Amy Stephens

MS, RDN, CSSD, CDCES

Licensed dietitian

specializing in sports nutrition

and eating disorders

College athlete

Delicious Recovery Smoothie Ideas for Athletes

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Delicious Smoothie Ideas for Athletes

  • By Amy Stephens RDN CSSD

Smoothies are great for after a workout because they contain the perfect balance of protein and carbohydrates. They also have plenty of antioxidants to help with tissue repair. Smoothies are a delicious and easy way to refuel and recover after a tough workout. Packed with protein, carbs, and antioxidants, these recovery smoothie ideas are perfect for athletes looking to optimize performance and recovery.

Berry Blast Smoothie

Blend together:

1 cup of mixed berries (strawberries, blueberries, and raspberries) 

1 banana (use frozen banana for creamy texture)

1 scoop of vanilla protein powder (optional)

2 tablespoons of peanut butter

1 cup of milk

handful of ice

Berries are rich in antioxidants that help reduce inflammation, while the protein powder provides essential amino acids for muscle repair and growth.

Green Monster Smoothie

Blend together:

1 cup of spinach

1 banana

1 scoop of vanilla protein powder (optional)

1 tablespoon of almond butter

1 cup of milk

handful of ice

Top with 1/2 teaspoon of chia seeds

Spinach is rich in vitamins and minerals, while the almond butter provides healthy fats that help reduce inflammation and support brain function.

Tropical Paradise Smoothie

Blend together:

1 cup of frozen pineapple chunks

1 banana

1 scoop of vanilla protein powder

1 cup of coconut water

handful of ice

Pineapple is rich in bromelain, an enzyme that helps reduce muscle soreness, while the coconut water provides essential electrolytes to support hydration and recovery.



Chocolate Peanut Butter Smoothie

Blend together:

1 cup of milk

2 tablespoons of cocoa nibs or cocoa powder

1 banana

1 tablespoon of natural peanut butter

2 tablespoons maple syrup, honey or agave

handful of ice

This smoothie is packed with protein and healthy fats, which help repair and rebuild muscles and support recovery.

Mango Vanilla Smoothie

Blend together:

1 cup Vanilla yogurt

handful of ice

½ cup fresh or frozen mango

1 banana

1 cup milk

1 teaspoon chia seeds added on top

Mango is a great source of antioxidants and potassium that is an electrolyte that helps to maintain proper hydration levels in the body.

 

Cherry Almond Smoothie

Blend together:

1 cup of frozen cherries

1 scoop of vanilla protein powder (optional)

1 tablespoon of almond butter

1 cup of milk

handful of ice

Cherries are rich in antioxidants that help reduce inflammation and promote recovery, while the almond butter provides healthy fats and protein for sustained energy.



Fuel Your Body: A Week of Nutritious Dinners for Athletes

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Fuel Your Body: A Week of Nutritious Dinners for Athletes

  • By Amy Stephens RDN CSSD

As an athlete, what you eat is crucial to fueling your body and providing the necessary nutrients to support your training and competition. However, it can be challenging to come up with new and healthy meal ideas each week. That’s why I’ve put together a list of weekly dinners that are perfect for athletes!

It’s important to prioritize your nutrition to fuel your training and competition. These weekly dinner ideas are just a starting point, but they provide a variety of nutrients and flavors to keep your meals interesting and healthy. Don’t be afraid to experiment with different ingredients and recipes to find what works best for you!

 
 photo: Well-Plated

Monday:

Grilled chicken with sweet potato and broccoli

Grilled chicken is a great source of protein, which is essential for muscle repair and growth. Sweet potatoes are an excellent source of complex carbohydrates, which provide energy for workouts and help to keep you feeling full. Broccoli is packed with vitamins and minerals, including Vitamin C, which is essential for the immune system.

Recipe The Spruce Eats

Tuesday: Quinoa and black bean bowl

Quinoa is a complete protein, which means it contains all of the essential amino acids that your body needs to build and repair muscle. Black beans are a great source of fiber, which can help regulate digestion and keep you feeling full. Add in some vegetables like peppers, onions, and tomatoes for added nutrients and flavor.

Recipe Eating Well 

 

Wednesday:

Salmon with roasted vegetables and brown rice

Salmon is an excellent source of omega-3 fatty acids, which can help reduce inflammation and improve cardiovascular health. Roasted vegetables such as Broccoli and carrots are loaded with vitamins and minerals, making this a well-rounded and nutritious meal.

Recipe Roasted Root

 

 

Thursday: Lentil soup and sourdough bread

Lentils are an excellent source of protein, fiber, and complex carbohydrates. This hearty soup is perfect for athletes as it is packed with nutrients, and it is easy to make in bulk and store for meals throughout the week. Add in some vegetables like carrots, celery, and spinach for added flavor and nutrition.

 

Friday: Whole wheat pasta with turkey meatballs

Whole wheat pasta is a great source of complex carbohydrates, which can provide sustained energy for workouts and competition. Turkey meatballs are a lean source of protein, and adding vegetables like spinach and tomatoes can help increase the overall nutrient content of the meal.

 

Saturday: Stir-fry with tofu and vegetables

Tofu is an excellent source of plant-based protein, and stir-frying with vegetables like broccoli, bok choy, and bell peppers makes for a colorful and nutrient-dense meal. Add in some brown rice for added fiber and carbohydrates.

 

Sunday:

Grilled chicken with roasted potato and asparagus

Chicken is a great source of protein and iron, which is essential for carrying oxygen throughout the body. Roasted potatoes provides complex carbohydrates, while asparagus is a great source of fiber and vitamins.

 

Easy LUNCH ideas for athletes

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quick LUNCH ideas for athletes

  • By Amy Stephens RDN CSSD

Why is eating LUNCH important to an athlete?

Lunchtime is an opportunity to replenish nutrients from your morning workout or prepare your body for an evening workout. Plan out lunches to ensure you have a variety of foods in your home to prepare meals.

Strive for a balanced lunch to help with feeling full, feeling energized and reduce cravings. 

Essential components of a balanced meal >> carbs, protein, fats

A balanced meal consists of three macronutrients: carbohydrates, fat and protein. If you have too much of one nutrient, you might miss out on important nutrients that your body needs to perform at its bes  Carbohydrates provide the primary source of fuel for exercise. As you exercise, your body breaks down glycogen into glucose for energy. Foods that increase your glycogen are carbohydrates. Ideally, these carbohydrates are broken down more slowly which help keep energy levels stable after a workout. Some examples are oatmeal, rice (white or brown), sweet or white potatoes, pasta, whole grain breads and quinoa.

 Before a workout, look for simple carbohydrates that are low in fat and fiber. Simple carbohydrates are digested quickly into usable energy. However, after a workout you should reach for complex carbohydrates that contain fiber and other nutrients for optimal recovery.

Protein-rich foods are essential to help with recovery and replenish amino acids used by muscles. By eating high-quality protein after a workout, the body can recover faster and gain more strength. Muscle strength is essential to running faster speeds. Best sources of protein are eggs, dairy, tofu, chicken, turkey, fish (salmon, mackerel, anchovies, herring) and lean beef.

Aim for 20-30 grams high-quality protein at each meal. That’s about 3-4 oz protein from an animal source and 1-2 cups from vegetable sources like beans, lentils, or tofu.

Fat provides calories to support hormone production and foods with fat also have important fat soluble vitamins such as A, D, E, and K. All of these vitamins help with menstruation, bone formation, or iron regulation. It’s important to get in enough healthy fat calories to keep you full and provide fat soluble vitamins. 

Best sources of fats are from avocado, nuts, seeds, olive oil, and fish.

Granola parfait with yogurt and berries

Scrambled eggs with sauteed vegetables such as onions and peppers. Serve with a side of mixed berries and whole grain toast. Use either the whole egg or egg whites to make a nutritious meal any time of day. Make a tofu scramble as a vegetarian option.

Pita pizza with mushrooms and spinach

Toast pita, add tomato sauce and handful of spinach and mushrooms then bake in the oven, toaster or air fryer at 350 x 15 min.

Stir fry (chicken, vegetable or tofu). Serve with white or brown rice. Recipe below.

Salads

Quinoa salad made with peppers, avocado, mango, chickpeas, nuts, cheese and chicken. Top with lime and olive oil dressing, see below for more dressing ideas.

Grilled chicken salad

Use fresh spinach as a base and top with rotisserie, leftover chicken or tofu. Add roasted chickpeas, hard-boiled egg and lemon-vinaigrette dressing (recipe below).

Kale chicken caesar salad

Buy the kale cleaned and washed to save time, then add chickpeas, parmesan and avocado. Mix in caesar dressing.

Salad Nicoise

Romaine lettuce, hard boiled eggs, steamed string beans, olives and top with lemon vinaigrette dressing (recipe below). Serve with a side of sourdough bread.

Easy three bean salad

Made with chickpeas, kidney beans and green beans (recipe below).

Pasta salad with vegetables, topped with balsamic vinaigrette dressing. Ingredients: cooked pasta, chopped cucumbers, carrots, feta (sub tofu for vegan version), and chickpeas.

Sandwiches & Wraps  – Serve with side of fruit

Hummus and avocado wrap with lettuce, tomato and shredded carrots.

Chicken caesar wrap with lettuce and tomatoes.

Egg salad sandwich – combine 4-6 hard boiled eggs with 2-3 Tbsp mayo.

Turkey and avocado sandwich on whole wheat. 

 

Grilled chicken wrap – can use rotisserie chicken. Serve with chopped red peppers and fruit salad.

Peanut butter and jelly sandwich, yogurt and fruit

Open-faced toast and avocado – add shredded carrots, sprouts (and any veggie you can fit).

Quesadilla

Whole wheat wrap with cheese, black beans, salsa, and avocado.

Burrito

Southwest burrito with grilled chicken, beans, rice, salsa, avocado.

Veggie burrito made with roasted sweet potato, black beans, salsa, and avocado. Click here for recipe from the Spruce Eats.

 

Smoothies

Green smoothie combine a handful of Kale, 1 banana, 2 handfuls of ice, 1 cup milk, 3 dates or honey, and 2 Tbsp peanut butter, optional: top with ½ tsp chia seeds or ground flax seeds

Bowls 

Quinoa bowl with sauteed spinach, egg, onion and sriracha. Click here for recipe from Dinner A Love Story.

 

Buddha bowl with quinoa, diced carrots, diced cucumber, diced tomato, crunchy chickpeas and sunflower seeds with avocado on top; meat protein optional; eat hot or cold. Click here for full recipe.

 

Salad Dressings

Basic balsamic vinaigrette

  • ¼ cup balsamic vinegar
  • 1 teaspoon honey or maple syrup
  • 1 garlic clove, minced
  • 2 teaspoons Dijon mustard
  • ½ teaspoon sea salt
  • Freshly ground black pepper
  • ¼ cup plus 2 tablespoons extra-virgin olive oil

Lemon vinaigrette

  • Juice of 1 fresh lemon (about ¼ cup)
  • 1 small garlic clove, grated
  • 1 teaspoon Dijon mustard
  • 1/4 teaspoon sea salt, more to taste
  • Freshly ground black pepper
  • 1/2 teaspoon honey or maple syrup, optional
  • 1/4 to 1/3 cup olive oil
  • 1/2 teaspoon fresh or dried thyme, optional

Soy sesame dressing

  • ¼ cup extra virgin olive oil
  • ¼ cup seasoned rice vinegar (can also use regular rice vinegar + ½ tsp sugar, ¼ tsp salt, or white vinegar)
  • 1 ½ T honey or maple syrup
  • 3 tablespoons sesame oil
  • 1 ½ teaspoons soy sauce (I use reduced sodium)
  • pinch salt
  • 1 -2 cloves garlic minced (optional)

Peanut dressing

  • 1 small clove garlic, minced
  • 2 T creamy peanut butter
  • 1/4 cup Juice of 1 lime
  • 1 T low-sodium soy sauce
  • 1 T honey or maple syrup
  • 1 T toasted sesame oil

Easy three bean salad with vinaigrette

For the salad:

  • 1 (15-ounce) can cannellini beans, rinsed and drained
  • 1 (15-ounce) can kidney beans, rinsed and drained
  • 1 (15-ounce) can garbanzo beans, rinsed and drained
  • 1/2 red onion, finely chopped (about 3/4 cup), soaked in water to take the edge off the onion
  • 2 celery stalks, finely chopped (about 1 cup)
  • 1 cup loosely packed, fresh, finely chopped flat-leaf parsley
  • 1 teaspoon fresh finely chopped rosemary

For the dressing:

  • 1/3 cup apple cider vinegar
  • 1/4 cup granulated sugar (more or less to taste)
  • 3 T extra virgin olive oil
  • 1 1/2 teaspoons salt
  • 1/4 teaspoon black pepper

Stir Fry recipe
Can also buy carrots and onions chopped to save time

  • 3/4 cup brown rice (cooked based on package instructions)
  • 3 garlic cloves (finely chopped)
  • 1 chunk ginger (small, peeled and finely chopped)
  • 1 yellow onion (chopped to your preference)
  • 1 head broccoli (stems removed)
  • 3 carrots (sliced)
  • 1 baby bok choy (ends cut off and leaves separated)
  • 1/4 cup toasted sesame oil
  • 1/4 cup tamari (or soy sauce)
  • scallions (sliced)
  • chili flakes
  • Sriracha
  • 2 # chicken or package of tofu, cut into 1 inch pieces

For the marinade:

  • 1 cup water
  • ¼ cup soy sauce
  • 5 teaspoons packed brown sugar or 2 Tbsp honey
  • ½ teaspoon ground ginger
  • ¼ teaspoon garlic powder

Combine and add protein (chicken or tofu). Let marinade for at least half an hour.

In a large omelet pan or dutch oven, saute garlic, onion, ginger, broccoli, and carrots. Cook for 5-10 minutes or until browned. Then add baby bok choy and cook for 3 minutes longer. Place vegetables on a large dish or pan. Add 2 Tbsp olive oil and 1 Tbsp sesame oil and cook protein (chicken or tofu) until golden brown. Pour in the rest of the marinade and cook over medium heat for 3 minutes. Add rice and vegetables and stir. Serve and add scallions, chili flakes or sriracha.

Best Nutrition Bars for Athletes

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Athlete’s Guide to Choosing a Nutrition Bar

  • By Amy Stephens RDN CSSD

I always recommend a food first approach but sometimes fresh food isn’t always available. Athletes have high energy demands, and in order to maintain a positive energy balance, athletes need to eat throughout the day. This might be challenging for athletes that have long, busy schedules or a second practice. There are many nutrition bar options available, but I’ve narrowed it down to a few that have enough protein and carbohydrates for athletes. 

Nutrition bars are a great way to offset hunger, prevent injury and help with recovery.

What to look for in a nutrition bar

Calories are a guide to know how much you need to eat. Most bars listed below are between 200-400 calories, which is an appropriate amount of calories for a snack. Athletes’ calorie levels can vary depending on time spent exercising and intensity. Therefore, calorie requirements can be as much as 2500-5000 calories for very active individuals, which can be hard to obtain in meals. If you need further guidance on calories, it’s best to work with a sports dietitian to help you determine the best calorie intake for you. 

Fat is an important nutrient that has key functions in the body such as helping to keep you fuller for longer, carry fat soluble vitamins and help with energy balance. Keep in mind, bars with high amounts of fat can take longer to digest, so it might be best to consume them well before you begin a workout or use them as a post workout recovery food. Athletes can target about 70-80 grams of fat per day, which is about 10 grams fat per snack and 25 grams fat per meal. 

Protein is important to help grow muscle and prevent muscle breakdown. To maximize muscle growth and repair, studies show that protein spread throughout the day will have the biggest impact on muscle growth. Protein slows down digestion and helps keep blood sugars steady. Aim for 10-20 grams protein per bar. 

Carbohydrates are essential for fueling working muscles before a workout and for recovery afterward. In between workouts, an athlete’s body is constantly restocking glycogen and recovering, even at rest. Bars are a great way to keep the supply of carbohydrates continuous. Look for nutrition bars that have 30-60 grams of carbs in the form of oats, fructose, glucose or maltose. 

Fiber is essential to helps grow good gut bacteria, stabilize blood sugars and promotes regular bowel movements. Dietary guidelines suggest 25-30 grams fiber per day. Look for bars with about 3-5 grams fiber. Keep in mind, some bars contain very high levels of fiber which can be challenging to have the day before an endurance event. Fiber expands in the colon creating an urgency to use the bathroom multiple times. This can be a problem for endurance athletes in a competition without a bathroom nearby. 

Sugar is okay for athletes. Diet culture has taught us that sugar is bad, but athletes have much higher energy demands and sugar can be part of a healthy diet in small quantities. Aim for bars with natural sugars such as honey or maple syrup on the label. Fructose and maltose have been shown to increase glycogen stores quickly, which helps performance and recovery. 

Best pre-workout bars 

Here are a few suggestions for pre-workout bars. I selected these options below because they contained higher carbohydrates, low-fat and low -fiber.  These nutriets tend to cause GI issues in some people. Studies support a greater amount of carbohydrates and less protein/fat/fiber before a workout. 

Nature’s Bakery Fig

Nutrition facts:

200 calories 

5 g fat  

38 g carb 

3 g fiber

3 g protein 

What I love: These bars are easy to find in local grocery stores, they’re inexpensive and contain high-quality ingredients. 

✓ GF, vegan 

$6.44/12 bars ($.54 each) 

Order 

Kind Oat Bar

Nutrition facts:

150 calories 

5 g fat 

23 g carb

2 g fiber 

3 g protein

What I love: Kind bars are available in most grocery stores and they contain five super grains such as oats, millet, buckwheat, amaranth, and quinoa. 

✓ GF 

$35.92/40 bars ($.90 each) 

Order 

Larabar

peanut-butter-chocolate-chip

 

Nutrition facts:

210 calories 

12 g fat 

23 g carb 

4 g fiber 

5 g protein 

What I love: Larabar has only six ingredients (almonds, dats, semisweet chocolate chips, apples, cocoa powder and sea salt) and they taste great. Good option if you’re on a budget. 

✓ GF 

$16.14/86 bars ($.90 each) 

Order 

Skratch energy bar

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Nutrition facts:

220 Calories 

9 g fat 

30 g carb 

3 g fiber 

5 g protein 

What I love: great for pre-workout quick fuel. Interesting flavors such as cherry pistachio or peanut butter and strawberry. 

✓ GF, Vegan, Kosher 

$29.94/12 bars ($2.50 each) 

Order 




Bobo’s (Oat bar)

Maurten Solid

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Nutrition facts:

340 calories 

12 g fat 

62 g carb

4 g fiber

6 g protein 

What I love: Bobo’s are sold in local grocery stores and available in a bunch of interesting flavors such as chocolate almond and maple pecan. They can be broken in half for two snacks. 

✓ GF, vegan 

$29.88/12 bars ($2.49 each) 

Order

Solid225_Single_Products.jpg

Nutrition facts:

225 calories 

3.6 g fat 

41.5 g carb 

2.4 g fiber 

2.9 g protein 

What I love: The fructose-glucose syrup is an ideal ratio for energy production plus the low fiber content make this a great choice for pre-workout fuel. 

✓ GF 

Cost $36.00/12 bars ($3.00 each)

Order 

 

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Best post-workout bars 

These are my suggestions based on the nutrient composition. I generally look for a 4:1 ratio of carbohydrates to protein. This ratio has been shown to maximize glycogen stores, stimulate muscle protein synthesis and promote recovery.

Macrobar

Nutrition facts:

290 calories 

11 g fat 

39 g carb 

2 g fiber

11 g protein

What I love: GoMacro is a great tasting vegan bar with protein from almond butter. Also has a snack size version. 

✓ GF, Vegan 

Cost $38.95/12 ($3.25 each) 

Order 



 

Clif

 

Nutrition facts:

235 calories

5 g fat 

43 g carb 

5 g fiber 

11 g protein

What I love: Clif bars are available in many local grocery stores. I also like the 4:1 carbohydrate: protein ratio which is great for recovery after a workout. 

✓ GF 

$18.77/18 bars ($1.04 each) 

Order 

 

Rxbar 

 

Nutrition facts:

210 calories 

9 g fat 

23 g carb 

5 g fiber 

12 g protein 

What I love: RXBars have tons of flavors and they are easy to purchase, plus they are small enough to easily fit in your pocket.

✓ GF 

$23.37/12 bars ($1.95 each) 

Order



 

Over Easy

Nutrition facts:

230 calories 

11 fat 

24 g carb 

6 g fiber 

10 g protein 

What I love: Over Easy bars are a great breakfast option as recovery food. They have a ratio of 2:1 carbs to protein which can help build glycogen and stimulate muscle protein synthesis (MSP). 

✓ GF,  dairy free 

$29.69/12 bars ($2.47 each) 

Order

Eating Disorders in Athletes: Impact on Performance

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Eating Disorders in Athletes: Impact on Performance

  • By Amy Stephens RDN CSSD
  • Edited by Amy Gregorek

Eating disorders affect an athlete both mentally and physically and have significant impacts on performance. This blog will discuss the prevalence of eating disorders, identify warning signs in athletes, distinguish the differences and similarities to relative energy deficiency syndrome (REDS), and provide resources for those struggling to seek help. Eating Disorders are a  serious issue for everyone, but especially for athletes. Nutrition requirements are high and the inability to fuel an athlete’s body will lead to worsening of disordered eating, injuries, and overall decline in performance. 

The most common forms of eating disorders are anorexia, bulimia and binge eating disorder. Anorexia refers to restriction of food and refusal to meet nutritional needs, typically resulting in extreme weight loss. Bulimia is defined by consuming a large quantity of food in a short period of time, followed by a desire to “get rid” of the food through vomiting, exercise, or medications. Often, athletes can have a combination of both. Binge eating disorder is another type of eating disorder characterized by consuming a large quantity of calories in a short period of time. In one study, up to 84% of athletes were found to have subclinical disordered eating, and engaging in maladaptive eating and weight control behaviors, such as binge eating, excessive exercise, strict dieting, fasting, self-induced vomiting, and the use of weight loss supplements (Chatterton, Clifford). Evaluation by a physician or therapist can determine the severity and  best form of treatment.

Eating disorders do not discriminate as they affect all races, genders, and socioeconomic classes.  Some populations have higher rates of eating disorders. Eating disorders are most commonly screened and diagnosed between the ages 12-19, but can occur at any age. The earlier an athlete is diagnosed, the more likely they are to recover and reverse any damage to their bodies. The longer an eating disorder behavior is untreated, the more difficult the treatment and full recovery become.

Prevalence

  • 13.5% of athletes struggle with an eating disorder (Ghoch).
  • Up to 45% of female athletes and 19% of male athletes struggle with an eating disorder (Bratland-Sanda)
  • In a study by Petrie, 19.2% of athletes surveyed had maladaptive eating behaviors such as restricting food intake, limiting food choices, excluding large groups of foods, and purging behavior.

Risk factors for developing eating disorders in athletes

Certain sports that are weight dependent and focus on leanness pose a bigger risk for eating disorders. Both male and female athletes are at risk.

In addition, athletes who have recently undergone stressful events such as an injury are at a greater risk for developing an eating disorder. Athletes who have been struggling with poor performance might want to restrict food and blame the body.

 

There are additional societal contributions that can lead to eating disorders. It’s important to be aware of these factors so proper education for athletes and coaching staff can help prevent disordered eating among athletes.

Societal contributions include:

  • A fixation on thinness and the need to have a certain appearance in order to be happy or successful
  • Social media’s tendency to reinforce negative body image by giving attention to overly thin athletes
  • Restrictive diet plans promoted by ill-trained professionals
  • Society’s fixation on toxic positivity and the need to seek perfectionism to achieve one’s goals 

All of these practices promote unhealthy relationships with the body and eating patterns. Athletes are no exception. Weight dependent sports not only encourage unhealthy dietary practices, but reward them. The thinner athletes promote themselves as having reached their performance levels due to their thin body type. Misinformation from friends, coaches, and media can cause an athlete  to try and achieve an inappropriate level of thinness that causes physical and mental harm to their body. Eating disorders are often overlooked if the athlete is performing well. 



Difference between eating disorders and Relative Energy Deficiency Syndrome (RED-S)

Relative Energy Deficiency Syndrome (REDS) is a new classification of symptoms identified in 2014 by International Olympic Committee Mountjoy. REDS is characterized by low calorie intake in relation to energy exerted during exercise. REDS was formerly named “The Female Athlete Triad Syndrome because it affected three key systems in the female body:low calorie intake, menstrual irregularities, and lowered bone density. The term REDS is new but the condition has been in existence for a long time. Simply put, exercising too much and not eating enough causes an imbalance in which the body cannot function at optimal levels. What’s most interesting to me is that someone with REDS can be any body weight. The difference between REDS and an ED is that REDS is an unintentional mismatch of calories. Once an athlete with REDS is evaluated and educated about an appropriate amount of calories to sustain daily exercise and body functions, the deficit is corrected and the body can function properly. ED is further explored if the athlete is unable to willingly consume calories to support energy expenditure.

Sometimes it may not be obvious or easy to diagnose REDS or eating disorders. Someone can be a normal weight but is exercising too much and refueling inadequately. In this instance, athletes may feel that they are eating well, but in truth, are not eating enough calories to support exercise.

Signs of chronic underfueling that warrant further screening to determine if disordered eating is present

  • Females – change in menstrual cycle, can be longer or lighter periods, it is NOT normal for a female athlete to miss a period

  • Males – low testosterone and growth hormone. Both are natural performance enhancing hormones made by the body. Low levels can negatively affect sport performances, muscle growth, and energy production. Also important for serotonin uptake for the brain, it can lift mood. (Skolnick)

  • Hormonal changes can lead to stress fractures and ultimately osteoporosis

  • Frequent injuries to bones and soft tissues

  • Isolated, eats alone

  • Withdrawn behavior

  • Sudden changes with diet or food choices

  • Noticeable fluctuations in weight, both up and down

  • Irritability

  • Lethargy, difficulty finishing a workout

  • Digestive issues such as bloating (often mistaken for IBS), gas, diarrhea (this is often worsened by further restricting suspected nutrients)

  • Decrease in sports performance

  • Difficulty sleeping

  • Not seeing improvements in performance despite increasing workouts

  • Depressed immune system

  • Decreased cognitive functioning (lower blood sugar supplied to brain)

Treatment

Treatment often begins with an evaluation by a physician, eating disorder dietitian, and therapist. Once the patient is evaluated, they are recommended to the best form of treatment depending on their situation. The dietitian will create a plan that provides adequate calories to support daily expenditure. It can be challenging to find the right physician to help especially since there are differing opinions among professionals. In my experience, missing a period leads to complications related to menstrual cycle and bone growth. It is important to  let your doctor know if you’ve lost your period for more than three months as this can be related to underfueling or the result of underlying medical conditions. Your doctor can help guide you to the best treatment approach.

Resources for help

There are many resources to help. If you or someone you are close to might have an eating disorder, here are some important resources that can help:

    • Visit your doctor and explain why you are concerned. Be sure to ask if your doctor works with eating disorders.
    • For college athletes, visit your health center and explain why you are concerned. The health professionals can conduct proper screenings and assessments.
    • Seek out a sports dietitian (ask if they have experience with eating disorders)
    • See a school psychologist
    • If you think you have an eating disorder, speak to a trusted family member or friend and share your concerns. Eating disorders are isolating so speaking out is a step in the right direction.
    • Seek out supportive teammates and coaches and share your eating concerns. They can help you locate the best resources for an evaluation and assessment.
    • National Eating Disorders Hotline (NEDA) 1-800-931-2237

 

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References

Bratland-Sanda S, Sundgot-Borgen J. (2013). Eating disorders in athletes: overview of prevalence, risk factors and recommendations for prevention and treatment. Eur J Sport Sci, 13(5):499-508.

Chatterton, J. M., & Petrie, T. A. (2013). Prevalence of disordered eating and pathogenic weight control behaviors among male collegiate athletes. Eating Disorders, 21(4), 328-341.

Clifford, T., & Blyth, C. (2018). A pilot study comparing the prevalence of orthorexia nervosa in regular students and those in university sports teams. Eating and Weight Disorders – Studies on Anorexia, Bulimia and Obesity, 24(3), 473-480.

Conviser, J. H., Schlitzer Tierney, A., Nickols, R. (2018). Essential for best practice: treatment approaches for athletes with eating disorders. J of Clin Sports Psych, 12.

Ghoch, M. E., et al. (2013). Eating disorders, physical fitness, and sport performance: a systematic review. Nutrients, 5:12.

Mehler, P.S., Sabel, A.L., Watson, T. and Andersen, A.E. (2018). High risk of osteoporosis in male patients with eating disorders. Int. J. Eat. Disord, 41: 666-672.

Mountjoy M, Sundgot-Borgen JK, Burke LM, et al. (2018). OC consensus statement on relative energy deficiency in sport (RED-S): 2018 update. Brit J of Sports Med, 52:687-697.

Petrie, Trent, Greenleaf, Christy,  Reel, Justine, Carter, Jennifer. (2018). Prevalence of Eating Disorders and Disordered Eating Behaviors Among Male Collegiate Athletes. Psych of Men & Masculinity, 9: 267-277.

Scott CL, Plateau CR, Haycraft E. (2020). Teammate influences, psychological well-being, and athletes’ eating and exercise psychopathology: A moderated mediation analysis. Int J Eat Disord, 53(4):564-573.

Shufelt CL, Torbati T, Dutra E. (2017). Hypothalamic Amenorrhea and the Long-Term Health Consequences. Semin Reprod Med, 35(3):256-262. 

Skolnick A, Schulman RC, Galindo RJ, Mechanick JI. (2016). The endocrinopathies of male anorexia nervosa: case series. AACE Clin Case Rep, 2(4):e351-e357.




Hydrating in heat and humidity

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Hydrating in heat and humidity

  • By Amy Stephens RDN CSSD
  • Edited by Amy Gregorek

Water is the forgotten nutrient

Exercise produces heat and leaves the body as sweat to stay cool. Studies have repeatedly shown that losing more than 2% body weight impacts performance (James). More sweat is produced when the temperatures are higher or when humidity is high. Dehydration results in an increase in one’s core temperature, reduced cardiovascular function and imparied exercise performance.

Essentially, dehydration increases an athlete’s perceived effort and reduces the ability to continue exercising at a high level (Nybo). If you’re overheating, the body will prioritize cooling itself versus rapid energy production (James).

Role of sweat

During exercise, the body produces heat and energy. Sweat is the body’s built-in cooling system that enables the body to make more energy. In warmer temperatures, exercise raises core temperatures at a faster rate which require more water expelled through the skin to keep the body cool. As temperatures increase, our bodies respond by sweating more. However, humidity compounds this problem by preventing evaporation. In situations where humidity levels are high, as we experience on the east coast all summer long, there is more moisture in the air and the sweat does not evaporate. As a result, the body’s core temperature increases, making exercise seem harder.

Dehydration affects performance

Many studies have shown that a 2% loss in body weight will impair performance (Lewis). The body has to work harder to keep the heart pumping to produce energy and muscles firing. Not only does it feel harder when you are dehydrated, but your body is also producing energy at a slower rate.

As core temperatures increase, energy metabolism shifts from aerobic production to anaerobic and this causes a buildup of anaerobic by-products that stimulate fatigue.  This process occurs at a faster rate in hot and humid conditions.  Fuel source shifts from fatty acids to glucose and amino acids and creates more hydrogen and lactic acid (Burke 2015). The heart receives less blood and therefore, less oxygen is delivered to working muscles. This makes exercising even more difficult in warmer conditions. Muscles have a harder time contracting when they’re overheated and premature fatigue can set in (Nybo).

Cramping

If you lose too much water, the risk of cramping is increased. Humidity increases risk of dehydration which causes an imbalance of electrolytes, especially potassium, magnesium and sodium. These electrolytes are lost at high levels through the skin and have a significant impact on cramping (Jung).

Symptoms of dehydration

  • feeling thirsty
  • lightheaded
  • fatigue
  • dry mouth
  • urinating less often
  • infrequent, dark colored urine

Dietary recommendations in the heat

Fluid requirements are individualized. Establish your sweat rate by using a sweat test to better estimate the amount of sweat you lose in one hour of exercise. Once you know how much fluid your body loses, you can more precisely match your fluid requirements. Estimate fluid losses by using a sweat rate calculator to input your weight and fluids. Calories do not need to be increased when exercising in heat (Burke).

  1. Start drinking fluids when you wake up. Have a glass of water before you drink coffee!
  2. Before exercising, urine should be a pale yellow color.
  3. Exercise in the beginning or end of the day when it’s cooler
  4. Don’t chug water without electrolytes, this can lead to hyponatremia.
  5. You will rehydrate faster when fluids contain electrolytes and carbohydrates. This helps stimulate thirst and retain fluids consumed (Baker & Jeukendrup 2014).

Hyponatremia is caused by drinking too much water and not enough electrolytes. Make sure to have salt or nuun tablets handy. Water follows electrolytes and when you sweat, you lose both!

The color of your urine is the best indicator of hydration. Aim for pale yellow, shade 1 or 2 on the chart is ideal. Clear urine can indicate fluid overload and hyponatremia. If your urine is dark yellow before a run, delay the start until you can drink more fluids.

References

Baker & Jeukendrup. Optimal composition of fluid replacement beverages. Comp Physiol. 2014;4:575-620.

Burke L. Nutritional needs for exercise in the heat. Comp Biochem Physiol Mol Integr Physiol. 2001; 128: 735-48.

Burke L. Clinical Sports Nutrition, 5th edition. 2015.

Cory M, et al. Resistance training in the heat improves strength in professional rugby athletes. Sci Med in Football. 2019;3:198–204.

James LJ, et al. Does Hypohydration Really Impair Endurance Performance? Methodological Considerations for Interpreting Hydration Research. Sports Med. 2019 Dec;49(Suppl 2):103-114.

Jung A, et al. Influence of Hydration and Electrolyte Supplementation on Incidence and Time to Onset of Exercise-Associated Muscle Cramps. J Athl Train. 2005; 40: 71–75.

Lewis J, et al. Does Hypohydration Really Impair Endurance Performance? Methodological Considerations for Interpreting Hydration Research. Sports Med. 2019;49:103-114.

Nybo & Sawka. Performance in the heat physiological factors of importance for hyperthermia-induced fatigue. Compr Physiol 2014;4:657-89.

Lau W, et al. Effect of oral rehydration solution versus spring water intake during exercise in the heat on muscle cramp susceptibility of young men. J of the Intl Soc of Sp Nutr. 2021; 18 (1).

optimize health and performance

Amy Stephens, MS, RDn, CDces, CSSD

Licensed dietiTian

specializing in sports nutrition and eating disorders

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