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The Health AthleteNutrition, Hydration, & Sleep in Youth Sports
Marc Kowalsky, MD
January 16, 2018
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Key Questions
• Is it a good idea for me (or my child) to specialize early in a given sport?
• What should I eat before competition?• What should I eat after practice/competition?• How do I hydrate effectively?• Are sports drinks and energy bars a good
idea?• How much sleep do I need?• Which supplements should I consider or avoid?
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Is It A Good Idea to Specialize?
• Is early sport specialization safe? Does early sport specialization increase the risk of injury in youth athletes?
• Is early sport specialization effective or necessary in achieving elite performance?
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Sport Specialization: Definition
• Participation in intensive training and/or competition in organization sports > 8 months per year
• Participation in 1 sport to the exclusion of participation in other sports
• Involvement of prepubertal children (seventh grade, or 12 years old)
• Limited overall free play
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Effect of Early Sport Specialization
• Execute less age-appropriate sport skills
• Do not develop protective neuromuscular patterns
• Increased organized play over free play doubles injury risk
• Specializing before age 12 years increases injury risk
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Effect: Psychological Burnout
• Adult-driven specialized training
• Characteristics
– Loss of (intrinsic) motivation
– Lack of enjoyment (younger)
– High perceived stress, anxiety
– Ineffective stress coping strategies
– Fear of reinjury at young age
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Effect: Psychological Burnout
• Manifestations
– Mood disturbances
– Social isolation
– Eating disorders
– Dropout
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Evidence
• Early Specialization
– Does not lead to elite performance
• Late Specialization
– Elite athletes typically specialize later
• Diversification
– Elite athletes participate in multiple sports
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Benefits of Early Diversification
• Enhance physical literacy
• Motor skill development
• Protective neuromuscular patterns
• Crossover effect of multiple sports
• Psychosocial and cognitive skills
• Accommodates psychological well-being
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Protective Strategies
• Provide opportunities for free, unstructured play
• Ratio of weekly hours of organized sport to free play should remain below 2:1
• Weekly hours of sports participation should not exceed child’s age, or total 16 hours
• Avoid specialization before age 13 years
• Structured strength & conditioning program
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What Should I Eat Before Competition?
• Key Concepts
– Adequate calories
– Balanced nutrients
– Consistent meals
– Fuel timing
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Energy BalanceCaloric Requirements
Age 14-18 ♂ ♀
Sedentary 2200 2000
Moderate 2800 2000
Active 3200 2400
Calories In Calories Out
• Digestion
• Metabolism
• Physical Activity
• Carbs = 4 kcal/gram
• Protein = 4 kcal/gram
• Fat = 9 kcal/gram
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Balance Nutrients
Carbohydrates45 – 55%
Protein10 – 30%
Fat25 – 35%
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Carbohydrates
• Major source of energy
• Synthesized into glycogen
• Guidelines
– Endurance:
• 7.0 – 10.0 g/kg per day
– High Intensity
• 5.0 – 8.0 g/kg per day
– Pre-training
• 1.0 – 4.0 g/kg 1-4 hrs prior
– Post-event refueling
• 1.7 g/kg within 2 – 3 hours
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Protein
• RDA for protein is 0.8 – 1.2 g/kg per day
– Strength athletes: 1.6 – 1.7 g/kg per day
– Endurance athletes: 1.2 – 1.4 g/kg per day
– Youth athletes age 14 – 18
• Girls Æ 46g
• Boys Æ 52g
• Diets exceeding 1.7 g/kg/day have not been proven to provide additional benefits
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Protein
• 35-50 g meat, fish
• 1/2 chicken breast
• 1 c breakfast cereal
• 1 c oatmeal
• 2 small eggs
• 1¼ c cow’s milk
• 1¾ c soy milk
• 1/3 c cheese
• 1 c yogurt
• 4 slices bread
• 2 c broccoli
• 2 cups cooked pasta
• 3 cups rice
• ½ c nuts or seeds
• ½ c tofu or soy meat
• ½ c legumes or lentils
• ¾ cup fruit smoothie
• 2 c spinach
• ½ c quinoa
• ¾ c farro
10g of Protein are found in:
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Fat
• 25 – 35% calories
should come from fat
• Healthy fats
– Plant oils
– Soft margarines
• Unhealthy fats
– Saturated fats
– Trans fats
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Meal Planning
• Pre-exercise
– 1 – 2 hours in advance
– 200 – 500 kcal
– Easily digestible
carbohydrates
– Avoid high fat, fiber
– Familiar foods
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What should I eat after competition?
• Within 30 minutes, and again within 1 – 2 hrs
• Allows glycogen synthesis
• Content– High carbohydrate
– Moderate protein
– Nutrient Dense
• Examples– Yogurt, almonds and fruit
– Banana with peanut butter
– Sports bar + orange slices
– Nut butter on whole grain toast
– Veggies and hummus
– Whole-grain breakfast cereal, milk, fruit
– Sandwich (meat, cheese, veggie)
– Salad and hard boiled egg
– Quinoa salad with roasted veggies
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How Do I Hydrate Effectively?
• Optimal Athletic Performance
– Loss of 1% body weight has detrimental effect
• Heat Illness
– Loss of 3% body weight increases risk
• Up to 75% of youth athletes age 8 – 18 arrive to practice already dehydrated!
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Hydration
• Symptoms of dehydration
• Objective assessment of hydration status– Pre- and post- participation weight
– Urine specific gravity
– Thirst scale
– Thirst
– Irritability
– Fatigue
– Weakness
– Nausea
– Headache
– Muscle cramping
– Dizziness or lightheadedness
– Dark yellow urine
– No desire to urinate
– Difficulty paying attention
– Decreased performance
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Hydration
• Pre-exercise (WATER)– 1 – 2 hrs prior: 16 – 20 oz.
– 15 – 30 min prior: 8 – 16 oz.
• During exercise– 4 – 8 oz. every 15 – 20 min
– If > 60 min Æ dilute sports drink
• Post-exercise (WATER)– 16 oz. for each pound lost
• Avoid over-hydration
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Are Energy Bars A Good Idea?
• Ingredients
– Seeds
– Nuts
– Peanut butter
– Whole grains
– Dried fruit
• Content
– Sugar < 10 – 12 g
– Protein = 5 – 10 g
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Are Sports Drinks A Good Idea?
• For exercise > 60 minutes
– Replace sweat nutrients
– Replenish carbohydrates
• Guidelines
– 6 – 8% carbohydrate
– 0.5 – 0.7g/L sodium (Na)
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How Much Sleep Do I Need?
• Adequate sleep essental for peak performance
Recommendations for Sleep Duration
Age Duration
3 – 5 Years 10 – 13 hours
6 – 13 Years 9 – 11 hours
14 – 17 Years 8 – 10 hours
18 – 64 Years 7 – 9 hours
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Sleep
• Sleep Hygeine
– Consistent waking and bedtimes
– Avoid regular napping
– Do not lie in bed awake > 10-15 min
– Use the bed only for sleep
– Avoid physical activity within 2-3 hrs of bedtime
– Limit evening caffeine or other stimulant intake
– Eat breakfast consistently, stay well hydrated
– Schedule one hour of relaxation prior to bedtime
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Sleep Aids
• Medication
• Carbohydrates
• Tryptophan
– Increases serotonin
– Food or supplement
• Valerian root
– Herbal remedy
– 400-900mg bet 30 -120 min prior to bedtime
• Melatonin
– 1mg or less about 90 min prior to bedtime
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What Supplements Should I Consider/Avoid?
• 66% of student-athletes > 16 years old use dietary supplements
• Most commonly used– Protein
– Caffeine
– Creatine
• Most common reasons– Muscle strength
– Endurance
– Performance
– Appearance
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Protein
• Mechanism of Action– Builds, maintains and repairs
muscle
• Evidence– Numerous trials
– Optimizes muscle training response during exercise and recovery
• Safety– 2.0g/kg
– No adverse effects
• Whey– fast digesting
• Casein– slow digesting
• Soy-based– least effective
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Beet Juice
• Mechanism of Action– Dilates blood vessels in exercising muscle
– Reduces oxygen use, improves energy production
• Evidence– Limited clinical trials
– Conflicting results
– Might improve performance and endurance
• Safety– No safety concerns for short-term
– Recommended dose: 16 ounces
– No adverse effects reported
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Creatine
• Mechanism of Action– Helps supply muscles with energy for
short-term, anaerobic activity
• Evidence– Numerous trials
– Beneficial for high-intensity, intermittent activity
– May increase strength, power, and work
– Of little value for endurance sports
• Safety– Safe at typical doses
– Loading dose of 20 g/day for up to 7 days
– 3 – 5 g/day for up to 12 weeks
– Weight gain due to water retention;
– Nausea, diarrhea
– Muscle cramps, muscle stiffness, heat intolerance
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Caffeine
• Mechanism of Action– Blocks activity of the neuromodulator
adenosine;
– Reduces perceived pain and exertion
• Evidence– Numerous trials
– Might enhance performance in endurance activities
– Might enhance performance in intermittent, long-duration activities
• Safety– Safe up to 400 – 500 mg/day for ADULTS
– Insomnia, restlessness
– Nausea, vomiting
– Tachycardia, arrhythmia
– Risk of death with acute dose of 10 – 14g
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Performance-Enhancing Drugs
• Anabolic Agents– Anabolic Steroids
– Testosterone
– Steroid Precursors• Dehydroepiandosterone
• Androstenedione
• Stimulants– Ephedrine
• Human Growth Hormone
• Erythropoietin
• Propranolol
• Diuretics
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Orthopaedic & Neurosurgery Specialists
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Resources
• American Academy of Pediatrics
• American College of Sports Medicine
• American Orthopaedic Society for Sports Med
• American Dietetic Association
• NIH Office of Dietary Supplements
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THANKS
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