EATING DISORDER OR RED-S? THE KEY DIFFERENCES

January 25, 2025December 1, 2024 by Britt

Eating Disorder or RED-S? The Key Differences

TW: This content mentions eating disorders and body image.

Eating disorders are mental health conditions, whereas RED-S (Relative Energy Deficiency in Sport) is a physiological state caused by an energy imbalance. However, these conditions can overlap. For instance, an athlete with an eating disorder may develop RED-S due to intentional caloric restriction. An athlete experiencing RED-S without an eating disorder may adjust their food intake to meet energy needs once under-fueling is recognized. In contrast, individuals with eating disorders may find increasing calorie intake more difficult, often requiring support from a medical team.

The main difference between an eating disorder and Relative Energy Deficiency in Sport (RED-S) lies in their definitions, causes, and impacts, although they can overlap in certain cases. Here’s a breakdown:

Eating Disorder

Definition: A mental health condition characterized by disordered eating behaviors and thoughts, such as extreme restriction, binge eating, purging, or obsessive food-related control.
Examples: Anorexia nervosa, bulimia nervosa, binge eating disorder, avoidant/restrictive food intake disorder (ARFID).
Cause: Psychological factors (low self-esteem, perfectionism, trauma), social influences (media, societal pressure), or biological predispositions.
Impact: Affects overall health, including physical, emotional, and social well-being.

Treatment Focus: Psychological therapy, nutrition rehabilitation, and medical stabilization.

Relative Energy Deficiency in Sport (RED-S)

Definition: A syndrome caused by insufficient energy intake relative to the energy expenditure required for optimal health and performance, often seen in athletes.
Cause: Unintentional (due to misunderstanding energy needs or increased training load) or intentional (associated with disordered eating behaviors).
Impact:
- Affects multiple body systems (e.g., reproductive, bone, digestive, cardiovascular, and immune systems).
- Can lead to decreased performance, delayed recovery, and increased risk of injuries.
- Symptoms include menstrual dysfunction, low testosterone in males, fatigue, and impaired concentration.

Treatment Focus: Restoring energy balance through increased caloric intake, reducing training loads, and addressing any disordered eating patterns.

Key Distinction

While eating disorders are mental health conditions, RED-S is a physiological state caused by an energy imbalance. However, the two can coexist. For example, an athlete with an eating disorder may develop RED-S due to intentional caloric restriction. Once under-fueling is identified, an athlete with RED-S will readily increase food intake to match energy expenditure. For an individual with an eating disorder, the addition of calories will be more challenging and may require treatment by a medical team. If nutrition requirements cannot be met, pausing or reducing exercise may be helpful to achieve a positive energy balance.

Addressing either condition requires a multidisciplinary approach involving dietitians, mental health professionals, and medical experts.

Winter Supplements for Runners

November 13, 2024 by Britt

Winter Supplements for Runners

Winter months bring unique nutritional needs for runners, including reduced sunlight exposure, which increases the need for Vitamin D. Meeting nutrition goals through food is ideal, but supplements can be helpful when dietary intake is insufficient. Below are recommended winter supplements and their top food sources. There are other supplements not mentioned that are supportive for performance, please refer to the post, best supplements for runners, for more information on performance. Runners following vegetarian or vegan diets may need to focus on nutrients like Vitamin D, calcium, B12, and zinc because plant-based foods do not contain these vitamins.

Enhance the effectiveness of supplements by ensuring you consume enough food to meet your energy needs. If your diet doesn’t support your current energy expenditure, supplements will be less effective. Athletes should aim for a balanced diet, with supplements serving as an addition to a healthy, well-rounded eating plan.

I had the opportunity to speak with a couple of elite runners about their supplement usage in the winter. Brendan Martin of Martin Physical Therapy who has a marathon PR of 2:15, follows a vegetarian diet and regularly takes vitamin B12 because he cannot obtain this nutrient from foods. Johannes Motschmann who recently placed 9th in the London marathon adds in Vitamin C and Zinc to support the immune system during high mileage weeks.

TIP: To build consistency, try taking supplements alongside daily routines, such as brushing your teeth.

Supplement Tip: Choose products that are third-party tested (e.g., by USP, NSF), which ensures they are free from harmful ingredients, though it does not guarantee the product’s effectiveness.

Vitamin D

Recommended Dietary Allowance (RDA): 600 IU/day (may need more for athletes).

Function: Vitamin D is essential for bone health and aids in calcium absorption, which strengthens bones. It also helps regulate the immune response, reduce inflammation, and protect against respiratory infections—benefits especially important for athletes during winter when Vitamin D levels often decline. Its anti-inflammatory effects are particularly beneficial for athletes, especially those with a history of bone stress injuries.

Top Sources:

Sunlight: UV exposure helps activate Vitamin D in the skin.
Food:
- Cod liver oil (1 Tbsp): 1360 IU
- Salmon (sockeye, 3 oz cooked): 570 IU
- Mushrooms (½ cup raw): 366 IU
- Milk (2%, 1 cup): 120 IU
- Egg (1 large): 44 IU

Calcium

Recommended Dietary Allowance (RDA):

Ages 9-18: 1,200 mg/day.
Ages 19-50: 1,000 mg/day.
Athletes: 1,500 mg/day, especially if there is a history of bone stress injuries.

Function: Essential for bone health, muscle contraction, and nerve function. Vitamin D aids calcium absorption.

Top Sources:

Milk/yogurt (1 cup): 300-400 mg
Cheese (1 oz, especially Parmesan): ~200 mg
Cooked kale or collard greens (1 cup): 250 mg
Fortified orange juice (1 cup): 350 mg
Fortified soy milk or almond milk (1 cup): 300-400 mg
Tofu (½ cup): 350 mg
Dried figs (4-5): 135 mg

Note: Combining food and supplements may be necessary to meet daily targets. It’s important to note that the body can absorb only 500 mg calcium per meal. It’s best to spread calcium-rich foods throughout the day to maximize absorption.

Omega-3 Fatty Acids

Function: Helps reduce exercise-related inflammation by modulating cell membranes and immune responses. Fatty fish are the best sources, though supplements can help when dietary intake is low.

Recommended Intake: 1.1-1.6 grams/day (1,100-1,600 mg).

Top Sources:

Salmon, sardines, herring (3 oz): ~1200 mg
Ground flax, chia, or hemp seeds (1 Tbsp): ~2300 mg

Vitamin C

Recommended Dietary Allowance (RDA): 75-90 mg/day.

Function: Boosts immunity, aids iron absorption, and is essential for collagen synthesis. Humans need to obtain Vitamin C from food.

Top Sources:

Strawberries (1 cup, halved): ~89 mg
Oranges (1 medium): ~70 mg
Pineapple/Mango/Cantaloupe (1 cup, cubed): ~65 mg
Red bell pepper (1 medium): ~152 mg
Broccoli (1 cup, cooked): ~102 mg
Kale (1 cup, raw): ~80 mg

Professional runner, Johannes Motschmann, who recently placed 9th at the London Marathon, adds in Vitamin C and Zinc to support the immune system during high mileage weeks.

Vitamin B12

Recommended Dietary Allowance (RDA): 2.4 mcg/day.

Function: B12 is essential for the production of healthy red blood cells, proper nerve function, and energy metabolism. It also supports neurotransmitter production, playing a key role in mood regulation and cognitive health. Low B12 levels have been linked to memory problems, depression, and mental confusion. B12 is mainly found in animal products such as meat, fish, and dairy.

Top Sources:

Salmon (3 oz): ~4.9 mcg (200% DV)
Trout (3 oz): ~5.4 mcg (225% DV)
Tuna (3 oz): ~2.5 mcg (104% DV)
Beef (3 oz): 5.1 mcg (215% DV)
Fortified Breakfast Cereals (1 serving): ~0.6–6 mcg (25-250% DV, depending on fortification level)
Dairy Milk (1 cup): ~1.2 mcg (50% DV)
Yogurt (8 oz): ~1.1 mcg (46% DV)
Swiss Cheese (1 oz): ~0.9 mcg (38% DV)
Eggs (2 large): ~1.1 mcg (46% DV)
Nutritional yeast (1 Tbsp): 2.4 mcg

Professional runner Brendan Martin, with a marathon personal record of 2:15 follows a vegetarian diet and regularly supplements with Vitamin B12.

Hydration with electrolytes

Hydrating during winter is just as essential as in warmer months, even though we may feel less thirsty in cold weather. Here are some tips to help maintain good hydration in winter:

Drink Regularly: Thirst signals decrease in cold weather, so make it a habit to sip water consistently throughout the day. Aim for at least 8 cups (2 liters) daily, adjusting based on activity level and body size.
Warm Beverages: Warm drinks like herbal teas, hot water with lemon, or broth-based soups are great options for hydration when cold water doesn’t appeal. Avoid excessive caffeine and alcohol, as it can contribute to dehydration.
Hydrating Foods: Winter fruits and vegetables like oranges, grapefruit, apples, pears, cucumbers, and leafy greens have high water content, helping you stay hydrated while adding nutrients.
Electrolytes: After exercise or if you’re sweating (even in winter), replenish electrolytes with options like coconut water or a light sports drink. Salty snacks or electrolyte supplements can also help retain hydration when balanced with water intake.
Watch for Signs of Dehydration: Dry skin, fatigue, and dark urine can indicate dehydration. Aim for urine that is pale yellow in color, a good indicator of proper hydration.
Humidify Your Environment: Winter air, especially with indoor heating, can be very dry. Using a humidifier adds moisture to the air, helping you retain hydration naturally.

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

November 5, 2024 by amystephens

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

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

How CGM Works

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

Components of a CGM System

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

Benefits of Using a CGM

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

Popular CGM Brands

Some well-known CGM systems include:

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

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

Potential Benefits of Using a CGM for Athletes:

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

Considerations and Potential Drawbacks:

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

Conclusion:

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

Caffeine to improve athletic performance

October 15, 2024October 10, 2024 by amystephens

Caffeine to improve athletic performance

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

How it works:

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

Benefits:

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

Risks:

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

Dose:

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

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

Form:

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

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

Green tea extract

Guarana

Guayaki yerba mate

Guayusa

Cola nut

Cacao

College athletes:

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

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

Olympic level athletes:

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

Food-first approach:

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

References

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

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

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

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

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

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

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

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

Guide to Carb Loading for a Marathon

November 19, 2024October 1, 2024 by amystephens

Guide to carb loading for a marathon

Plan, Prepare, and Prioritize Your Nutrition

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

The Importance of a Successful Carbohydrate Loading

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

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

– Katy Kunc, Professional runner and Olympic Trials Qualifier 2022

Photo: IG @runninphotog

What is carbohydrate loading?

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

What are the benefits of carbohydrate loading?

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

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

What should you eat during race week?

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

Race week meal ideas:

Breakfast

Eggs with potatoes and toast

Granola bowl with fruit and yogurt

Smoothie – recipes

Toast with peanut butter and banana

Frozen waffles with fruit and syrup

French toast and side of yogurt

Oatmeal with nut butter and fruit

Baked banana oats with fruit

Toast with avocado and hemp seeds

Cinnamon raisin bagel with almond butter or peanut butter

Lunch

Wrap with hummus or turkey

Quesadilla

Burrito bowl

Smoothie and bagel

Pasta with protein

Rice bowl with protein and vegetables

Snack ideas

Bars – cliff, kind, Rx

Toast with peanut butter and banana

Toast with nutella

Crackers with peanut butter

Yogurt with fruit

Tortilla chips with hummus

Rice cake with peanut butter and banana

Trail mix

Fruit or dried fruit

Popcorn

Energy bites – recipes

Dinner

Grilled salmon or chicken with baked potato + fruit

Sushi

Pasta

Rice and beans

Burrito

Soba noodles

Chicken or tofu fried rice

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

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

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

When traveling for the marathon, pack these essentials:

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

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

What should you eat the night before a marathon?

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

Early Dinner

Pasta, rice, potatoes, bread with protein

Bedtime Snack

Salty crackers like pretzels or saltines

What should you eat on race day?

3- 4 Hours Before Race

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

2-3 Hours Before

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

1 Hour Before

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

15 Minutes Before (optional)

Take a gel, chew, or liquid carb source.

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

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

References

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

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

Sherman WM, Costill DL, Fink WJ,Miller JM. Effect of exercise-diet manipulation on muscle glycogen and its subsequent utilization during performance. Int J Sports Med 1981;2(2):114-8.

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

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

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

October 18, 2024August 26, 2024 by amystephens

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

By Kate Cochran, Nutrition Intern, NYU Track and Field

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

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

Some symptoms of RED-S and LEA are:

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

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

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

How to treat RED-S:

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

OPTIMIZING NUTRITION FOR A HIGH SCHOOL FEMALE ATHLETE

August 26, 2024August 14, 2024 by amystephens

Optimizing NUTRITION FOR A HIGH SCHOOL FEMALE ATHLETE

I’m Kate Cochran, a graduate student at NYU studying nutrition and a member of the NYU cross country and track team. I’ve been running competitively since I was fifteen, and my journey has taught me the critical role that nutrition plays in athletic performance. One of my main reasons for pursuing a graduate degree in nutrition is to share valuable information with young athletes about how proper fueling can enhance their sports performance. It wasn’t until college that I truly focused on my nutrition, and once I started eating well and enough, I saw a dramatic improvement in my running performance.

High school is a time of significant change for young women, especially those who are athletes. As your body undergoes physical and hormonal transformations, it can be challenging to keep up with your sport while managing social perceptions on body image and the differences in individual experiences with changing bodies and progress in sports. Some girls might see their performance plateau during puberty, while others may not. It’s crucial to embrace these changes and support your body with proper nutrition to ensure healthy development. Especially because of your body’s changes during puberty, you must fuel in order to be healthy. Your career isn’t over after puberty; proper nutrition can help you overcome any plateau.

When I began running in high school, I wasn’t educated about nutrition. Running was easy before puberty, but my performance plateaued as my body changed. Frustrated and receiving mixed messages from coaches, I stopped caring, ate poorly, and skipped meals. It wasn’t until I was twenty-one that I researched nutrition, and it significantly improved my athletic performance. Start focusing on nutrition now to support your body’s natural changes and avoid unnecessary struggles, like underfueling.

Why Focusing on Nutrition is Essential

For female athletes, a significant amount of energy is required to support the physical and hormonal changes during puberty and early teenage years. If you don’t eat enough to support your growth and training, it can delay maturation by slowing down your endocrine system and suppressing hormones, leading to long-term health effects.

What to Expect When Your Body Changes During Puberty

What’s most important is ensuring you’re eating enough to fuel your body’s needs, especially as your body changes during puberty and throughout adolescence. To manage these symptoms and support your body through these changes, follow these tips:

Body Composition Changes: Shifts in muscle and fat distribution.
Shift in Energy Levels: Fluctuations in stamina and performance due to hormonal changes.
Increased Nutrient Needs: Higher caloric and nutrient demands.

Nourish Your Body Through Puberty

Eat Three Balanced Meals a Day: Include protein, fat, and carbohydrates.
Snack Between Meals: Keep your energy levels steady.
Fuel Before and After Workouts: Ensure you have the energy for performance and recovery.
Always Have a Snack on Hand: Be prepared to refuel anytime.

Key Nutrients to Support Growth and Development

A wide variety of foods can meet your caloric and nutrient needs. Eating a variety of whole foods from different food groups can help ensure proper nutrient intake.

Carbohydrates

Sources: fruits, vegetables, potatoes, breads, pasta, rice, and cereals.

Calcium

Sources: Milk, cheese, yogurt, leafy greens, nuts, fortified OJ and beans.

Protein

Sources: Black beans, tofu, chicken, fish, beef, yogurt, and pork.

Iron

Sources: Red meat, chicken, turkey, leafy green vegetables, almonds, black beans, and lentils.

Fueling and the Menstrual Cycle

Proper fueling will ensure that female athletes maintain a healthy menstrual cycle, which is a key aspect of overall health and sports performance. Normal menstrual cycles are typically 21-35 days apart and last two-to-seven days. Missing a period is not normal. If you have missed several cycles in a row, speak with your doctor. The menstrual cycle is especially important to athletes, as it indicates hormonal and bone health, and energy availability.

Energy balance: consume enough calories to support your daily activity. Irregular or missed periods can indicate an imbalance with energy intake and expenditure, also referred to as underfueling or low energy availability (LEA). This can negatively impact performance and lead to injury.

Underfueling – what is it and why is it harmful?

Underfueling is when you aren’t eating enough to meet the energy demands of your daily activities and workouts. This means you’re not providing your body with the necessary fuel it needs to function properly and perform well in sports. Underfueling is harmful especially during puberty for several reasons:

Without enough fuel, your body can’t perform at its best. You’ll feel more tired, and your running times may plateau or even slow down.
Underfueling can delay growth and development of new muscle and bone tissue and weaken existing tissues due to a lack of nutrients needed for muscle and bone maintenance.

Signs and symptoms of underfueling:

Amenorrhea (missing a period)
Low energy
Fatigue
Irritability
Not seeing improvements in performance despite training

How to prevent underfueling:

Have three balanced meals a day and snack between meals.
Ensure you’re getting a mix of carbohydrates, proteins, and healthy fats in your diet.
Pay attention to hunger signals and make sure you’re eating enough to feel energized.
Recognize that normal hunger cues might be absent; eating often will ensure adequate fueling.
Fuel properly before and after workouts to ensure recovery.

For more information on fueling for proper energy availability, read the blog post on relative energy deficiency syndrome (RED-S).

By focusing on nutrition now, you can support your body’s natural changes and avoid unnecessary struggles. Remember, your athletic career doesn’t end with puberty; proper nutrition can help you overcome any plateau and achieve your full potential.

When I was in high school I didn’t realize how important it was to eat three meals per day. Fueling doesn’t need to be complicated. There isn’t one “magic” fueling plan; eating is individualized. It’s more important to listen to your body and choose foods that meet your nutritional needs. You don’t need to eat exactly what’s listed here if you are listening to your body by eating enough, and eating a good balance of carbs, protein and healthy fats.

Here is a sample fueling plan for a workout day:

Breakfast: 1 cup of oatmeal with your favorite toppings (nut butter, yogurt, fruit, honey) & a fruit smoothie (add protein powder for some extra protein)

Snack: 1 cup greek yogurt with honey, berries, and granola

Lunch: turkey or chicken sandwich with cheese and your favorite crunchy snack (trail mix, chips, crackers)

Snack before practice: toast with your favorite nut butter, cinnamon and sliced banana, granola bar

Post practice snack: protein bar and a chocolate milk

Dinner: grilled chicken breast & rice with a vegetable that is appealing to you (kale, swiss chard, spinach) or grilled vegetables (peppers, broccoli, sweet potatoes, and carrots)

Key tip: try to pack your bag with enough snacks and fuel the night before school/practice.

Where to get nutrition information:

Registered dietitians with a concentration in sports nutrition. Look for professionals with credentials such as RD (Registered Dietitian) or CSSD (Certified Specialist in Sports Dietetics).
Trusted websites such as The Academy of Nutrition and Dietetics or American College of Sports Medicine

Conversations with Rachel Kaplan, Division 1 College Gymnast

August 11, 2024 by amystephens

Conversations with Rachel Kaplan, Division 1 College Gymnast

I had the opportunity to watch the Olympic gymnastics with my niece, Rachel Kaplan, a Division 1 gymnast and uneven bar specialist. Here are some key excerpts from our conversation that can be valuable for anyone looking to compete in college, especially females in body image-focused sports:

How many hours per week did you train?

High School: I trained about 27 hours per week. My schedule also included a full day of school then practice from 3 to 7:30 p.m. During weekends, training was less frequent due to traveling and competing. In the winter season, I had a similar routine.

College: I trained around 20 hours per week while being a full-time speech pathology student. I also lifted twice a week and swam during the preseason. I had to run a mile in under 7 minutes, which was more challenging for me than a release move on the bars. Note: The mile time trial was only at George Washington University.

Where did you get nutrition information?

Growing up, my mom and family had good conversations about food, which helped shape my understanding of nutrition.

Did you ever underfuel?

Yes, I often tried to eat as little as possible, driven by a desire to lose weight and be skinnier. I was concerned about body image and appearance, thinking that being lighter would make gymnastics easier. Coaches made comments about my body from a young age, which influenced my approach to fueling. I didn’t always optimize my nutrition, focusing more on being skinnier rather than properly fueling my body. For example, I would restrict my intake before Sunday night practices and only eat a protein bar. On Saturdays, I’d indulge in pizza and alcohol but then compensate by restricting my food intake the next day. Looking back, I realize that I was motivated by negative reinforcement rather than proper nutrition.

How much of your day were you thinking about food?

Food occupied my thoughts constantly. I’d go through cycles of eating “well” and restricting carbs, but still wasn’t happy with how I looked. This often led me to abandon my diet, get frustrated, and overeat—sometimes even “healthy” foods like hummus, carrots, popcorn, rice cakes, and nuts. I used MyFitnessPal for a summer to track calories, but I didn’t lose weight and was even more frustrated.

How did you prepare nutrition for traveling for competitions?

For competitions, my team relied on places like Panera for food and packed snacks for the road. Good restaurants like Olive Garden were also part of the plan. Coaches had specific rules about what to eat—no fettuccine Alfredo, only one breadstick, and no soda.

What did you eat before a competition?

I usually had hotel oatmeal before competitions. There were times I was so nervous that I couldn’t eat before a competition.

Did you eat junk food such as chips or cookies?

I didn’t eat junk food like chips or cookies. I tried to stick to what I thought would be more beneficial for my performance.

Did you have your body composition measured?

Yes, I had my body composition measured using a Bod Pod at University of Washington. I disliked weighing myself and felt uncomfortable when someone shared their body fat results in the locker room. My friends didn’t care about my body size as much as I did.

What advice do you have for younger gymnasts?

Focus on feeling good and performing well rather than just being skinny. Accept your body as it is and don’t let food fears dictate your diet. Choose foods that nourish and energize you rather than restricting yourself based on weight. It’s important to address what’s causing body image issues and shift focus to performance and well-being.

You don’t want to look back and wonder if you could have been more successful, or even just happier, if you had made choices to feel good day in and day out. You want to look back and know you gave it your all, and you gave yourself the opportunity to be your best.

Optimizing Performance: Nutrition Strategies for a Soccer Game

September 23, 2024July 31, 2024 by Britt

Optimizing Performance: Nutrition Strategies for a Soccer Game

Soccer is an endurance sport that requires a steady supply of nutrients. Optimizing energy levels and performance involves special attention to fueling strategies before, during and after training and competing. In order to keep up with high energy and fluid requirements, special attention needs to focus on practices, games and tournaments. Stay ahead of your fueling by following these guidelines.

Pre-Game Nutrition (1-4 hours before the game):

Hydration: Start hydrating well in advance. Aim to drink water consistently throughout the day leading up to the game. Avoid excessive sugary drinks and caffeinated beverages.

3-4 hours before kick-off:

Meal: Consume a meal rich in carbohydrates about 3-4 hours before the game. This could include pasta, rice, bread, or potatoes. Carbohydrates are crucial for providing the energy needed during prolonged physical activity. Include a moderate amount of lean protein (e.g., chicken, fish, tofu, or peanut butter) in your pre-game meal to support muscle repair and maintenance. Keep fats moderate in your pre-game meal to avoid stomach discomfort. Opt for healthy fats like those found in nuts, seeds, or avocado.

1-2 hours before kick-off:

Snack (Optional): If your pre-game meal is more than 4 hours before the game, consider a small snack. A banana, pretzels, peanut butter on crackers, yogurt, or a granola bar can provide a quick energy boost.

Avoid Heavy or New Foods: Stick to foods you are familiar with and avoid heavy, greasy, or spicy meals that may cause digestive issues.

Photo credit Claudia Heitler

Hydration During the Game:

Water: Drink water regularly throughout the game. Small, frequent sips are better than drinking large amounts at once.

Electrolytes: If the game is intense or in hot weather, consider a sports drink that provides electrolytes to help maintain hydration and replace minerals lost through sweat.

Half-Time Nutrition:

Quick Carbs: Consume easily digestible carbohydrates during half-time to replenish glycogen stores and maintain energy levels. Some examples include:

Small banana
Apple slices
Orange slices
Apple squeeze packets
Dried fruit such as mango or raisins
Energy bar – Clif Zbar
Pretzels
Sports drink or coconut water

Foods to avoid at half time: protein bars, fatty foods (chips) or high-fiber foods can cause gastrointestinal issues because they take longer to leave the gut.

Post-Game Recovery:

Hydration: Continue to drink water to replace fluids lost during the game. Replace fluids by sipping water or sports drinks with your post-game meal.

Food: Within an hour of finishing the game, consume a meal or snack that combines carbohydrates and protein to support muscle recovery and glycogen replenishment. Examples include a turkey sandwich, yogurt with fruit, or a protein shake with fruit.

Travel tips:

Frequent travel can make it difficult to keep up with your fueling plan. Pay special attention to timing of meals and snacks to ensure plenty of time for digestion.

Eat meals 3-4 hours before kick off
Use insulated coolers to keep beverages cold
Pack extra snacks

○ Peanut butter and jelly sandwich

○ Trail mix with dried fruit

○ Rice cakes or pita chips and hummus

○ Fresh or dried fruit

○ Granola bar

○ Clif bar

○ Dry cereal

○ Pretzels

○ Peanut butter pretzels

○ Saltines

INJURY PREVENTION FOR MARATHON RUNNERS

July 21, 2024July 12, 2024 by Britt

Injury prevention for marathon runners

Brendan Martin discusses important tips to prevent injuries at the start of marathon training.

Amy Stephens