Fueling Systems The Cross Over Concept Phosphagen System (ATP - PDF document

3/1/2019 Outline Fueling the Athlete: the role • Fueling Systems Review of the Sports RD • Nutrient Timing • Making Weight Laura Moretti, MS, RD, CSSD, LDN • Energy Availability (EA) and Relative Energy Deficiency Nicole Farnsworth, MS, RD, LDN in Sport (RED-S) • Disordered Eating/Eating Disorders in Athletes Division of Sports Medicine Boston Children’s Hospital • Concerning Dietary Trends in Athletes Female Athlete Program 1 2 Sports nutrition is the practical science of hydrating and fueling before, during, and after exercise. THE ENERGY SYSTEMS & FUELING Fueling Systems The Cross Over Concept • Phosphagen System (ATP – PCr) – fast, powerful, short burst • 6-10 secs stored energy • Vertical Jump, Sprints, Olympic Lifting • Anaerobic Glycolysis – moderate power/moderate duration • 1-3 mins w/o oxygen, >60mins with oxygen • Moderate glycogen stores required • 50 m swimming, basketball, 200-400 m sprinting • Aerobic Glycolysis – low power/long duration • Heavy reliance on glycogen and FA (when low intensity) • Distance running, cycling, swimming • Low to moderate intensity CHO & lipids play major role • Relative aerobic power (60%-65%) CHO become increasingly more important • Better trained athletes can stay in the aerobic/fat training zone longer 6 1

3/1/2019 Carbohydrates Determining Protein Needs • Enables athletes to exercise • Protein: 10-35% longer and harder • Non-athlete: 0.8 g/kg • Strength Athlete: 1.6-2.0 g/kg • Recommendation: • Endurance Athlete: 1.2-1.4 g/kg – 30-60g CHO/hour (120-240cal) • Medium to High GI – Gels, Gatorade Fat Metabolism Athletes and Fat Intake • Endurance • 20-35% of total energy intake • >90 minutes • Very low fat diets ( less than 19 % fat) not • 65-75% VO2 max recommended! • Fat oxidation • Triad, RED-S • High intensity exercise • 70-80 VO2 max • Carbohydrate oxidation • Training • Improves fatty acid oxidation Building a Powerful Plate The Athlete’s Plate Step 1: Animal Sources Step 3: Slow-Digesting Salmon Yogurt Protein-Rich Tuna Greek yogurt Carbohydrates Halibut Low-fat Foods Cod cottage Oatmeal Shrimp cheese Cream of Wheat Chicken Tenderloin Whole grain (WG) Breast Pork loin Dry Cereals Lean Turkey Filet WG Bagels Breast Sirloin WG Sandwich Bread Eggs Rolls, and buns Milk Brown Rice Soy milk Peanut butter Sunflower seeds Multigrain Pasta Almonds Hummus Whole wheat Couscous Pecans Beans Corn or whole wheat Peanuts Soy products Tortillas Walnuts (tofu) Potatoes Sweet Potatoes • Add two servings Bananas Peaches Broccoli Romaine of calcium/vitamin Apples Cherries Green Mushrooms Oranges Berries peppers Carrots D rich foods daily Grapes Mangos Red peppers Cauliflower Step 2: Grapefruit Tangerines Green Beans Snap Peas Pineapple Dried Fruit Zucchini V-8 Juice Fruits + Fruit Juice Squash • Add healthy fat to Spinach Vegetables Field Greens each meal 2

3/1/2019 Energy Needs Example Macronutrients by Sport Calculations 19 year old female open weight collegiate rower. Sport CHO g/kg/d PRO g/kg/d Trains 2-3 hours per day and lifts twice weekly. Ht: Baseball 3-5 1.2-1.7 175 cm. Weight: 68kg. Looking to maintain weight. Basketball >5, 7-12 during vigorous training/competition 1.4-1.7 Figure Skating 3-7 1.2-1.7 68 x 6 = 408 g carbs/day = 1632 kcals (60%) Football >5, 7-12 during vigorous training, position specific 1.4-1.7 Gymnastics 3-7 1.2-1.7 68 x 1.5 = 102 g protein/day = 408 kcals (15%) Ice Hockey >5, 8-10 during training and competition 1.4-1.7 Rowing 5-7 1.2-1.7 68 x 1 = 68 g fat/day = 612 kcals (23%) Soccer >5, 7-12 during vigorous training/competition 1.4-1.7 Swimming 7-12 1.2-1.7 Total daily calories = 2652 How does it Compare? Harris Benedict Equation: 1533 (RMR) x 1.725 (Activity factor) = 2,644 kcals NUTRIENT TIMING 2652 vs 2644 !! 15 16 Pre-Activity Post-Activity • Consumption of 10-20 grams of protein • 1 ½ hours before • The Recovery Window • low-fiber, and low fat • 4:1 ratio • carbohydrate/protein • Carbohydrate : Protein • Will leave the stomach and intestine more quickly • Restoration of muscle and liver glycogen stores • 1.5g CHO/kg immediately after exercise • 1.5g CHO/kg 2 hours later 17 18 3

3/1/2019 Pre-Post Workout Fueling Pre-Workout Post- Workout Mainly Carbs Carb + Protein • • Granola Bar Chocolate Milk • • Yogurt and Fruit Banana & PB/AB • • Fruit and Yogurt/Milk Banana + Pretzels Smoothie • Apple Sauce and Nuts • Graham Crackers and • Pretzels and Nuts PB/AB • Low Fiber Dry cereal • Yogurt with Granola • Sports Drinks • Turkey Sandwich (1/2 or • Energy Chews LET’S TALK WEIGHT… whole) 20 Weight Management & Making Race/Competition Weight (24-48h) Training • Low residue diet • Take it SLOW (0.5 – 1 lb/week) • Decreased fiber • Rapid weight loss (>1 kg/week) = water, glycogen, muscle • Conservative decrease in energy intake • Safe fluid restriction • Never during winter training • Note: performance deficit at • Short period of time • After recovery from last session of day water loss equaling 2% body weight • Carbohydrate • Rehydration immediately after • Kept high; protein-sparing weigh in • Protein • Weigh: once a week, first thing in • Slight increase or no change AM “You need to find a Balance” Energy Availability & the Athlete Calories Consumed - Training Calories ________________ Energy Availability Are RDs asking enough questions to support prevention of injury and promotion of long-term health? 23 4

3/1/2019 RED-S Relative Energy Deficiency in Sport The Female Athlete Triad Health Consequences Nattiv A, et al. Med Sci Sports Exerc. 2007 Oct;39(10):1867-82. De Souza MJ, et al. Br J Sports Med. 2014 Feb;48(4):289. Mountjoy M, et al. Br J Sports Med, 2014 26 RED-S Relative Energy Deficiency in Sport Signs/Symptoms of Low EA Potential Performance Consequences Mountjoy M, et al. Br J Sports Med, 2014 27 28 RED-S at BCH Sports Med Assessing EA/RED-S • Survey of 1000 females presenting to sports • Predictive Equations medicine clinic (ages 15-30, >= 4 hrs/wk of exercise) – Harris Benedict • Self Report of DE/ED, BEDA-Q, ESP – Mifflin St-Jeor • 84.5% response rate • Positive answers as surrogates for LOW • Bone Density/Body EA/RED-S Composition Testing 47.3% – DXA – Bod Pod Ackerman KE, et al . Br J Sports Med 2018 29 30 5

3/1/2019 Disordered Eating (DE) and Eating DXA Disorders (EDs) in Athletes • Body fat % on results can be misleading • Prevalence of DE/EDs is higher – Includes fat on ear lobes, among athletes than non-athletes bottom of feet – Higher risk in female than male athletes – Higher risk among athletes in leanness sports • 46% of elite females in leanness • ‘Spiderman’ sports and 20% in non-leanness – Low in essential body fat sports struggle with clinical eating – Body composition shift to disorder support bone health and menstrual function Smolak L, et al. Int J Eat Disord, 2000. Torveit et al 31 Similarities between Good Athlete Common Obstacles for Athletes Traits and Anorexia Characteristics • Not eating enough GOOD ATHLETE PERSON WITH • Not drinking enough ANOREXIA NERVOSA • Skipping meals Mental Toughness Asceticism • Missing out on recovery nutrition Commitment to training Excessive exercise • Uninformed vegetarianism Pursuit of excellence Perfectionism • An obsession with scale/body image Coachability Overcompliance • Unsafe dieting Unselfishness Selflessness • Unhealthy relationship with food Performance despite pain Denial of discomfort Thompson RA and Sherman RT. Eating Disorders: J Treat and Prev, 1999. Incorporating Exercise in ED RD’s Approach Treatment • All Athletes: • Allowing an athlete to remain on • Performance goals his/her athletic team and • Injury prevention participate at any level deemed • Education on basic fueling concepts appropriate helps to maintain • Meal/Snack Timing the athlete identity and self esteem • ED/DE Athlete: • Food exposure therapy • Food legalization  no “good foods” or “bad foods” • Helps athlete learn how to fuel • Pre/post/during fueling for sport while still in treatment • Balance out calories and output  adjust as needed Sherman R, Thompson R. Professional Psychology Research and Practice, 2001. Cook B, et al. Med Sci Sports Exerc, 2016 Feb 24. [Epub ahead of print] 36 6

3/1/2019 GLUTEN FREE: THE FACTS CONCERNING DIETARY TRENDS IN ATHLETES 38 37 Gluten What it is (we all know this): • Protein found in wheat, barley, and rye • Gives dough an elastic texture What it is not (what athletes may think it is): • The magic bullet for: – Weight loss – Athletic performance Novak Djokovic Drew Brees – ALL GI issues 39 40 Why Are Athletes Going Other GI effects Gluten Free? • GI distress is reported in 30-50% of endurance • Performance enhancement athletes • Non celiac gluten intolerance or celiac disease • This can be attributed to: – Psychological factors, splanchnic hypoperfusion, • Decrease inflammation dehydration, fiber, carbohydrate type, or timing of nutrient intake • Weight loss/body comp optimization • GI distress* (number one reason) Bottom line: Eliminating gluten may not be the solution! • Because ________ athlete went GF! Arranz E , OmniaScience 2015 41 42 7