Amy Stephens

MS, RDN, CSSD, CDCES

Licensed dietitian

specializing in sports nutrition

and eating disorders

Blog

UNDERSTANDING EATING DISORDERS: INSIGHTS FOR COACHES, FAMILIES AND FRIENDS​

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Understanding Eating Disorders:
Insights for Coaches, Families and Friends

  • By Amy Stephens RDN CSSD

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




5 Myths You Hear as a College Athlete

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5 Myths You Hear as a College Athlete

  • By Amy Stephens RDN CSSD
    Sara Fischer, Intern
  • Edited by Amy Gregorek

TW: This content mentions eating disorders and body image.

1. Thinner = faster ✖

It is crucial for an athlete to fuel their body for performance. A stronger athlete is a better athlete. Many athletes believe that in order to be in peak condition performing  as fast as possible, they need to sit at a very low body fat percentage or lose weight. Being in a state of low energy availability is extremely harmful to an athlete’s physical and mental well being. 

When an athlete focuses on weight loss and the external “aesthetics” of their body, they may believe that weight loss is always a good thing. Unfortunately, that same athlete may be in an unnecessary state of low energy availability due to malnourishment, causing their body to focus its metabolic and physiological energy primarily on survival, rather than its other natural processes. In a study by Melin, Heikura, Tenforde, and Mountjoy, an athlete training for over 90 mins per day can even fall into a low energy availability state of survival if they are consuming less than 2,300 calories a day (depending on the athlete/training session). Prolonged weight loss or maintaining a low body weight that inhibits the body’s ability to carry out its processes can be dangerous. Low energy availability results in hormonal imbalances, menstrual dysfunction, decreased bone mineral density, immune system dysfunction, and threatens cardiovascular health and organ function. 

 

2. I have to be strict about my nutrition to achieve my goals ✖ 

 A balanced diet is a healthy diet. When you are eating enough, every food fits. Athletes do not need to miss out on social experiences to stick to a strict nutrition regimen. Due to societal ideas of a positive correlation between low body weight and increased success in sports performance, many endurance athletes are subject to low energy availability, developing eating disorders, and further damaging their health. In a survey by Tenforde et al. in 2015, out of 748 runners surveyed, 23% of females and 8% of males reported skipping meals or dieting to lose

weight during their youth, or early years in the sport (Watson, 2017). This suggests that false ideals around body weight and performance are instilled in athletes at a very young age, who may then grow and become entrenched in the mindset that they need to be extremely rigid around their nutrition. Rigid or restricted manipulation of caloric and nutrition intake may sacrifice an athlete’s long-term health. 

3. I should eat the same as my non-athlete friends ✖

Your friends may not be putting in 7+ hours a week of training like you are. Most people eat intuitively, listening to their own body’s hunger cues. If they don’t feel like eating breakfast, they won’t. If they are not hungry within 3-4 hours of eating a meal, they will not force themselves to eat a snack. Everybody’s needs are different, but it is important for athletes to note that they should absolutely not compare their own eating habits to their non-athlete peers. For an athlete, even a sustained energy deficit of ~300 calories per day can lead to a variety of health issues (Cialdella-Kam et al., 2014). While athletes absolutely do not need to constantly be thinking about food or how to fuel their training properly, comparing themselves to their peers and attempting to follow an eating pattern that doesn’t fit their personal goals may result in low energy availability, hindering their health and ultimately their performance as an athlete.

4. Not having a regular period is normal for high intensity female athletes ✖ 

Even if your teammates talk about their irregular menstrual cycles, this is not normal. Healthy hormones are crucial for an athlete’s overall health. Exercise related menstrual dysfunction is associated with compromised bone health such as risk of osteoporosis and stress fractures. Additionally, exercise related menstrual dysfunction is also associated with a variety of other health issues, such as cardiovascular dysfunction, endothelial dysfunction, increased cortisol levels, and higher risk for muscular injuries (Ciadella-Kam, 2014). Although it sounds convenient, a missing period poses the risk for many health consequences.

5. Sleep is not important ✖

While it is hard to balance college sports, academics, and a social life, it is crucial not to neglect sleep. Sleep is an integral part of recovery and many studies suggest evidence that sleep deprivation negatively affects performance. Sleep deprivation raises the risk of injury and illness in addition to hindering recovery from practices or workouts (Watson, 2017). Athletes need at least 8-10 hours of sleep per night.

References

Cialdella-Kam L, Guebels CP, Maddalozzo GF, Manore MM. Dietary intervention restored menses in female athletes with exercise-associated menstrual dysfunction with limited impact on bone and muscle health. Nutrients. 2014 Jul 31;6(8):3018-39. doi: 

10.3390/nu6083018. PMID: 25090245; PMCID: PMC4145292. 

Melin, A. K., Heikura, I. A., Tenforde, A., & Mountjoy, M. (2019). Energy Availability in Athletics: Health, Performance, and Physique, International Journal of Sport Nutrition and Exercise Metabolism, 29(2), 152-164. Retrieved Jun 19, 2023, from 

https://doi.org/10.1123/ijsnem.2018-0201 

Watson AM. Sleep and Athletic Performance. Curr Sports Med Rep. 2017 Nov/Dec;16(6):413-418. doi: 10.1249/JSR.0000000000000418. PMID: 29135639.

FUELING AN INDOOR WORKOUT: A GUIDE

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FUELING AN INDOOR WORKOUT: A GUIDE

  • By Amy Stephens RDN CSSD
    Sports Nutritionist NYC
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

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Fueling for winter training

  • By Amy Stephens RDN CSSD
    Sports Nutritionist NYC

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

  1. 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. 
  2. 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

  1. 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.
  2. 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. 
  3. 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. 
  4. 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?

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

  • Amy Stephens RDN CSSD
    Sports Dietitian Nutritionist NYC

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.

NYU Women’s cross country

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  • Posted by Amy Stephens RDN CSSD
    Sports Dietitian Nutritionist NYC
‘Unrecognizable’: How the NYU women’s cross country team went from 4 runners to 5th in the nation in less than three seasons, Head Coach Tyler Deck Shipley elevated a struggling cross country team to one of the nation’s best.
 

Click HERE for full story.

 

Written by Ethan Rendon, Staff Writer for NYU News.

 

MARATHON RACE DAY – 7 Common Mistakes Runners Make

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MARATHON RACE DAY 7 Common Mistakes Runners Make

  • By Amy Stephens RDN CSSD
    Sports Nutritionist NYC
  • Sara Fisher, Intern

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.

 

  1. 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.

  2. 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!

  3. 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.

  4. 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. 

  5. 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!

  6. “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.

  7. 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.



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

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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.



Iron for endurance athletes

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Iron for endurance athletes

Iron levels for athletes

  • By Amy Stephens RDN CSSD
  • Edited by Amy Gregorek

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.

Iron for endurance athletes

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 prevent GI issues in runners

by

How to prevent gi issues in runners

  • By Amy Stephens RDN CSSD
  • Edited by Amy Gregorek

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. 

  1. As you run, the stomach and gut are literally being shaken, and this makes it difficult for your body to digest foods. 
  2. 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.
  3. 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. 

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. 

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. 

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.

optimize health and performance

Amy Stephens, MS, RDn, CDces, CSSD

Licensed dietiTian

specializing in sports nutrition and eating disorders

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