Energy Deficiency, Supplements, and Nutrient Timing BY: STEPHANIE HORVATH, MS, MAED, RDN, CSSD, LDN DIRECTOR OF SPORTS NUTRITION UNIVERSITY OF TENNESSEE
Energy Deficiency, Supplements, and Nutrient TimingBY : STEPHANIE HORVATH , MS , MAED , RDN , CSSD , LDNDIRECTOR OF SPORTS NUTR IT ION UNIVERS ITY OF TENNESSEE
My Background
School Work
Indiana Notre Dame
Kent State Illinois
Virginia Tech Tennessee
Position statementPosition Statement, updated in 2016
Key Words: Evidence-Based Analysis
A Joint Effort from: • Academy of Nutrition and Dietetics • Dietitians of Canada• American College of Sports Medicine
Training VS. Competition Goals
In Training: Adapt the body to develop metabolic efficiency and flexibility
In Competition: nutrition strategies focus on providing adequate substrate stores to meet the fuel demands of the event & support cognitive function
Athletes get this confused—sometimes do something “special” for competition, because it will give them an “edge” when in reality,
Competition should be like training◦ May need a little more carbohydrates to handle nerves◦ More protein if it will be a multi-event day
◦ (swimming, track, baseball, softball)
Special Cases
Fatigue, Loss of Appetite, Cramping
Type 1 DM
Eating Disorders/Disordered Eating
Stress Fractures
Energy Availability
Energy intake in relation to the energy cost of exercise
EA has been defined as the amount of ingested energy remaining for bodily function and physiological processes such as growth, immune function, locomotion, and thermoregulation after the energy required for exercise/training has been removed
From the ACSM Female Athlete Triad Position Statement
How is it calculated?
Energy Availability
Calculate by:
Subtracting energy expenditure during
exercise from energy intake adjusted for fat-
free mass
Energy availability=
Energy intake- Exercise energy expenditure/fat-
free mass (kg)
Energy availability thresholds:
An energy availability if at least (45 kcal)/kg fat-free mass/day is recommended to maintain
adequate energy for all physiological functions
Reduced or sub-clinical energy availability ranges from 125-188 kJ (30-45 kcal)/kg fat-free mass/day. This is suggested as a tolerable range for athletes
aiming for weight-loss as a part of a well-
constructed dietary and exercise regimen over a short time period.
Low energy availability is defined as less than 125 kJ (30 kcal)/kg fat-free mass/day and suggest an unsafe energy level for optimal body function;
this, in turn, may lead to unfavorable health outcomes and sports performance.
Example Calculation of EA
• 60 KG BODY WEIGHT (BW), 20% BODY FAT, 80% BODY FAT
• (=48.0 KG FFM), EI=2,400 KCAL/DAY, ADDITIONAL ENERGY EXPENDITURE FROM EXERCISE = 500 KCAL/DAY
• EA=(EI-EEE)/FFM=(2,400-500) KCAL-D/48.0 KG=39.6 KCAL/KG FFM/DAY
• DECREASED EA BELOW 30 KCAL/KG IS ASSOCIATED WITH PERTURBATION OF REPRODUCTIVE FUNCTION AND BONE METABOLISM
Low Energy Availability, Defined
LEA occurs when an individual has insufficient energy to support normal physiological function after the cost of energy expended during exercise has been removed
Your body starts to adapt it’s physiological systems to compensate
for lowered calorie intake (or higher
calorie expenditure)
Mountjoy M, Sundgot-Borgen J, Burke L, et al. The IOC consensus statement: beyond the Female Athlete Triad-Relative Energy Deficiency in Sport (RED-S). Br J Sports Med. 2014;48(7):491-7.
“Scientific evidence and clinical experience around the effects of low energy availability shows that several body systems in addition to the reproductive and musculoskeletal systems are affected, and that men are at risk as well as women.”
What Does Low Energy Availability Impact?Relative Energy
Deficiency in Sport = RED-S
The syndrome of RED-S refers to impaired physiological functioning
caused by relative energy deficiency and includes but is not limited to impairments of metabolic rate,
menstrual function, bone health, immunity, protein synthesis and
cardiovascular health1.
Can impact male athletes, too!
LEA, Low Energy Availability
Can occur intentionally or unintentionally
Regardless of etiology…
macro- and micro-nutrient deficiencies
unfavorable physiological changes
harmful health outcomes
suboptimal sports performance
LEA is Difficult to Assess
Low Energy Availability Is Difficult to Assess but Outcomes Have Large Impact on Bone Injury Rates in Elite Distance Athletes.
Int J Sport Nutr Exerc Metab. 2018 Jul 1;28(4):403-411. doi: 10.1123/ijsnem.2017-0313. Epub 2018 Jun 12. DOI:10.1123/ijsnem.2017-0313
Summary: Based on cross-sectional analysis, current reproductive function (questionnaires/blood hormone concentrations) appears to provide a more objective and accurate marker of optimal energy for health than the more error-prone and time-consuming dietary and training estimation of EA.
What EA calculations lack
Although the negative effects of low EA on hormonal function are robustly detected in controlled laboratory settings, our study clearly demonstrates that the real-world measurement of EA, via dietary and exercise recording is challenging and lacking in sensitivity as a diagnostic tool for the presence of low EA.
Even thought an EA assessment has appeal as apparently low-cost, low-technology, and a noninvasive text, in reality, it carries a large burden in terms of athlete compliance and practitioner time.
Insights on Practical Applications
Colleague:
"Finding your sweet spot"
I have a checklist of physical/mental symptoms for the athlete to be more aware if possibly their energy balance is off
We tend to get caught on the numbers when the symptoms tell the story.
Diet Culture
Fight Diet Culture Every Day
Especially prone to misinformation, marketing
They want to perform well, thus compromising their ability to decipher what is good and bad
Especially adhere to the personal testimonial approach
Fad Diets
Often, way too low in carbohydrate (trendy)
Remember the position statement has high performance athletes at 50-60% of their diet from carbohydrates◦ Ex: 4000 kcals ◦ 2000-2400 kcals from CHO◦ How many grams of carbohydrates? 500-600g PER DAY◦ Don’t shy away from them
Paleo, Whole-30 Diet
Cuts food groups entirely
Not scientifically proven to be a better diet than a high-performance diet
Good points: focus on vegetables, whole-foods
Bad points: cut dairy, grains (B-vitamins, riboflavin, niacin, fiber, calcium, etc)
Steer athletes away from these diets
Liquid Cleanses
Far too low in calories
Not good during any of the training phases
Extremely low in fiber, nutrients (no grains, dairy)
Quick fix for a long-term, larger problem
Why To Steer Athletes Away from TRENDY DIETS
Be weary of any diets that cut food group
As the professional, you MUST focus on evidence-based analysis, peer-reviewed information
Any diets That cut food groups in an effort to cut calories or create a calorie deficit—is not helpful for athletes Competing
All Foods Fit
Fueled vs. Under-fueled
Calories and injury-prevention
Having a little more on board seems to be better than less
RED-S◦ Men and Women Affected ◦ Stress-Fractures, Mental Fatigue, Bone Health Disruptions
IOC Consensus Statement: Dietary Supplements and the High Performance Athlete
Published on March 14th, 2018
Highlights
There is no single definition, either legal or within nutritional science, of what constitutes a dietary supplement
“A Food, food component, nutrient, or non-food compound” that is purposefully ingested in addition to the habitually consumed diet with the aim of achieving a specific health and/or performance benefit.
IOC Consensus statementPrevalence of, and rationale for, use by athletes
Assessing the evidence base for supplement use ◦ The effectiveness of sports foods might be hard to isolate when they are
used within the general diet to meet everyday energy needs and nutrient targets
Supplements used to prevent or treat nutrient deficiencies, used to provide a practical form of energy and nutrients, and that indirectly or directly improve sports performance
Adverse affects
Contaminants due to manufacturing practices ◦ Metal, Lead, Broken Glass
Failure to address what in their supplement would be an adverse affect ◦ Number of Hospitalizations, but some less severe
Small prohibited substance, ineffective dose for performance, causes positive drug test ◦ The IRONY!
Supplements
Help athletes see/realize the cost-to-benefit ratio
They are of greatest value when added to a well-chosen eating plan
Example, even sport “foods” like sports drinks, sport bars, sports gels, protein supplements, etc. the cost is than whole foods, and may be used unnecessarily or in inappropriate protocols
“Typical Day”What is typical?
Busy schedules: with academic strain, group projects, balancing a social life, film/video, supplemental workouts, recovery time, lifts, rehab/preventative injury training
However, we try to encourage athletes to get on an eating schedule as much as possible
SOLID NUTRITION IS ABOUT TIMING!
Macronutrients
Carbohydrates
ProteinFat
• To a certain extent, any three of the energy-producing nutrients, carbohydrates, fat, and protein can provide the body with needed energy on a short-term basis.
• However, our goal is to provide energy in the most efficient form for the body.
All three are needed, and important in the
diets of high performance athletes
Eating Schedule #1 Swimmer• Whole-grain Cereal & Milk, banana, plenty of water5:00am
• Practice starts, hydrate before and during. Practice ends around 8:30-Recover in locker room with Chocolate Milk or Protein Shake6:30am
• Breakfast in Dining Hall: Veggie Omelet w/ Cheese, Whole Grain Toast, Fresh Fruit w/Berries, Water9:00am
• Subway: Large Grilled Chicken Sub with Veggies, Olive Oil, Lettuce, Tomato, etc
12:00pm
• Trail Mix/String Cheese & Fruit/Apple and Peanut Butter/Greek Yogurt2:30pm
• 2nd Practice, End with recovery again3:00pm
• Training Table: Citrus Grilled Salmon, Wild Rice, Parmesan Asparagus, Spinach Salad, Fruit, Water/Milk
6:30pm
8:30pm • Pre-bed Snack: Homemade trail mix, ½ sandwich, or light snack like popcorn
Important Points
Eat every 2-3 hours- very important to recovery: Recovery in anabolic window-eat within 30 minutes THEN 2 hours later have another meal/snack
Significant body composition improvements seen in breakfast eaters who haven’t eaten breakfast in the past
◦ Show they are leaner, motivates them to keep a healthy habit going
Eating Schedule #2 Baseball Athlete • Breakfast @ Smokey’s: Omelets, eggs, bacon, English muffins,
oatmeal, cereal, grits, fresh fruit 8:30am
• Snack: Beef jerky or Protein bar10:00am• Lunch w/ Team Grilled BBQ Chicken, rice, steamed broccoli, Greek
yogurt and fruit, Gatorade and water12:30pm
• Film/Meet in Team Room1:15pm
• Batting practice, practice grab Clif Bar2:30pm
• Recovery RTD, snacks from fueling station 4:45pm
• Chipotle Burrito Bowl with Brown Rice, Chicken & Steak, Cheese, Black Beans, Veggies, Lettuce, and Guacamole5:30pm
•Bowl of Cereal in Dorm Room, Weight shake to maintain weight (Peanut Butter, Extra Protein Powder w/ Carbs, Milk, and Greek Yogurt)8:30pm
Training Table MenusSalad Bar
◦ Cottage Cheese◦ Lettuce ◦ Lots of Toppings
Proteins:◦ Peppered Flank Steak◦ Lemon-Crusted Tilapia◦ Honey BBQ Chicken◦ Roasted Garlic Pork Loin
Starches:◦ Sweet Potato Mash◦ Baked Potato◦ Brown Rice
Vegetables: ◦ Mixed Veggies◦ Broccoli◦ Green Beans
Desserts (Yogurt or Pudding Parfait Bar):◦ Low Fat Pudding (Chocolate or Vanilla)◦ Low Fat Yogurt (Vanilla or Blueberry)◦ Greek Yogurt◦ Fruit: Strawberries, Pineapple, Cantaloupe◦ Cookies, Brownies
Nutrient TimingThe right snack, at the right time,
can aid an athlete in the right way.
What is the most time-consuming part of nutrient timing?
Developing, planning, and implementing the plan
CompetitionIt is typical for athletes to “all of a sudden” pay attention to their nutrition right before a competition or game
Don’t be that athlete
Superstitions are one thing. Trying something completely new and different is another. ◦ WORST possible time to experiment with new foods ◦ Why? If you don’t tolerate something well- your food is hurting instead of helping you!
Nutrition Prior to TrainingTrial and Error
◦ Unfortunately, there isn’t a whole lot of room for “error”◦ Better than testing the waters before a game/race/competition/match/meet
It’s a guessing game, what works for one may not work for the other
Depends on the training session◦ Time of Day◦ Aerobic/Anaerobic (Cardio or Weight Training Session)◦ Intensity ◦ Duration
Your Body & YouKnowing your body
It is the only way to know what is going to be the best and work the best for you
For some, it is hard to eat (fill-in-the-blank) “in the morning” or “before workouts”
For others it is easy and they face no troubles at all
Routine, routine, routine
Suggested Pre-Training FoodsCereal and Milk
◦ Can be easily digested◦ Watch for what dairy does to your system◦ Stick with skim milk (low-fat)
Pretzels
Fruit w/high water content/Applesauce
Dried Fruits/Fruit Cups in their own juice ◦ Digests easily for some, high carbohydrate content
Foods to Avoid Prior to TrainingFoods high in fiber
◦ Raw Vegetables (Ex: Carrot Sticks)◦ Fiber One Bars
Spicy/Acidic Foods ◦ Hot/Peppered Food
Pure Protein (Whey, Beef Jerky, etc)◦ May or may not tolerate well ◦ Harder for your body to break down
Dairy? ◦ Some can, some can’t
Trail Mix/Peanuts/Too Much Peanut Butter◦ High in both fat (healthy fat) and fiber◦ Difficult for your system to breakdown
Foods you have aversions to, or anything you haven’t tolerated
well in the past.
Eating while training Arguably one of the best times to be fueling
Physical AND Mental edge
Literally can make or break a marathon, triathlon, ironman, ultra-marathons
Easier if you have a halftime, a break in play/timeouts, or “heats” in races
Personal PreferenceFueling during competition or training will come down to personal preference
Often easier to start with liquids
Sometimes you will find you need something “heavier” if the intensity of the workout is known beforehand, or if under fueling took place during the day
Start with GatoradeNever ate or drank during practice before?
Gatorade is a good first step
Easily digestible, electrolytes, carbohydrates
Absorbed easily, and can be taken on the fly
Typically, fairly available where ever you go/travel
Experiment on your ownAlways good to experiment when doing workouts/training on your own
Summer, breaks from school, extra “supplemental” workouts
Practice may or may not be the best time
Doesn’t have to be big to be great5 pretzels
½ of a banana
8oz of Gatorade (3-4 sips)
.9oz package of 100% fruit Snacks (Welch’s or Mott’s)
Good things come in small
packages
RecoveryPlanning is key
30 minute window- what are you typically doing in the 30 minute window?◦ Talking as a team? Stretching? Showering? Running to class?
Where can you go, what can you pack?
Maximizing the Recovery Window 30 minute window and 2 hour window
2 hour window--- ideally recovering with whole grain/complex carbohydrates, fruits/vegetables, low-fat dairy &/or animal protein or with a balanced protein-containing meal
Once you master the 30 minute window timing, think about when and where you will fuel 2-3 hours later
Quick Recovery Options Chocolate Milk
◦ Tons of Research ◦ Natural Source of Protein and Carbohydrates ◦ Casein and Whey Protein Source
Greek Yogurt Protein BarFruit and Nut Butter/Jerky/String CheeseCereal and Milk
DOES NOT HAVE TO BE THE SAME THING EVERYTIMEVariety is actually good for your body
Recovery is Mental and Physical Take the time to fuel and refuel your body properly
Try to MINDFULLY eat
Try not to rush through meals, try not to study and eat a meal (doesn’t mean you can’t eat while studying, but take 20 minutes to eat a meal)
Eat with your friends!
Not One Size Fits AllIt can be easy to paint a broad brush stroke
Examine, observe, think, use clinical judgment
The more I see, the less I know◦ Each case is Particularly Unique
Nutrition Pillars
All Good things Take Time
Nutrition & Behavior
Is environment stronger than willpower?
Quick & Convenient culture
Sometimes nourishing yourself takes time
Self-care, not self-control
Intuitive Eating
Hunger/fullness scale
Appetite vs. Hunger◦ Implications with sleep
Some Thoughts to keep in mind
Nutrition is an art as well as a science- we do not eat in a vacuum
Strive for Strong Plates, not perfection
Savor your food
References
Position of the Academy of nutrition and Dietetics, Dietitians of Canada, and the American College of Sports Medicine: Nutritionand Athletic Performance. J Acad Nutr Diet. 2016;116:501-528.
Maughan RJ, Burke LM, Dvorak J, et Al. IOC consensus Statement: Dietary Supplements and the high performance athlete. Br J Sp Med 2018; 0:1-17.
Nattiv A, loucks ab, manore mm, et al. American College of Sports Medicine Position Stand. The Female athlete Triad. Med Sci Sports Exerc. 2007;10:1867-82.
• Mountjoy M, Sundgot-Borgen J, Burke L, et al. The IOC consensus statement: beyond the Female Athlete Triad-Relative
Energy Deficiency in Sport (RED-S). Br J Sports Med. 2014;48(7):491-7.