Signs and Symptoms of an Eating Disorder

April 7, 2025April 4, 2025 by amystephens

signs and symptoms of an eating disorder

TW: This content includes references to eating disorders and body image, which may be a sensitive topic to some readers.

Eating disorders can show up in many different ways, making them difficult to recognize at times. There’s a common belief that you have to fit a specific mold or experience every symptom for an eating disorder to be “real.” This can cause people to downplay their struggles, thinking, “I don’t look a certain way,” or “I’m not xx weight, so it doesn’t count.” But the truth is, eating disorders can affect anyone, regardless of appearance or specific symptoms.

Social media also influences how eating disorders are perceived. While some accounts help raise awareness and normalize conversations, they can also create a narrow picture of what an eating disorder looks like. This might make someone question their own experience if it doesn’t match what they see online—whether in terms of appearance, behaviors, or eating patterns. But the truth is, eating disorders don’t look the same for everyone, and every struggle is valid.

When it comes to sports nutrition, eating disorder symptoms can be a little harder to spot because certain behaviors—like meal planning and intense training—are often seen as part of being an athlete. But there’s a fine line between dedication and disordered habits. Here are some common signs that might indicate an issue:

Obsession with “clean” eating or only sticking to “healthy” foods.
Restricting food groups that you once enjoyed.
Comparing your body to those of your competitors, teammates, or online influencers.
Skipping meals or eating less than your energy needs require in order to stay light.
Constantly thinking about food, training, or your body weight/image.
Avoiding social situations that involve food.
Viewing training as a way to “burn off” or “earn” food. Food should be seen as fuel for your performance—not something you have to work for or make up for.

Here are some symptoms that results from having an eating disorder or underfueling in general:

Frequent fatigue, injuries, illnesses, or slow recovery.
Loss of menstrual cycle (for female athletes).
Decreased libido (for male athletes).
Decreased concentration.
Low heart rate (can often be mistaken for fitness).
Decreased strength and power.
Inconsistent energy.
Dizziness.
Hypothermia.
Sleep disturbances or waking up hungry in the middle of the night.

If any of these symptoms resonate with you, there are plenty of ways to assess whether you might need extra support or professional help. One great tool is the Eating Disorders Screen for Athletes (EDSA), which helps gauge the likelihood of an eating disorder—you can check it out here. Another great screening tool is the SCOFF questionnaire.

The SCOFF questions*

Do you make yourself Sick because you feel uncomfortably full?

Do you worry you have lost Control over how much you eat?

Have you recently lost more than One stone in a 3 month period?

Do you believe yourself to be Fat when others say you are too thin?

Would you say that Food dominates your life?

*One point for every “yes”; a score of ≥2 indicates a likely case of anorexia nervosa or bulimia

Keep in mind, you don’t need to experience every symptom for it to be a concern. Even one or two signs are worth paying attention to. Recognizing an eating disorder early is key to getting the right support, as both short-term and long-term effects can impact your health and performance.

If you or someone you know is struggling with an eating disorder, there are several trusted places to turn for help, depending on your needs and location. Talk with your healthcare provider, physician, therapist, or dietitian that specializes in eating disorders. In the US, you can also call or text the National Eating Disorder Association (NEDA) helpline at 1-800-931-2237.

References

Morgan J F, Reid F, Lacey J H. The SCOFF questionnaire: assessment of a new screening tool for eating disorders BMJ 1999; 319 :1467 doi:10.1136/bmj.319.7223.1467.

National Eating Disorders Association. (n.d.). Coaches & trainers: What you need to know. National Eating Disorders Association. https://www.nationaleatingdisorders.org/coaches-trainers

Eating Disorders Screen for Athletes. (n.d.). EDSA screening tool. https://sites.google.com/view/edsa-screening-tool/

Logue, D. M., Madigan, S. M., Delahunt, E., Heinen, M., Mc Donnell, S. J., Corish, C. A., & Warrington, G. D. (2022). Low energy availability in athletes: A review of prevalence, impact, and assessment. International Journal of Sport Nutrition and Exercise Metabolism, 32(4), 317–329. https://doi.org/10.1123/ijsnem.2022-0033

DIY Electrolyte Drink

March 26, 2025March 25, 2025 by amystephens

DIY electrolyte drink

Here are a couple of DIY electrolyte drinks that are favorites among the NYU Track and Field team:

Makes 1 Liter of Electrolyte Drink

Turmeric Ginger

Ingredients:

4 cups brewed Turmeric Ginger tea
4 tbsp table sugar
1 tsp Himalayan salt
Juice of 1 lemon

Alternative Herbal Tea Options: Raspberry, peach, mango, or mint (preferably decaffeinated).

Directions:

Bring 4 cups of water to a boil and steep 4 tea bags for about 5 minutes.
Dissolve the Himalayan salt and 4 tbsp sugar, stirring until fully dissolved.
Let the mixture cool and add the juice of 1 lemon or lime.
Combine the ingredients in a pitcher or insulated hydration bottle with ice.

Nutrition (per 8 oz serving): 550 mg sodium, 17g carbs, 60 calories.

Lemon & Lime

Ingredients:

4 cups water
4 tbsp table sugar
1 tsp Himalayan salt
Juice of 1 lemon
Juice of 1 lime

Directions:

Dissolve sugar and salt in warm water.
Add the freshly squeezed lemon and lime juice.
Combine the ingredients in a pitcher or insulated hydration bottle with ice.

Nutrition (per 8 oz serving): 550 mg sodium, 17g carbs, 60 calories.

How to prevent GI issues in runners

March 10, 2025March 6, 2025 by amystephens

How to prevent gi issues in runners

We all know far too well that gastrointestinal issues can derail a training run or race physically and mentally. Cramping, bloating, and diarrhea can quickly worsen dehydration and become very painful or even debilitating. In this post, I outline some easy strategies to help you feel better and improve performance when facing GI issues. By following these nutrition strategies, one can improve symptoms and performance as a whole.

GI issues can happen before, during, or after a run and can rapidly cause dehydration and electrolyte imbalance. If GI issues are not addressed, they can lead to underfueling, cramping, and poor performance. Underfueling will eventually lead to hitting the wall, or even dropping out of a race altogether.

Why do GI issues happen with some athletes?

There are a few reasons for GI issues in runners.

As you run, the stomach and gut are literally being shaken, and this makes it difficult for your body to digest foods.
Running also requires the body to divert blood flow away from the gut to supply oxygen rich blood to the working muscles. This process makes it very difficult for the body to digest food and run at the same time.
Eating too much right before a run can cause GI discomfort. Stick to easily digestible foods like toast with jelly about an hour before running. Most people need 3-4 hours to digest a meal and 1-2 hours for a snack, so timing is key for optimal performance.
Feeling nervous can also cause GI issues. Nervousness is something I’ve experienced myself during track workouts! Typically, if I dive a bit further into how an athlete feels before a race or track workout, feelings of nervousness usually surface. Breathing and mental exercises can help soothe an athlete’s nerves. Similar to running, feeling nervous takes blood supply away from the gut and diverts it to the nervous system to cope with stress (elevated heart rate, sweat, increased blood supply to brain, etc.).

Nutrition strategies to prevent GI issues:

It’s important for athletes to ensure they’re hydrated before heading out for a run. When exercising, the blood is shunted to working muscles and away from the gut causing a lower blood volume. Ultimately, any food or sports beverage you consume during a workout may cause GI distress.

1. Time meals so you finish eating at least one hour before running. Work with a sports dietitian to time your food so it’s digested by the time you start exercising.

2. Hydrate by drinking 10-20 oz of water one hour before a run and 2-4 oz every 15 min for runs lasting one hour or longer. You might need to do a sweat test to see how much water your body loses. Take note that you lose more water when exercising in hot, humid, dry, and high altitude.

3. Experiment with different foods to find what works best for your body.

4. Foods – Include bland foods such as, rice, bananas, oatmeal, dry toast, or potatoes before your run. Another dietary strategy is called Low Fodmap which has been shown to help with GI symptoms. I’ll write more about this and how to follow in a separate post.

Quick tips:

Eat at least one hour before running
10-20 oz of water before, then 2-4 oz every 15 min (depending on heat, humidity, altitude)
Limit caffeine or switch to tea
Limit spicy foods, high-fat foods, high-fiber foods (beans or lentils) or dairy.

Try these gu’s, gels, and chews during your run because they are made with fewer processed ingredients. Instead of maltodextrin, they use monosaccharides like glucose and fructose which are easier for the body to digest. They are best tolerated with a gulp of water.

Try these Gels, Gu’s or chews

Gels/Gu’s

Honey stinger – website

Untapped energy gels – website

Huma energy gels – website

Energy chews are great because you can ingest them at a slower rate. This allows your gut to work more slowly and not cause GI issues. For best results, you may take a few at a time.

Liquid sports drinks such as Skratch or Maurten can be helpful because they are hydrating and can be taken in a small amount at a time. When using, be careful not to overwhelm the gut by ingesting too much too fast.

You can also ask your doctor about the over the counter medication called imodium.

References

Gibson PR, et al. Other dietary confounders: FODMAPS. Dig Dis. 2015;33(2):269–276.

Lis DM. Exit Gluten-Free and Enter Low FODMAPs: A Novel Dietary Strategy to Reduce Gastrointestinal Symptoms in Athletes. Sports Med. 2019 Feb;49(Suppl 1):87-97.

O’Keeffe M, Lomer MC. Who should deliver the low FODMAP diet and what educational methods are optimal: a review. J Gastroenterol Hepatol. 2017;32(Suppl 1):23–26.

Staudacher HM, et al. Comparison of symptom response following advice for a diet low in fermentable carbohydrates (FODMAPs) versus standard dietary advice in patients with irritable bowel syndrome. J Hum Nutr Diet. 2011 Oct;24(5):487-95.

BEST foods to eat after a workout – tips from the Martin Coaching Team

January 30, 2025January 23, 2025 by amystephens

BEST foods to eat after a workout - tips from the Martin Coaching Team

Foods consumed after a workout will impact recovery and sports performance.

We asked the Martin coaching team about which foods they eat after a workout and it was no surprise that we received great responses instantly. At the elite level, nutrition is dialed in and the athletes know which foods to grab after a tough workout to promote recovery. We created this post to highlight the importance of refueling and provide some great options from the pros.

How exercise affects energy stores

During a workout or run, the body breaks down glycogen into usable energy to supply working muscles. As the workout progresses, glycogen stores become depleted and muscle tissue further breaks down. Once exercise stops, the body will absorb nutrients to start the recovery process (Burke). If nutrients are not available, recovery after a workout can take longer. This can be a problem if you are training again the next day or later that same day.

Food is the best recovery tool

Nutrition can promote faster recovery. Eating the right amount of food immediately after a workout will restore muscle and liver glycogen which is essential for recovery between training sessions or competitive events. Recovery foods are especially important for athletes who work out or compete multiple times per day, as they have limited time for recovery. Carbohydrates and a small amount of protein are necessary to kickstart recovery.

Glycogen window: carbs and protein

Take advantage of the glycogen window by consuming adequate carbohydrates and protein within the first hour of a workout. During this time, the muscles are primed to absorb nutrients at a faster rate, then slows. Aim for about 100 grams carb ( 1-1.2 g/kg) and 20-30 grams protein post exercise to maximize glycogen resynthesis (Burke). For example, a 150 pound person could eat a bagel with peanut butter and a fruit smoothie.

These numbers are estimates, your body might require more or less food based on the intensity of the workout and how you feel. Recovery will continue over the next few hours but at a slower rate.

Include high glycemic foods such as honey, syrup or carbohydrate-rich beverages to maximize glycogen uptake for athletes who have limited recovery time between workouts (Donaldson).

Post-workout nausea

If solid foods are not tolerated after a workout, take small bites from bland foods like crackers, dry toast or cold beverages such as a sports drink, until your appetite improves.

Martin Coaching staff’s favorite recovery foods

Ravenna

I love a loaded smoothie! Go to recipe: plain Greek yogurt, a little honey, blueberries, fist of spinach, tbsp of nut butter (partial to Stoke), banana and frozen mango. Plenty of protein to replenish stores and easy on the stomach.

Brendan and Aubrey Martin

Breakfast burrito with kale, eggs, vegan cheese, whole wheat tortilla, and hot sauce! Carbs + protein + sodium.

Protein knockout from Juice Generation and everything bagel with tofutti.

Tortilla with hummus, “micro greens” or baby spinach + ranch dressing.

Johannes Motschmann

Fruit
Vegan chocolate protein shake powder with oat milk and bananas. (Within 15 minutes of finishing the workout).

Maurten Solid Bar and regular soda. The consumption of sugar in conjunction with exercise will accelerate glycogen repletion (Kerksick).

Occasionally:  2L of Fanta from a nearby bodega after a 20 miler along the Hudson in the summer

Johannes Motschmann during the World Athletics Marathon. Budapest, Hungry 2023 Photo: @uyberlin

Luciano Fiore

Two bananas 🍌 after every run and recently been loving MacroBars post run. Especially if the weight-room is soon to follow. Bananas provide the most versatile fruit in the game and an extra 12 grams plant-based protein boost from the macro bar.

On colder days, Fiore likes oats with chunky peanut butter (Brands - Santa Cruz Peanut butter or Once Again if I’ve got some spending cash) cocoa nibs, cinnamon, banana and honey.

Usually eat half. Leave the second half in my passenger seat. And rationalize eating it after training because of the mandatory metabolic window.

Liam Dee

Like Luciano, I’ve been double-batch cooking my oats so that I can have some pre and post run. Usually, I’ll add honey, milk, raisins, banana and chia seeds for extra texture and omega-3.

If I’m in the mood for something more lunch-forward, I love Hummus sandwiches on a nice Portuguese roll loaded with greens, cucumber and cherry tomatoes and topped with chips and a bit of spicy honey if I have it! More recently I have acquired a rice-cooker which means I can set that going before an evening jog and can quickly stir-fry some veg and tofu and be eating a proper meal in 15 minutes post-run.

Of late, I have been fiendishly eating bananas out of sheer practicality, but my go-to quick satiating snack is yoghurt with cherries or frozen fruit and honey, and some kind of cereal topping.

Amy Stephens, Sports Dietitian

My favorite food after a workout is avocado toast with a hard boiled egg and red pepper. Avocado provides a great source of healthy fats and eggs provide high quality protein with all essential amino acids.

Some additional recovery food options include:

Granola, yogurt and fruit
Peanut butter, honey and banana sandwich on whole-wheat bread
Chocolate milk
Fruit smoothie made with banana, strawberries, mango, and milk.
Sports beverage containing carbohydrate and protein – Skratch Horchata
Turkey sandwich on whole wheat bread
Peanut butter on crackers
Dried fruit and nuts
Graham crackers and yogurt
Peanut butter and apple slices

References

Burke LM, Hawley JA, Wong SH, Jeukendrup AE. Carbohydrates for training and competition. J Sports Sci. 2011;29 Suppl 1:S17-27. doi: 10.1080/02640414.2011.585473. Epub 2011 Jun 9. PMID: 21660838.

Burke LM, Kiens B, Ivy JL. Carbohydrates and fat for training and recovery. J Sports Sci. 2004 Jan;22(1):15-30. doi: 10.1080/0264041031000140527. PMID: 14971430.

Burke L and Deakin V. Clinical Sports Nutrition, Third Edition.

Donaldson CM, Perry TL, Rose MC. Glycemic index and endurance performance. Int J Sport Nutr Exerc Metab. 2010 Apr;20(2):154-65. doi: 10.1123/ijsnem.20.2.154. Erratum in: Int J Sport Nutr Exerc Metab. 2011 Jun;21(3):262-4. PMID: 20479489.

Kerksick CM, Arent S, Schoenfeld BJ, Stout JR, Campbell B, Wilborn CD, Taylor L, Kalman D, Smith-Ryan AE, Kreider RB, Willoughby D, Arciero PJ, VanDusseldorp TA, Ormsbee MJ, Wildman R, Greenwood M, Ziegenfuss TN, Aragon AA, Antonio J. International society of sports nutrition position stand: nutrient timing. J Int Soc Sports Nutr. 2017 Aug 29;14:33. doi: 10.1186/s12970-017-0189-4. PMID: 28919842; PMCID: PMC5596471.

HOW TO USE GELS FOR ENDURANCE ATHLETES

February 6, 2025January 9, 2025 by amystephens

How to Use Gels for Endurance Athletes

Gels are a compact and convenient way to deliver easily digestible carbohydrates during endurance sports like running, cycling, swimming, or triathlons. They provide quick energy to fuel your performance and help you maintain steady energy levels throughout your activity. Here’s a breakdown of the key factors to consider when selecting the best gels for your events.

During exercise, your body relies on glycogen, the stored form of carbohydrate, as a primary fuel source. After glycogen stores are depleted, your body requires additional carbohydrate fuel from gels. Here’s why gels are essential:

Prevent “Hitting the Wall”:

Your glycogen stores provide enough energy for about 90 minutes of continuous exercise.

After glycogen is depleted, you experience a significant drop in energy levels, often referred to as “hitting the wall.”

Sustain Energy Levels:

Gels provide a quick source of easily digestible carbohydrates to replenish glycogen stores and maintain steady energy.

Delay Fatigue:

By keeping your energy supply consistent, gels help delay the onset of fatigue, allowing you to maintain a steady pace during long endurance events.

Improve Performance:

A steady carbohydrate intake ensures your body has the fuel it needs for both physical and mental performance, crucial for sustaining endurance activities like marathons, triathlons, or open-water swims.

Differences Between Gels

Carbohydrate Content

Most gels contain 20–40 grams of carbohydrates, usually a mix of fructose and glucose (dextrin) for quick absorption and energy delivery.

Natural gels (e.g., maple syrup or honey) provide the same sugars from natural sources.

Rapid Absorption

The combination of fructose and glucose ensures faster energy uptake, helping sustain energy during prolonged exercise.

Easily Digestible

Gels bypass the slow digestion of solid foods, reducing the risk of gastrointestinal (GI) issues like nausea or bloating.

Electrolytes

Gels vary in their electrolyte content (sodium, potassium, magnesium, calcium), which are crucial for energy generation, blood pressure regulation, and muscle function.

Sodium is the most critical, as it is lost in the greatest amounts through sweat.

Always check labels to ensure the gel meets your electrolyte replacement needs.

Taste

Available in a wide range of flavors, from fruity to savory.

Testing different flavors can prevent palate fatigue during long events.

Texture

Gels vary in texture:

Aqueous (easier to swallow).

Thick, honey-like (requires more effort to ingest).

Jell-o-like (a unique option for those who prefer a different consistency).

Some newer gels are hydrated, eliminating the need to drink water when consuming them.

Additional products include chews and sports drinks that deliver carbohydrate in a different form.

Caffeine Content

Caffeine enhances performance by reducing perceived exertion and delaying fatigue.

Gels may contain up to 100 mg of caffeine per serving.

Recommended daily caffeine intake for performance is 3–5 mg/kg body weight.

Excessive caffeine can cause GI issues, shakiness, or heart palpitations, so it’s essential to read labels and track your intake.

Cost

Prices range from $1.50 to $4.50 per gel.

Frequent use during training and racing can add up over time. Consider budgeting for your endurance events.

Tips for Choosing the Right Gel

Match the carbohydrate and electrolyte content to your event’s duration and intensity.

Test different flavors and textures during training to find what works best.

Monitor your total caffeine intake if using caffeinated gels.

Why Are Gels Better Than Food During Exercise?

During exercise, blood flow is redirected from the digestive system to working muscles and lungs, making it harder to digest solid foods. Gels provide an advantage because:

They require minimal digestion, allowing energy to be absorbed and used quickly.
Solid foods take longer to break down, and undigested food can cause GI issues like:
- Nausea
- Bloating
- Diarrhea
- Vomiting

Gels are designed to fuel workouts efficiently and avoid these digestive problems.

When to Use Gels

Before Exercise: A gel 5–15 minutes before starting can provide an energy boost.

During Exercise:

Take your first gel within the first 30–45 minutes of exercise to keep up steady energy levels and prevent early fatigue.
Continue by taking one gel every 30–45 minutes during activities lasting longer than 60–90 minutes to sustain energy.

Avoid This Common Mistake:

Don’t wait too long to take your first gel. Delaying can lead to an energy deficit that’s hard to recover from, making it difficult to maintain performance.

The Best Ways to Carry Gels During Endurance Events

For endurance activities, carry gels in a way that’s both secure and easily accessible. Here are some effective options:

Where to Stash Gels

Pockets:
- Use the small pockets found in running shorts, tights, or jackets.
- Many running belts or hydration packs also have gel-specific compartments.
Hats or Headbands:
- Tuck gels into the band of your hat or headband for quick access.
Gloves:
- In cold weather, stash gels inside gloves with built-in pockets or tuck them securely into the cuff.
Sports Bras:
- Many sports bras have hidden pockets ideal for storing gels during long runs.
Shorts or Tights with Gel Loops:
- Use running shorts or tights designed with loops or slots specifically for gels.
Running Belts or Armbands:
- Invest in a lightweight running belt or armband to carry multiple gels without impacting your movement.
Use gels provided on the course:
- Check the race website to see which gels will be offered and how often.
- If you plan to use them, practice with those gels during training to ensure you can tolerate them.
- Take advantage of the gels provided on the course to reduce the number you need to carry.

Practice

Test During Training: Use your long runs and tempo workouts to practice carrying and consuming gels.

Refine Your Technique: Practice opening gels on the move to avoid fumbling during the event.

Evaluate Comfort: Ensure your chosen carrying method doesn’t cause discomfort, chafing, or shifting during activity.

By practicing during training, you’ll develop a system that feels natural and effective, ensuring you’re well-prepared for race day.

Body Composition Testing: When is it Helpful and When is it Harmful?

January 26, 2025January 8, 2025 by amystephens

Body Composition Testing: When is it Helpful and When is it Harmful?

TW: This content mentions eating disorders and body image.

Body composition testing offers a window into the intricate components that constitute our bodies. It surpasses simple weight measurements by evaluating the distribution and proportion of tissues like fat mass, muscle mass, and bone density, providing a detailed profile of physical makeup.

Skinfold assessment using calipers

There are a few different ways to measure body composition:

Hydrostatic weighing: Measures body density by comparing a person’s weight on land to their weight submerged in water. Very accurate.
Air Displacement Method (Bod pod): Similar whole body measurement as hydrostatic weighing. Computer sensors determine the amount of air displaced by your body. Very accurate.
Skinfold assessment using calipers: Measures the thickness of skinfolds at specific sites on the body to estimate total body fat percentage. Less accurate for very lean individuals.
Dual-Energy X-Ray Absorptiometry (DEXA scan): Uses X-rays to differentiate among bone mass, fat mass, and lean muscle mass. Expensive and requires specialized equipment. Very accurate.

Dual-Energy X-Ray Abroptiometry (DEXA scan)

Body fat and its impact on athletic performance

Some sports emphasize the relationship between reduced body fat levels and improved athletic performance. For the majority of athletes, physical appearance does not influence scoring or competition outcomes. Athletes who are frequently featured on social media may feel compelled to achieve a specific physique, which can result in unnecessary stress and pressure, potentially leading to eating disorders among both male and female athletes.

It’s important to point out that each person has a genetically determined amount of body fat that is unique to them. When athletes strive to lower their body fat below their natural range, it can have adverse effects on their performance, general health, and mental well-being. This can also lead to disruptions in hormones, increased fatigue, susceptibility to injuries, and a compromised immune system. Athletic performance is influenced by a multitude of factors beyond body composition, including genetics, diet, rest, resilience, hydration, overall health, mental attitude, and more.

When Body Composition Testing Could Be Helpful

For endurance athletes, especially those prone to injuries or with low bone density, body composition testing can be valuable. Body composition and fat testing can be helpful to determine if body fat is too low to support proper functioning. It offers insights into muscle mass and overall body composition, aiding in tailored training and injury prevention strategies.

Beneficial Scenarios for Body Composition Testing:

Athletes recovering from injuries can benefit by understanding muscle and bone health to tailor rehabilitation.
Guidance from certified sports physiologists and sports dietitians ensures that testing results are used constructively.
Ensures body fat levels are within a minimim healthy range to prevent issues like low energy availability, amenorrhea, or hormonal imbalances, especially for athletes in sports emphasizing leanness (e.g., gymnastics, running, or swimming).

When Body Composition Testing Isn’t Helpful

The introduction of mandatory body composition testing in collegiate settings has raised concerns. It can feel invasive and exacerbate body image issues, potentially leading to eating disorders among athletes. These psychological challenges can detract from performance by causing fatigue due to inadequate nutrition and increasing injury risks. Rather than focusing on achieving a specific body fat, a great way to improve performance is to focus on overall nutrition and health. Knowing your body fat percentage is just a small part of understanding athletic performance; it is not everything.

Frequent body composition testing may not offer additional benefits for individuals already maintaining health through exercise and balanced nutrition. Collegiate and high-performing athletes, already under significant physical stress, may not need the added pressure of constant body fat monitoring, as its impact on performance is marginal compared to other training factors.

Scenarios Where Testing Is Not Beneficial:

○ Healthy individuals with consistent exercise and nutrition routines.

○ Athletes susceptible to body image issues or eating disorders, where testing could worsen these conditions.

In summary, while body composition testing can enhance training precision and injury prevention for athletes, its application should be mindful of potential psychological impacts. Prioritizing factors like hydration, sleep, and diet remains fundamental to improved performance. For those genuinely interested in understanding their body’s composition, exploring such testing can offer insightful perspectives but should be approached with consideration of individual needs and well-being.

Alternative Metrics Influencing Sports Performance

Several metrics influence sports performance without necessitating body composition testing:

Ensuring adequate macronutrient intake (fueling with carbohydrates, refueling with carbohydrates, protein, and fat).
Ensuring an overall adequate intake of food to fuel training.
Getting enough sleep (8-10 hours per night).
Cultivating a positive mindset towards training.
Maintaining proper hydration levels.
Building a strong support system (coaches, teammates, family).
Incorporating mental training techniques (visualization, mindfulness, goal setting).

By focusing on these aspects, athletes can optimize performance and well-being without the potential drawbacks of intensive body composition testing. Body composition testing serves as a powerful tool in the realm of sports science, yet its implementation requires careful consideration of both physiological benefits and psychological impacts on athletes.

References

Beestone C. Body composition testing. Science for Sport. March 1, 2024. Accessed July 8, 2024.

https://www.scienceforsport.com/body-composition-testing/.

Kuzma C. Body composition testing – college running programs moving away from body comp tests. Runner’s World. Accessed July 19, 2024. https://www.runnersworld.com/news/a42437488/body-composition-testing-colleg e-programs/.

Mathisen TF, Ackland T, Burke LM, et al Best practice recommendations for body composition considerations in sport to reduce health and performance risks: a critical review, original survey and expert opinion by a subgroup of the IOC consensus on Relative Energy Deficiency in Sport (REDs) British Journal of Sports Medicine 2023;57:1148-1160. https://bjsm.bmj.com/content/57/17/1148

Strout E. Why top NCAA triathlon coaches won’t use body composition testing. Triathlete. January 5, 2023. Accessed July 8, 2024. https://www.triathlete.com/culture/news/why-top-ncaa-triathlon-coaches-wont-use -body-compos ition-testing/.

Body composition: UC Davis Sports Medicine: UC Davis health. Body Composition | UC Davis Sports Medicine |UC Davis Health. Accessed July 19, 2024.

Should Athletes Use a CGM? A Look at the Benefits and Drawbacks

November 5, 2024 by amystephens

Should Athletes Use a CGM? A Look at the Benefits and Drawbacks

A Continuous Glucose Monitor (CGM) is a medical device designed to deliver real-time measurements of glucose (sugar) levels in the body. Although it is mainly utilized by individuals with diabetes to regulate their blood sugar, it has also become increasingly popular among athletes and health enthusiasts. While these devices offer a wealth of data, it’s crucial to consider how that information will be applied effectively. Here’s how it works and its main components:

How CGM Works

Sensor Insertion: A small sensor is inserted under the skin, typically on the abdomen or the back of the arm. This sensor measures glucose levels in the interstitial fluid (the fluid between cells) rather than directly in the blood.
Continuous Monitoring: The sensor continuously measures glucose levels, usually every few minutes, providing a real-time view of fluctuations throughout the day and night.
Data Transmission: The sensor sends glucose data to a receiver or a smartphone app via Bluetooth or other wireless technologies. This allows users to see their glucose levels in real-time, track trends, and receive alerts for high or low levels.
Calibration: Some CGMs require periodic calibration with a fingerstick blood glucose meter, while others do not, depending on the model.

Components of a CGM System

Sensor: The small device that is placed under the skin to measure glucose levels.
Transmitter: A component that attaches to the sensor and sends the glucose data wirelessly to a display device.
Display Device: This could be a standalone monitor, a smartphone, or a smartwatch that receives the data and displays glucose readings.

Benefits of Using a CGM

Real-Time Data: Provides continuous monitoring, allowing users to respond quickly to fluctuations in glucose levels.
Trend Analysis: Helps identify patterns in glucose levels in response to food, exercise, stress, and other factors.

Popular CGM Brands

Some well-known CGM systems include:

Dexcom: Offers a range of CGM products with various features, including a mobile app for tracking.
Freestyle Libre: Known for its simple sensor application and a focus on ease of use.
Medtronic: Provides integrated systems that often work in conjunction with insulin pumps.

Using a Continuous Glucose Monitor (CGM) can be beneficial for athletes, especially those involved in endurance sports or those with specific dietary and training goals. Here are some key considerations for athletes thinking about using a CGM:

Potential Benefits of Using a CGM for Athletes:

Real-time Glucose Monitoring: CGMs provide continuous, real-time glucose data, helping athletes understand how their blood sugar levels fluctuate throughout training and competition.
Optimizing Nutrition: By tracking glucose levels, athletes can fine-tune their nutrition strategies to enhance performance, avoid crashes, and ensure they’re fueling adequately before, during, and after workouts.
Identifying Patterns: Athletes can identify how different foods, hydration levels, and exercise intensities affect their glucose levels, allowing for personalized dietary adjustments.
Avoiding Hypoglycemia: For athletes, especially those in sports with high energy demands, monitoring glucose levels can help prevent hypoglycemic episodes, which can impair performance.
Recovery Monitoring: After intense workouts, monitoring glucose levels can provide insights into recovery and metabolic response, helping athletes optimize their post-workout nutrition.
Managing Stress Responses: CGMs can help athletes understand how stress (from training, competition, or other life factors) affects their glucose levels, allowing for better stress management techniques.

Considerations and Potential Drawbacks:

Cost: CGMs can be expensive, and not all insurance plans cover them, making them a financial consideration for many athletes. Dexcom (Supersapien) may cost $300-400 for the device and $150-200 for the subscription. Freestyle libre (Lingo) costs about $75 per sensor, each one lasting up to 14 days. Additional costs include: $150 per month, plus a one time $60 fee for the reader.
Learning Curve: Athletes may need time to learn how to interpret CGM data effectively and integrate it into their training and nutrition regimens.
Over-reliance: There’s a risk of becoming overly focused on glucose levels, which might lead to anxiety or second-guessing nutrition and training decisions.
Not for Everyone: While CGMs can provide valuable information, they may not be necessary for all athletes, especially those who do not have blood sugar management issues.
Lag time: CGMs placed on the arm (Freestyle Libre) measures glucose in interstitial fluid, which can be delayed compared to blood glucose, especially during rapid changes (like after eating or during exercise). This lag is generally about 5-10 minutes, so the device might not immediately capture sudden spikes or drops.
Factors Affecting Accuracy: Certain factors, like dehydration, sensor placement, compression (from lying on it or tight clothing), and high temperatures can reduce accuracy. Users also tend to get better readings when it’s kept at a consistent temperature.
Stress affects blood sugar readings: Other factors that can lead to fluctuations in blood sugar, apart from food, include stress hormones like cortisol and adrenaline. These hormones may rise during periods of illness, physical or mental stress, medication use (such as steroids), menstrual cycles, or hormonal imbalances. Analyzing CGM data can make it challenging to differentiate between fueling and the body’s normal response to stress.

Conclusion:

Ultimately, the decision to use a CGM should be based on individual goals, health conditions, and the nature of the sport. Athletes interested in using a CGM should consider consulting with a sports nutritionist or a healthcare professional to tailor the use of glucose monitoring to their specific needs and training goals.

Caffeine to improve athletic performance

October 15, 2024October 10, 2024 by amystephens

Caffeine to improve athletic performance

Studies have shown an improvement in sports performance when caffeine is consumed before exercise (Clarke, 2018). Here are details about how caffeine works and the safe and effective dose that yields the best results.

How it works:

Caffeine blocks adenosine receptors that, in turn, prevent you from feeling tired. By blocking adenosine receptors, you can feel less pain, increase neuro-excitability, and improve your ability to focus which can lead to ergogenic effects on exercise performance.

Benefits:

Reduces perception of pain and fatigue
Mobilizes fat to use for energy, sparing glycogen
Increasing alertness (reaction time and mood)

Risks:

Effects of too much caffeine can cause jitteriness, shakiness, upset stomach, or reflux. None of these symptoms are ideal before or during a race. Be sure to test out caffeine dose and response before race day.

Dose:

The effective dose of caffeine is 3-6 mg/kg about one hour before competition which is approximately 200-400 mg for a person weighing 150 pounds (70kg) which is equivalent to a tall coffee from Starbucks.

There is a bigger performance benefit when caffeine is reduced prior to competition (Beaumont).

Form:

The amount of caffeine in energy bars, gels and medications tends to be standardized, while the amount in coffee and tea can vary considerably. Be sure to read labels and know how much you are consuming.

Some energy drinks or pre-workout beverages might have caffeine listed as one of these ingredients:

Green tea extract

Guarana

Guayaki yerba mate

Guayusa

Cola nut

Cacao

College athletes:

Caffeine is a banned substance by the NCAA. A urinary caffeine concentration exceeding 15 micrograms per milliliter (corresponding to ingesting about 500 milligrams, the equivalent of six to eight cups of brewed coffee, two to three hours before competition) results in a positive drug test.

* Caffeine content varies among brewing methods. See chart below.

Olympic level athletes:

Caffeine is permitted in sports governed by the World Anti-Doping Agency (WADA).

Food-first approach:

The perception of having increased energy from caffeine will not replace the actual energy provided from food. Successful athletic performance is dependent on a nutrition plan that meets your energy and nutrient needs through food first. Caffeine can be used to improve performance and will be most effective if energy needs are met with food-first.

References

Beaumont R, Cordery P, Funnell M, Mears S, James L, Watson P. Chronic ingestion of a low dose of caffeine induces tolerance to the performance benefits of caffeine. J Sports Sci. 2017 Oct;35(19):1920-1927. doi: 10.1080/02640414.2016.1241421. Epub 2016 Oct 20.

Clarke ND, Richardson DL, Thie J, Taylor R. Coffee Ingestion Enhances 1-Mile Running Race Performance. International Journal Sports Physiology and Performance. 2018;13(6):789-794.

Davis JK, Green JM. Caffeine and anaerobic performance: ergogenic value and mechanisms of action. Sports Med. 2009;39:813–832.

Laurent D, Schneider KE, Prusaczyk WK, et al. Effects of caffeine on muscle glycogen utilization and the neuroendocrine axis during exercise. J Clin Endocrinol Metab. 2000;85:2170–2175.

McLellan TM, Bell DG. The impact of prior coffee consumption on the subsequent ergogenic effect of anhydrous caffeine. Int J Sports Nutr Exerc Metab. 2004;14:698–708.

Spriet LL. Exercise and sport performance with low doses of caffeine. Sports Med. 2014;44:175–184.

Talanian JL, Spriet LL. Low and moderate doses of caffeine late in exercise improve performance in trained cyclists. Appl Physiol Nutr Metab. 2016 Aug;41(8):850-5.

Wiles JD, Bird SR, Hopkins J, Riley M. Effect of caffeinated coffee on running speed, respiratory factors, blood lactate and perceived exertion during 1500-m treadmill running. Br J Sports Med. 1992; 26:116–120.

Guide to Carb Loading for a Marathon

November 19, 2024October 1, 2024 by amystephens

Guide to carb loading for a marathon

Plan, Prepare, and Prioritize Your Nutrition

Especially during taper week, it’s crucial to stay organized and mindful of your diet, particularly if you’re balancing a busy schedule. Even though we’re running less in the taper, nutrition is just as important as our bodies absorb all the training we’ve put in during our training cycle.

The Importance of a Successful Carbohydrate Loading

A well-executed taper can improve performance by 2-3% (as noted by Hawley), but it may also cause anxiety as you decrease your workload and question your readiness. Workouts get shorter, and hunger levels fluctuate, leading to self-doubt. However, trust the process—this reduction in intensity helps your muscles recover and adapt, restoring glycogen to maximum capacity. The greater the amount of glycogen present in your body, the greater your body’s capacity to run faster for a longer period. Fully stocked glycogen stores can significantly enhance your ability to endure the 26.2-mile journey and potentially boost your performance.

As I tapered for my first marathon, focusing on carbohydrates was key. I relied on foods like bagels, oatmeal, pasta, dried fruits, and sports drinks in the week leading up to race day. When I hit the 20-mile mark and still felt strong, I knew my fueling strategy had worked, helping me finish with an Olympic Trials qualifying time.

– Katy Kunc, Professional runner and Olympic Trials Qualifier 2022

Photo: IG @runninphotog

What is carbohydrate loading?

Carbohydrate loading represents the final phase of your marathon training plan. Over the course of a marathon training cycle, you train your body to adapt to running longer distances. Those longer distances are fueled by glucose from carbohydrates, which your body breaks down to provide energy to your working muscles. This glucose is stored within the body as glycogen and serves as the primary fuel source during a marathon and especially during the last few miles of your race. Achieving effective carbohydrate loading involves consuming ample carbohydrate-rich meals in the days leading up to your race to ensure your glycogen stores are at their maximum capacity. This requires careful attention to meal planning and food preparation as the race day approaches. This can be anxiety producing, especially as you must continue eating while logging fewer miles.

What are the benefits of carbohydrate loading?

Carbohydrate loading allows the body to maximize adaptations, fully restore glycogen levels, and boost overall performance. By prioritizing these factors, athletes can enhance their endurance, ensure glycogen stores are at their highest, and effectively power through the final 10k of a 26.2-mile marathon. It is normal to gain weight during this period of the training cycle. Change in weight when carb loading:

A shift in your body weight is probably a result of rising glycogen levels. Because glycogen retains water, you may observe a minor uptick in your body weight.
Have confidence in your fitness level. A change in weight is not an indication of a decrease in physical activity.
As you get closer to race day, you will be eating more carbohydrates than you’re used to and exercising less. It’s okay for your body to feel different.
Even if you’re not trying to gain fitness, your body is still working to retain muscle which is heavy.
Instead of thinking about numbers and weight, think about which nutrients are important to crush your 26.2.

What should you eat during race week?

As the week progresses, steadily increase the amount of carbohydrates in your diet.
It’s essential to stick to the foods you usually eat but increase the carbohydrate portion in each meal. There’s no need to change the types of foods in your regular diet. There’s less of an emphasis on post-run refueling because your runs are less demanding.
Consume a carbohydrate-rich diet to fully replenish glycogen stores. Research suggests a guideline of 4-5 grams of carbs per pound of body weight daily. For a 150-pound individual, that equates to around 600 grams of carbohydrates. However, if your usual diet is low in carbs, suddenly increasing carb intake may lead to bloating, distention, and sluggishness. Include: bread, pasta, rice, potatoes, oats, cereals, fruit, beans, and lentils.
It’s okay to gain a couple of pounds this week. Carbohydrates hold on to water which can increase your weight but give you an extra edge when racing 26.2. Each gram of glycogen holds 3 grams of water (Fernandez).
Eat every 3-4 hours to maintain adequate glycogen levels. This can consist of small meals throughout the day or three meals along with three snacks. Doing so will promote tissue repair, maximize muscle strength, and

Race week meal ideas:

Breakfast

Eggs with potatoes and toast

Granola bowl with fruit and yogurt

Smoothie – recipes

Toast with peanut butter and banana

Frozen waffles with fruit and syrup

French toast and side of yogurt

Oatmeal with nut butter and fruit

Baked banana oats with fruit

Toast with avocado and hemp seeds

Cinnamon raisin bagel with almond butter or peanut butter

Lunch

Wrap with hummus or turkey

Quesadilla

Burrito bowl

Smoothie and bagel

Pasta with protein

Rice bowl with protein and vegetables

Snack ideas

Bars – cliff, kind, Rx

Toast with peanut butter and banana

Toast with nutella

Crackers with peanut butter

Yogurt with fruit

Tortilla chips with hummus

Rice cake with peanut butter and banana

Trail mix

Fruit or dried fruit

Popcorn

Energy bites – recipes

Dinner

Grilled salmon or chicken with baked potato + fruit

Sushi

Pasta

Rice and beans

Burrito

Soba noodles

Chicken or tofu fried rice

Burger (veggie, beef, turkey) on bun with baked potato

Stuffed baked potato (white or sweet potato) topped with yogurt

How do you eat if you’re traveling for a race?

When traveling for the marathon, pack these essentials:

Energy bars (Cliff, Rx, etc.)
Fruits like bananas
Peanut butter for quick snacks
Crackers and pretzels
Favorite breakfast foods (bagels, oatmeal)
Hydration options (water, Gatorade, electrolytes)

Book dinner reservations in advance, aiming for places that offer pasta, rice, or potatoes, like Italian, Chinese, or American bistro-style restaurants. A solid meal the night before the marathon can significantly impact your performance.

What should you eat the night before a marathon?

Aim to eat dinner early so you have plenty of time to digest.
Try to eat familiar foods that you’ve had in the past.
If you are prone to reflux, avoid common irritants such as tomato sauce, fatty foods, dairy or spicy foods.

Early Dinner

Pasta, rice, potatoes, bread with protein

Bedtime Snack

Salty crackers like pretzels or saltines

What should you eat on race day?

3- 4 Hours Before Race

Have a carb-rich meal with some protein, such as a bagel with peanut butter and a banana, or oatmeal with fruit.

2-3 Hours Before

Consume a smaller meal (~100g carbs), like a bagel and banana or a Cliff bar with fruit.

1 Hour Before

A small snack like a piece of fruit or a Honey Stinger waffle.

15 Minutes Before (optional)

Take a gel, chew, or liquid carb source.

Trust in your preparation, nutrition, and tapering process—these final adjustments will help you feel strong and ready on race day.

By following these guidelines for carbohydrate loading and tapering, you can optimize your nutrition and readiness for marathon day. Have a great race!

References

Fernández-Elías VE, Ortega JF, Nelson RK, Mora-Rodriguez R. Relationship between muscle water and glycogen recovery after prolonged exercise in the heat in humans. Eur J Appl Physiol. 2015 Sep;115(9):1919-26. doi: 10.1007/s00421-015-3175-z. Epub 2015 Apr 25. PMID: 25911631.

Hawley JA, Schabort EJ, Noakes TD, Dennis SC. Carbohydrate-loading and exercise performance. An update. Sports Med. 1997 Aug;24(2):73-81. doi: 10.2165/00007256-199724020-00001. PMID: 9291549.

Sherman 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):114-8.

Stellingwerff T, Cox GR. Systematic review: Carbohydrate supplementation on exercise performance or capacity of varying durations. Appl Physiol Nutr Metab. 2014 Sep;39(9):998-1011. doi: 10.1139/apnm-2014-0027. Epub 2014 Mar 25. PMID: 24951297.

Stellingwerf T. Case study: Nutrition and training periodization in three elite marathon runners. Int J Sport Nutr Exerc Metab. 2012 Oct;22(5):392-400. doi: 10.1123/ijsnem.22.5.392. PMID: 23011657.

Don’t Wait: Understanding Relative Energy Deficiency in Sport (RED-S) and Low Energy Availability (LEA)

October 18, 2024August 26, 2024 by amystephens

Don't Wait: Understanding Relative Energy Deficiency in Sport (RED-S) and Low Energy Availability (LEA)

By Kate Cochran, Nutrition Intern, NYU Track and Field

When I first learned about low energy availability (LEA) and relative energy deficiency in sport (RED-S) at twenty-one, I was four years deep into my distance running journey. It was while reading “How She Did It” by renowned female distance athletes Molly Huddle and Sara Slattery, both esteemed Olympians themselves, where I first learned about the syndrome. It was something I wish I knew when I began running at sixteen. I firmly believe it’s essential for every female athlete to familiarize themselves with RED-S early on, considering its potential impact on their athletic path.

LEA, or Low Energy Availability, is a condition where the body lacks sufficient energy to sustain vital physiological functions, jeopardizing overall health. It occurs when caloric intake fails to match the increased demands of intensified training, such as higher mileage or more strenuous workouts. Counting calories, restricting necessary food groups, waiting too long to eat after exercising, running on an empty stomach, and skipping meals can often result in LEA. When your energy availability is low, your performance in sport will likely suffer. In short, being in a constant state of low energy availability will prevent you from reaching your potential in sport.

Some symptoms of RED-S and LEA are:

Frequent illnesses (common cold, stomach bugs)
Recurring injuries
Regularly feeling tired and sluggish in and after training
Absent or irregular periods
Poor concentration
Low mood
Underperforming in training and competition
Loss of enjoyment from sports
Poor sleep

Being in a prolonged state of low energy availability will eventually lead to RED-S. RED-S is a broader syndrome encompassing LEA as one of its components. RED-S involves a spectrum of health and performance issues resulting from prolonged low energy availability, affecting not only physical health but also metabolic, hormonal, and psychological aspects, ultimately impairing athletic performance. In addition to LEA, RED-S may involve disruptions in menstrual function, bone health, immunity, cardiovascular health, and psychological well-being.

Those at risk for RED-S are typically female endurance athletes, and anyone who is cutting calories while playing a high demand sport.

How to treat RED-S:

Ensure you’re consuming enough calories to meet the energy demands of your training and daily life. This might involve working with a registered dietitian to develop a balanced meal plan tailored to your needs. Generally, you should aim to consume as many calories as you are losing through sport and everyday activities.
Make sure you are getting a good balance of macronutrients. Carbohydrates, fats, and proteins support energy production, muscle repair, and overall health. In your diet, aim for about half of your food to come from carbohydrates, around one-third from protein, and another one-third from fats.
Incorporate adequate rest, sleep, and recovery strategies into your routine to support overall health and performance.
Consider working with a mental health professional or sports psychologist to manage stress, anxiety, or disordered eating patterns.
With sufficient rest and energy intake, the majority of athletes can replenish their energy stores and maintain their training at their usual capacity.

Amy Stephens