 40 of nutrients, 28, 28f of protein, 37–38 of simple sugars, 29–31 of vitamins, 40, 94 of water, 25, 40

academics, sports nutrition jobs in, 461

Academy of Nutrition and Dietetics (AND), 220, 456

acceptable daily intakes (ADIs), 65 Acceptable Macronutrient Distribution

Range (AMDR), 69, 101 for protein, 123, 126

acclimatization, 409 accreditation council for education in

nutrition and dietetics (ACEND), 456

acesulfame K, 65t, 66 acetylcholine, 154 acetyl coenzyme A (acetyl CoA), 50–51,

74 acid-base balance, water and, 212, 213f action, in Transtheoretical Model,

282–283 active listening, sports nutrition

professionals and, 20 active transport, 29, 30f “added,” as nutrient content

claims, 18 adenosine diphosphate (ADP), 43, 43f adenosine monophosphate (AMP), 43,

43f adenosine triphosphate (ATP)

chemical energy and, 42–43, 43f defined, 6 in muscle, 43 pool, 44 production rate, 109, 331 supply from phosphagen system,

44–45, 46f adequate intake (AI), 6, 7t, 142

in Dietary Reference Intake, 274 of vitamins/minerals, 277

adipocytes, 76 adolescent athletes, 431–435

fluid needs for, 434 growth and maturation, nutritional

requirements for, 431–434 vitamin and minerals for, 434–435

ADP–ATP cycle, 43f

aerobic exercise, energy expenditure and, 309

aerobic power, 331 “aerobic powerhouse of the cell,” 44 aerobic system

breakdown of carbohydrates, 50–52 characteristics of, 47 defined, 45 metabolic factory analogy and, 45, 46f utilization

during endurance exercise, 331, 332f aesthetics, 292 age, and protein needs, 126 air displacement plethysmography, 297,

298, 298f albumin, 122 alcohol

consumption, 8 by college athletes, effects of,

437–440, 439f on WADA prohibited substances list

for 2016, 250t allium vegetables, 171 alpha-ketoglutarate, 253, 254t altitude, hydration requirements and,

225 AMDR. See acceptable macronutrient

distribution range amenorrhea, 318 American college of cardiology (ACC), 108

lifestyle management techniques, guidelines for, 109, 109t

American College of Sports Medicine (ACSM), 220, 248, 265, 309, 310, 315, 322t

American Diabetes Association, 421 American Heart Association (AHA), 101,

108, 309 lifestyle management techniques,

guidelines for, 109, 109t amino acid pool, 38, 39 amino acids, 117

branched chain, 118 conditionally essential, 118 digestion of, 38–39 ergogenic effect on muscle growth

and development, 377 essential, 118, 118t during exercise, 134–135 functions of

protein synthesis, 5, 38–39, 39f intake prior to training, 133–134 limiting, 120 nonessential, 5, 118, 118t role of, 118 structure of, 117, 117f supplements, 37–38 in supplements, 129, 131

amylase, 27 anabolic agents

defined, 251 nutritional ergogenic aids as, 251–252,

252t for strength/power athletes, 256t on WADA prohibited substances list

for 2016, 249t anabolic hormone, 372 anabolic pathways, 49, 49f anabolic processes, 41, 41f anaerobic–aerobic continuum, 331f anaerobic exercise, energy expenditure

and, 309 anaerobic glycolysis, 50, 51f anaerobic metabolism

carbohydrates, 76 anaerobic system (anaerobic glycolysis)

characteristics of, 47 defined, 45 metabolic factory analogy and, 45,

46f metabolic pathways in, 50, 50t

andro. See androstenedione android body shape (apple), 296f androstenedione, 251, 252t, 257t anemia

iron-deficiency, 192–193, 192t sports, 193 vitamin/mineral deficiency, 192t

animal proteins, 120 animal starch. See glycogen anorexia athletica, 316

characteristics of, 317t anorexia nervosa, 316, 318 anthocyanin, 170 antibodies, protein-derived, 122 anticatabolics

defined, 253 nutritional ergogenic aids as, 253, 254t

antioxidants, 156, 164, 168. See also vitamin C; vitamin E

enzymatic, 168 nonenzymatic, 168, 168f for strength/power athletes, 380–381 supplements, 168–169 vitamins, 168

appetite, 303 arginine, 118

for team sport athletes, 257t arsenic, 205t artificial sweeteners

as carbohydrate source, 65–66, 72, 73t regulation of, 65–66 in sports drinks, 229 sweetness of, 65t

ascorbate. See vitamin C ascorbic acid. See vitamin C

Note: Page numbers followed by f, or t indicate material in figures, or tables, respectively.

ut te

rst oc

k / fr

ac ta

l-a n

INDEX

aspartame, 65, 65t, 66 atherosclerosis, 156

defined, 96 low-density lipoprotein and, 108, 108f

athletes beneficial commercial sports

beverages for, 228–230 consultation process with, 266 daily and exercise-specific fluid

recommendations for, 234t defined, 4 diet, 276 disordered eating patterns, causes of,

314–315 endurance (See endurance athletes) female (See female athletes) food label information and, 12–14, 13f fueling process, 4 health claims on food labels and,

16–17 knowledge of sports nutrition,

264–265 nutrient content claims and, 15–16 nutritional adequacy, 274 nutritional education for, 265–266 nutrition assessments for, 265–266 nutrition goals of, 278 older (See master athletes) plan development and, 19 sound nutrition plan for, 266 sports nutrition plan for (See sports

nutrition, plan) strength/power (See strength/power

athletes) team sport (See team sport athletes) travel schedule (See traveling) ultra-endurance (See ultra-endurance

athletes)

B basal metabolic rate (BMR), 42, 303 BCAAs. See branched chain amino acids beans, intake, in MyPlate food guidance

system, 9, 10 beet root juice for endurance athletes,

255t Benefat, 100, 100t beta-2 agonists, on WADA prohibited

substances list for 2016, 249t beta blockers, on WADA prohibited

substances list for 2016, 250t beta cells, defined, 31 Beta-hydroxy-beta-methyl-butyrate

(HMB), 252, 252t, 256t, 257t beta-oxidation, 53 beverages

caffeinated, fluid losses and, 219 carbohydrate replacement, 344 carbonated, 221f, 229–230 coffee, 221 for fluid replacement (See fluid

replacement beverages) glycerol-containing, for preexercise

ydration, 222 intake during exercise, types of fluids

for, 225

milk (See dairy/alternative group) for preexercise hydration, 220–222 sports drinks (See sports drinks) tea, 221 water (See water)

“big sweaters,” fluid and electrolyte needs for, 352

bile, in fat digestion, 34 binge eating disorder, 316 bioelectrical impedance analysis (BIA),

299, 299f bioenergetics

defined, 44 magnesium role in, 185

biomechanical ergogenic aids, 240, 240t biotin

deficiency, complications of, 152–153 DRIs, 143t food sources and suggestion, 153 importance for athletes, 152–153 RDA/AI for, 152 supplements, 153 toxicity, 153

blood glucose levels. See glucose, blood levels

blood pressure high (See hypertension) magnesium on, effect of, 185 potassium and, 16 potassium on, effects of, 188, 189

blood volume, water and, 212 Board Certified as a Specialist in Sports

Dietetics credential (CSSD), 459 board examination, registered dietitian,

458 BOD POD, 298, 298f body composition

changes in athletes, 301, 302t, 308–309 components of, 296–297 goals, determination of, 306–307 individual variations in, 296–297 measurement methods

air displacement plethysmography, 297, 298, 298f

bioelectrical impedance analysis, 299, 299f

dual-energy X-ray absorptiometry, 298–299, 298f

skinfold assessment, 299–300, 300f, 300t

underwater weighing, 297–298, 297f sport performance and, 301–302 for sports, 301, 308–309

body fat distribution, 295, 296f excessive, 92 percentages, for athletes, 296 visceral/subcutaneous, function of,

93–94 body mass index (BMI), 294–295

calculation of, 294 classifications for, 294–295, 294t defined, 292, 294 in determining weight goals, 307 mortality rates and, 293 normal, 292 overweight and, 292, 294t use of, 294–295

body shape, apple vs. pear, 295, 296f body water

functions of, 211–212, 211f, 213f loss, 213–214, 214f

body weight. See weight bone health

calcium role in, 181 magnesium role in, 185 phosphorus role in, 183, 184

bone mineral density (BMD), 298, 318, 318f, 319

bone mineral mass (BMM), 296 bonking, 335, 344 boron, 205t, 252, 252t

for strength/power athletes, 380–381 bottled water, 212–213 Bowes and Church’s Food Values of Portions

Commonly Used, 19th ed., 274t branched-chain amino acids (BCAAs),

118, 122 anticatabolic, 253, 254t defined, 342 for endurance sports, 135 as energy source

for endurance athletes, 255t, 342 metabolism of, 135, 135f in supplements, 131 suppression of central fatigue and,

342, 343f for team sport athletes, 257t

brush border disaccharidases, 28–29 bulimia nervosa, 316

C caffeinated beverages, fluid losses and,

219 caffeine, 219, 220

diuretic effect of, 219 for endurance athletes, 255t as fat reducer, 253, 253t intake, fluid losses and, 219 in sports drinks, 229 for team sport athletes, 257t

calcitriol, 161 calcium, 71

absorption, 181 deficiency, complications of, 181–182 DRI values for, 180t for endurance athletes, 350 food sources, 182, 183f functions of, 181

blood clotting, 181 bone and tooth formation, 181 disease prevention and weight

management, 181 muscle contraction, 181 nerve transmission, 181

importance to athletes, 181–183, 183f

for masters athletes, 442 osteoporosis and, 16 RDA/AI for, 181 for strength/power athletes, 381 supplements, 182–183 toxicity, 182 in vegetarian foods, 449

504 Index

calories intake, 276

after training session/competitive event, 334

reductions in, 307, 308 from sports beverages, in training

diet, 309 needs/requirements

for weight gain, 323 on Nutrition Facts panel, 13 percentage

establishing for weight loss, 307 from fat, 13, 104–106, 105f, 106f

strength/power athletes requirements of, 366–372

daily needs, 366–368, 366t to gain muscle mass, 368–371, 372t during training and competition,

371–372 for weight loss, 367–368 for weight maintenance, 368

weight gain and, 323 weight loss and, 307 weight maintenance and, 8, 8f

cancer fruits/vegetables use and, 171 health claims on food labels and, 16

cannabinoids, on WADA prohibited substances list for 2016, 250t

carbohydrate loading before competition, 336–337, 337t defined, 78 for endurance athletes, 76–77 male vs. female, 78 methods of, 78, 79t

carbohydrates, 59–85, 125, 424 aerobic breakdown of, 50–52 anaerobic metabolism, 76 assimilation into body, 31 cherry juice, 339 classification of, 61, 61t

artificial sweeteners, 65–66, 65t complex carbohydrates, 63–65, 63f,

63t, 64t simple sugars, 61–63, 62f, 63t

components of, 60–61 conversion to glucose, 5 defined, 5 digestion of, 27–31 for endurance athletes, 340–341

during exercise, 338 loading, 336–337, 337t role of, 335, 335f timing of preexercise meal, 337–338

as energy source, 76 fluid replacement beverages, 225–226,

228t food sources, 70–72, 71t–74t

content, on Nutrition Facts panel, 13 food-labeling guidelines, 13–14 liquid, 84–85

functions of, 66–67 glycemic index and, 72–73, 74t health and, 67–68, 68f ingestion of, 77 intake, 60, 276

assessment of, 276 current body weight and, 69, 69t

cutting, 67 daily, 68–70 during exercise, 81–83, 82t fatigue delay and, 76–77, 76f–77f performance and, 76 preexercise, 77–81, 80t for recovery, 338–340, 339t stage of training/competition and,

70 in weight loss diet for athletes, 308

low, nutrient content claims for, 66 metabolic pathways for, 75, 75f needs/requirements

for endurance athletes, 335–340 during exercise, 338

needs/requirements determination of, 69–70, 69t

photosynthesis, 60–61, 60f postexercise options, 339t with proteins, for recovery, 84 RDA, 69 for recovery, 83–84, 84f, 85t, 338–340,

339t examples of, 84, 85t with proteins, 84

replacement products with, 234, 344 solution, mouth rinse with, 81 storage, 75–76

vs. fat storage, 93, 93t for strength/power athletes, 372–375

daily needs, 372–373 for recovery, 375 before and during training and

competition, 373–375, 374f structure of, 61 for team sport athletes, 395–400

daily, calculation of, 397–398, 398t prior to team practice, 398–399, 399f for recovery, 400 during team sport activities, 399–

400, 399f tissue content, water and, 211 type of

after exercise/sport, 84–85 in sports drinks, 229

utilization, during exercise, 74–77, 75f–77f

carbonated beverages for preexercise hydration, 221f,

229–230 sports drinks, 229–230

cardiac arrhythmia, 383 cardiac drift, 216 cardiorespiratory endurance, 331 cardiovascular disease risk, AHA/

ACC 2013 report on lifestyle management to reduce, 109

carnitine, 155 carotenoids, 159

DRIs, 143t food sources, 161 importance for athletes, 160–161 intake, tips for increasing of, 161 RDA/AI for, 161

casein protein, 136, 254t catabolic pathways, 49, 49f catabolic processes, 41, 41f catabolism, 377

catechin, 170 celiac disease, 37 cell differentiation, vitamin A role in,

158 cell membrane, 44, 45, 45f, 98 cell signaling, role of protein in, 122 Certified Diabetes Educator (CDE), 424 chemical energy, adenosine

triphosphate and, 42–43, 43f cherry juice, 339 chewing, 24 child athletes, 431–435

fluid needs for, 434 growth and maturation, nutritional

requirements for, 431–434 vitamin and minerals for, 434–435

chitosan, 253, 253t chloride

deficiency, complications of, 188 food sources and suggestion, 188 functions of, 188 importance for athletes, 188 intake, during exercise, 226 RDA/AI for, 188 supplements, 188 toxicity, 188

cholecalciferol, 161 cholecystokinin (CCK), 34 cholesterol

blood levels, 108 content, on Nutrition Facts panel, 13 coronary artery disease and, 16 fat intake and, 106 food sources, 106, 107t functions of, 99 heart disease risk and, 16 high, Nutrition Coach scenario, 3 levels, classification of, 106–108 production, in liver, 99 structure, 99, 99f

choline deficiency, complications of, 155 DRIs, 143t food sources and suggestion, 155, 155t importance for athletes, 154–155 RDA/AI for, 155 supplements, 155 toxicity, 155

chromium deficiency, complications of, 197 as fat reducer, 253, 253t food sources and suggestion, 197 functions of, 196–197 importance for athletes, 196–197 for masters athletes, 441 RDA/AI for, 196 for strength/power athletes, 256t, 381 supplements, 197 toxicity, 197

chromium picolinate, 197, 252t chylomicron, 35 CINAHL, 247 cis, defined, 97 cis fatty acids, structure, 97, 97f citric acid cycle

carbohydrate metabolism, 74, 75f defined, 51 described, 51, 53f

Index 505

clinical settings, sports nutrition jobs in, 461

clonidine, 251, 252t clothing, for exercising, 212 coaches, nutritional education for

athletes and, 265 cobalamin. See vitamin B12 coenzyme Q 10, 255t coenzymes, 142 coffee, for preexercise hydration, 221 collagen, 156 college athletes, 435–440

alcohol consumption and, 437–440, 439f

energy needs, 435–436 meal plan, 436–437, 436t

college sport teams, sports nutrition jobs in, 461

colon, in digestive process, 25, 27f colon cancer

calcium role in, 181 fiber and, 67 high iron intakes and, 194

communication with athlete, importance of, 264

competition before (See preexercise) recovery from (See recovery) schedule, carbohydrate intake and,

70 strength/power athletes

calorie requirements, 371–372 carbohydrates, 373–375, 374f fats for, 380 fluids for, 385 protein for, 377–378

complementing proteins, 120 complete protein, 120 complex carbohydrates

defined, 61 dietary fiber (See fiber, dietary) food sources, 63–65, 63f glycogen (See glycogen) intake, before training session/

competition, 79 oligosaccharides, 63 polysaccharides, 63 in sports drinks, 229 starch (See starch)

condensation, 117 conditionally essential amino acids, 118 conduction, for heat transfer, 212 confidentiality, of nutrition

consultation, 287–288, 288f conjugated linoleic acid (CLA), 252t, 256t constipation, 67 Consumer Labs, 246t contemplation, in Transtheoretical

Model, 282 convection, for heat transfer, 212 copper

deficiency, complications of, 199 food sources and suggestion, 199, 199f functions of, 199 importance for athletes, 199–200 RDA/AI for, 199 supplements, 200 toxicity, 199

coronary artery disease, health claims on food labels and, 16

coronary heart disease risk, 16 corporations/food industry, sports

nutrition jobs in, 461 cost, of recovery products, 234–235 creatine kinase, 47 creatine monohydrate, 48

claimed actions of, 252t, 256t, 257t for strength/power athletes, 256t for team sport athletes, 257t

creatine phosphate (CP), 46, 183 crossover point, 75, 75f cruciferous vegetables, 171 CSSD (Board Certified as a Specialist in

Sports Dietetics credential), 459 cysteine, 118 cytoplasm, 44, 45 cytosol, 44

D daily values footnote, on Nutrition Facts

panel, 13 dairy/alternative group

carbohydrate-rich, 71–72, 71t chocolate milk vs. carbohydrate

replacement drink, 344 fats in, 103, 104t intake, in MyPlate food guidance

system, 9, 10 DASH diet, 181 databases, for food record analysis, 273–

274, 273f deamination, 53, 54f defecation, 27 dehydration

consequences of, 211 defined, 214 effects

on heart rate, 215, 215f progressive, 215–216, 216f on rectal temperature, 215f

high-protein diet and, 126 prevention, recommendations for,

408–410 self-induced, 312

dehydroepiandrosterone (DHEA), 252t, 253t, 257t

denaturation, 36–37, 37f density formula, 297 dental caries

fluoridated water and, 16 sweeteners and, health claims on

food labels and, 16 deoxyribonucleic acid (DNA), 39 diabetes, 421

athletes with, 19 exercise considerations for, 423 management, sports excellence

and, 423–427 nutrition recommendations for,

424–425 defined, 31 diagnostic criteria, 423 regulation of blood glucose levels in,

421f types of, 421–423

diabetic emergencies during exercise, 426–427

didactic program in dietetics (DPD), 456

dietary adequacy, 266 dietary analysis

report, 277f resources for, 274t

Dietary Approaches to Stop Hypertension (DASH) study, 181

dietary fiber bloating and flatulence, 64–65 colon cancer and, 67 as complex carbohydrates, 63–65 defined, 63, 64 functional, defined, 64 glycemic index and, 73 health and, 67–68, 68f insoluble, 64 intake, recommendations for, 64 soluble, 64 total, defined, 64

Dietary Folate Equivalents (DFE), 152 Dietary Guidelines for Americans, 7–9,

8f, 274, 275–276 Dietary Reference Intake (DRI), 142,

274 in assessing nutritional adequacy,

274–275 defined, 6–7, 7t for vitamins, 143t

Dietary Supplement Health and Education Act (DSHEA), 241–243, 248

dietary supplements. See also supplements

contents of, 244 defined, 241 for endurance athletes, 254–258, 255t labels, 243–244, 243f manufacturers, 241

marketing ploys of, 244 selection of, 245

Nutrition Coach scenario, 239 product market for, 241 safety differences in, 244–245, 245f for strength/power athletes, 254–258,

256t for team sport athletes, 255–258, 257t testing/scientific approval process for,

243–244 usage

by athletes, 241–242 in United States, 241–242

diet history assessment of dietary adequacy,

266 defined, 266 direct interview process for, 266 food frequency questionnaire, 269,

271, 271f food intake information, 268–269 food records, 269–270, 270f health history questionnaire, 266,

267f, 268 supplement usage and, 268 24-hour dietary recall, 269, 270–271 for walk-in/short sessions, 286–287

506 Index

dietitians licensed, 265 registered (See registered dietitians) vs. nutritionists, 265

diets cherry juice, 339 cholesterol-lowering, 108, 109t credible, determination of, 313 fad, 313 high-carbohydrate vs. low-

carbohydrate, 83, 84f high-cholesterol, 109t high-fat, 102, 345, 346

long-term pattern, performance and, 110–111

high-fiber, 64 high-protein

fluid loss and, 219 intake comparing with nutrition

recommendations, 274–277, 275t ketogenic, 346 low-calorie, 313 low-carbohydrate

Nutrition Coach scenarios, 59 vs. high-carbohydrate, 83, 84f

low-fat, calorie intake and, 101 popular programs for, 313 short-term pattern, performance and,

110 digestion

of carbohydrates, 27–31 defined, 24 of fats, 31–35 of protein, 35–40 small intestine in, 25, 26f, 27f

digestive system, anatomy of, 24, 24f diglyceride, 32 dipeptide, 119 direct interview process for, 266 disaccharides, 27, 61–62, 62f diuretics, on WADA prohibited

substances list for 2016, 250t docosahexaenoic acid (DHA), 101, 102 documentation for intake, 269 doping

defined, 248 inadvertent, 250 substances, commonly used, 251–254,

252t–254t World Anti-Doping Code, 249t–250t

dress, method of for cold weather exercise, 212 for hot weather exercise, 212

DRIs. See Dietary Reference Intakes drug–nutrient interactions, 268 drugs. See medications dual-energy X-ray absorptiometry

(DEXA), 298–299, 298f

E eating disorders, 315–322, 321t

anorexia athletica, 316–317, 317t anorexia nervosa, 316, 318 binge eating disorder, 316 bulimia nervosa, 316 classification of, 315

female athletes and, 317–319 incidence/prevalence of, 315 male athletes and, 319–320 performance and, 317 prevention of, 320–322, 321t sports with risks for, 315 treatment of, 320 types of, 315–317 weight-cutting practices and, 314

Eating Disorders Examination (EDE), 314

Eating Disorders Inventory (EDI), 314, 315, 318, 319

eating patterns, healthy, 8 education

nutrition assessment and, 265–266 related to nutritional goals, 258t,

284–285 eggs, fat content of, 104 eicosanoids, 98 eicosapentaenoic acid (EPA), 101, 102 electrolytes, 179, 187

chloride (See chloride) deficiencies, 227 for endurance athletes, 255t

during activities, 351–352 for “big sweaters,” 352 for ultra-endurance athletes,

352–353 in fluid replacement beverages, 226–

227, 228t losses

magnitude during exercise, 222–223 in sweat, 226

potassium (See potassium) sodium (See sodium)

electron transport chain (ETC), 52, 54f emulsifiers, 33–34, 98 Endocrine Society, 163 endocytosis, 29, 30f, 31 endoplasmic reticulum (ER), 45 endurance

cardiorespiratory, 331 muscular, 331

endurance athletes, 330–359 ATP during sports, 47–48 calcium for, 350 calorie intake of, 331 carbohydrate loading for, 76–77 carbohydrates for, 335–341

during exercise, 338 loading, before competition, 336–

337, 337t preexercise intake, 337–338 during recovery, 338–340, 339t role of, 335, 335f timing of preexercise meal, 337–338

cherry juice, 339 defined, 331 electrolyte needs

during activities, 351–352 for “big sweaters,” 352 for ultra-endurance athletes,

352–353 energy

daily energy needs, 332–333, 332t, 333t–334t, 334

REE calculations, 332, 332t

fats for, 344–348 during activities, 347–348 daily needs, calculation of, 346–347 for recovery, 348

fluids needs, 350–353 during activities, 351–352 for “big sweaters,” 352 daily, calculation of, 351 for recovery, 353

iron for, 349–350 macronutrients for, 348 overtraining, 340 potassium for, 350, 351f protein intake

calculation of, 340–341 during endurance activities,

342–343 meal planning and, 341, 341t prior to exercise, 341–342 for recovery, 343–344

sodium for, 350 supplements for, 254–258, 255t training, intensity of, 340 ultra-endurance athlete

defined, 331 vitamin/mineral for, 348–350, 349t

endurance sports case study, 356–357 energy system utilization during, 331,

332f Ironman nutrition/hydration plan,

359t Jack’s meal plan during RAAM, 358–

359, 359t meal planning/event logistics for,

354–359 recovery period, carbohydrate intake

during, 338–340, 339t training/competition

calorie intake after, 334 calorie intake during, 333–334

energy defined, 41–42 forms of, 42 intake, 302–306

assessment of, 276, 276t, 277f influences on, 302–303

levels, increasing, Nutrition Coach scenario, 3

production, 4–5 requirements, for college athletes,

435–436 requirements, for team sport athletes

during an event, 395, 396t daily, calculation of, 394–395, 395t

sources fats, 5 proteins, 5

vitamin and mineral intake and, 405–406

for weight loss, determination of, 307

energy balance, 302 energy bars for endurance athletes,

255t energy continuum, 48 energy drinks, 257t

vs. sports drinks, 256

Index 507

energy expenditure components, 303–306

resting metabolic rate, 303–304, 304t thermic effect of activity, 304–306 thermic effect of food, 306

determination, regression/prediction equations for, 304

matching with energy intake, 334 of sport activities, 305t–306t total daily, assessment of, 304 utilization

during endurance exercise, 331, 332f energy gels for endurance athletes, 255t energy metabolism, 41 energy nutrients, 6 energy production

niacin in, 145–146 phosphorus role in, 183 riboflavin in, 144 thiamin role in, 144

energy systems characteristics of, 44–45, 46t strength/power athletes and, 365, 366f team sport athletes and, 393–394, 393f

“enriched,” as nutrient content claims, 18

enrichment, 7 Environmental Protection Agency (EPA),

water standards, 213 enzymes, 122

dietary intake of protein and, 122 function of, 122

ephedra, 241 ephedra-containing supplements, ban

on, 241–242 ephedrine alkaloids

for fat mass reduction, 253t, 257t removal from U.S. market, 241–242

epinephrine, 122 epiphysis, 433 ergocalciferol, 161 ergogenic aids, 240–258

anabolic, 251–252, 252t as anticatabolics, 253, 254t defined, 240 for fat reducers, 2, 253, 253t as hormone releasers, 251–252, 252t information on, 246–248, 246t–247t

research tools for, 246–248 instructions for evaluating, 248 minerals as, 254 as prohormones, 251–252, 252t types of, 240–241, 240t vitamins as, 254

esophagus, 25 essential (nutrients), 4–5 essential amino acid, 118, 118t, 136 essential body fat, 296 essential fatty acids, 98

deficiency, 102 Estimated Average Requirement (EAR),

6, 7t, 142, 274 euhydration, 224 eumenorrhea, 318 evaporation, for heat transfer, 212 evidence-based practitioners, 4 “excellent source of,” nutrient content

claim, 18

exercise. See also specific types of exercise/ sport

aerobic, energy expenditure and, 309 anaerobic, energy expenditure and,

309 assessment, for nutritional

assessment, 280 blood glucose levels and, 76 body water loss during, 213–214 carbohydrate

intake during, 81–83, 82t, 338 utilization during, 74–77, 75f–77f

during cold weather, clothing for, 212 free radicals and, 168 glycemic index and, 74 during hot weather, clothing for, 212 magnesium, effect on, 185 as medicine, 310 for off-season weight loss, 310 protein consumption and

after exercise, 135–137, 402 prior to training, 133–134, 134t during training, 134–135, 135f

and protein needs, 125 for weight loss, 309–310

exercise/training log, for nutritional consultation, 271, 272f

“extra,” as nutrient content claims, 18 extracellular space, 122 extracellular water, 211 “extra lean/lean,” as nutrient content

claims, 18

F facilitated diffusion, 29, 30f fast-food restaurants meal options, for

team sports athletes, 414–415 “fat adaptation” strategy, 110 fat-free mass (FFM), 296, 297, 301 fatigue, 122

carbohydrate intake and, 76–77, 76f–77f

central, suppression of, 342, 343f defined, 44 from lactic acid buildup, 50 Nutrition Coach scenarios, 210 onset during endurance training/

competition, 345–346 fat loading, 345 fat mass (FM), 296, 297, 301 fats, dietary, 91–112. see also lipids

absorption of, 31–34, 33f assimilation into body, 34–35, 35f breakdown, aerobic, 52–54, 52f calories from, 276

athlete’s goal for, 107 in food, 104–106, 105f, 106f Percent Daily Value and, 105–106, 106f

competitive performance and, 108– 109, 109f

content of foods, 96t–97t defined, 5, 92 for endurance athletes, 344–348

during activities, 347–348 daily needs, calculation of, 346–347 for recovery, 348

as energy source, 5 food sources, 103–104, 103t–104t functions of, 5, 93–94

as carriers, 93–94 enhancement of sensory qualities

of food, 94 glycemic index and, 73 health claims for, 16–17 intake

after exercise, 112, 112t enhancement of sensory qualities

of food, 94 before exercise, 110 during exercise, 111–112 overconsumption of, 101, 102 prior to exercise, recommendations

for, 111, 111t recommendations for, 101–102 satiety level and, 94 too high, 102 too low, 102

in oil group, 104, 104t percentage of calories from, on

Nutrition Facts panel, 13 RDA, 101 saturated, on Nutrition Facts panel,

13 storage vs. carbohydrate storage, 93,

93t for strength/power athletes, 379–380

daily needs, 379–380 for recovery, 380 before and during training sessions

and competitions, 380 for team sport athletes, 402–404

after exercise for recovery, 403–404 daily, calculation of, 402–403

total, on Nutrition Facts panel, 13 training effects, 108–109, 109f transport of, 34 utilization during exercise, 109,

111–112 in weight loss diet, 308

fat-soluble vitamins, 142, 157–158. See also vitamins

absorption, 40, 94 carotenoids, 160–161 vitamin A, 158–160, 158f, 159f, 160f vitamin D, 161–164, 162f, 163t, 164f vitamin E, 164–165, 165f vitamin K, 166, 167f

fats reducers, nutritional ergogenic aids as, 253, 253t

fat substitutes, 100, 100t fatty acids

essential, 98 hydrogenation of, 95–96 nonessential, 98 saturation level, 95–97, 95f structure, 94, 94f, 97, 97f

FDA Center for Food Safety and Applied Nutrition, 246t

Federal Trade Commission (FTC), 244 female athletes

eating disorders and, 317–319 sports at risk for eating disorder

development, 315 supplements and, 242

508 Index

Female Athlete Screening Tool (FAST), 318

female athlete triad, 182, 318–319, 318f ferritin, 191, 195 fiber, dietary

bloating and flatulence, 64–65 cancer and, health claims for, 16 colon cancer and, 67 as complex carbohydrates, 63–65 content, on Nutrition Facts panel, 13 coronary heart disease risk and, 16 defined, 64 functional, defined, 64 glycemic index and, 73 health and, 67–68, 68f insoluble, 64 intake, recommendations for, 64 soluble, 16, 64 total, defined, 64

fibrin, 181 Fit Day, 274t flavin adenine dinucleotide (FAD), 51–52 flavonoids, 170–171 fluid, 219. See also water

for child athletes, 434 daily intake, 223

recommendations for, 218–219, 218t for endurance athletes, 350–353

during activities, 351–352 for “big sweaters,” 352 daily, calculation of, 351 for recovery, 353

equivalents, determination of, 223 intake during exercise

amount of, 223 gastric emptying and, 224 guidelines for, 230, 233 intestinal absorption and, 224 osmolality of fluid and, 227 ounces needed per hour of exercise,

224 session length and, 233 temperature, 228–229 timing during session, 230 types of fluids for, 225

losses, 219–220 beverages and, 219 high-protein and, 219 medications and, 219–220

needs/requirements assessment of, 218–219, 218t determination of, 224

Nutrition Coach scenarios, 210 preexercise intake, 80 recommendations for team sport

athletes, 407–410 dehydration prevention and,

408–410 performance and, 408

for recovery, 230, 233–235, 234t amount of fluid for, 233 guidelines, 235 types of fluid for, 233–234

replacement, 222 for strength/power athletes, 382–385

during activities, 384 after training sessions and

competitive events, 385

issues regarding, 382–383 selection of fluids, 384–385 timing of consumption, 384–385

for young athletes, 434 fluid balance, role of protein in, 122 fluid replacement beverages

carbohydrate, 344 carbohydrate in, 225–226, 228t electrolytes in, 226–227, 228t protein in, 228, 228t taste of, 226

fluoride deficiency, complications of, 198 in drinking water, 198 food sources and suggestion, 198,

198f functions of, 197–198 importance for athletes, 197–198 RDA/AI for, 197 supplements, 198 toxicity, 198, 198f

fluorosis, 198, 198f flu shot, 122 folate (folic acid)

deficiency, complications of, 152 DRIs, 143t food sources and suggestion, 152,

153f fortification of grains and flours, 152 growth and development of fetus, role

in, 151, 152 health claims on food labels and, 16 importance to athletes, 151–152 RDA/AI for, 152 supplements, 152 toxicity, 152

food access to, sports nutrition plan

development and, 19–20 calories in, percentage from fats, 104–

106, 105f, 106f combinations, glycemic index and,

73, 74t comparisons, using Percent Daily

Value, 13, 17f enriched, 7 fat content, 96t–97t, 103–104, 103t–104t fortified, 7 high-carbohydrate, 63, 63t high-fiber, 64, 67 liquid vs. solid, glycemic index and, 74t low carbohydrate, 66 mechanical breakdown, in digestive

process, 28 nutritional quality, evaluation of, 12 plant-based, protein content of, 120,

121t preactivity, 134 serving sizes, 309 thermic effect of, 306

Food and Drug Administration (FDA) ban on ephedra-containing

supplements, 241–242 bottled water standards, 212–213 contact information, 246t–247t defined, 11 enriched and fortified food, 7 food label regulations, 11, 105–106

Food and Nutrition information Center, 246t

food–drug interactions, examples, 444t

food frequency questionnaire (FFQ), 269, 271, 271f

food labels calculating percentage of total

calories from fat, 104–106, 105f, 106f

95% fat-free, 106 information on, 11–17, 11f nutrient content claims, 15–16 regulations, creation of, 11 trans fats on, 105

food records analysis of, 273–277, 273f, 274t–276t,

277f clarifying questions for, 273, 273f defined, 269 reviewing/analyzing of, 280–281 sample, 285t software/databases for, 273–274,

274t use in nutritional consultation,

269–270, 270f food sources

biotin, 153 calcium, 182, 183f carbohydrate-rich, 80, 80t chloride, 188 choline, 155, 155t chromium, 197 fluoride, 198, 198f folate, 152, 153f iodine, 201, 202f iron, 194, 194f magnesium, 185, 186f manganese, 200, 200f niacin, 147, 147f phosphorus, 184, 184f potassium, 189, 189f, 190 riboflavin, 145, 146f selenium, 203, 204f sodium, 187, 188f sulfur, 190 thiamin, 144, 145f vitamin A, 159–160, 160f vitamin B6, 148, 149f vitamin B12, 150, 150f vitamin C, 156, 157f vitamin E, 165, 165f vitamin K, 166, 167f zinc, 196, 196f

Food Values of Portions Commonly Used (Bowes & Church), 274t

fortification, 7 “free,” as nutrient content

claim, 18 free fatty acids, defined, 32 free radicals, 160, 164, 166–168

antioxidants and, 168 damage, 167f, 168 definition of, 166–167 and exercise, 168 outside sources of, 167 oxidation, 167

“fresh,” as nutrient content claim, 18

Index 509

fructose absorption of, 29 defined, 61 in fluid replacement beverages, 226 intake, during exercise, 81 in juices, 221 structure of, 61, 62f

fruits carbohydrate-rich, 71, 71t, 72t dietary intake, 8 fats content, 103, 103t health claims for, 16 intake, in MyPlate food guidance

system, 9 protein in, 127–128, 128t

functional fiber, 64

G galactose

absorption of, 29 defined, 61 intake, during exercise, 81 structure of, 61, 62f

gastric emptying, fluid intake during exercise and, 224

gastric lipase, 34 gastrointestinal tract (GI tract). See also

specific gastrointestinal structures/ organs

defined, 25 Gatorade, 228 Generally Recognized as Safe (GRAS),

65, 66 genes, 39 ginseng for endurance athletes, 255t glucagon, 122 glucocorticosteroids, on WADA

prohibited substances list for 2016, 250t

gluconeogenesis, 53, 55f glucose

absorption of, 29 assimilation into body, 31, 32f blood levels

exercise and, 76 self-monitoring of, 423–424

conversion from carbohydrates, 5 flowchart of, 32f in fluid replacement beverages, 226 low blood levels, signs of, 77 structure of, 60–61, 62f

glucose-alanine cycle, 133 glucose tolerance factor (GTF), 196–197 glucose transporters (GLUTs), 31, 421, 422 glucosinolates, 171 glutamic synthetase, 200 glutamine, 254t glutathione peroxidase, 203 glycemic index (GI)

calculation of, 73 defined, 73 exercise and, 74

glycemic load, 73–74 glycerol

defined, 92 for endurance athletes, 255t

glycerol-containing beverages, for preexercise hydration, 222

glycogen defined, 31, 61, 61f depletion, 77, 335, 335f stores, 63

in liver, 76 in muscle, 75–76, 76f

structure of, 61, 61f glycolysis, defined, 50 goiter, 201 Golgi apparatus, 45 good manufacturing practices (GMPs),

244–245 good source, as nutrient content claim,

18 grains

fat content of, 103, 103t health claims for, 16 intake, in MyPlate food guidance

system, 9 low-fat, 103, 103t protein in, 127, 128t whole

carbohydrate-rich, 71, 71t dietary intake, 8 health claims for, 16

green tea, polyphenols in, 171 growth channel, 431 growth factors, on WADA prohibited

substances list for 2016, 249t growth hormone, 377 gynoid body shape (pear), 296f

H Harris-Benedict equation, 304t health

carbohydrates and, 67–68, 68f simple sugars and, 68

health claims defined, 11 on food labels, 16 for supplements, 243

health clubs, in gaining practical sports nutrition experience, 460

health history, sports nutrition plan and, 18–19

health history questionnaire, 266, 267f, 268

Health Insurance Portability and Accountability Act (HIPAA) of 1996, 287

health/wellness information, listing on health history questionnaire, 267f, 268

healthy, as nutrient content claim, 18 heart disease

high iron intakes and, 194 soluble fiber and, 68 vitamin B6 as dietary protector

against, 147 heart rate, dehydration and, 215, 215f heat acclimatization, hydration

requirements and, 224–225 heat-related disorder prevention, 214,

215t

heat transfer methods, 212 height, measurement of, 296 hematocrit, 191 hematuria, 193, 349 hemochromatosis, 179, 193–194 hemoglobin, 122, 147, 191 hemolysis, 193, 349 hemorrhoids, 67, 428 herbal products, in sports drinks, 229 “high,” as nutrient content claim, 18 high-density lipoprotein (HDL)

blood levels, 107 high-fat diets, 345, 346 high fructose corn syrup (HFCS), 68 high-protein diets, 219 high-quality protein, 120 “hitting the wall” (bonking), 335, 344 homocysteine, and heart disease, 148,

148f, 149 hormone releasers, 251–252, 252t hormones

protein-derived, 122 on WADA prohibited substances list

for 2016, 249t hospitals, in gaining practical sports

nutrition experience, 460 human growth hormone for strength/

power athletes, 256t Human Performance Resource Center,

246t hunger

constant, Nutrition Coach scenario, 3 defined, 302–303 vs. satiation and satiety, 302–303, 302f

hydration during exercise, 222–233

goals of, 222 role of, 222

intake amounts, 218–219 needs/requirements

altitude and, 225 assessment of, 218–219, 218t determination of, 230 heat acclimatization, 224–225

over hydration, 216 preexercise, 220–222 for recovery, 233–235 status

indexes of, 216t monitoring of, 216–217, 216t, 218f water balance, 216

training, 233 types of fluids for, 220–222, 221f

hydrochloric acid (HCl), 28, 36, 188 hydrogenation, 95–96 hydrogen molecule, 212 hydrolysis, 118 hydrolyzed protein, 136 hydrophobic molecules, 92 hyperaminoacidemia, 135 hypercalcemia, 163, 182 hyperglycemia, 426

defined, 422 diabetes and, 422 during exercise, 426 preventing, 423

hyperhydration, 214 hyperkalemia, 189

510 Index

hyperkeratosis, 159 hypermagnesemia, 185 hypertension

sodium and, 16 hypocalcemia, 181–182 hypoglycemia, 423 hypokalemia, 189 hyponatremia, 187, 216, 227, 353

I immediate energy system, 46 immune function

protein in, role of, 122 vitamin A role in, 158 vitamin B6 role in, 148

inadvertent doping, 250 incomplete protein, 120 individualization, in nutrition planning,

19 Informed Choice, 246t inorganic elements, 179 inosine for team sport athletes, 257t insensible perspiration, 213 insoluble fiber, 64 insulin, 122, 372

defined, 31 during recovery, 344 regulation of blood glucose levels, 421,

421f sensitivity to, 422

insulin-dependent diabetes, 422 International Bibliographic Information

on Dietary Supplements (IBIDS) Database, 246t

International Olympic Committee (IOC), 248, 325

International Units (IU), 159 internships, 457–458, 460 intestinal absorption, fluid intake

during exercise and, 224 intracellular space, 122 intracellular water, 211 in vegetarian foods, 449–450 iodine

deficiency, complications of, 201 food sources and suggestion, 201, 202f fortification of salt, 7 functions of, 201 importance for athletes, 201 RDA/AI for, 201 supplements, 201 toxicity, 201

iodopsin, 158 iron

absorption, factors influencing, 191, 192f

deficiency, 179 complications of, 191–192 dietary assessment and treatment

of, 193 iron-deficiency anemia, 192 iron-deficiency erythropoiesis, 192 iron depletion, 192

for endurance athletes, 349–350 food sources and suggestion, 194, 194f functions of, 191

heme, 191, 194 high intakes of, 193–194 importance for athletes, 191–195 for masters athletes, 441–442 nonheme, 191, 194 for pregnant athletes, 430, 431t RDA/AI for, 191 risk for iron-deficiency anemia,

192–193 status, evaluation of, 191 for strength/power athletes, 381–382 supplements, 194–195 toxicity, 193–194 in vegetarian foods, 448

iron-deficiency anemia, 192–193, 192t Ironman nutrition/hydration plan, 359t irregular menstruation, 318 isomer, 97 isothiocyanates, 171

J Jack’s meal plan during RAAM, 358–359,

359t Journal of Medical Internet Research, 312 juices, 221

K Keshan disease, 203 ketoacidosis, 422 ketogenic diet, 346 ketone bodies, 422 ketones, 424 ketosis, 422 kidneys, effects of high protein intake

on, 126 kidney stones, 182 kilocalories (kcals), 42 knowledge, 20

L labeling. see also food labels

of supplements, 243–244, 243f laboratory assessments, for nutrition

consultation, 272 lactase, 29 lactic acid, 75, 122 lactose, 29, 62 large intestine

colon, 25 defined, 25 in digestive process, 25, 27f rectum, 25, 27f

L-carnitine, 253t, 254, 255t lean body mass (LBM), 296 lean/extra lean, as nutrient content

claims, 18 lecithin, 98 less, as nutrient content claims, 18 leucine, 122, 254t licensed dietitian nutritionist (LDN),

459 licensed dietitians (LD), 265, 459

licensure laws for dietitians/nutritionists, 265–266 registered dietitian (RD), 459–460

“light,” as nutrient content claim, 18 limiting amino acid, 120 lingual lipase, 34 linoleic acid, 98 linolenic acid, 98, 102 lipid peroxidation, 168 lipids

absorption of, 34, 36f classification of, 92–101 defined, 31 sources of, 93

lipophilic substances, 92 lipoprotein(a), 108 lipoprotein lipase (LPL), 35 lipoproteins, 34 liver, 99 loading. See carbohydrate loading long-chain fatty acids (LCFAs), 94, 94f long-chain triglycerides (LCTs), 111 long exercise bouts, diabetic athletes

eating during, 425–426 “low,” as nutrient content claim, 18 low-density lipoprotein (LDL)

atherosclerosis and, 108, 108f blood levels, 108 plant sterols/stanols and, 99–100 plaque formation and, 108, 108f

lutein, 161 lycopene, 94, 171–172 lysine, 120 lysosome, 45 lysyl oxidase, 199

M macronutrients

for chemical energy, 42 defined, 5 for endurance athletes, 348 in weight loss diet for athletes, 308

magnesium deficiency, complications of, 185 food sources and suggestion, 185, 186f functions of, 185 importance for athletes, 184–186, 186f for masters athletes, 442–443 for pregnant athletes, 430 RDA/AI for, 185 in sports drinks, 229 for strength/power athletes, 382 supplements, 186 toxicity, 185

ma huang, for team sport athletes, 257t maintenance, in Transtheoretical Model,

283 major minerals, 179–181, 180t, 190. See

also minerals; specific mineral calcium, 181–183, 183f chloride, 188 magnesium, 184–186, 186f phosphorus, 183–184, 184f potassium, 188–190 sodium, 187–188, 188f sulfur, 190

Index 511

malabsorption, 34 maltase, 29 maltose, 62–63 manganese

deficiency, complications of, 200 food sources and suggestion, 200,

200f, 201 functions of, 200 importance for athletes, 200–201 RDA/AI for, 200 supplements, 201 toxicity, 200

mannitol, 65t, 66 Mark’s race-day nutrition plan, 353–354,

355t masking agents, on WADA prohibited

substances list for 2016, 250t master athletes, 440–443

calcium requirements, 442 calorie requirements, 440–441 chromium requirements, 441 chronic diseases and, 443 iron requirements, 441–442 magnesium requirements, 442–443

mastication, 24 meals

after exercise, examples, 85 high-fat, 110–111 plans, 285t

for body composition goals, 308–309 3,000 calorie, 333t 4,000 calorie, 333t–334t 5,000 calorie, 334t Dave’s, 341, 341t endurance sports, 354–359 to increase calories, 333, 333t–334t Jack’s meal plan during RAAM, 358–

359, 359t with lower-fat protein foods, 104t Mark’s race-day nutrition plan, 353–

354, 355t for strength/power athletes, 385–386 for team sport athletes, 410–415 for weight loss, 308–309

preexercise carbohydrate-rich, 80t

for recovery, 112, 112t skipping, 309 timing of, glycemic index and, 74t

medical conditions, listing on health history questionnaire, 266, 267f, 268

medical information disclosure form, 288, 288f

medications as ergogenic aids, 240, 240t fluid loss and, 219–220 listing on health history

questionnaire, 266, 267f, 268 medium-chain fatty acids (MCFAs), 94,

94f, 112 medium-chain triglycerides (MCTs), 111,

112, 347 for endurance athletes, 255t intake during exercise, 112 for strength/power athletes, 256t

MEDLINE, 247 MedWatch, 246t

megaloblastic anemia, 151, 152 Menkes syndrome, 199 messenger ribonucleic acid (mRNA), 39 metabolic factory, 44, 46f metabolic modulators, on WADA

prohibited substances list for 2016, 249t

metabolic pathways in aerobic breakdown

of fats, 52–54, 52f of proteins, 52–54, 52f

in anaerobic system, 50, 50t for carbohydrates, 75, 75f defined, 49

metabolic water, 212 metabolism, 41f

defined, 41 energy, 19 knowledge, importance of, 41 metabolic factory analogy and, 44, 46f

micelles, 34 micronutrients, 5, 254 milk, 61, 71 minerals, 178–206

absorption of, 40, 179 for adolescent athletes, 434–435 bioavailability of, 179 for child athletes, 434–435 content, on Nutrition Facts panel, 13 defined, 5–6 definition of, 179 dietary intake standards, vs. intake of

team sport athletes, 404–405 DRI values for, 180t for endurance athletes, 348–350, 349t functions of, 179, 204f high doses, in sports drinks, 229 intake, assessment of, 277 loss

during exercise, 227 major, 179–181, 190

calcium, 181–183, 183f chloride, 188 magnesium, 184–186, 186f phosphorus, 183–184, 184f potassium, 188–190 sodium, 187–188, 188f sulfur, 190

as nutritional ergogenic aids, 254 Nutrition Coach scenario, 178 role of, in sport performance, 179 for strength/power athletes, 380–382 for team sport athletes, 404–407

energy consumption and, 405–406 supplements, 406–407

toxicity, 179 trace, 179, 191, 205t

chromium, 196–197 copper, 199–200, 199f fluoride, 197–198, 198f iodine, 201, 202f iron, 191–195 manganese, 200–201, 200f molybdenum, 201–202 selenium, 202–203, 204f zinc, 195–196, 196f

transport of, 40 mitochondrion/mitochondria, 45f

as “aerobic powerhouses,” 52 defined, 45

mobile apps, weight management and, 312

molybdenum deficiency, complications of, 202 food sources and suggestion, 202 functions of, 202 importance for athletes, 201–202 RDA/AI for, 202 supplements, 202 toxicity, 202

monoglyceride, 32 monosaccharides

absorption of, 29 types of, 61, 62f

monounsaturated fats, intake, 101 monounsaturated fatty acid, 95, 95f Montmorency cherries, 339 “more,” as nutrient content claims, 18 multivitamin/mineral supplements

for endurance athletes, 255t for strength/power athletes, 256t, 382 whole foods vs., 406–407, 407t

muscle ATP in, 43 cramping, 227 wasting, in diabetes, 422

muscle cramps, magnesium deficiency and, 185

muscle dysmorphia, 320, 320t muscle glycogen, bonking or “hitting

the wall” and, 335 muscle mass, increase in

amino acids, ergogenic effect of, 377 calorie requirements for, 368–371, 372t Nutrition Coach scenario, 263 from resistance training, 322–323

muscular endurance, 331 myelin, 94 My Food Record, 274t myoglobin, 191 MyPlate food guidance system, 128

in assessing nutritional adequacy, 275, 275t

description of, 9–11, 9f , 10f empty calories in, 71 fats in, 104 resources for, 274t

N narcotics, on WADA prohibited

substances list for 2016, 250t National Athletic Trainers’ Association

(NATA), 217 National Center for Complementary

and Alternative Medicine, 246t National Collegiate Athletic Association

(NCAA), 246t, 313–314, 314f, 325 National Health and Nutrition

Examination Survey (NHANES), 218, 292

National Institutes of Health (NIH), 294, 296, 301, 310

National Institutes of Health: Dietary Supplement Label Database, 246t

512 Index

National Institutes of Health: Office of Dietary Supplements, 246t

National Osteoporosis Foundation, 182 National Resources Defense Council,

213 Natural Medicines Comprehensive

Database, 247t “natural” sports beverages, 229 negative energy balance, 302, 307 neural tube defects, folate and, health

claims on food labels and, 16 niacin, 348

deficiency, complications of, 146 DRIs, 143t food sources and suggestion, 147, 147f importance to athletes, 145–147 RDA/AI for, 146 supplements, 147 toxicity, 146

nickel, 205t nicotinamide adenine dinucleotide

(NAD), 51–52, 348 nicotinamide adenine dinucleotide

(NAD+), 145–146 nicotinamide adenine dinucleotide

phosphate (NADP), 348 night blindness, 159 nitric oxide boosters, for strength/power

athletes, 256t nitrogen balance, 123

negative, 123 positive, 123, 324

nondiabetic athletes, 425 nonessential (nutrients), 5 nonessential amino acids, 5, 118, 118t nonessential body fat, 296 nonessential fatty acids, 98 non-RD professionals, 459–460 nonverbal communication, 278 norepinephrine, 122 NSF international, 247t nucleus, 45 NutriBase, 274t nutrient content claims

defined, 11 FDA approved, 15–16 implied, 18–19 lean/extra lean, 18 for supplements, 243

nutrients. See also specific nutrients absorption of, 28, 28f basic, 4–6 essential, 5 ingestion of, 24–25, 25f, 26f macronutrients, 5 mechanisms of absorption, 30f micronutrients, 5 nonessential, 5 physical activity and, 6 roles of, 6

nutrition assessment

anthropometric data, 280 case study, 278–285, 279f Dietary Guidelines for Americans

and, 275–276 DRIs for, 274–275

energy intake assessment in, 276, 276t

exercise assessment, 280 food record review/analysis,

280–281 MyPlate food guidance system for,

275, 275t and education, 265–266 guidelines

Dietary Guidelines for Americans, 7–9, 8f

MyPlate food guidance system, 9–11, 9f , 10f

professionals, 266, 268 Nutritional ergogenic aids, 240–241 nutritional goals

determination of, 283–284 education related to, 280

nutrition consultation, 263–288 confidentiality of, 287–288, 288f dietary history, 24-hour dietary recall,

269, 270–271 exercise/training log for, 271, 272f follow-up process, 285–286 food records, 269–270, 270f importance of, 264 initial session

assessment stage of, 278–281, 279f clarifying reasons for consultation,

278 clinical assessments for, 272 establishing rapport for, 278 interview for, 278 physical space for, 278

Nutrition Coach scenario, 263 process

beginning of, 266 diet history in (See diet history)

readiness to change, assessment of, 281–283

short sessions, 286–287 summary and closure, 285 walk-in sessions, 286–287

Nutrition Facts label, for sports drinks, 229–230

Nutrition Facts panel, contents of, 12–14, 13f

Nutritionist Pro, 274t nutritionists

defined, 456 funtions, 456 licensure laws for, 265–266 vs. dietitians, 265

Nutrition Labeling and Education Act (NLEA), 11, 15

O Oatrim, 100, 100t obesity

BMI classifications for, 295, 295t health consequences and health risks

of, 293–294 identification, evaluation and

treatment, 294, 295 prevalence and significance of, 292–

294, 293f

octacosanol, 252t oils

fats in, 104, 104t intake, in MyPlate food guidance

system, 10 older adults, and protein needs, 126 Olestra (Olean), 100–101, 100t oligomenorrhea, 318 oligopeptides, 119 oligosaccharides, 27, 63 omega-3 fatty acids, 98, 102, 104 omega-6 fatty acids, 98, 102 omega-9 fatty acids, 98 oral cavity, 24 oral contraceptives, carbohydrate

loading and, 78 organelles, defined, 44 organosulfides, 171 ornithine, for team sport athletes, 257t osmolality

defined, 227 of fluid consumed during exercise,

227 osmolarity, 220 osteopenia, in female athlete triad, 318,

319 osteoporosis, 182, 187

calcium and, 16 in female athlete triad, 318, 318f, 319

outcome-oriented goal, 283 overhydration, signs of, 224 overtraining, 340 overweight

BMI classifications for, 295, 295t health consequences and health risks

of, 293–294 identification, evaluation and

treatment, 294, 295 prevalence and significance of, 292–

294, 293f

P pancreatic amylase, 28 pancreatic lipase, 34 pantothenic acid

deficiency, complications of, 154 DRIs, 143t food sources and suggestion, 154, 155f importance for athletes, 154 supplements, 154

parotid glands, 24–25, 25f passive diffusion, 29, 30f pellagra, 146 pepsin, 37 peptidases, 37 peptide bonds, 117 peptide hormones, on WADA prohibited

substances list for 2016, 249t percent body fat (%BF), 296 Percent Daily Value (%DV)

comparisons of, 13–14, 17f importance to athletes, 14–15 vs. percentage of calories from fat,

105–106, 106f percent fat free, as nutrient content

claims, 18

Index 513

performance body composition and, 301–302 carbohydrate intake and, 76 dietary fats and, 108–109, 109f effects of eating disorders on, 317 evaluation, for weight management

success, 311 fluid recommendations for team

sport athletes and, 408 protein intake prior to exercise and,

341–342 weight management and, 292

permission to disclose medical information, 287–288, 288f

pernicious anemia, 150 personalization, in MyPlate food

guidance system, 9, 9f pharmacological ergogenic aids, 240,

240t phenolic compounds, 170–171 phosphagen system

characteristics of, 46–47 in metabolic factory analogy, 44–45,

46f phosphatidylcholine, 98 3-phosphoadenosine-5-phosphosulfate

(PAPS), 190 phosphocreatine, 46 phospholipids

defined, 92 functions, 98–99 structure, 98, 99f

phosphorus, 183–184, 184f deficiency, complications of, 183–184 food sources and suggestion, 184, 184f functions of, 183 importance to athletes, 183 RDA/AI for, 183 supplements, 184 toxicity, 184

photosynthesis, 60–61, 60f physical activity. see also exercise

guidelines for Americans, 8–9 in MyPlate food guidance system,

10–11, 10f nutrients and, 6 for off-season weight loss, 310 for weight loss, 309–310

physiological ergogenic aids, 240, 240t phytochemicals, 170–173

defined, 67 definition of, 170 in foods, 170, 170t intake, increasing, 172, 172t–173t lycopene, 171–172 organosulfides, 171 phenolic compounds, 170–171

plant proteins, 120–121 plant stanols, 16, 99–100 plant sterols, 16, 99–100, 106 plus, as nutrient content claims, 18 polyols, 66 polypeptides, 119 polyphenolic tannins, 170 polysaccharides, 27, 63

dietary fiber as, 67 undigested, 29

polyunsaturated fats, intake, 101

polyunsaturated fatty acid, 95, 95f portion control, for weight loss, 307,

307t, 309 positive energy balance, 302, 323 postexercise hydration, role of, 233–235 potassium, 179

deficiency, complications of, 189 for endurance athletes, 350, 351f food source, 220, 222–223 food sources and suggestion, 189,

189f, 190 functions of, 189 health claims for, 16 importance for athletes, 188–190 loss

during exercise, 227 magnitude during exercise, 222–223

RDA/AI for, 189 in recovery beverage, 234 supplements, 190 toxicity, 189

power, 365 sports, 77

practical experience, registered dietitian, 460–461

preactivity meal, 134 precontemplation, in Transtheoretical

Model, 282 prediabetes, 422 preexercise, 78

blood glucose levels, 424, 424t carbohydrates intake and, 77–81, 80t

for endurance athletes, 337–338 fat intake, 111, 111t glucose guidelines, 424t hydration

guidelines for, 222 intake amounts, 220 types of fluids for, 220–222, 221f

meals, 78 high-fat, 111

protein consumption, 133–134, 134t pregnant athletes

caloric requirements, 427–428 iron requirements, 430, 431t magnesium requirements, 430 protein requirements, 428 special considerations, 427 vitamins for, 428–429

preparation, in Transtheoretical Model, 282

private consulting, sports nutrition jobs in, 461

process-oriented goal, 283 professional teams, sports nutrition

jobs in, 461 progressive dehydration, effects of, 215–

216, 216f prohormones, 251–252, 252t proteases, 37 protein, 116–137. See also amino acids

absorption of, 37–38 amino acids in, 38–39, 39f animal, 120 breakdown, aerobic, 52–54, 52f carbohydrate-rich sources, 80 with carbohydrates

after exercise, 84

for recovery from endurance activities, 343–344

classification of, 119 complementing, 120, 120f complete and incomplete, 119–121 content, on Nutrition Facts panel, 13 for daily training, 132–133 defined, 5 denaturation of, 36–37, 37f in diabetic diet, 424 digestion of, 35–40 as energy source, 5 fats content, 104, 104t in fluid replacement beverages, 228,

228t food group

carbohydrate-rich, 72, 73t food sources of, 127, 127t

dairy/alternative foods, 128, 128t fruit and vegetables, 127–128, 128t grains, 127, 128t oils and empty calories group,

128–129 protein foods groups, 128, 129t

functions of, 121–122, 121f glycemic index and, 74t high-protein diets, effects of, 126–127

dehydration, 126 on kidney function, 126 weight gain, 127

high-quality, 120 importance to athletes, 117 incomplete, 120 intake, 276

after exercise, 135–137 assessment of, 276 for athletes, 123–124 during endurance activities,

342–343 excessive, 126–127 during exercise, 134–135, 135f low dietary protein intake, 133 prior to training, 133–134 for recovery, 343–344

in MyPlate food guidance system, 9–10

needs/requirements, 123–126, 124t age and, 126 body weight and, 123–124 carbohydrate availability and, 125 desire to lose or gain weight and,

124–125 of endurance athletes, 340–344 endurance athletes and, 124 exercise intensity and duration and,

125 injury status and, 126 quality of dietary protein and, 125 for recovery from endurance

activities, 343–344 total energy intake and, 124 training status and, 125

nitrogen balance and, 123 Nutrition Coach scenario, 116 percentage of total calories from

protein, calculation of, 124 plant, 120–121 postexercise consumption, 135–137

514 Index

protein (Cont.) carbohydrate–protein combination,

136 quantity of protein, 136–137 timing of, 137 type of protein, 135–136

preexercise consumption, 133–134, 134t

benefits of, 133 ideal time, 134 type and quantity, 134

for pregnant athletes, 428 for strength/power athletes, 375–379

amino acids, ergogenic effect on muscle growth and development, 377

daily needs, 375–376 “optimal” daily dose of, 376 “optimal” food sources, 376, 377t for recovery, 378–379 before and during training sessions

and competitions, 377–378 structure of, 117–118, 117f–119f supplements, 129–132, 324, 325f

carbohydrate plus, 136 comparison of, 130t cost of, 131, 132t risks associated with, 132 and sport performance, 131–132 Supplement Facts label on products,

129, 131f use of, 129

for team sport athletes, 400–402 after exercise for recovery, 402 daily, calculation of, 400–401, 401t

tissue content, water and, 211 in vegetarian foods, 446–448 for weight gain, 324–325 weight loss

diet for athletes, 308 protein–muscle mass connection,

117 psychological ergogenic aids, 240,

240t public domain information

examples of, 265 on nutrition, 265

PubMed, 247t pyridoxal phosphate, 147 pyruvate

conversion to acetyl CoA, 50–51, 52f defined, 50–51 for endurance athletes, 255t

R Race Across America (RAAM)

diet for Team 70+, 70 Jack’s meal plan during, 358–359, 359t

radiation, for heat transfer, 212 rapport, establishing for nutritional

consultation, 278 reactive oxidative species (ROS), 168 rebound scurvy, 156–157 recipes

baseball barbeque sandwiches, 104t berry soy smoothie, 173t

black-eyed peas with Chinese greens, 154t

goalie guacamole, 103t poolside parfait, 183t roasted broccoli and cauliflower, 155t salmon pepper salad, 173t slow cooker navy bean soup, 154t summertime salad, 190t sunshine broccoli salad, 172t sweet potato fries, 201t Teriyaki chicken stir-fry, 186t volleyball veggie dip, 104t

Recommended Dietary Allowance (RDA), 142

defined, 6 in Dietary Reference Intake, 274–275 of vitamins/minerals, 277

recovery carbohydrate intake during, 338–340,

339t, 375, 400 carbohydrates intake for, 83–84, 84f,

85t fats intake for, 112, 112t, 348, 380,

403–404 fluid intake, guidelines for, 235 fluids for, 353 hydration status and, 233–235 products for, 234–235 protein needs for, 343–344, 378–379,

402 supplements for, 234–235

rectal temperature, dehydration and, 215f

rectum, 25, 27f red blood cell count, 191 “reduced,” as nutrient content claims,

18 red wine, 170 registered dietitian (RD)

board examination, 458 continuing education requirements,

458 curriculum requirements for

undergraduate degree, 456–457 defined, 456 educational requirements, 456–458 functions, 456 functions of, 265, 266 internships and experiences, 457–458 licensure, 266, 459–460 practical experience, 460–461 specialty board certification for, 459

registered dietitian nutritionist (RDN) defined, 456 functions, 456

regular exercise, 423 rehabilitation, and protein needs, 126 rehydration, 235 research

in gaining practical sports nutrition experience, 460

sports nutrition jobs in, 461 resistance training, 125

for weight gain, 322–323 restaurants, meal options, for team

sports athletes, 414–415, 414t resting energy expenditure (REE), 276,

276t

calculation, 276f for endurance athletes, 332, 332t for strength/power athletes, 366–367,

366t resting metabolic rate (RMR)

defined, 42 energy expenditure and, 303–304, 304t factors in, 304 vs. basal metabolic rate, 303

retinoids, 158. See also vitamin A retinol activity equivalent (RAE), 159,

159f rhodopsin, 158 riboflavin

deficiency, complications of, 144 DRIs, 143t food sources and suggestion, 145, 146f importance to athletes, 144–145 RDA/AI for, 144 supplements, 145 toxicity, 144

ribosomes, 39, 40, 45 “rich in,” as nutrient content claim, 18 rowers, 314, 350

S saccharin, 65t, 66 saliva, 27 salivary glands, 24–25, 25f satiation, 303 satiety, 303 saturated fats

calories from, 105 coronary artery disease and, health

claims for, 16 heart disease risk and, 17 intake, 103

saturated fatty acids defined, 95 intake, reduction of, 8

scurvy, 156, 157 secretin, 34 selenium

deficiency, complications of, 203 food sources and suggestion, 203, 204f functions of, 203 importance for athletes, 202–203 RDA/AI for, 203 supplements, 203 toxicity, 203

selenocysteine, 203 self-monitoring

of blood glucose levels, 423–424 of hydration status, 216–217, 216t, 218f

serum iron, 191 serum total iron binding capacity

(TIBC), 191 serving size, on Nutrition Facts panel,

12–13 servings per container, on Nutrition

Facts panel, 12–13 SGLUT1, 29, 31 short-chain fatty acids, 94–95, 94f silicon, 205t simple carbohydrates, 61, 61t, 229 Simplesse, 100, 100t

Index 515

simple sugars absorption into intestinal wall, 29–31 assimilation into body, 31, 32f as carbohydrate source, 72, 73t defined, 61 fructose, structure of, 61–62, 62f galactose, structure of, 61, 62f health and, 68 lactose, 62 in sports drinks, 227 sucrose, 62, 62t types of, 61–64

skinfold assessment, 299–300, 300f, 300t skinfold calipers, 299 small intestine

defined, 25 in digestive process, 25, 26f, 27f

snacks after exercise, examples, 85 high-quality options for, 385–386

social physique anxiety, 315 sodium, 179

content, on Nutrition Facts panel, 13 deficiency, complications of, 187 for endurance athletes, 255t, 350 food sources and suggestion, 187, 188f functions of, 187 hypertension and, health claims for,

16 importance for athletes, 187–188, 188f intake

during exercise, 226–227 recommendations for, 8 reduction of, 8

loss, magnitude during exercise, 222–223

RDA/AI for, 187 in recovery products, 234 serum levels, dilution of, 216 supplements, 188 toxicity, 187

sodium bicarbonate, 212, 255t buffering system, 212, 213f

soluble fiber, 64, 68 sorbitol, 65t, 66 soy, 120, 136 soy protein

coronary heart disease risk and, 16 health claims for, 16

special populations, 420–450 children, 431–435 college athletes, 435–440 defined, 421 diabetic athletes, 421–427 masters athletes, 440–443 Nutrition Coach scenario, 420 pregnant athletes, 427–431 teenagers, 431–435 vegetarian athletes, 443–450

speed-strength, 365 SportDiscus, 247 sport performance companies, sports

nutrition jobs in, 461 sports

beverages comparison of, 231t–232t for endurance athletes, 255t

body composition and, 301

overweight/obesity prevalence in, 292 performance

ATP during, 47–48 power, 77 weight classifications for, 292, 312–315

sports, cardiovascular, and wellness nutrition (SCAN), 462

sports anemia, 133, 193 sports drinks

benefits of, 228–230 carbohydrate content, 81, 82t energy drinks vs., 256 ergogenic effects, 244 for fluid replacement during exercise,

225–226 for hyponatremia prevention, 216 Nutrition Facts or Supplemental Facts

label, 229–230 for preexercise hydration, 80, 221–222 simple sugars in, 227 specialty formulas, 230

sports nutrition defined, 4 jobs in, 455–463

markets overview, 461–462 Nutrition Coach scenario, 455 registered dietitians, 456–458 websites, 462

knowledge, 4 plan, development of

food access and, 19–20 health history and, 17–20 living arrangements and, 19–20 sports bioenergetics/logistics and,

19 total weekly training/competition

time and, 19, 20f travel schedule and, 19–20

professionals active listening and, 20 experts, 4 as specialty area, 4 universal supplement policy, 246

table display, 287 sprinting, energy demand for, 48 starch

defined, 27 digestion to sugar, 63 structure of, 61, 61f

steady state exercise, 48 steatorrhea, 34 sterols

defined, 92, 99 plant, 99–100

stimulants in sports drinks, 229 on WADA prohibited substances list

for 2016, 250t stomach, 25

cramping, protein intake and, 343 strength, 365 strength/power athletes, 364–386

antioxidants for, 380–381 boron intake for, 380–381 calcium intake for, 381 calorie requirements, 366–372

daily needs, 366–368, 366t to gain muscle mass, 368–371, 372t

during training and competition, 371–372

for weight loss, 367–368 for weight maintenance, 368

carbohydrates for, 372–375 daily needs, 372–373 for recovery, 375 before and during training and

competition, 373–375, 374f chromium supplementation for, 381 defined, 365 energy systems utilized by, 365, 366f fats for, 379–380

daily needs, 379–380 for recovery, 380 before and during training sessions

and competitions, 380 fluid requirements, 382–385

during activities, 384 after training sessions and

competitive events, 385 issues regarding, 382–383 selection of fluids, 384–385 timing of consumption, 384–385

iron for, 381–382 magnesium supplementation for, 382 meal-planning/event logistics,

385–386 multivitamin/mineral

supplementation for, 382 Nutrition Coach scenario, 364 protein for, 375–379

amino acids, ergogenic effect on muscle growth and development, 377

daily needs, 375–376 “optimal” daily dose of, 376 “optimal” food sources, 376, 377t for recovery, 378–379 before and during training sessions

and competitions, 377–378 supplements for, 254–258, 256t,

380–382 vitamin and minerals for, 380–382 zinc for, 382

structure/function claims, for supplements, 243, 243f

sublingual glands, 24–25, 25f submandibular gland, 24–25, 25f sucralose, 65t, 66 sucrase, 29 sucrose

defined, 62 in fluid replacement beverages, 226

sugar alcohols, 66 sugars. See also specific types of sugar

content, on Nutrition Facts panel, 13 sweetness of, 65t

sulfite oxidase, 202 sulfur

deficiency, complications of, 190 food sources and suggestion, 190 functions of, 190 importance for athletes, 190 RDA/AI for, 190 supplements, 190 toxicity, 190

sunshine vitamin. See vitamin D

516 Index

superoxide dismutase, 199, 200 Supplement Facts label, 340 Supplement Facts panel, 229–230, 242,

242f supplements, 268

amino acids, 37–38 antioxidants, 168–169 biotin, 153 calcium, 182–183 chloride, 188 choline, 155 chromium, 197 cost of, 340 for endurance athletes, 254–258, 255t for endurance sports, 339–340 fluoride, 198 folate, 152 fortification of, 7 iodine, 201 iron, 194–195 listing in diet history, 266 magnesium, 186 manganese, 201 niacin, 147 pantothenic acid, 154 phosphorus, 184 potassium, 190 powder/bars, 252t, 256t protein, 129–132 for recovery, 234–235, 338–340 regulations on, 242–244, 242f, 243f riboflavin, 145 selenium, 203 sodium, 188 for strength/power athletes, 380–382 sulfur, 190 for team sport athletes, 406–407 thiamin, 144 universal, 246 vitamin A, 160 vitamin B6, 148–149 vitamin B12, 151 vitamin C, 156–157 vitamin E, 165 vitamin K, 166 for weight gain, 324–325, 325f zinc, 196

Supplements Watch, 247t sweat glands, 211 sweat/sweating

composition of, 226–227 rate, calculation of, 223–224

sweat trials determination, 384 individual, calculation of, 223–224 outdoor track, 384 weight room, 384

sweeteners, health claims on food labels and, 16

swimmers Nutrition Coach scenario, 330 precarbohydrate feeding and, 338

T tagatose, 65t, 66 tapering, 336

tea for preexercise hydration, 221

teaching/graduate assistantships, 460 team sport athletes, 392–415

carbohydrates for, 395–400 daily, calculation of, 397–398, 398t prior to team practice, 398–399, 399f for recovery, 400 during team sport activities, 399–

400, 399f defined, 393 energy requirements, 394–395

during an event, 395, 396t daily, calculation of, 394–395, 395t

energy systems utilized by, 393–394, 393f

fats for, 402–404 after exercise for recovery, 403–404 daily, calculation of, 402–403

fluid recommendations for, 407–410 dehydration prevention and,

408–410 performance and, 408

meal-planning/event logistics, 410–415

Nutrition Coach scenario, 392 protein for, 400–402

after exercise for recovery, 402 daily, calculation of, 400–401, 401t

supplements for, 255–258, 257t vitamins and minerals for, 404–407

dietary intake standards, 404–405 energy consumption and, 405–406 supplements, 406–407

team sport logistics , 410 team sports

defined, 393 teas, 171 technology, in weight management, 312 temperature

body rectal, dehydration and, 215f

clothing or exercising and, 212 environmental

altitude, hydration requirements and, 225

of fluids consumed during exercise, 228–229

termination, in Transtheoretical Model, 283

tetraiodothyronine (T4), 201 thermic effect of activity (TEA), 304–306 thermic effect of food, 134 thermic effect of food (TEF), 306 thiamin (vitamin B1)

deficiency, complications of, 144 DRIs, 143t food sources and suggestion, 144,

145f importance to athletes, 144, 145f RDA/AI for, 144 supplements, 144 toxicity, 144

thiamin pyrophosphate, 144 tocopherols, 164 tocotrienols, 164 Tolerable Upper Intake Level (UL), 6, 7t,

142, 274

total cholesterol, blood levels, 107 total fiber, defined, 64 toxicity

biotin, 153 calcium, 182 chloride, 188 choline, 155 chromium, 197 fluoride, 198, 198f folate, 152 iodine, 201 iron, 193–194 magnesium, 185 manganese, 200 niacin, 146 phosphorus, 184 potassium, 189 riboflavin, 144 selenium, 203 sodium, 187 sulfur, 190 thiamin, 144 vitamin A, 159 vitamin B6, 148 vitamin B12, 150 vitamin C, 156 vitamin E, 165 vitamin K, 166 zinc, 195–196

trace minerals, 179, 180t, 191, 203. See also minerals; specific mineral

arsenic, 205t boron, 205t chromium, 196–197 copper, 199–200, 199f fluoride, 197–198, 198f iodine, 201, 202f iron, 191–195 manganese, 200–201, 200f molybdenum, 201–202 nickel, 205t selenium, 202–203, 204f silicon, 205t trace, 205t vanadium, 205t zinc, 195–196, 196f

trainers, athletic nutritional education for athletes

and, 265–266 training

dietary fats and, 108–109, 109f and protein needs, 125, 132–133 stage, carbohydrate intake and,

70 of strength/power athletes

calorie requirements, 371–372 carbohydrates for, 373–375, 374f fats for, 380 fluids for, 385 protein for, 377–378

training/competition time, total weekly, in developing sports nutrition plan, 19, 20f

trans, defined, 97 transcription, 39 trans fats

heart disease risk and, 17 intake, 103

Index 517

trans fatty acids defined, 97 intake, 8 structure, 97–98, 97f

transfer ribonucleic acid (tRNA), 40 transferrin saturation, 191 translation, 40 Transtheoretical Model, 281–283 traveling

food recommendation for athletes while, 414–415, 414t

sports nutrition plan development and, 19–20

team sports athletes, restaurant options for, 412–415, 413t, 414t

triglycerides (triacylglycerols) defined, 31, 92 functions of, 93–94 structure of, 92–93, 93f

triiodothyronine (T3), 201 tripeptide, 119 tryptophan

suppression of central fatigue, 342, 343f

24-hour dietary recall defined, 269 utilization of, 270–271 for walk-in/short sessions, 286–287

type 1 diabetes, 422, 423 type 2 diabetes, 422, 423 tyrosine, 118

U ubiquinone. See Coenzyme Q 10 ultra-endurance athlete. see also

endurance athletes defined, 331 electrolyte needs of, 352–353

underwater weighing (UWW), 297–298, 297f

United States Anti-Doping Agency (USADA), 247, 247t

contact information, 247t defined, 247

United States Pharmacopeia, 247t United States Pharmacopeia (USP), 244,

245 universal supplements, 246 unsaturated fats, sources of, 103, 103t unsaturated fatty acid, 95 urine

color hydration status and, 216t, 217, 218f recovery fluid intake and, 233

glucose levels, self-monitoring of, 423–424

ketone levels, self-monitoring of, 424 specific gravity, hydration status and,

216t, 217 volume, hydration status and, 217

U.S. Department of Agriculture (USDA), 7

U.S. Department of Health and Human Services (HHS), 7

USDA Database for Standard Reference, 274t

V vanadium, 205t vanadyl sulfate, 252t vegetables

carbohydrate-rich, 71, 71t, 72t fats content, 103, 103t health claims for, 16 intake, 9

vegetables, protein in, 127–128, 128t vegetarian athletes, 443–450 vegetarian diets, 446–450 vegetarianism

defined, 443 types of, 444–446

very-low-density lipoprotein (VLDL), 108 vigilant assessment of water loss, 219 villi, 25 vitamin A, 142

as anti-infection vitamin, 159 deficiency, complications of, 159 DRIs, 143t food sources and suggestion, 159–160,

160f fortification of milk, 7, 94 importance for athletes, 158–160 for pregnant athletes, 429 RDA/AI for, 159 supplements, 160 toxicity, 159 and visual cycle, 158f

vitamin B, 142 for endurance athletes, 348, 349t for pregnant athletes, 428–429

vitamin B1. See thiamin vitamin B6

deficiency, complications of, 148 DRIs, 143t food sources and suggestion, 148,

149f importance to athletes, 147–149 RDA/AI for, 148 supplements, 148–149 toxicity, 148

vitamin B12 (cobalamin) absorption, 151 deficiency, complications of, 150 DRIs, 143t food sources and suggestion, 150, 150f importance to athletes, 149–151 RDA/AI for, 149 supplements, 151 toxicity, 150 in vegetarian foods, 449–450

vitamin C, 127–128, 142, 179 deficiency, complications of, 156 DRIs, 143t for endurance athletes, 348–349, 349t food sources and suggestion, 156, 157f and free radical damage, 168, 168f importance for athletes, 156–157 for pregnant athletes, 429 RDA/AI for, 156 supplements, 156–157 toxicity, 156

vitamin D, 71, 142, 161, 162f deficiency, complications of, 163 DRIs, 143t

food sources, 163, 164f fortified milk, 7, 94, 103

importance for athletes, 161–164 primary role of, 161 RDA/AI for, 163 serum concentrations and status, 163t supplements, 163–164 toxicity, 163 in vegetarian foods, 449

vitamin E, 168 as anti-aging vitamin, 164 as antioxidants, 164 deficiency, complications of, 165 for endurance athletes, 348–349, 349t food sources, 165, 165f importance for athletes, 164–165 RDA/AI for, 164–165 supplements, 165 toxicity, 165

vitamin K deficiency, complications of, 166 food sources, 166, 167f importance for athletes, 166 in large intestine, 40 RDA/AI for, 166 supplements, 166 toxicity, 166

vitamins, 141–173. See also specific types of vitamins

absorption of, 40, 94 for adolescent athletes, 434–435 antioxidant properties, 166–169 for child athletes, 434–435 classifications of, 142 content, on Nutrition Facts panel, 13 defined, 5 dietary intake standards, vs. intake of

team sport athletes, 404 DRIs for, 142, 143t for endurance athletes, 348–350, 349t as energy source, 5 fat-soluble, 142, 157–158

carotenoids, 160–161 vitamin A, 158–160, 158f, 159f, 160f vitamin D, 161–164, 162f, 163t, 164f vitamin E, 164–165, 165f vitamin K, 166, 167f

fortification program, 7 functions of, 142, 169f high doses, in sports drinks, 229 intake

assessment of, 277 as nutritional ergogenic aids, 254 Nutrition Coach scenario, 141 for pregnant athletes, 428–429 sport performance, role in, 142 for strength/power athletes, 380–382 for team sport athletes, 404–407

energy consumption and, 405–406 supplements, 406–407

transport of, 40 water-soluble, 40, 142, 144

biotin, 152–153 choline, 154–155, 154t folate, 151–152, 153f niacin, 145–147, 147f pantothenic acid, 154, 155f riboflavin, 144–145, 146f

518 Index

vitamins (Cont.) thiamin, 144, 145f vitamin B6, 147–149, 148f, 149f vitamin B12, 149–151 vitamin C, 156–157, 157f

volunteer work, 460

W waist circumference, 293, 295, 295t waist-to-hip circumference, 297 waist-to-hip ratio (WHR), 295 water, 210–235

absorption of, 25, 40 bottled, 212–213 defined, 6 extracellular, 211 fluoridated, 16 food sources, 219, 219f functions of, 6, 211–212, 211f, 213f intake

amount, during exercise, 223–225 daily, 218–219 for fluid losse, 219–220 preexercise, 220–222 recommendations, current, 218–219,

218t intracellular, 211 loss, 213–214, 214f

magnitude during exercise, 222–223 performance and, 222

metabolic, 212 needs/requirements, assessment for,

218–219, 218t Nutrition Coach scenario, 210 for recovery, 230, 233–235, 234t

amount of fluid for, 233 guidelines, 235 types of fluid for, 233–234

restriction, death from, 211 sources of, 6, 212–213 storage, fluctuations in, 211 transport of, 40

water balance defined, 214 poor, consequences of, 214–217, 215f,

215t, 216f, 216t, 218f water intoxication, 216 water-soluble vitamins, 142, 144, 157.

See also specific vitamin biotin, 152–153 choline, 154–155, 154t folate, 151–152, 153f niacin, 145–147, 147f pantothenic acid, 154, 155f riboflavin, 144–145, 146f thiamin, 144, 145f vitamin B6, 147–149, 148f, 149f

vitamin B12, 149–151 vitamin C, 156–157, 157f

weather, heat acclimatization, hydration requirements and, 225

weight, 291–325 BMI classifications for, 294–295, 294t body composition importance,

296–302 changes in athletes, 301, 302t concerns for athletes, 292 current, carbohydrate intake and, 69,

69t cutting, 312, 314 daily morning, hydration status and,

217 gain

achieving positive energy balance for, 323

calorie requirements for, 323 dietary practices for, 325, 325t dietary supplements, 324–325 during exercise, 224 positive nitrogen balance for, 324 requirements for, 322 resistance training for, 322–323 simple sugars and, 68 supplements for, 324–325, 325f

loss calorie requirements for strength/

power athletes, 367–368 dietary changes to, 307–309 eating disorders and, 315–322 energy needs, determination of, 307 during exercise, 223 exercise/physical activity and,

309–310 goals for, 306–307, 310–311 macronutrient composition of diet

and, 308 methods for athletes, 306–312 monitoring, 311 popular diet programs and, 313 portion control and, 307, 307t, 309 rate of, 306 recommendations for, 311–312, 312t in weight classification sports,

312–315 maintenance, 307 measurement of, 292 monitoring

by athletes, 301–302, 302t for weight loss, 311

Nutrition Coach scenario, 291 performance and, 292 pre- and postpractice, hydration

status and, 217 preexercise, hydration status and,

217t

status determination, 294–295 waist circumference, 294, 295, 295t

technology in management of, 312 wrestling and, 217

weight-class system, for sports, 292, 382 weight gain

high-protein diet and, 127 and protein needs, 124–125

weight loss calcium and, 181 and protein needs, 124–125

whey protein, 136, 253, 254t whole grains. See grains, whole Wilson’s disease, 199 wine intake, and cardiovascular disease,

170 women

athletes (See female athletes) pregnant (See pregnant athletes)

World Anti-Doping Agency (WADA) contact information, 247t defined, 247 prohibited substances list for 2016,

249t–250t World Health Organization (WHO)

body composition determination and, 296, 301

equation, 304t wrestling

body weight and, 217 fats requirements, 379 weight loss practices for, 313, 314, 314f

wrestling weight certification program (WWCP), 313, 314

X xylitol, 65t, 66

Y yohimbe, 253, 253t

Z zeaxanthin, 161 zinc

deficiency, complications of, 195 food sources and suggestion, 196, 196f functions of, 195 importance for athletes, 195–196 RDA/AI for, 195 for strength/power athletes, 382 supplements, 196 toxicity, 195–196 in vegetarian foods, 449

Index 519

Title Page
Copyright
Brief Contents
Contents
Preface
How to Use This Book
About The Authors
Acknowledgments
Section 1 The Basics of Sports Nutrition

Chapter 1 Introduction to Sports Nutrition

What is sports nutrition?
Why study sports nutrition?
What are the basic nutrients?

What are carbohydrates?
What are proteins?
What are fats?
What are vitamins?
What are minerals?
What is water?

How does the body produce energy?
What are the dietary reference intakes?
What are enriched and fortified foods?
What are the basic nutrition guidelines?

What are the Dietary Guidelines for Americans?
What is the MyPlate food guidance system?

How should athletes interpret the information on food labels?

Who created the food label regulations?
How can the ingredient list be useful to athletes?
How can the nutrition facts panel be useful to athletes?
How can the percent daily value be useful to athletes?
How can nutrient content claims be useful to athletes?
How can health claims be useful to athletes?

What are the factors to consider when developing an individualized sports nutrition plan for athletes?

Why should a sports nutrition plan consider an athlete’s health history?
Why should a sports nutrition plan consider a sport’s bioenergetics and logistics?
Why should a sports nutrition plan consider an athlete’s total weekly training and competition time?
Why should a sports nutrition plan consider an athlete’s living arrangements, access to food, and travel schedule?

How can sports nutrition knowledge be converted into practical applications?
Key Points of Chapter
Study Questions
References

Chapter 2 Nutrients: Ingestion to Energy Metabolism

What happens to nutrients after they are ingested?

What are the functions of the various parts of the digestive system?

How are carbohydrates digested, absorbed, transported, and assimilated in the body?

What happens to carbohydrates once they are put into the mouth?
How are the simple sugars absorbed into the intestinal wall?
What happens to carbohydrates once they make it into the blood?
What happens to carbohydrates once they make it to the cells of the body?

How are fats digested, absorbed, transported, and assimilated in the body?

What happens to fats once they are put into the mouth?
What happens to the fats once they are absorbed?
What happens to fats once they make it to the cells?

How are proteins digested, absorbed, transported, and assimilated in the body?

What happens to proteins once they are put into the mouth?
How are proteins absorbed into the intestinal wall?
What happens to amino acids once they make it to the bloodstream?
What happens to amino acids once they make it to the cells of the body?

How are minerals, vitamins, and water absorbed and transported in the body?
What is energy metabolism, and why is it important?
What is energy?
What is the human body’s source of chemical energy?
How do cells make ATP?
What are the three energy systems?

What are the characteristics of the phosphagen system?
What are the characteristics of the anaerobic and aerobic energy systems?

How do the energy systems work together to supply ATP during sport performance?
What metabolic pathways are involved with the energy systems?
Key Points of Chapter
Study Questions
References

Chapter 3 Carbohydrates

What’s the big deal about carbohydrates?
What are carbohydrates?
How are carbohydrates classified?

What are simple sugars?
What are complex carbohydrates?
Are artificial sweeteners carbohydrates? Are they beneficial or harmful?

What functions do carbohydrates serve in the body?
How can carbohydrates affect overall health?

What role does fiber play in health?
What role do simple sugars have in health?

How much carbohydrate should be consumed daily?

What is the relationship between current body weight and carbohydrate intake?
How can carbohydrate needs be determined based on a percentage of total calories?
What impact does the stage of training or competition schedule have on carbohydrate intake?

What are the various sources of dietary carbohydrates?

What are the best carbohydrate choices within the grains group?
What are the best carbohydrate choices within the fruit and vegetable groups?
What are the best carbohydrate choices within the dairy/alternative group?
What are the best carbohydrate choices within the protein foods group?
Can foods containing simple sugars or artificial sweeteners be used as a source of carbohydrates?

What are the glycemic index and glycemic load, and how can they be used in sports nutrition?

What is glycemic load?
How does the glycemic index relate to exercise?

How are carbohydrates utilized during exercise?

How much carbohydrate is stored within the body?
Why are carbohydrates an efficient fuel source?
Does carbohydrate intake enhance performance?
Does carbohydrate intake delay fatigue?

What type, how much, and when should carbohydrates be consumed before exercise?

What should an athlete eat on the days leading up to an important training session or competition?
What should an athlete eat in the hours leading up to an important training session or competition?

What type, how much, and when should carbohydrates be consumed during exercise?

What types of carbohydrates should be consumed during exercise or sport?
How much carbohydrate should be consumed during exercise or sport?
When should carbohydrates be consumed during exercise or sport?

What type, how much, and when should carbohydrates be consumed after exercise?

When should carbohydrates be consumed after exercise or sport?
What type of carbohydrates should be consumed after exercise or sport?
How much carbohydrate should be consumed after exercise or sport?
What are some examples of good meals/snacks for after exercising?

Key Points of Chapter
Study Questions
References
Additional Resources

Chapter 4 Fats

What’s the big deal about fats?
What are fats?
How are lipids (fats) classified?

What are triglycerides?
What is the molecular structure of a triglyceride?
What are some of the functions of triglycerides in the body?
What are fatty acids?
What are phospholipids?
What are sterols?
Is there such a thing as artificial fats?

How much fat is recommended in an athlete’s diet?

Can a diet be too low in fat?
Can a diet be too high in fat?

Which foods contain fat?

How much fat is in the grains group?
How much fat is in the fruit and vegetable groups?
How much fat is in the dairy/alternative group?
How much fat is in the protein foods group?
How much fat is in the oils?

How can the percentage of calories from fat be calculated for specific foods?
What’s the big deal about cholesterol?

What is dietary cholesterol, and which foods contain it?
How is blood cholesterol classified?

How can fats affect daily training and competitive performance?
What type, how much, and when should fats be consumed before exercise?

Is a single high-fat meal prior to exercise beneficial?
Is a short-term pattern of eating high-fat meals beneficial to exercise performance?
Is a long-term pattern of eating high-fat meals beneficial to exercise performance?
What are the recommendations for fat intake prior to exercise?

What type, how much, and when should fats be consumed during exercise?
What type, how much, and when should fats be consumed after exercise?
Key Points of Chapter
Study Questions
References
Additional Resources

Chapter 5 Proteins

Why is protein important to athletes?
What are proteins?

What is the difference between a “complete” and an “incomplete” protein?

What are the main functions of proteins in the body?
What is nitrogen balance?
How much protein should athletes consume daily?

How can protein requirements be calculated based on body weight?
How do various dietary and training factors affect protein recommendations?
Can too much protein be harmful?

Which foods contain protein?

Which foods in the grains group contain protein?
Which foods in the fruit and vegetable groups contain protein?
Which foods in the dairy/alternative group contain protein?
Which foods make up the protein foods group?
Do foods in the oils and empty calories group contain protein?

Are protein supplements beneficial?

What is the quantity of protein or amino acids in the product? Is the supplement necessary?
What is the cost of protein supplements?
Will protein supplements enhance performance?
Are there any risks associated with taking the supplement?

Why is protein essential for daily training?
What type, how much, and when should protein be consumed before exercise?

What type and how much protein should be consumed 4 to 24 hours prior to training or competition?
What type and how much protein should be consumed 1 to 4 hours prior to training or competition?

What type, how much, and when should protein be consumed during exercise?
What type, how much, and when should protein be consumed after exercise?

Which type of protein or amino acid source is most beneficial to consume after exercise?
Is there a recovery benefit of combining carbohydrates and proteins after exercise?
How much protein should be consumed after exercise?
When should protein or amino acids be consumed after exercise?

Key Points of Chapter
Study Questions
References
Additional Resources

Chapter 6 Vitamins

What’s the big deal about vitamins?
What are vitamins?
How are the dietary needs for vitamins represented?
What are the water-soluble vitamins?

Why is thiamin important to athletes?
Why is riboflavin important for athletes?
Why is niacin important for athletes?
Why is vitamin B6 important for athletes?
Why is vitamin B12 important for athletes?
Why is folate important for athletes?
Why is biotin important for athletes?
Why is pantothenic acid important for athletes?
Why is choline important for athletes?
Why is vitamin C important for athletes?

What are the fat-soluble vitamins?

Why is vitamin A important for athletes?
Why are the carotenoids important for athletes?
Why is vitamin D important for athletes?
Why is vitamin E important for athletes?
Why is vitamin K important for athletes?

Which vitamins or compounds have antioxidant properties?

What are free radicals?
What is the relationship between free radicals and exercise?
Do athletes need antioxidant supplements?

What are phytochemicals?

What are phenolic compounds?
What are organosulfides?
What is lycopene?
How can athletes increase phytochemical consumption through whole foods?

Key Points of Chapter
Study Questions
References
Additional Resource

Chapter 7 Minerals

What’s the big deal about minerals?
What are minerals?
What are the major minerals?

Why is calcium important for athletes?
Why is phosphorus important to athletes?
Why is magnesium important for athletes?
Why is sodium important for athletes?
Why is chloride important for athletes?
Why is potassium important for athletes?
Why is sulfur important for athletes?

What are the trace minerals?

Why is iron important for athletes?
Why is zinc important for athletes?
Why is chromium important for athletes?
Why is fluoride important for athletes?
Why is copper important for athletes?
Why is manganese important for athletes?
Why is iodine important for athletes?
Why is molybdenum important for athletes?
Why is selenium important for athletes?
Are other trace minerals important for athletes?

Key Points of Chapter
Study Questions
References
Additional Resources

Chapter 8 Water

What’s the big deal about water?

What are the functions of water in the body?
What are the sources of water?
What are the ways in which we lose body water?

What are the consequences of poor water balance?

Is it possible to overhydrate the body?
How can hydration status be monitored?

How much fluid do individuals need on a daily basis?

What are the current recommendations for daily fluid intake?
Can certain beverages, foods, or medications contribute to fluid losses?
What are some practical guidelines for consuming fluids on a daily basis?

What is the role of preexercise hydration?

How much fluid should be consumed before exercise?
What types of fluids should be consumed?
What are practical guidelines for consuming fluids before exercise?

What is the role of hydration during exercise?

What is the magnitude of water and electrolyte losses during exercise?
How much fluid should be consumed during exercise?
What types of fluids should be consumed during exercise?
What are some practical guidelines for consuming fluids during exercise?

What is the role of postexercise hydration?

How much fluid should be consumed?
What types of fluids should be consumed?
Are supplements beneficial after exercise?
What are some practical guidelines for consuming fluids after exercise?

Key Points of Chapter
Study Questions
References

Chapter 9 Nutritional Ergogenics

What is an ergogenic aid?
What are dietary supplements?

Why do athletes use dietary supplements?
What are the regulations governing dietary supplements?
Are some supplements better or safer than others?

Where can information on nutritional ergogenic aids be found?
What tools are available to research information on ergogenic aids?
What is doping?
What are some of the commonly encountered doping substances?

Which nutritional ergogenic aids are commonly used as anabolic agents, prohormones, and hormone releasers?
Which nutritional ergogenic aids are commonly used to reduce fat mass?
Which nutritional ergogenic aids are commonly used as anticatabolics?
Which vitamins and minerals are commonly used as nutritional ergogenic aids?

What types of dietary supplements and nutritional ergogenics are commonly used by endurance athletes, strength/power athletes, and team sport athletes?
Key Points of Chapter
Study Questions
References

Section 2 The Practical Application of Sports Nutrition

Chapter 10 Nutrition Consultation with Athletes

Why is nutrition consultation and communication with athletes important?
How much do athletes know about sports nutrition?
Who provides nutrition assessment and education to athletes?
How does the consultation process with athletes begin?
What is a diet history?

What is a health history questionnaire?
Why is an inquiry about supplement use important?
What type of food intake information should be obtained from the athlete?
How is an exercise/training log used in a nutrition consultation?
Which clinical assessments should be conducted in the initial consultation session?

How are food records analyzed?

How do you compare dietary intake to nutrition recommendations?

What are the steps for the initial consultation with the athlete?

How is rapport established with an athlete?
How can you determine the reasons for a requested consultation?
How is the nutrition assessment conducted?
How can an athlete’s readiness for change be assessed?
How can appropriate nutrition goals be established?
How can appropriate nutrition education be provided to an athlete?
How should a consultation be summarized and closed?

What are the steps for a follow-up consultation with the athlete?
What should walk-in or short sessions with athletes involve?
Are there any concerns about the confidentiality of the health, nutrition, and exercise information provided by the athlete?
Key Points of Chapter
Study Questions
References

Chapter 11 Weight Management

What are the common weight management concerns for athletes?
What are the prevalence and significance of overweight and obesity?

What are the main health consequences and health risks of overweight and obesity?

What methods are used to determine weight status?

What is body mass index?
What can measures of body fat distribution tell us?

Why is body composition important?

What makes up the composition of the body?
What are the methods for measuring body composition?
How does body composition affect sport performance?

What are the components of energy intake and energy expenditure?

What influences energy intake?
What are the components of energy expenditure?

What methods do athletes use to lose weight?

How are weight and body composition goals for athletes determined?
How are energy needs for weight loss determined?
What dietary changes are necessary for athletes to lose weight?
How do exercise and physical activity influence weight loss for athletes?
How does goal setting help athletes lose weight?
What are the summary recommendations for athletes regarding weight loss?

What are the weight loss issues for athletes in weight classification sports?
What happens when weight loss efforts develop into disordered eating patterns?

What are the different types of eating disorders?
What are the main concerns regarding female athletes and eating disturbances/disorders?
What are the main concerns regarding male athletes and eating disturbances/disorders?
What are the best treatment options for eating disorders?
How can eating disorders be prevented?

How can athletes gain weight healthfully?

What kind of resistance training program is best for gaining weight?
How can an athlete achieve a positive energy balance?
How can an athlete achieve a positive nitrogen balance?
Do athletes need dietary supplements to gain weight?
What other dietary practices might help an athlete gain weight?

Key Points of Chapter
Study Questions
References
Additional Resources

Chapter 12 Endurance and Ultra-Endurance Athletes

What is different about endurance athletes?
What energy systems are utilized during endurance exercise?
Are total energy needs for endurance athletes different from energy needs of other types of athletes?

How are daily energy needs calculated for endurance athletes?
How many calories should be consumed during endurance training or competition?
How many calories are required after a training session or competitive event?

Are macronutrient needs different for endurance athletes?
How important are carbohydrates to endurance athletes?

How are daily carbohydrate needs calculated for endurance athletes?
How should endurance athletes carbohydrate-load before competition?
Should carbohydrates be consumed in the hours or minutes prior to endurance activities?
Should the endurance athlete consume carbohydrates during endurance activities?
Is carbohydrate intake important during the recovery period after endurance training or competition?

Are protein needs different for endurance athletes?

How are daily protein needs calculated for endurance athletes?
What is the effect of consuming protein prior to endurance activities?
Should proteins be ingested during endurance activities?
Is protein needed for recovery from endurance exercise?

Should endurance athletes eat more fats to meet their energy needs?

How are daily fat needs calculated for endurance athletes?
Should fats be eaten while performing endurance activities?
Is fat needed for recovery from endurance exercise?

Are vitamin/mineral needs different for endurance athletes?

Why are the B vitamins important for endurance athletes?
Why are vitamins C and E important for endurance athletes?
Why is iron important for endurance athletes?
Why is calcium important for endurance athletes?
Why are sodium and potassium important for endurance athletes?

Why are fluids critical to endurance performance?

How are daily fluid needs calculated for endurance athletes?
How are fluid and electrolyte needs during endurance activities determined?

What meal planning/event logistics need to be considered during endurance events?

How can a nutrition plan be developed for sports that are not conducive to consuming foods or fluids while exercising?
How can a nutrition plan be developed for sports lasting 24 hours or longer?
How can a nutrition plan be developed for a multiday event that will be fully supported?
How can a meal plan be developed for a sport such as a long-distance triathlon that includes a nonconducive eating environment, a length of time spanning several meals, and race course support?

Key Points of Chapter
Study Questions
References
Additional Resources

Chapter 13 Strength/Power Athletes

What is different about strength/power athletes?
What energy systems are utilized during strength/power exercise?
Are the calorie needs of strength/power athletes different from those of other types of athletes?

How are daily calorie needs calculated for strength/power athletes?
How are calorie needs calculated during strength/power training and competition?

Are carbohydrate needs different for strength/power athletes?

How are daily carbohydrate needs calculated for strength/power athletes?
Are carbohydrates needed before and during training and competition?
Are carbohydrates needed for recovery from strength/power activities?

Are protein needs different for strength/power athletes?

How are daily protein needs calculated for strength/power athletes?
Do individual amino acids have an ergogenic effect on muscle growth and development?
Is protein needed before and during training sessions and competitions?
Is protein needed for recovery from strength/power activities?

Are fat needs different for strength/power athletes?

How are daily fat needs calculated for strength/power athletes?
Are fats needed before and during training sessions and competitions?
Is fat needed for recovery from strength/power activities?

Are vitamin and mineral needs different for strength/power athletes?

Do strength/power athletes need to supplement with antioxidant vitamins?
Should strength/power athletes supplement boron intake?
Should strength/power athletes be concerned about calcium intake?
Is chromium supplementation important for strength/power athletes?
Should strength/power athletes worry about iron?
Is magnesium supplementation important for strength/power athletes?
Why is zinc important for strength/power athletes?
Is multivitamin/mineral supplementation necessary for strength/power athletes?

Are fluid needs different for strength/power athletes?

What issues are of concern regarding the fluid intake of strength/power athletes?
How are fluid needs during strength/power activities determined?
What should athletes drink and when should they drink it?
How much fluid should strength/power athletes drink after training sessions and competitive events?

What meal-planning/event logistics need to be considered during strength/power events?

What are high-quality options for snacks between events at meets?
What are high-quality options for snacks after competition?

Key Points of Chapter
Study Questions
References
Additional Resources

Chapter 14 Team Sport Athletes

What is different about athletes in team sports?
What energy systems are utilized during team sports?
How are energy needs different for team sport athletes?

How are daily energy needs calculated for team sport athletes?
How can energy needs during an event be calculated?

Are carbohydrate needs different for team sport athletes?

How are daily carbohydrate needs calculated for team sport athletes?
What is the effect of carbohydrate consumption prior to team sport activities?
Is carbohydrate intake required during team sport activities?
Is carbohydrate intake needed for recovery from team sport activities?

Are protein needs different for team sport athletes?

How are daily protein needs calculated for team sport athletes?
Is protein recommended after exercise for recovery?

Are fat needs different for team sport athletes?

How are daily fat needs calculated for team sport athletes?
Is fat recommended after exercise for recovery?

Are vitamin and mineral needs different for team sport athletes?

How does vitamin intake of team sport athletes compare to the dietary intake standards?
How does mineral intake of team sport athletes compare to the dietary intake standards?
How does energy consumption affect vitamin and mineral intake?
Are vitamin and mineral supplements recommended for team sport athletes?

What are the fluid recommendations for team sport athletes?

Why are fluids critical to team sport performance?
How can dehydration be prevented in team athletes?

What meal-planning/event logistics need to be considered during team sport events?

Should food be consumed during an event?
What should athletes consume between games and at tournaments?
Which foods are recommended for athletes while traveling?

Key Points of Chapter
Study Questions
References
Additional Resources

Chapter 15 Special Populations

What is a “special population”?
What are the special considerations for athletes with diabetes?

What are the main types of diabetes?
What are the considerations related to exercise for athletes with diabetes?
How can athletes manage their diabetes and excel in sports?

What are the special considerations for athletes who are pregnant?

How are an athlete’s caloric requirements affected by pregnancy?
How are an athlete’s protein requirements affected by pregnancy?
How are an athlete’s B vitamin requirements affected by pregnancy?
How are an athlete’s vitamin C requirements affected by pregnancy?
How are an athlete’s vitamin A requirements affected by pregnancy?
How are an athlete’s magnesium requirements affected by pregnancy?
How are an athlete’s iron requirements affected by pregnancy?

What are the special considerations for child and teen athletes?

How does nutrition affect growth and maturation in the child or teen athlete?
Are fluid needs for young athletes different from those of adult athletes?
Do young athletes require higher vitamin and mineral intake?

What are the special considerations for college athletes?

Are college athletes’ energy needs higher than their precollege needs?
What are practical tips for the implementation of a college athlete’s meal plan?
How does alcohol consumption affect college athletes’ nutrition?

What are the special considerations for masters athletes?

How do the nutrient needs of masters athletes change?
How does the presence of chronic disease affect nutrient needs of masters athletes?

What are the special considerations for vegetarian athletes?

What are the various types of vegetarianism?
Which vegetarian foods are rich in protein?
Which vegetarian foods are rich in iron?
Which vegetarian foods are rich in zinc?
Which vegetarian foods are rich in calcium and vitamin D?
Which vegetarian foods are rich in vitamin B12?

Key Points of Chapter
Study Questions
References
Additional Resources

Chapter 16 Jobs in Sports Nutrition

Why should you consider becoming a registered dietitian?
What are the steps to becoming a registered dietitian?

What are the curriculum requirements for an undergraduate degree in dietetics?
Do individuals need a graduate degree to be a sports dietitian?
What do the dietetic internships entail, and how does the experience relate to becoming a dietitian?
How is the board exam taken, and what topic areas are covered?

Is continuing education required once the RD credential is obtained?
What is the Board Certified as a Specialist in Sports Dietetics credential?
Is licensure necessary for registered dietitians?

What if you are not an RD and don’t have a license—can you still give nutrition advice to athletes?

How can students and professionals obtain practical experience in the field of sports nutrition?
What are the potential job markets in sports nutrition?
Key Points of Chapter
Study Questions
References

Appendix A You Are the Nutrition Coach—Answers
Appendix B The Gastrointestinal Tract
Appendix C Major Metabolic Pathways
Appendix D Calculations and Conversions
Appendix E Growth and Body Mass Index Charts
Appendix F Dietary Reference Intakes
Glossary
Index