UNDERSTANDING EATING DISORDERS: INSIGHTS FOR COACHES, FAMILIES AND FRIENDS

January 28, 2024 by Britt

Understanding Eating Disorders:
Insights for Coaches, Families and Friends

Eating disorders are complex conditions influenced by a combination of genetic, biological, environmental, psychological, and sociocultural factors. It’s important to note that these factors interact in complex ways, and not everyone with risk factors will develop an eating disorder. Additionally, eating disorders can affect individuals of any age, gender, socioeconomic status, or cultural background. An eating disorder is not visibly apparent. An individual may appear healthy but may be struggling. It’s important to note that eating disorders are a mental illness.

Addressing eating disorders early can improve the likelihood that individuals will be able to pursue their academic career and physical goals. A comprehensive approach to treatment that addresses physical, emotional, and psychological aspects is crucial for recovery

Prevalence

Among the general population, an estimated 9% of the U.S. population, or 28.8 million Americans, will have an eating disorder in their lifetime (Deloitte, 2020).

95% of people with an eating disorder are between the ages 12-25 years old (Bratland-Sanda, 2013).

Eating disorders are a mental illness with the highest death rate, higher than depression, bipolar or schizophrenia (Arcelus, 2011).

Among athletes, eating disorders may be particularly hard to detect due in part to secretiveness, stigma, and symptom presentation (Eichstadt, 2020).

Athletes may be less likely to seek treatment for an eating disorder due to stigma, accessibility, and sport‐specific barriers (Flatt, 2021).

13.5% of athletes have a diagnosable eating disorder (Goch, 2013).

Up to 47% of female athletes, versus 19% of male athletes have an eating disorder (Brantland-Sanda, 2013).

Causes

There is no single cause for eating disorders, but several factors may contribute to their development:

Genetic Factors:

Research suggests a genetic predisposition to eating disorders. Individuals with a family history of eating disorders may be more susceptible.

Biological Factors:

Abnormalities in brain chemistry and neurotransmitter imbalances, such as serotonin and dopamine may play a role in the development of eating disorders.

Psychological Factors:

Personality traits, such as perfectionism, low self-esteem, and high levels of anxiety or depression, are associated with an increased risk of developing eating disorders.

Environmental Factors:

Societal pressures, cultural ideals of beauty, and exposure to thinness-promoting media can contribute to body image dissatisfaction, leading to disordered eating behaviors.

Traumatic Experiences:

Traumatic events, such as childhood abuse, bullying, or other significant life stressors, may contribute to the development of eating disorders as a coping mechanism.

Dieting and Weight Concerns:

Strict dieting or extreme focus on weight loss can trigger disordered eating behaviors. Dieting may disrupt normal eating patterns and lead to the development of unhealthy relationships with food.

Athletics and Performance Pressure:

Athletes, especially those in sports that emphasize leanness or specific body types, may be at increased risk. The pressure to perform and meet certain body standards can contribute to the development of eating disorders.

Family Dynamics:

Family factors, such as dysfunctional family relationships, communication problems, or a history of parental eating disorders, can contribute to the development of disordered eating patterns.

Social Influences:

Peer pressure and the desire to fit in with a particular group may contribute to the adoption of unhealthy eating habits.

Signs and symptoms

Recognizing if someone has an eating disorder can be challenging, as individuals with these disorders often try to conceal their behaviors. However, there are signs and behaviors that may indicate the presence of an eating disorder. It’s essential to approach the situation with empathy and sensitivity, avoiding judgment. Here are some common signs that someone may have an eating disorder:

Changes in Eating Habits:

- Frequent dieting or a sudden switch to restrictive eating patterns.
- Excessive focus on calories, fat content, or specific food groups.
- Eating alone or avoiding meals altogether.
- Consuming an inadequate amount of food before or after a workout.
- Denying or minimizing behaviors related to food, body image or weight.
- Evidence of binge eating, like finding large amounts of food wrappers.

Physical Signs and Symptoms:

- - Significant weight loss or fluctuations in weight.
  - Noticeable changes in appearance, such as a pale complexion or brittle nails.
  - Fatigue, weakness, or dizziness.
  - Frequent fluctuations in energy levels.
  - Evidence of self-induced vomiting, laxative use, or excessive exercise.

Emotional and Behavioral Changes:

- Preoccupation with body image, weight, or food.
- Avoidance of social events that involve food.
- Anxiety or distress around mealtime.
- Frequent comments about feeling fat or expressing dissatisfaction with one’s body.

Social Withdrawal:

- Isolation from friends and social activities.
- Desire to be alone.
- Changes in relationships, especially if they involve food-related activities.

Mood Changes:

- Increased irritability, mood swings, or signs of depression.
- Emotional distress before, during, or after eating.

Denial of the Problem:

- Dismissing concerns about weight loss or changes in eating habits.

Physical Health Issues:

- Menstrual irregularities or the absence of menstrual periods in females.
- Digestive problems, such as constipation or bloating.
- Frequent complaints of feeling cold or wearing layered clothing to hide weight loss.

The presence of one or more of these signs does not necessarily confirm an eating disorder. However, if you notice several of these behaviors persisting over time, it may be an indication that further evaluation is needed.

How to help

Early intervention has been shown to improve outcomes. Treatment provides an opportunity for individuals to learn and adopt healthy eating habits, coping mechanisms, and stress management skills. If you suspect an individual has an eating disorder, express your concern in a nonjudgmental and caring manner. Encourage them to seek help from a healthcare professional, therapist, or dietitian who specializes in eating disorders. Remember that though eating disorders share commonalities, everyone is unique. You might need to bring up this issue several times before the person is willing to seek help.

References

Arcelus J, Mitchell AJ, Wales J, Nielsen S. Mortality Rates in Patients With Anorexia Nervosa and Other Eating Disorders: A Meta-analysis of 36 Studies. Arch Gen Psychiatry. 2011;68(7):724–731. doi:10.1001/archgenpsychiatry.2011.74

Bratland-Sanda S, Sundgot-Borgen J. Eating disorders in athletes: overview of prevalence, risk factors and recommendations for prevention and treatment. Eur J Sport Sci. 2013;13(5):499-508. doi: 10.1080/17461391.2012.740504. Epub 2012 Nov 13. PMID: 24050467.

Deloitte Access Economics. The Social and Economic Cost of Eating Disorders in the United States of America: A Report for the Strategic Training Initiative for the Prevention of Eating Disorders and the Academy for Eating Disorders.June 2020. Available at: https://www.hsph.harvard.edu/striped/report-economic-costs-of-eating-disorders/.

Eichstadt, M., Luzier, J., Cho, D., & Weisenmuller, C. (2020). Eating disorders in male athletes. Sports Health: A Multidisciplinary Approach, 12(4), 327–333. https://doi.org/10.1177/1941738120928991

Flatt, R., Thornton, L., Fitzsimmons‐Craft, E., Balantekin, K., Smolar, L., Mysko, C., Wilfley, D. E., Taylor, C. B., DeFreese, J. D., Bardone‐Cone, A. M., & Bulik, C. M. (2021). Comparing eating disorder characteristics and treatment in self‐identified competitive athletes and non‐athletes from the National Eating Disorders Association Online Screening Tool. International Journal of Eating Disorders, 54(3), 365–375. https://doi.org/10.1002/eat.23415

Ghoch M, et al. Eating disorders, physical fitness and sport performance: a systematic review. Nutrients. 2013 Dec 16;5(12):5140-60. doi: 10.3390/nu5125140. PMID: 24352092; PMCID: PMC3875919.

Paul A. Krebs, Christopher R. Dennison, Lisa Kellar, Jeff Lucas, “Gender Differences in Eating Disorder Risk among NCAA Division I Cross Country and Track Student-Athletes”, Journal of Sports Medicine, vol. 2019, Article ID 5035871, 5 pages, 2019. https://doi.org/10.1155/2019/5035871

FUELING AN INDOOR WORKOUT: A GUIDE

January 2, 2024January 1, 2024 by amystephens

FUELING AN INDOOR WORKOUT: A GUIDE

Providing your body with the essential energy for powering through exercises is crucial during a gym or indoor track workout. This guide provides tips on how to effectively fuel and hydrate your body during indoor workouts. The focus is on the right timing and type of nutrients to avoid energy crashes or gastrointestinal issues, and to keep energy levels up.

before

One-to-two hours before your workout, it is important to have a pre-workout snack that is rich in carbohydrates and protein to give you the energy you need to perform at your best. Some great pre-workout snacks include a banana with peanut butter, toast with peanut butter, rice cakes or a nutrition bar such as Clif, Nutrigrain or Maurten bar. If you need a quick snack right before you start your workout, opt for quick acting carbohydrates. Excellent choices include fruit snacks, sports drinks, or energy gels.

Target about 40-60 grams of carbohydrate and 8-12 oz fluids.

during

During your workout, it is important to stay hydrated by drinking water or a sports drink to replace the fluids lost through sweat. Consider adding electrolytes if you find yourself sweating excessively. If your workout lasts longer than an hour, consider having a small snack such as an energy gel, fruit, or sports drink to keep your energy levels up.

Hydration needs during the workout depend on its duration and intensity. A common recommendation is to drink about 4-10 ounces (about 100-300 milliliters) of water every 10-20 minutes during the exercise.

after

After your workout, it is important to refuel your body with a post-workout snack or meal that is rich in protein and carbohydrates. This will help to replenish your energy stores and aid in muscle recovery. Some great post-workout snacks include chocolate milk, a piece of fruit with a protein shake, trail mix and dried fruit, a turkey and avocado wrap, hummus wrap, or fruit and granola.

Rehydrate after the workout by drinking fluids (water or sports drink). A general guideline is to consume about 16-24 ounces (about 500-700 milliliters) of water for every pound (0.45 kilograms) of body weight lost during exercise.

Remember, fueling and hydration requirements can vary from person to person based on individual preferences and dietary restrictions. It’s essential to listen to your body and find what works best for you. Proper fueling before, during, and after your indoor workout is key to achieving your fitness goals and maintaining a healthy body.

Fueling for winter training

December 8, 2023 by amystephens

Fueling for winter training

During the winter months, nutrition priorities shift towards hydration, foods that generate body warmth, and those that boost the immune system.

Hydration

1. Hydrate even if you don’t feel thirsty. Your body loses water through both respiration and perspiration. This becomes particularly crucial during winter months and even more so if training at altitude. Performance can be impacted by dehydration, so maintain hydration by consistently sipping fluids throughout the day. If you tend to sweat heavily, consider incorporating electrolytes as well.

2. Layer your clothing to avoid overheating. Aim to dress for temperatures that are 10-20 degrees warmer than the outside temperature. If the temperature is 32℉ (0 ℃), dress for 40 or 50℉ (4-10℃). As your body temperature rises during activity, you can gradually remove layers to prevent overheating. Wearing too many layers can lead to increased sweating, potentially hastening dehydration.

3. Replenish fluids immediately after a workout. Kickstart recovery and hydration by choosing warm fluids like soups, teas or hot chocolate.

4. Do not let the need to remove layers for restroom breaks lead to intentional fluid restriction. Stopping and removing extra layers to urinate can be time-consuming and inconvenient. Nevertheless, athletes should be mindful that dehydration can significantly impair sports performance.

Fuel

Take advantage of food’s thermic effect, eating can increase body temperature and help the body warm up before a workout. Along with warm fluids (coffee or tea), eat a banana or a warm bowl of oatmeal 30-60 minutes before a workout to help your body warm up.
Refuel after a workout to continue to experience the thermic effect of food. Refueling will also help replenish glycogen stores and repair damaged muscle tissue. Choose meals that have plenty of complex carbohydrates, proteins and fats.

Recovery foods

Be conscious of Vitamin C consumption to keep the immune system working at peak level. Include seasonal foods such as frozen fruits, beets, broccoli, avocado, sweet potato and citrus fruits.
Incorporate foods with Vitamin D. Sunlight is our bodies natural form of Vitamin D however in winter months, we don’t get nearly enough sunshine to activate Vitamin D. Best foods to choose are salmon, sardines, herring, eggs, and yogurt.
Choose warmer meals that are rich in carbohydrates and protein. Some great choices are soups, stews, hot chocolate, warm sandwiches, pasta with meatballs and bowls. Eat enough to replenish glycogen and promote recovery.
Eat the same amount of food in colder temperatures. Energy expenditure doesn’t change too much in winter months unless you are carrying extra gear (i.e. skis, hiking gear, or large hydration vests).

Sample winter meal plan

Breakfast

Oatmeal made with frozen blueberries, topped with sliced banana, nut butter and cinnamon

Snack

Trail mix with dried fruit and salted almonds

Lunch

Homemade soup or stew

carrot ginger, winter vegetable and farro, chicken noodle, lentil, beef stew

Snack

Homemade muffins (apple and carrot superhero muffin recipe)

Chamomile or turmeric tea

Dinner

Salmon with roasted sweet potatoes, and a kale salad with feta cheese, pumpkin seeds, dried cranberries and lemon vinaigrette dressing

What’s the difference between a dietitian and a nutritionist?

November 21, 2023 by amystephens

What’s the difference between a dietitian and a nutritionist?

It’s a matter of education and training.

Consult with a healthcare provider who has appropriate training in the specific area you require assistance with. Inquire about your practitioner’s training to verify it aligns with your nutrition objectives. Following advice from an untrained provider can be detrimental, potentially preventing or delaying appropriate treatment.

Dietitian

Education

Starting in 2024, individuals will need a Master’s degree from an accredited university in order to be eligible for the dietetic exam which is necessary to become a registered dietitian (RD). Courses include clinical practice, complementary and alternative nutrition therapies, diseased gut, and clinical nutrition assessment. For more detailed information about requirements, click here.

Training

Complete a 1,200-hour dietetic internship by an accredited program. During the internship, students rotate through different settings such as hospital, community-based rotation and food service areas. Students learn how to practice medical nutrition therapy (MNT) and communicate with medical teams that include physicians, physical therapists, mental health providers, and family members.

Dietetic exam

After successfully completing eligibility requirements and being validated by the commission on dietetic registration, individuals must take and pass the board exam in order to become a registered dietitian. For more information about the exam such as the outline and study resources, click here.

Place of work

Dietitians can hold positions in hospitals, universities, the military, international olympic committee (IOC), foodservice, or doctor’s offices.

Continuing medical education (CME)

Every five years, the commission on dietetic registration (CDR) requires 75 credits of CME. This can be accrued through seminars, journal articles, workshops, webinars, training programs, additional certifications, etc. For a full list of how to obtain CME, click here.

Specialty certifications

In addition to the registered dietitian credential, there are many other specialties which are listed below. They each have different training requirements, supervised hours and exams.

Nutritionist

Education

No standard. Anyone can claim to be a nutritionist…There is no formal governing body.

Training

There is no current standard for training nutritionists. The type of courses offered and length of programs for nutritionists varies. Some nutritionist programs can be as little as 10 weeks online. No state licensure standard for all nutritionists.

MARATHON RACE DAY – 7 Common Mistakes Runners Make

October 27, 2023 by amystephens

MARATHON RACE DAY 7 Common Mistakes Runners Make

You might have the best shoes and completed the best training plan, but if your nutrition is off on race day, you won’t perform your best. Whether this is your first or tenth marathon, here are a few common mistakes that I hear from my athletes.

Starting your fueling plan too late on race day

Even if you’re feeling good, aim to start your fueling plan within the first 30-45 minutes. This will help preserve precious glycogen in your muscles so you have enough energy for the last 10k.
Not bringing enough gels to your race

Plan out how many gels you need. It will likely be more than you’re used to carrying. Stash the gels in pockets, in gloves, hats – anywhere you can easily access them. It is better to be over prepared than underprepared!
Trying new products or foods on race day

On race day, the last thing you want to worry about is if a new food will sit well in your stomach before a race. It is best to stick to the food, drinks and energy products you know you can handle, and that you’ve practiced with on long runs during training. On the course, there might be lots of foods offered like bananas, candy, bars or gels, take these only if you’ve had them in the past.
Eating too close to start time
Establish a race day food plan that you’ve tested out and stick to it! Recognize that race day will likely be different and you might need to be eating while traveling to the start line. Stick with the same timing that you’ve practiced so you have plenty of time to digest. Race day is not the day to try a new fuel timing plan.
Thinking you have to cut out “unhealthy foods” during training

Your diet does not have to be perfect to be a runner. As long as most of your foods are nutritious, and you are eating enough, there is room in your diet for less nutrient dense foods that you enjoy!
“It’s cold out, so I don’t need to hydrate!”

Proper hydration in the cold weather is essential for keeping your muscles firing. Even in the colder weather, when you do not feel like you are sweating as much, your hydration needs do not decline much.
Not eating anything on race day because you’re too nervous

Calm the nerves by prepping your race day foods. Lay out all the foods you’ll need and list the times that you normally eat them.

Iron for endurance athletes

June 24, 2024September 10, 2023 by amystephens

Iron levels for athletes

Why iron deficiency is important

Iron is an important nutrient to endurance athletes because it carries oxygen and produces energy. Low levels of iron mean that fewer red blood cells are available to carry oxygen. Oxygen is essential to power muscles and the removal of metabolic waste so the body can function at peak performance. Many studies have reported the prevalence of iron deficiency in endurance athletes to be as high as 50% in females and 30% in males (Koehler 2012, Tan 2012). Although more common in female athletes, male athletes are also at risk for low iron. Often, athletes will report low energy levels or difficulty completing a workout, and later will find it’s iron deficiency. This post will review how iron impacts performance, symptoms of low iron, and how to prevent iron from impacting performance.

Stages of deficiency

Dr. Peeling defined stages of deficiency and depletion (2007). What’s interesting about these stages is that iron stores can be depleted while hemoglobin levels remain within normal range. It’s not until stages 2 or 3 of deficiency that an athlete begins to see a performance impact. Before a substantial training block begins, assessing individuals’ risk factors and low iron risk factors is helpful. If an athlete has a drop in iron during a racing season, treatment can take a few weeks, which can have a detrimental impact on the racing schedule. A basic iron assessment contains the following labs: ferritin, hemoglobin, and transferrin saturation. Your physician can order these tests and a sports dietitian can help interpret them and review best treatment options.

> Stage 1—Iron deficiency (ID): iron stores in the bone marrow, liver and spleen are depleted (ferritin < 35 μg/L, Hb > 115 g/L, transferrin saturation > 16%). Treat with food first approach by including many iron-rich foods along with Vitamin C.

> Stage 2—Iron-deficient non-anemia (IDNA): erythro- poiesis diminishes as the iron supply to the erythroid marrow is reduced (ferritin < 20 μg/L, Hb > 115 g/L, transferrin saturation < 16%). Initiate iron supplements 65mg elemental iron. Can take 4-12 weeks to show results.

> Stage 3—Iron-deficient anemia (IDA): Hb production falls, resulting in anemia (ferritin < 12 μg/L, Hb < 115 g/L, transferrin saturation < 16%). When levels are this low, consult with your physician about the cause and best treatment options.

NOTE: 325 mg ferrous sulfate is equivalent to 65 mg elemental iron.

Risk factors for low iron

There are a variety of factors that contribute to low iron levels. Any one of these risk factors can cause iron levels to drop, and multiple risk factors will carry an even greater risk for low iron. Endurance athletes are at the greatest risk due to the hemolysis from the footstrike and blood loss in the gut while running and sweat. During a training block, iron can drop 25-40% (McKay).

Menstruation for females
Underfueling/Low calorie intake (RED-S)
Endurance athletes
Altitude training
Vegan or vegetarian diets
Have a history of low iron stores

Symptoms

Initially, symptoms are not overt, however, you may feel tired overtime or less of a desire to complete a workout. Most common symptoms include: feeling lethargic, dizzy, negative mood, or poor performance (Sim).

Hepcidin

Hepcidin is a hormone released during exercise that inhibits iron absorption for 3-6 hours after a workout (Sim). This hormone regulates the amount of iron absorbed by the gut. Hepcidin levels are known to elevate 3-6 hours after a workout, thus reducing the amount of iron absorbed from food and supplements.

Iron- rich foods

There are two types of iron-rich foods – heme and non heme sources. Heme sources are more bioavailable compared to plant-based iron sources. Up to 35% of heme versus 20% iron from plants are absorbed (Beard). An athlete can add a Vitamin C food to further enhance absorption. If iron stores are very low or you are at a higher risk for iron deficiency, you may require iron supplements in addition to dietary intervention. Currently, the RDI for iron men is 8mg and 18 mg for women.

Heme iron

Beef
chicken
fish
turkey

Non-heme

Lentils, beans
Chickpeas, hummus (especially if made with tahini)
Spinach
Apricots, prunes
Baked potato with skin
Enriched breakfast cereals (Cheerios)
Enriched pasta

Click here for a full list of iron-rich foods from the USDA database.

Sample meal ideas

Grilled chicken over rice with roasted red peppers.

Turkey sandwich on whole wheat bread with an orange.

Spinach salad with chickpeas, dried apricots, and lemon vinaigrette dressing.

Key points

Iron is an important nutrient involved with energy production and promoting oxygen uptake. Iron deficiency can negatively impact performance in athletes by reducing oxygen transferred to the cells and making the body work harder to produce energy.

Females, vegetarians, calorie-restricted diets (RED-S), endurance athletes and training at altitude increase the risk for low iron.

Symptoms of iron deficiency include fatigue, negative mood and poor performance.

Hepcidin is a hormone that reduces iron absorption for 3-6 hours following a workout. The best time to take an iron supplement or eat an iron rich meal is outside this window.

Best food sources of iron include meat, fish, poultry, dark green leafy vegetables. Combine iron rich foods with Vitamin C to enhance absorption.

Certain foods will compete with iron absorption, such as calcium and phytates.

Speak with your physician or sports dietitian to help assess and treat iron deficiency.

References

Beard J, Tobin B. 2000. Iron status and exercise. Am J Clin Nutr. 72 (2):594S-597S.

Coates A, Mountjoy M, Burr J. Incidence of iron deficiency and iron deficient anemia in elite runners and triathletes. Clin J Sport Med. 2016.

Koehler K, Braun H, Achtzehn S, Hildebrand U, Predel H-G, Mester J, Schänzer W (2012) Iron status in elite young athletes: gender- dependent influences of diet and exercise. Eur J Appl Physiol 112(2):513–523

McKay, AKA, Peeling P, et al. (2019a) Chronic adherence to a ketogenic diet modifies iron metabolism in elite athletes. Med Science Sports Exercise. 51(3):548-555.

McKay et al. Iron metabolism: interactions with energy and carbohydrate availability. Nutrients. 2020 Nov 30.12(12); 3692

Ostojic SM & Ahmetovic Z. Weekly training volume and hematological status in female top-level athletes. Ahmetovic Journal of Sports Medicine and Physical Fitness; Sep 2008; 48, 3; ProQuest Nursing & Allied Health Source pg. 398

Peeling P, Blee T, Goodman C, Dawson B, Claydon G, Beilby J, Prins A (2007) Effect of iron injections on aerobic-exercise perfor- mance of iron-depleted female athletes. Int J Sport Nutr Exerc Metab 17(3):221–231

Sim et al. Iron considerations for the athlete: a narrative review. Eur J Appl Physiol. 2019 July; 119(7):1463-78

Tan D, Dawson B, Peeling P (2012) Hemolytic effects of a football-specific training session in elite female players. Int J Sports Physiol Perform 7(3):271–276

USDA database for iron rich foods

How to Restore Your Period as an Endurance Athlete

November 11, 2023August 25, 2023 by amystephens

How to Restore Your Period as an Endurance Athlete

Athletes burn tons of extra calories each day because of the high demands of their training. If their nutritional needs are not being met, they may be underfueling. For female athletes, underfueling poses a high risk for secondary amenorrhea, which is defined as the absence of three or more periods in a row by someone who has had periods in the past. It can lead to a variety of other health issues, specifically impacting bone health and lowering immunity. Unfortunately, secondary amenorrhea is extremely common in female runners. The good news is, it is possible for an athlete to regain their menstrual cycle and potentially reverse the effects caused by secondary amenorrhea. But how?

The short answer is simple: exercise less, and eat more.

The long answer is that it isn’t so simple for athletes. Many athletes may feel that they have no chance at regaining their menstrual cycle, because their lifestyle directly goes against the baseline rule of exercising less and eating more to restore their period. Additionally, some athletes may fear weight gain despite the fact that it may be necessary for them to restore their cycle. However, secondary amenorrhea is reversible, and here are 5 ways in which an athlete can make small changes in order to restore their period:

Increasing Calories – Secondary amenorrhea is caused by a prolonged caloric deficit. The most important thing an athlete must do to restore their menstrual cycle, is to increase their caloric intake. It does not need to be a major lifestyle change or a completely new diet, adding in 1-2 nutritionally dense snacks every day might even do the trick. Adding between 350-450 calories per day above energy requirements, may be enough to restore an athlete’s menstrual cycle (Ciadella-Kam et al., 2014). However, if you are substantially under nourished, your body may require a higher level of calories to meet nutritional needs.
Timing of Fueling – No matter what time of day it is, refueling as soon as possible after a run or a hard workout is essential for your body to properly recover. It is best to eat a snack or a meal within 30 minutes of finishing a run, to kickstart replenishing your glycogen stores. Additionally, eating as soon as possible after a workout is a great way to replenish the calories expended during the training session. By refueling, you are preventing your body from falling into a prolonged calorie deficit, thus supporting the goal of avoiding a caloric deficit for restoring the menstrual cycle.
Dialing Back Training – Studies show that reducing exercise intensity restores estrogen production and hormonal balance. It may be beneficial for an athlete to dial back on their training, if they are struggling to regain their menstrual cycle after a period of time. However, there are some athletes that can restore their period by making nutritional changes, and continuing their normal training pattern. Focusing more on food timing around workouts may be supportive to athletes who need to be training year round.

4. Increasing Healthy Fats – Healthy fats supply the building blocks for female hormone production in the body. Increasing healthy fats when in secondary amenorrhea recovery supports the production of estrogen, progesterone, and healthy brain tissue. Healthy fats also support overall nutrient absorption, so consuming healthy fats allows your body to make the most out of all the other food you eat, ensuring that you are absorbing all the nutrients you need. Some easy ways to increase healthy fats can be from foods like full fat dairy products, avocados, fish, nuts and nut butters, seeds, and cooking with olive oil.

5. Necessary Weight Gain and Increasing Body Fat – It is a common misconception among runners and other athletes that being thinner will improve performance. This is not true, and in fact having a body fat percentage that is too low can be dangerous. For menstrual health, body fat is crucial. Women that have a low BMI (body mass index) are producing less estrogen, which can lead to secondary amenorrhea. While everybody is different, and using BMI may not be an accurate representation of what is healthy versus what is not, if an athlete has a low BMI as a result of extremely demanding training as well as a calorie deficit, it is not healthy. This is especially the case if they suffer from secondary amenorrhea. If you have lost your menstrual cycle, even if you are not necessarily “underweight” as understood by the BMI scale, you may be at an unhealthy bodyweight for YOU. Gaining some essential body fat will support hormone health by aiding the production of estrogen, allowing your body to regain its menstrual cycle.

6. Shift away from the diet mindset – Deliberately limiting your food or food intake with the aim of losing weight can lead to changes in your metabolism and hormone balance. Ensure that you eating enough to sustain your physical activity and promote recovery. Seek guidance from a sports dietitian expert to accurately assess your nutrition requirements and create a well-balanced meal plan.

7. Pay attention to your body’s hunger cues – Feeling hungry is a sign that your body needs food. By ignoring hunger cues, your body’s natural rythms can become imbalanced. When you feel hungry, opt for a nutritious meal or snack to address your body’s needs.

In addition to misinformation regarding the effects and severity of amenorrhea in athletes, it is also common for people to believe that going on birth control will fix these issues. While the birth control pill can produce a “period” it’s actually a withdrawal bleed. It’s not a natural period where your body has enough nutrients to produce hormones. A withdrawal bleed is not a real period and it doesn’t indicate you are in calorie balance.

Your physician may suggest that, as an athlete, it’s ok to miss your period. As mentioned, losing a period is not healthy and indicates an imbalance with nutrition and exercise that requires attention. Prolonged amenorrhea can have long-term effects on bone health.

Ultimately, there is no formula for restoring your period. Everybody is different, and some methods may work better than others. Additionally, some people may regain their periods faster than others, but this does not mean that you should stop trying. Small changes over time build up, and eventually by using these tips you can restore your period and continue becoming the strongest and healthiest athlete you can be.

Reach out to an informed physician or sports dietitian who can provide additional guidance about restoring your cycle.

References

Cialdella-Kam, L.; Guebels, C.P.; Maddalozzo, G.F.; Manore, M.M. Dietary Intervention Restored Menses in Female Athletes with Exercise-Associated Menstrual Dysfunction with Limited Impact on Bone and Muscle Health. Nutrients 2014, 6, 3018-3039.

De Souza MJ, Mallinson RJ, Strock NCA, Koltun KJ, Olmsted MP, Ricker EA, Scheid JL, Allaway HC, Mallinson DJ, Kuruppumullage Don P, Williams NI. Randomised controlled trial of the effects of increased energy intake on menstrual recovery in exercising women with menstrual disturbances: the ‘REFUEL’ study. Hum Reprod. 2021 Jul 19;36(8):2285-2297.

Hackney AC. Menstrual Cycle Hormonal Changes and Energy Substrate Metabolism in Exercising Women: A Perspective. Int J Environ Res Public Health. 2021 Sep 24;18(19):10024.

Ihalainen JK, Kettunen O, McGawley K, Solli GS, Hackney AC, Mero AA, Kyröläinen H. Body Composition, Energy Availability, Training, and Menstrual Status in Female Runners. Int J Sports Physiol Perform. 2021 Jul 1;16(7):1043-1048.

ENERGY BARS AND BITES

August 17, 2023August 11, 2023 by amystephens

ENERGY BARS and BITES

Athletes have high energy demands, and it can be difficult to meet these needs with meals alone. Energy bars and bites are a great way to offset hunger and fill in gaps between meals. Together with my intern, Sara, we created a list of energy bars and bites that we personally enjoy. These recipes can be easily prepared as a convenient way to meet nutritional needs.

Chocolate Peanut Butter Bites

Ingredients:

1 cup old-fashioned oats (use instant oats if you don’t have a blender)
2/3 cup shredded coconut (sweetened or unsweetened)
1/2 cup creamy peanut butter
1/2 cup ground flaxseed
1/2 cup mini chocolate chips
¼ cup maple syrup
1 tablespoon chia seeds (optional)
1 teaspoon vanilla extract
2-3 Tbsp water

Directions:

Combine all ingredients (except chocolate chips) in a food processor and pulse until well-mixed. If you don’t have a food processor, use instant oats.
Add 2-3 Tbsp water to hold the mixture together.
Remove from the food processor and stir in mini chocolate chips.
Scoop mixture and roll into balls. Freeze until solid and store in the freezer or refrigerator.

Mint Chocolate Bites

Ingredients:

1 cup rolled oats
1 1/4 cups Medjool dates — softened and pitted (about 10 dates)
1/2 cup peanut butter
3 tablespoons mini chocolate chips
1 tablespoon chia seeds (optional)
1 tablespoon ground flaxseed
1/8 teaspoon salt
3 tablespoons cocoa powder
2-3 Tbsp water

Directions:

To soften dates, leave in water for 10 min or add to boiling water for 5 min.
Place the dates in the bowl of a food processor and pulse several times until the dates break into small bits and form a ball that sticks to the side of the bowl.
Add the oats, peanut butter, and salt. Pulse until the mixture is broken down and in small pieces but not completely smooth. Add the cocoa powder and pulse to combine. At this point, the dough will look like crumbs. Add 2-3 tablespoons of water until the mixture forms a paste.
Scoop some into your hand and press to roll it into a ball, it should hold together easily. If it seems too dry and isn’t holding together, add a little peanut butter; if it’s too sticky, add a few more oats. (The amount you need may vary based upon the brand of peanut butter you use and the moisture of the dates.)
Roll the dough into balls of your desired size (I did slightly over 1 inch and ended up with 14 energy balls).
Place in the freezer or refrigerator to harden.

Energy bar

Inspired by wellplated

Ingredients:

3/4 cup creamy peanut butter
1/3 cup honey
2 tablespoons coconut oil
2 cups old fashioned rolled oats
Optional – 1/2 cup vanilla protein powder about 2 scoops, depending upon your brand
3 tablespoons flaxseed meal
1/4 teaspoon ground cinnamon
1/4 teaspoon kosher salt
1/3 cup mini chocolate chips or dried cranberries

Directions:

1. Line an 8×8- or 9×9-inch baking pan with parchment paper, leaving an overhang on two sides like handles.
2. Place the peanut butter, honey, and coconut oil in a medium heatproof bowl. Set the bowl over a saucepan of water and bring the water to a simmer over medium to medium-high heat. (Do not let the water boil, and make sure the water does not touch the bottom of the mixing bowl.) Stir and heat until the mixture is smoothly combined. Remove the bowl from the saucepan and turn off the heat
3. Add the oats, protein powder, flaxseed, cinnamon, and salt to the bowl with the peanut butter mixture. Stir to combine. The mixture will seem very dry at first but will come together as you stir. It won’t be sticky but should hold together when pressed.
4. Fold in the chocolate chips or cranberries. (If the mixture is still fairly warm, pop the bowl into the refrigerator for a few minutes to let it cool. Cooling the mixture will prevent the chocolate from melting. Don’t worry if they do melt a little—the bars will still be delicious!)
5. Press evenly into the prepared pan and refrigerate for 1 hour or until firm.
6. Lift the bars from the pan using the parchment handles and transfer them to a cutting board. Slice into bars as desired and enjoy.

Pumpkin energy bites

Inspired by pinchofyum

Ingredients:

2 cups oats
1/2 cup canned pumpkin puree
1/4 cup almond butter or peanut butter
1/4 cup chia seeds
1/4 cup pumpkin seeds
1 teaspoon vanilla extract
1/2 teaspoon cinnamon (optional, see notes)
1/2 cup maple syrup or honey
generous pinch of salt
1/2 cup dark chocolate chips

Directions:

Pulse all ingredients (except chocolate chips) in a food processor until well-mixed.
Add chocolate chips and pulse a few more times until they are in small pieces.
Scoop mixture and roll into balls. Freeze until solid and store in the freezer or refrigerator.

Energy Bites By Sara Two Ways

IG @eatzbysara

Coconut Cashew Energy Bites

Ingredients:

1 cup oats
½ cup cashew butter
¼ cup honey
1 cup shredded coconut
Optional: 2 tbsp vanilla protein powder

Maple Cinnamon Energy Bites

Ingredients:

1 cup oats
½ cup almond butter
¼ cup maple syrup
2 tbsp chia seeds
*(for this recipe I recommend Justin’s Maple Almond Butter for flavor)*

Directions for both recipes:

Mix all ingredients together in a large bowl
With your hands, roll the mixture into balls (you can make them any size you like, I usually make them about 1-2 inches in diameter. This way, the recipe yields about 12-15 bites.

NYC MARATHON NUTRITION PANEL

August 17, 2023August 8, 2023 by amystephens

NYC marathon nutrition panel

If you’re a marathon runner, you’ll appreciate this presentation. On July 16th, 2023, I was invited to participate in the NYC Marathon nutrition panel hosted by NYRR. We covered a lot of important topics for runners such as: hydration, fueling, gear, and how to prevent hitting the wall. There were over 1,000 individuals on live stream and 50 attended at the NYRR Run Center. Below is the YouTube link for the full talk.

How To Eat If You Are Training for a Marathon

July 22, 2024July 11, 2023 by amystephens

How To Eat If You Are Training for a Marathon

The way you nourish your body is equally important as your training and strength exercises. As a sports nutritionist based in NYC, I frequently encounter questions regarding dietary recommendations for individuals preparing for a marathon. In collaboration with my intern, Sara Fischer, we have developed this guide specifically tailored to individuals participating in the NYC marathon or any fall marathon, providing valuable insights on how to fuel your body leading up to the 26.2-mile journey.

What to eat

CALORIES:

It is important for runners to eat a well rounded, nutrient rich, balanced diet. First and foremost, runners need to ensure they are eating enough calories. Because running requires a lot of energy, it is extremely important that runners are in an energy balance to prevent underfueling. Underfueling leads to serious health effects.

Energy requirements are not static throughout a marathon training block. As the training volume intensifies, higher levels of nutrients become essential. The energy demands may be less on recovery days, but it is equally important to continue fueling to restock glycogen and repair muscle tissue.

A common mistake is to underfuel on recovery days. Recovery days require an adequate amount of nutrients to help the body recover for the next workout. Energy is required for cross-training, daily activities such as attending work or class, errands, or commuting. It’s possible that you may not require as many snacks during these lower intense periods.

CARBOHYDRATES:

Runners need to focus on a carbohydrate rich diet. If you are training for a marathon, you are spending most of your time either recovering from a run, or preparing for another one. Since running requires glucose from the bloodstream, your body is in need of carbohydrates to replenish those glycogen stores after workouts. Runners should aim for 60-70% of their calories from carbohydrates.

Over time, with adequate carbohydrates, the body gradually increases the amount of glycogen that can be stored in muscles and liver. Proper fueling throughout training can increase your overall glycogen storage capacity. Glycogen is one way to help prevent “hitting the wall”. This occurs when runners have not properly trained, run too fast on race day or under fuel on race day.

In order to maximize glycogen stores, runners should aim to consume 7-10 grams of carbohydrates per kilogram of body weight, daily. The average runner should aim for 475-700 g/day. This can be met by eating carb-rich meals spread into three meals plus two-to-three snacks.

PROTEIN:

Protein is broken down into amino acids which are essential for building and repairing damaged tissue. Eating protein throughout the day is also helpful to maintain the immune system and prevent muscle breakdown. Eating too much protein can displace other important nutrients that are necessary to optimize sports performance. Aim for 1.5-1.7 grams protein/kilogram which is about 20-30 grams with meals and 10-15 grams for snacks.

HEALTHY FATS:

It is crucial that runners include healthy fats in their diet. Healthy fats are necessary to absorb fat soluble vitamins, they help to lower injury risk, and regulate energy levels. Healthy fats are a great source of omega-3’s which have been shown to reduce inflammation. In order to keep the diet balanced, aim for approximately 20-30% of calories from fats.

VITAMINS:

Runners need to make sure they are giving their bodies adequate vitamins. Vitamin D and Calcium are particularly important for bone health, specifically reducing the risk of stress fractures. Iron is important to keep you energized. Iron deficiency can lead to decreases in performance. B vitamins are essential to energy production.

How to eat around your workouts

Before a run, especially if the run is 60 minutes or longer, your body will need fuel beforehand. Your pre-run snack should be rich in carbohydrates, and eaten at least 30 mins to an hour before you head out. Avoid high fiber foods as they are difficult to digest and may lead to discomfort during the workout.

Pre-run snack examples include a banana, toast with peanut butter, homemade energy balls, dates, dried fruit, granola bar or Clif bar.

For runs lasting less than 60 minutes, fueling is optional. If you experience hunger, consuming snacks and fluids can be beneficial for sustaining energy levels.

For a run lasting longer than 90 minutes, your body might need additional carbohydrates. Your body processes approximately 60g carbs per hour of exercise, so during these longer sessions you will need to start fueling within 45 minutes, and continue to consume 30-60g carbs/hour for the duration of the run.

You can accomplish this by eating things like energy gels, easy-to-eat dried fruit, go-go squeeze applesauce, or even gummy bears. You can also put a spoonful of honey mixed with something like coconut water into your water bottle to make a carb and electrolyte rich sports drink.

After a run, your body needs to replenish its glycogen stores. Refuel after runs by eating a balanced meal or snack high in protein and carbs. It is best to eat this within 30 minutes to an hour of finishing a run, so that you can kick start the recovery process and be ready to go for your next session. Prioritize recovery food especially on tough workout days or if you are planning a double workout session.

How to hydrate

Hydration requirements are individualized. Sweat rates depend on many factors such as: genetics, gender, heat acclimation, exercise intensity, humidity, etc. A sweat test is a great way to determine individual sweat rates.
Easy runs: 1-2 hours before your run, drink 10-20oz of water. During your run, it is your choice whether you want to sip on water throughout. After your run, replenish the lost fluids with 35-70 oz of water with electrolyte. Take note of your hydration level prior to running. If you begin your workout in a dehydrated state, you will need to consume fluids regardless of the duration. Additional fluids will aid in replenishing lost fluids from previous workouts and prevent further dehydration.
Long runs/tempos: 1-2 hours before your workout, drink 10-20oz of water. During your run, drink 4-8oz of water every 20 minutes, with electrolytes. After your workout, replenish the fluids with 35-70 oz of water with electrolytes.

References

Burke L, Hawley J, Wong S & Jeukendrup A. Carbohydrates for training and competition, J Sp Sc, 2011. 29:sup1, S17-S27.

Coyle, E. F. Fluid and fuel intake during exercise. J Sp Sc 2004. 22: 39–55.

Jeukendrup, A. E. and Chambers. Oral carbohydrate sensing and exercise performance. Current Opinion in Clinical Nutrition and Metabolic Care, 2010. 13: 447–451.

Sawka MN, et al. American College of Sports Medicine position stand. Exercise and fluid replacement. Med Sci Sports Exerc. 2007. 39(2):377-90.

Amy Stephens