Sports Nutrition

Definition

Purpose

Description

Precautions

Interactions

Complications

Parental concerns

Resources

Definition

Sports nutrition is a broad interdisciplinary field that involves dietitians, biochemists, exercise physiologists, cell and molecular biologists, and occasionally psychotherapists. It has both a basic science aspect that includes such concerns as understanding the body's use of nutrients during athletic competition and the need for nutritional supplements among athletes; and an application aspect, which is concerned with the use of proper nutrition and dietary supplements to enhance an athlete's performance. The psychological or psychiatric dimension of sports nutrition is concerned with eating and other mental disorders related to nutrition among athletes.

Some persons who specialize in the field of sports nutrition are registered dietitians (RDs) who have pursued a master's or other advanced degree in the field of exercise physiology; the American Dietetic Association (ADA) has a dietetic practice group or DPG for sports nutritionists called Sports, Cardiovascular, and Wellness Nutritionists (SCAN), which has its own website and telephone contact number. Most academic sports nutritionists, however, hold doctoral

Fluid intake guidelines

Recommended fluid intake for athletes. (Illustration by GGS Information Services/Thomson Gale.)

degrees in the field of exercise physiology and often specialize in working with athletes in one particular type of sport, such as baseball or swimming. Although sports nutrition can be applied to almost any form of athletic training or physical activity—including yoga, tai chi, martial arts, and professional dance—professional sports nutritionists do most of their work with team sports, endurance sports (cycling, long-distance running, triathlon training, etc.) or sports involving weight training (wrestling, weight-lifting, some forms of bodybuilding). Some nutritionists also work one-on-one with individual athletes.

Purpose

Sports nutrition has several purposes:

• To prepare athletes before performance or training.
• To maintain an acceptable level of performance during competition or training.
• To help the athlete's body recover after training or athletic competition.
• To provide sound information about healthy dietary practices and use of supplements.
• To monitor athletes for signs of eating disorders, doping, supplement abuse, or other unhealthful nutritional practices.
• To provide specialized nutritional advice to athletes following vegetarian, vegan, or other special diets.
• To monitor the special nutritional needs of persons with disabilities who participate in athletic activities and programs.

Description

Hydration

Hydration, or maintaining a proper level of fluid in the body, is an important aspect of sports nutrition because of the loss of water and sodium through sweating during athletic activity. Dehydration results in loss of muscle strength, difficulty concentrating, irritability, and headache. An adult who has lost more than 8% of

KEY TERMS

Amenorrhea —Absence or suppression of normal menstrual periods in women of childbearing age, usually defined as three to six missed periods.

Bioelectrical impedance analysis (BIA) —A technique for evaluating body composition by passing a small amount of electrical current through the body and measuring the resistance of different types of tissue.

Body dysmorphic disorder —A mental disorder involving extreme preoccupation with some feature of one's appearance. Excessive time spent in physical exercise, often involving bodybuilding or weight-lifting practices, is a common symptom of the disorder in adolescents.

Creatine —An organic acid formed and stored in the body that supplies energy to muscle cells. Meat and fish are good dietary sources of creatine.

Doping —The use of performance-enhancing drugs in sports competition, including anabolic steroids and other substances banned by most international sports organizations. The English word is thought to come from the Dutch dop, which was the name of an alcoholic beverage drunk by Zulu warriors before a battle.

Electrolyte —Any of several chemicals dissolved in blood and other body fluids that are capable of conducting an electric current. The most important electrolytes in humans and other animals are sodium, potassium, calcium, magnesium, chloride, phosphate, and hydrogen carbonate.

Ergogenic —Enhancing physical performance, particularly during athletic activity.

Erythropoetin (EPO) —A hormone produced by the kidneys that regulates the production of red blood cells. It is sometimes used by athletes to increase the oxygen-carrying capacity of their blood.

Female athlete triad—A group of three disorders often found together in female athletes, consisting of disordered eating, amenorrhea, and osteoporosis.

Glycogen —A complex sugar that is the primary form in which glucose is stored in muscle and liver tissue. Purging—A behavior associated with eating disorders that includes self-induced vomiting and abuse of laxatives as well as diuretics.

Sports drink —Any beverage containing carbohydrates, electrolytes, and other nutrients as well as water, intended to help athletes rehydrate after training or competition. Sports drinks are isotonic, which means that they contain the same proportion of water, electrolytes, and carbohydrates as the human body.

Vegan —A vegetarian who excludes all animal products from the diet, including those that can be obtained without killing the animal. Vegans are also known as strict vegetarians.

Water intoxication —A potentially fatal condition that occurs when an athlete loses sodium from the body through perspiration and drinks a large quantity of water in a short period of time without replacing the sodium. Long-distance runners are particularly susceptible to water intoxication.

initial body weight through sweating without replacing the lost fluid is at risk of heat cramps, heat exhaustion, and heat stroke. Moreover, dehydration may be progressive in athletes who do not replace fluid loss overnight; the greater the loss of body fluid, the longer it takes to rehydrate the body. When dehydration has taken place over 2 to 3 days, it will take a minimum of 48 hours to replace the fluids in body tissues. The health risks of dehydration are a major reason why abuse of diuretics is dangerous in athletes.

People vary in their sweating rates; therefore, health professionals must evaluate athletes on an individual basis to determine how much fluid is needed after exercise or training. The most common way to measure this need is to weigh the athlete before and after exercise; the amount of weight lost should be replaced with an equal amount of fluid before the next workout. The usual rule of thumb is 1 pint of fluid containing carbohydrates and electrolytes for each pound of weight loss.

Good hydration is more effectively maintained by consuming sports drinks or other beverages that contain salt and carbohydrates than by drinking plain water. Sports drinks are isotonic; that is, they contain the same proportion of electrolytes and carbohydrates to fluid as the human body. After exercise, the body requires carbohydrates to replace the glycogen (a complex sugar) stored in muscle tissue and the liver. Glycogen is an important source of reserve energy for muscles; long-distance runners who deplete their stores of glycogen may experience fatigue to the point of being unable to move. In addition to the risk of glycogen depletion, drinking only water places the athlete at risk of water intoxication, a potentially fatal condition in which the sodium lost through sweat is not replaced and is followed by the rapid intake of a large quantity of water. The resulting electrolyte imbalance affects the brain and central nervous system. Blood plasma sodium levels below 100 mmol/L (2.3g/L) frequently result in swelling of the brain tissue, coma, and even death.

Assessment of energy needs

Athletes usually require a higher level of calorie intake than nonathletes, although the amount varies depending on the athlete's sex, age, height, weight, body composition, stage of growth, level of fitness, and the intensity, frequency, and duration of physical exercise. An appropriate diet for most athletes consists of a minimum of 2000 calories per day; 55–65% should come from carbohydrates, 15–20% from protein, and 20–30% from fats.

Assessment of weight and body composition

The use of the body mass index (BMI) to evaluate athletes’ weight is not recommended because many have a high proportion of muscle tissue to fat and may therefore be considered “overweight” by standard body mass charts. A better reference guide is to check whether the athlete falls between the 25th and the 75th percentile of weight for height by age, measured according to the National Center for Health Statistics (NCHS) guidelines.

Well-nourished athletes should have a lean muscle mass above the 25th percentile, although the ideal ratio of lean muscle to body fat has not yet been established for any sport. Male athletes, however, should not have less than 7% body fat. There are several methods for estimating the proportion of body fat on an athlete's body: underwater weighing (equipment is expensive and limited in availability); skinfold measurements taken by high-precision calipers on three to five sites on the right side of the body (the right side is always used even if the athlete is left-handed); bioelectrical impedance analysis or BIA (a technique that measures body composition by passing a small electrical current through the body and measuring the resistance of various body tissues, as lean muscle contains a higher proportion of water than fat); and computerized calipers.

Strategies for weight change

It is important for athletes in any age group needing or desiring to lose or gain weight to be properly supervised by a nutritionist as well as a physician, because unhealthful dietary practices can lead to long-term mental as well as physical disorders. The American Academy of Pediatrics (AAP) makes the following recommendations for weight change in young athletes:

• The dietary program should be started in a timely fashion to permit gradual weight gain or loss over a reasonable time period.
• The program should allow a gain or loss of no more than 1.5% of body weight per week.
• It should be designed to permit weight lost to be fat and weight gained to be muscle.
• It should be accompanied by appropriate strength and conditioning training.
• The diet should provide an appropriate balance of carbohydrates, protein, and fats.

WEIGHT LOSS. Weight loss programs are sometimes recommended for athletes in weight-sensitive sports, most often wrestling or judo for boys and figure skating, gymnastics, long-distance running, rowing, and swimming for girls. Unfortunately, many young people go too far in adopting unhealthful eating or exercise patterns in order to keep their weight down. Because of this tendency, the AAP states that children younger than the ninth grade should not be put on weight-loss regimens to improve athletic performance.

Restricting food intake is the most common method of weight loss among athletes, but a large percentage of young athletes also engage in purging (self-induced vomiting plus abuse of laxatives and diuretics), fasting, or the use of stimulants, wet suits, sauna baths, or compulsive exercising. Some studies have shown that as many as 11% of wrestlers meet the criteria for eating disorders, and 15% of swimmers.

Unhealthful weight loss practices are dangerous because much of the weight lost will be lean muscle rather than fat, which can affect athletic performance. Girls who develop eating disorders or body dysmorphic disorder are at risk of developing the so-called female athlete triad, which consists of disordered eating, cessation of menstrual periods (amenorrhea), and osteoporosis or brittle bones. A common symptom associated with the triad is an unusually high number of stress fractures during the girl's athletic career. The triad, which was first described in 1993, may have long-term consequences for a woman's health. Female athletes in their freshman year of college are reported to be at increased risk of developing the triad, particularly if it is their first experience of living away from home or they are having academic difficulties.

WEIGHTGAIN. Athletes in sports requiring strength or weight lifting (football, rugby, basketball, bodybuilding) may try to gain weight in order to build the body's muscle mass. Inappropriate methods, however, will lead to gaining fat rather than muscle, putting the athlete at risk in midlife for high blood pressure, cardiovascular disease, and type 2 diabetes. It is important for athletes to recognize the genetic limitations related to their body build, as persons who are naturally slender cannot add as much muscle tissue to their bodies as those who are built more solidly.

The safest way to gain weight and build muscle tissue is to consume 1.5 to 1.75 grams of protein per kilogram of body weight per day and participate in strength training. The most effective form of strength training is thought to be multiple sets of weight lifting with a relatively high number of repetitions (8–15) per set. Athletes should avoid the use of dietary supplements in building muscle, particularly steroids, which have been shown to be harm-fultohealthinboth males and females.

Use of ergogenic aids

Ergogenic aids are drugs or dietary supplements taken to improve athletic performance or endurance by providing energy or adding muscle tissue. The most common ergogenic aids used are anabolic or andro-genic steroids (male sex hormones), steroid precursors, growth hormone, creatine (an organic acid stored in the body that supplies energy to muscle cells), and ephedra , an herb sometimes called by its Chinese name, ma huang. Some ergogenic aids are illegal to use in competition.

Medical and nutritional professionals are concerned about the use of ergogenic aids among young athletes for two major reasons. The first is that these drugs and supplements, first used by adult athletes in the 1980s, are now being used by children as young as 10 or 12. The second is that creatine and anabolic steroids may produce long-term adverse effects on the body even though they do produce gains in body mass and strength, while steroid precursors, ephedra, and growth hormone pose a good many risks to health without any proof that they enhance athletic performance.

The ADA's position statement says, “Nutritional ergogenic aids should be used with caution, and only after careful evaluation of the product for safety, efficacy, potency, and whether or not it is a banned or illegal substance.”

Precautions

Consultation with a qualified sports nutritionist is a sound practice for anyone in any age group who is heavily involved in any sport, whether amateur or professional. Specific precautions:

• Consultation should be individualized, as people vary in their energy needs, sweating rates, body composition, etc.
• Any female athlete who stops having menstrual periods (amenorrhea) or has only scanty periods (oligomenorrhea) should be evaluated for disordered eating.
• Nutritional advice should be given by a registered dietitian or physician, not by a coach. The American Academy of Pediatrics notes that “most coaches do not have an adequate nutritional background to counsel an athlete about weight loss.”
• Coaches should avoid discussing weight loss with young athletes (with the exception of sports requiring weigh-ins before competition), as such discussions often lead to the athlete's use of harmful weight-loss practices.
• Athletes should not take any dietary supplement without consulting their physician and a nutritionist.
• Athletes following a vegetarian or vegan diet require special attention to protein and iron intake.

Interactions

Some herbal dietary supplements used by athletes are known to interact with prescription medications, such as St. John's wort (Hypericum perforatum) and ephedra (Ephedra sinica), often used to promote weight loss; valerian (Valeriana officinalis),often taken for insomnia; cayenne (Capsicum frutescens), ginseng (Panax ginseng), and cordyceps (Cordyceps sinensis), taken internally to increase carbohydrate metabolism or increase endurance; and Siberian ginseng (Eleutherococcus senticosus) and echinacea (Echinacea angustifolia), taken to boost the immune system. Some of these drug interactions are potentially serious. Athletes should not take any herbal remedies, including those marketed specifically to athletes, without consulting their physician and a nutritionist.

Complications

There are no complications associated with nutritional monitoring of athletes by qualified professionals. The AAP, however, recommends seeking nutritional information and assessment from dietetics professionals, not from team coaches or personal trainers.

Parental concerns

Parental concerns about sports nutrition are age-related in most cases. Parents of young children should be aware of the ways in which children's hydration requirements during athletic activity differ from those of adults. Parents of adolescents who are heavily involved in sports should acquaint themselves with the signs of unhealthy eating or dieting practices in high school or college-age athletes.

Hydration needs in young children

Young children are more susceptible to heat-related illnesses than adults during exercise for several reasons: they produce more heat relative to body mass for the same intensity of exercise; they have a lower cardiac output than adults at any exercise level; they have a higher threshold for rise in body temperature before beginning to sweat; and they have a lower sweating capacity than adults, which makes it harder for them to dissipate body heat through evaporation. Children also have a less efficient thirst mechanism than adults, which means that they are more likely to become dehydrated during exercise because they do not feel as intense a need to drink liquids. Orange- or grape-flavored drinks are often a good way to rehydrate children because they will increase their fluid intake when the beverage is flavored.

Female athlete triad

Parents should watch for indications of the female athlete triad, such as missing three or more menstrual periods; an unusual number of stress fractures; an excessive amount of time spent exercising or working out; a tendency to wear baggy or concealing clothes even in warm weather; and a restricted eating pattern. Adopting a vegetarian or vegan diet may indicate the onset of an eating disorder in a female athlete.

Doping

Doping in sports refers to the practice of taking anabolic steroids and other substances forbidden by international sports organizations. The word is derived from the Dutch word for an alcoholic drink consumed by Zulu warriors to give them energy before a battle. In the early twentieth century, doping referred primarily to the illegal drugging of race horses, but has been applied to human athletes since the 1920s.

In the 1970s, testing of athletes’ blood samples focused largely on steroid use, but in the 1980s and 1990s, new tests had to be devised to detect evidence of blood doping. Blood doping refers to the use of blood transfusions or a hormone called erythropoetin (EPO) in order to increase the level of hemoglobin in an athlete's blood, and therefore its oxygen-carrying capacity. The use of EPO in such endurance sports as marathon running or cycling increases the athlete's risk of heart disease if it is used to raise blood hemoglobin levels above 13.0 g/dL.

Newer forms of doping include the use of modafinil (Provigil), a drug ordinarily used to treat narcolepsy (a sleep disorder), and gene doping. Gene doping is defined by the World Anti-Doping Agency, an organization founded in 1999, as “the non-therapeutic use of cells, genes, genetic elements, or of the modulation of gene expression, having the capacity to improve athletic performance.” One possible technique of gene doping would be the use of a synthetic gene that could last for years and produce high amounts of naturally occurring muscle-building hormones.

Vegetarian and vegan diets

It is possible for an athlete to maintain strength and overall health on a vegetarian diet provided that a variety of plant-based sources of protein are consumed on a daily basis and energy intake is adequate. Vegetarian and especially vegan athletes are at risk of inadequate creatine and iron intake, however, as well as insufficient amounts of zinc, vitamin B₁₂, vitamin D, and calcium. Iron deficiency will eventually affect athletic performance, as will low levels of creatine. Coaches and trainers should be aware that sudden adoption of a vegetarian or vegan diet in an athlete who was previously eating meat and fish may indicate the onset of an eating disorder.

Resources

BOOKS

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision. Washington, DC: American Psychiatric Association, 2000.

American Society of Health-System Pharmacists (ASHP). AHFS Drug Handbook, 2nd ed. Philadelphia: Lippin-cott Williams & Wilkins, 2003.

Larson-Meyer, D. Enette. Vegetarian Sports Nutrition. Champaign, IL: Human Kinetics, 2007.

MacLaren, Don, ed. Sport and Exercise Nutrition. New York: Elsevier, 2007.

McArdle, William D., Frank I. Katch, and Victor L. Katch. Exercise Physiology: Energy, Nutrition, and Human Performance, 6th ed. Philadelphia: Lippincott Williams & Wilkins, 2007.

Pelletier, Kenneth R., MD. The Best Alternative Medicine, Chapter 6, “Western Herbal Medicine.” New York: Fireside Books, 2002.

PERIODICALS

American Academy of Pediatrics (AAP), Committee on Sports Medicine and Fitness. “Promotion of Healthy Weight-Control Practices in Young Athletes.” Pediatrics 116 (December 2005): 1557–1564.

American College of Sports Medicine, American Dietetic Association, and Dietitians of Canada. “Joint Position Statement on Nutrition and Athletic Performance.” Medicine and Science in Sports and Exercise 32 (December 2000): 2130–2145.

American Dietetic Association (ADA). “Position of the American Dietetic Association: Nutrition Intervention inthe TreatmentofAnorexia Nervosa, Bulimia Nervosa, and Other Eating Disorders.” Journal of the American Dietetic Association 106 (December 2006): 2073–2082.

Calfee, R., and P. Fadale. “Popular Ergogenic Drugs and Supplements in Young Athletes.” Pediatrics 117 (March 2006): 577–589.

Gottschlich, Laura M., DO. “Female Athlete Triad.” eMedicine, June 29, 2006. Available online at http://emedicine.com/sports/topic163.htm (accessed April 15, 2007).

Judge, B. S., and B. H. Eisenga. “Disorders of Fuel Metabolism: Medical Complications Associated with Starvation, Eating Disorders, Dietary Fads, and Supplements.” Emergency Medicine Clinics of North America 23 (August 2005): 789–813.

Karlson, K. A., C. B. Becker, and A. Merkur. “Prevalence of Eating Disordered Behavior in Collegiate Lightweight Women Rowers and Distance Runners.” Clinical Journal of Sport Medicine 11 (January 2001): 32–37.

Kiningham, R.B., and D. W. Gorenflo. “Weight Loss Methods of High School Wrestlers.” Medicine and Science in Sports and Exercise 33 (May 2001): 810–813.

Nichols, J. F., M. J. Rauh, M. J. Lawson, et al. “Prevalence of the Female Athlete Triad Syndrome among High School Athletes.” Archives of Pediatric and Adolescent Medicine 160 (February 2006): 137–142.

Suleman, Amer, MD. “Exercise Physiology.” eMedicine, July 28, 2006. Available online at http://emedicine.com/sports/topic145.htm (accessed April 15, 2007).

Venderley, A. M., and W. W. Campbell. “Vegetarian Diets: Nutritional Considerations for Athletes.” Sports Medicine 36 (April 2006): 293–305.

Vertalino, M., M. E. Eisenberg, M. Story, and D. Neumark-Sztainer. “Participation in Weight-Related Sports Is Associated with Higher Use of Unhealthful Weight-Control Behaviors and Steroid Use.” Journal of the American Dietetic Association 107 (March 2007): 434–440.

OTHER

Kundrat, Susan, RD, MS. “Herbs and Athletes.” Sports Science Exchange 18, no. 96 (2005). Available online athttp://www.gssiweb.com/ (accessed April 16, 2007).

ORGANIZATIONS

American Academy of Pediatrics (AAP). 141 Northwest Point Blvd., Elk Grove Village, IL 60007. Telephone: (847) 434-4000. Website:http://www.aap.org.

American College of Sports Medicine (ACSM). P. O. Box 1440, Indianapolis, IN 46206-1440. Telephone: (317) 637-9200. Website:http://www.acsm.org.

American Council on Exercise (ACE). 4851 Paramount Drive, San Diego, CA 92123. Telephone: (858) 279-8227. Website: htpp://www.acefitness.org.

American Dietetic Association (ADA). 120 South Riverside Plaza, Suite 2000, Chicago, IL 60606-6995. Telephone: (800): 877-1600. Website:http://www.eatright.org.

American Society of Health-System Pharmacists. 7272 Wisconsin Avenue, Bethesda, MD 20814. Telephone: (301) 657-3000. Website:http://www.ashp.org.

Dietitians of Canada/Les dietetistes du Canada (DC). 480 University Avenue, Suite 604, Toronto, Ontario, Canada M5G 1V2. Telephone: (416) 596-0857. Website:http://www.dietitians.ca.

Gatorade Sports Science Institute (GSSI). 617 West Main Street, Barrington, IL 60010. (800) 616-4774. Website:http://www.gssiweb.org. The GSSI website has a useful online library of over a hundred articles on various aspects of sports nutrition, training and performance, and sports medicine, including material on specific sports.

Herb Research Foundation (HRF). 4140 15th Street, Boulder, CO 80304. Telephone: (303) 449-2265. Website:http://www.herbs.org.

National Center for Health Statistics (NCHS). Telephone: (800) 311-3435. Website:http://www.cdc.gov/nchs/.

National Strength and Conditioning Association (NSCA). 1885 Bob Johnson Drive, Colorado Springs, CO 80906. Telephone: (800) 815-6826 or (719) 632-6722. Website:http://www.nsca-lift.org.

Sports, Cardiovascular, and Wellness Nutritionists (SCAN). SCAN is a dietetic practice group (DPG) of the American Dietetic Association. Telephone: (800) 249-2875 or (847) 441-7200. Website:http://www.scandpg.org.

U. S. Food and Drug Administration (FDA). 5600 Fishers Lane, Rockville, MD 20857-0001. Telephone: (888) INFO-FDA. Website: http://www.fda.gov/default.htm.

World Anti-Doping Agency (WADA). Stock Exchange Tower, 800 Place Victoria, Suite 1700, P.O. Box 120, Montreal, Quebec, Canada H4Z 1B7. Telephone (514) 904-9232. Website:http://www.wada-ama.org.

Rebecca J. Frey, PhD