goodson the ins and outs of working with the female athlete · whey protein is a quick digesting...

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Amy Goodson, MS, RD, CSSD, LD

Ben Hogan Sports Medicine Sports DietitianTCU Sports Dietitian

Dallas Cowboys Sports Dietitian

Texas Rangers Sports Dietitian

FC Dallas Sports Dietitian

[email protected]

www.texashealth.org/benhogan

817.250.7512

The Ins and Outs of

Working with the

Female Athlete

Outline

� Macronutrient recommendations

� Carbohydrate, protein and fat needs for exercisers and

athletes

� Pre, during and post-exercise recommendations

� Easy, moderate and hard training days

� The Female Athlete Triad

� Three issues of concern with the female athlete

� Case studies

� High school, college and adult female athlete

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Carbohydrate Needs of Athletes

� No real % recommendations for

carbohydrate intake for athletes

� General recommendation: 50-60% of total daily

energy should come from CHO for normal

people, but not for athletes

� Carbohydrate Recommendations

� 3-5 g CHO/kg BW for athletes in off-season &

attempting to lean out

� 5-7 g CHO/kg BW for general training needs

� 7-10 g CHO/kg BW for endurance athletes

� 11+ g CHO/kg BW for ultra-endurance athletes

Carbohydrate Goals

� Pre-Workout Goal:

� Provide long-lasting energy to start and sustain

beginning part of exercise

� Bagels, oatmeal, brown rice, pasta, whole grains

� During-Workout Goal:

� Maintain energy levels

� Provide carbohydrate to spare glycogen stores

� Energy bars, gus, energy chews, sports drinks

� Post-Workout Goal:

� Replenish glycogen stores

� Provide body with energy

� Quick digesting carbohydrate

� Sports drinks, fruit, milk, flavored milk, honey, etc.

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Protein Needs� 0.8 gm/kg BW per day

� Sedentary individuals

� 1.0 gm/kg BW per day

� “Workout” people

� 1.2-1.4 gm/kg BW per day

� Endurance athletes, cycling


� Basketball, hockey, soccer, tennis, swimming, track


� Strength athletes

� Baseball, football

� 2.0 gm/kg BW per day

� Extreme exercise & heavy weight lifting

Protein: Best Choices

� Animal proteins are better absorbed

� Chicken, turkey, lean ham, lean red meat, fish, tuna, turkey bacon, turkey sausage, etc.

� Eggs and egg whites

� Low-fat dairy products

� Whey protein powders

� Good for smoothies/shakes

� Whey protein is a quick digesting protein

� Plant proteins are not absorbed as well so vegetarian/vegan athletes might need more protein than their exercise level

� Quinoa, oats, other whole grains

� Nuts, seeds, nut butters

� Beans and lentils

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Fat Recommendations for Athletes

� 20-35% of total calories

� Anything less than 20% does not show

performance enhancement

� Essential Fatty Acids

� Consume at least 3-5% of dietary fat from food

sources such as fish and plant oils

� Consequences of low-fat diets in athletes

� Low-fat diets may not meet energy demands for

growth & development in young athletes

� Low-fat diets over time could cause deficiencies in

fat-soluble vitamins & essential fatty acids

� In females, low-fat diets can contribute to menstrual

dysfunction due to insufficient calories

Pre-Exercise Eating

� Pre-exercise meal

� 2-4 hours before a workout/game

� High carbohydrate

� Low in fat & fiber

� These slow down digestion

� Moderate protein

� Combine protein + carbohydrate

� Plenty of fluids (16-20 oz)

� Immediate Pre-exercise Snack

� 30 minutes before workout/game

� High carbohydrate, small amount of protein to

provide you with a boost of energy

� 5-10 oz water or sports drink

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The Athlete’s Plates are a collaboration between the United States Olympic Committee Sport

Dietitians and the University of Colorado (UCCS) Sport Nutrition Graduate Program.



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Morning Training

� Athletes that train early cannot always eat 2-4

hours prior workout

� Recommend quick carbohydrate snack

� Moderate to high GI goods

� Food or drink with ~25-50 gm carbohydrate

� Granola bar, banana, baggie of dry whole grain

cereal with a few nuts, slice of bread with smear of

peanut butter, etc.

� Bland, easy-to-digest carbohydrate likely best

� Some protein recommended for those clients

training harder, specifically strength training

� Protein bar, pack of peanut butter crackers, peanut

butter and jelly sandwich on wheat bread, etc.

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During Workouts

� Carbohydrate-rich foods/drinks

� Carbohydrates digest the quickest & thus provide

energy faster!

� Avoid fat and fiber when exercise

� Slows digestion and increases time in which energy

is available to be used

� 100-300 calories of carbohydrates per hour,

after the first hour of exercise

� 30-60 grams of carbohydrate per hour

� 1 gram carbohydrate/kg body weight/per hour

� Fluid losses – match sweat losses

� Consume 5-10 oz fluid every 15-20 minutes

Mid-Practice/Workout Snacks

� Carbohydrates, some protein, little fat

� Energy bars and a fruit

� Granola bars and nuts

� Peanut butter and jelly sandwich

� Peanut butter crackers

� Dry cereal/trail mix with small amount of nuts

� Banana and beef jerky

� Sports drink with snack

� Athletes unintentionally losing weight

� Need to eat snack(s) during practice

� Constantly drink sports drink

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Post-Exercise Nutrition

� The three R’s to post-workout recovery:

� Replenish carbohydrate burned during exercise

� Repbuild damage done to lean muscle mass

� Rehydrate the body to euhydration

Post-Exercise 2-Hour Window

� 2-Hour Window of Recovery

� Your body has a specific time period, post-exercise,

when you are able to more effectively take up nutrients

� Blood flow to muscles is greater

� Muscle cell is more likely to take up glucose

� Muscle cells more sensitive to the effects of insulin

during this time

� 0-45 minutes

� Best time to eat at least a snack…muscles more sensitive

to absorb nutrients!

� 45 minutes – 2 hours

� Try to get a nice-size meal or larger snack

� The window is the most important time to consume plenty

of carbohydrate, protein, & fluids to replenish & refuel

� Essential if participating in twice a day training

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Post-Exercise Fueling Goals

� Carbohydrate - Replenish

� Body NEEDS lots of carbohydrate post-exercise to

replace energy stores

� Simple carbs are best: milk, sports drink, fruit,

juice

� Protein - Rebuild

� Body needs some protein to start repairing tiny

muscle tears

� Ideally 20 gm protein immediately post-workout

� 10 gm seems to show benefit to athletes who need

less calories post-workout

� Whey protein is the highest in BCAAs, specifically

leucine which has been shown to re-synthesize

muscle the fastest after a workout

Whey Protein

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Protein

Source

BCAA

Content

Leucine

Content

Whey 26% 14%

Egg 20% 9%

Soy 18% 8%

Wheat 15% 7%

Join the Conversation: #BeyondLI

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Post-Exercise Eating

� Carb-Protein Combo Food Examples

� If you have products available:

� Carb-Protein Replacement Shake

� Muscle Milk, Rockin’ Refuel or EAS

� Energy bar & Gatorade

� Smoothie made with 1-2 cups low-fat milk, fruit,

cold water, ice, and 1 scoop NSF Certified whey

protein powder

� If you are on a budget:

� 16-20 oz low-fat chocolate milk

� Granola bar and 12 oz low-fat milk

� Yoplait Greek 2x Protein Yogurt and a string cheese

Post-Exercise Eating

� Refuel with post-workout chocolate milk!

� 90% water which helps replace fluids and

rehydrate the body

� Contains calcium, Vitamin D and phosphorus to

help promote, maintain and build strong bones

� Contains protein to reduce muscle breakdown

� Contains carbohydrate to fuel muscles during

exercise and help muscles recover after exercise

� Contains potassium which helps with fluid and

mineral balance and muscle contraction

� Contains B vitamins that help convert food to

energy to fuel working muscles

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Why chocolate milk works!

� Athletes love the taste

� It is inexpensive

� It is found everywhere

� School cafeterias

� Fast food restaurants

� Restaurants

� Convenience stores

� Grocery stores

Fueling Summary for

Female Athletes

� Sports Nutrition

� Pre-workout

� Meal of complex carbohydrate and protein 2-4 hours

before workout and carbohydrate snack 30 minutes prior

� 16-20 oz fluid with meal and 5-10 oz with snack

� During-workout

� Consume electrolyte-rich fluids consistently throughout

workout; 5-10 oz every 15-20 mins

� Carbohydrate foods like sports drinks, energy bars, gus,

fruit, etc. are needed during workouts over 1 hour long

� Post-workout

� Replenish with carbohydrate

� Rebuild with protein

� Rehydrate with fluid

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Female Athlete Triad

� Syndrome that comprises 3 medical disorders:

� Disordered eating

� Amenorrhea

� Osteoporosis

ACSM’s Position Stand Paper


� Low energy availability – key piece of the

metabolic and health consequences

� Energy availability = Energy intake –

Energy expenditure/kg of fat-free mass

� Need to identify reason for low energy

availability

� Result of disordered eating OR because an

athlete does not meet exercise energy

requirements due to lack of nutrition

knowledge, time constraints, and/or food

availability issues

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Disordered Eating

� General term used to describe the spectrum of

abnormal and harmful eating behaviors that are

used to lose weight or maintain a lower than

normal body weight

� Examples:

� Excessive dieting

� Excessive exercise

� Fat and sugar phobias

� Patterns of alternating starvation & overeating

� Excessive supplementation with vitamins,

minerals and/or herbs

� Inability to eat adequately in public

� Laxative abuse

Signs and Symptoms of

Disordered Eating

� Physical� Chronic fatigue

� Orthostatic hypotension

� Anemia

� Noticeable weight loss or

gain

� Alopecia (hair loss)

� Callused fingers

� Cold intolerance

� Frequent GI

problems/complaints (such

as excessive gas,

constipation, ulcers, or

abdominal bloating)

� Lanugo (fine hair on face

and body)

� Brittle nails

� Tooth erosion or excessive

dental caries

� Dry skin and hair

� Frequent or prolonged

illnesses

� Irregular or absent

menstrual cycles (in

women)

� Delayed or prolonged

wound or injury healing

� Cardiovascular

abnormalities (such as

palpitations, prolonged QT

intervals, or bradycardia)

� Frequent musculoskeletal

injuries (such as stress

fractures)

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Signs and Symptoms of

Disordered Eating

� Behavioral� Depression

� Social withdrawal

� Bathroom visits after eating

� Excessive use of diuretics,

laxatives, or diet pills

� Secretly eating or stealing

food

� Excessive criticism of

one’s body weight or shape

� Compulsive, excessive

exercise

� Mood swings, irritability

� Preoccupation with the

dietary patterns and eating

behaviors of other people

� Avoiding food-related

social activities

� Preoccupation with food,

calories, or weight

� Excessive fear of being

overweight or becoming fat

that does not diminish as

weight loss continues

� Consumption of large

amounts of food

inconsistent with the

athlete’s weight

� Lack of concern for

excessive weight loss or

extremely low body weight

Amenorrhea

� Difference between Amenorrhea,

Oligomenorrhea, and Eumenorrhea

� Primary Amenorrhea

� Never had a menstrual cycle by age 15

� Secondary Amenorrhea

� Started menstrual cycle and has had menstrual

cycle cease for at least 3 months

� Oligomenorrhea – menstrual cycles at intervals

longer than 35 days

� Luteal deficiency and anovulation do not have

detectable symptoms

� Eumenorrhea – menstrual cycles at intervals near

the median interval for young adult women

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Osteoporosis

� Osteoporosis – skeletal disorder

characterized by compromised bone

strength predisposing an individual to an

increased risk of fracture

� Bone strength and fracture risk are based on

� Internal structure of the bone mineral

� Density of the bone mineral

� Quality of bone protein

� Cause is not always a result of increased bone

mineral loss in adulthood, but may also be

related to not obtaining an ideal bone mineral

density during childhood and adolescence

Osteoporosis:

Bone Mineral Density

� Athletes participating in weight-bearing

sports typically show a 5-15% higher BMD

compared to nonathletes

� ACSM’s definition of low BMD includes:

� History of nutritional deficiencies

� Hypoestrogenism

� Stress fractures

� Other secondary clinical factors for fracture

� Along with a BMD Z-score between -1.0 and -2.0

� ACSM’s definition of osteoporosis includes:

� Secondary clinical risk factors for fracture with

BMD Z-scores ≤ -2.0

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� Source of problem is two-fold:

� Burdened by sociocultural demands placed

on women to be thin

� Expected to meet weight standards and/or

body size expectations for sports

� Without a normal menstrual cycle female

athletes might experience declines in bone

mineral density

Warning Signs

� Excessive dieting for weight loss, large

fluctuations in body weight, or too much

weight loss

� Irregular or absent menstrual periods

� Stress fractures, especially recurrent stress

fractures

� Self-esteem and mood that appear to be

dictated by body weight and shape

� Compulsive over-exercising

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Sports Putting Females at Risk

� Sports emphasizing leanness:

� Sports having subjective performance

scoring (i.e. dance, skating, diving, and

gymnastics)

� Endurance sports

� Sports that require an athlete to wear body-

contouring or body-revealing clothing

� Sports that require weigh-ins or specific

weights

� Sports that emphasize a preadolescent body

build for success

Effects on Health

� Macronutrient

deficiencies

� Micronutrient

deficiencies

� Anemia

� Chronic fatigue

� Increased risk of

injury, infections,

and illnesses

� Reduced basal

metabolic rate

� Cardiovascular and

GI disorders

� Depression

� BMD decreases

� Menstrual

dysfunction in

females

� Potential decreases

in testosterone for

males

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Effects on Performance

� Chronic/severe energy restriction can be

detrimental to performance, and is due to

one or more of the following:

� Frequent infection, illness, and/or injuries

� Anemia

� Fatigue

� Nutrient deficiencies

� Decreased cardiovascular function

Female Athlete Triad Treatment

� First goal is to increase energy availability

� Through an increase in energy intake or a

reduction in energy expenditure

� Discuss that increases in body weight might

be needed to increase BMD

� Treatment for eating disorders and

disordered eating includes:

� Nutritional counseling

� Individual psychotherapy

� Cognitive-behavioral, group, family, and

behavioral therapy may also be utilized

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Treatment for Eating Disorders

� Multidisciplinary approach:

� Sports medicine team

� Nutritionist/Dietitian

� Exercise physiologist

� Psychologist

� Coach

� Trainer

� Parents

� Friends

Eating Disorder Prevention

� Focus on the environmental risk factors

� Sociocultural emphasis on thinness

� Unrealistic body weight ideals

� Unhealthful eating and weight control practices

� For the younger athlete – education should

also focus on the parents

� Focus on dispelling myths and

misconceptions related to nutrition, body

weight and composition, weight loss, and

the affect of these factors on the individual’s

athletic performance

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Issues of Concern with

Female Athletes

� Micronutrients of concern

� Calcium and Vitamin D

� Iron

� Fads with females

� Communicating with female athletes


Female Athletes� Micronutrients of concern

� Calcium and Vitamin D

� Essential to bone health; bone is fully developed by about

age 25 in females with 90% by age 17

� Inadequate intake of calcium coupled with heavy intense

training can have detrimental effect on bone health in

maturing children

� Recommendation: 1000-1300 mg/day of calcium

� Best choice is low-fat dairy: milk, cheese and yogurt

� Ideally 3 servings per day

� Iron

� Puberty increases the requirements for iron due to

increase in hemoglobin mass, tissue deposition, growth

spurts and onset on menstruation in females

� Best choices: lean red meat, whole eggs, green leafy

vegetables, nuts and peanut butter

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Female Athletes

� Fads with female athletes

� Lack of understanding how many calories and

carbohydrates they actually need to train

� Cutting out entire food groups like dairy, grains,

processed foods, etc.

� Jumping on fad diets they see celebrities or their

friends go on and thinking that can fuel their body

adequately

� Orthorexia: Obsession with healthy eating

� Filling up on nutrient-rich, low-calorie foods

� Thinking that amenorrhea is a good thing and a

sign of adequate training

� Lack of concern with health issues


Female Athletes

� How to communicate with female athletes

� Most don’t want to hear they need to eat more, gain

weight, eat higher calorie foods, etc.

� Don’t use the term disordered eating, eating

disorder, etc. as many will become defensive

� Educate about nutrition needs under the umbrella

of energy versus calories and fueling versus eating

� When talking about the Female Athlete Triad,

communicate about energy availability

� Understand that you likely will have to build them

up to the macronutrients and calories they need

� Most will not increase calories by large amounts

over night and be okay with it

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Case Study:

High School Athlete

� Age: 16 – Height: 5’11” – Weight: 175 lbs

� Goal: Weight loss

� Lost 30 lbs but gained most of it back

� Weight went up upon upon switching schools and a

medication change

� Training

� Cross country: 5 miles a morning daily

� Lifts weights 3x/week

� Switches to soccer in cross country off-season

� Plays golf

� Amenorrhea for 1 year and 2 months

� Calorie needs: 2600-2800 for weight

maintenance with current exercise

Case Study:

High School Athlete

� Currently eating 800-1000 calories

� 7:00 am: Run

� 8:00 am: Breakfast of 2 egg whites, 1 cup

melons, 1 slice pita bread

� 8:30 am: 600 crunches, 600 heel touches, some

light dumbbell work, no cardio

� 12:15 pm: Lunch of bagel thin with little turkey,

lots of lettuce and mustard, 1 serving pretzels,

celery, 6 oz low-fat Greek yogurt OR ½

grapefruit and a rice cake with cottage cheese

� 6:00 pm: Dinner of grilled chicken, roasted

vegetables and quinoa

� Water to drink at all meals

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Case Study:

High School Athlete

� First meal plan goal: 1600-1800 calories

� 8:00 am: Breakfast of ½ cup (measured dry) oats

with 1 Tbs. peanut butter, 6 oz low-fat Greek yogurt,

1 fruit

� 10:00 am: Snack of KIND Bar

� 12:15 pm: Lunch of 1 serving whole wheat crackers,

2 oz deli meat, 2% string cheese, ½ cup cottage

cheese and a fruit

� 4:00 pm: 8 oz low-fat chocolate milk post-run then 1

serving whole wheat pita chips and ¼ cup hummus

� 6:30 pm: Dinner of 3 oz lean meat, veggies, 1 cup

carbohydrate, 8 oz low-fat milk

� 9:00 pm: Snack of 1 apple with 1 Tbs. Justin’s cocoa

almond butter

Case Study:

High School Athlete

� Goal 1 month later

� Increase to 2000 calories

� Training had increased due to soccer and cross

country and workouts moved to afternoon

� Goal of adding another afternoon snack as she felt

hungry

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Case Study:

College Athlete


� Goal: Weight gain; goal of 108

� 125# in high school; lost weight for running down to

110-115; then continued to lose

� Training

� Cross country: 40 miles a week

� Lifts weights 2x/week with core training

� Amenorrhea for 1 year; taking birth control

� RMR: 1095 calories

� RMR + daily activity: 1434 calories

� Maintenance calories with exercise: 2070 calories

� Weight gain calorie goal: 2500-2600 calories

Case Study:

College Athlete


� 8:30 am: ¾ cup oatmeal made w/ ¼ cup egg whites,

½ scoop protein powder, 1 Tbs. peanut butter and a

banana

� 1:00-1:30pm: Sandwich w/turkey, avocado and

veggies, laughing cow cheese with pretzels and an

apple

� Pre-workout: Protein bar or Greek yogurt w/ granola

� Post-workout: 1 scoop whey protein in water or

protein bar

� 7:30pm: Chicken, vegetables, large sweet potato with

1 Tbs. peanut butter

� 9:00pm: Greek yogurt with 1 scoop casein protein

powder and a Lara bar crumbled in

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Case Study:

College Athlete

� Goals

� Add mid-morning snack around 11:00am

� Energy bar, fruit, string cheese

� ½ cup trail mix, 6 oz Greek yogurt, fruit

� 2 Kashi cookies with 8-12 oz low-fat milk

� Add 100-ish calories to each meal and snack

� 1 Tbs. peanut butter or 3 Tbs. nuts

� ½ avocado

� 1/3-1/2 cup hummus

� 2-3 Tbs. granola

� Eat a meal/dessert out with friends that she did

not prepare, look-up or subtract calories for

earlier in the day

Case Study:

Adult Exerciser


� Goal: Gain muscle

� Normally around 94-95 pounds

� Training

� 3 d/week run 3-4 miles and abs

� 3 d/week group resistance training for 1 hour

� Osteopenia

� Lactose intolerant and severe GI issues

� RMR: 971 calories

� RMR + daily activity: 1165 calories

� Maintenance calories with exercise: 1700 calories

� Weight gain calorie goal: 2200-2300 calories

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Case Study:

Adult Exerciser


� 7:30 am: 2 egg whites, English muffin, 8-12 oz

Lactaid milk

� 10:00 am: Homemade protein bar 125 calories (15 c,

10 p, 3 f)

� 12:00-1:00 pm: Sandwich thin with lunch meat and

maybe nuts

� 3:30pm: 8-12 oz Lactaid and 1 Tbs. peanut butter

� 7:00pm: 4-5 oz lean protein, vegetables (used to eat

couscous)

Case Study:

Adult Exerciser

� Goal of 2000-2200 calories

� 7:30 am: ½ cup oats w/1 Tbs. peanut butter, 6 oz

low-fat Greek yogurt and 8-12 Lactaid milk

� 10:00 am: Homemade protein bar 125 calories (15 c,

10 p, 3 f) with 8-12 oz Lataid milk

� 12:00-1:00 pm: Whole wheat pita with 2 oz chicken,

¼ cup 2% cheese, veggies and 1/3 avocado, salad

with balsamic vinaigrette and banana

� 3:30pm: 1 Kashi cookie with 1 Tbs. peanut butter and

a 2% string cheese

� 7:00pm: 4-5 oz lean protein, vegetables, 1 cup Barilla

Pasta Plus and salad with balsamic vinaigrette

� 1 hard-boiled egg and a fruit

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Case Study:

Adult Exerciser

� Follow-up

� Would barely eat 1500 calories

� When she would eat more in one place, she would

subtract it another place

� Frustrated and confused why she could not gain

weight

� Seemed unwilling to try to add more nutrient dense

foods

� Recommended adding Boost Plus or Ensure Plus a

few times a day to help get calories in

References

� American Dietetic Association, Dietitians

of Canada, and the American College of

Sports Medicine: Nutrition and Athletic

Performance Position Stand. Medicine &

Science in Sports & Exercise: March 2009;

Volume 41, Issue 3: 709-731.

� Dunford M and Coleman EJ. Sports

Nutrition: A Practice Manual for

Professionals, 5th ed.

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Questions

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goodson the ins and outs of working with the female athlete · whey protein is a quick digesting...

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