sports: special populations lecture
TRANSCRIPT
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SPECIAL POPULATIONS
Lona Sandon, M.Ed., R.D., L.D.Assistant ProfessorReference: Fink HH, Burgoon LA, Mikesky AE, eds. Practical Applications in Sports Nutrition. Sudbury, MA: Jones and Bartlett
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OBJECTIVES
Describe the unique needs of diabetic, vegetarian, pregnant, adolescent, collegiate, and masters athletes
Provide guidelines and recommendations for meeting nutritional needs in the populations listed above
Provide recommendations for managing blood glucose with exercise
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SPECIAL CONSIDERATIONS: DIABETES Complications of diabetes
Altered carbohydrate metabolism – unable to get glucose into cells for energy
Hyperglycemia Sugar in urine = higher urine output =
higher risk of dehydration Ketosis/ketoacidosis – caused by fat
breakdown for energy Protein breakdown – loss of lean body mass,
muscle weakness, weight loss Increases risk for heart and kidney disease Causes peripheral nerve damage
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SPECIAL CONSIDERATIONS: DIABETES
Exercise – Important part of
treatment for both Type I & II
Helps makes cells more receptive to insulin
Improve glucose transporter activity independent of insulin
May help lower blood glucose for several hours after exercise
Can lead to hypoglycemia More frequent monitoring
of blood glucose is needed
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COMMON SYMPTOMS OF DIABETES
Excessive thirst Excessive urination Dehydration Dizziness Headache Blurred vision
Unexplained weight loss
Excessive hunger Poor wound healing
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DIABETES AND EXERCISE
TYPE 1 TYPE 2 Requires careful self-
monitoring Timing of insulin Dosage of insulin Timing of meals Meal composition
Comparatively easier to manage
Requires some self-monitoring
Insulin not usually required because exercise enhances glucose uptake
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PRE-EXERCISE GLUCOSE GUIDELINES
Pre-exercise glucose (mg/dL)
Recommendation
<100 Eat 15-40 g CHO prior to exercise
>250 Test for ketones
>250 with ketones
Don’t exercise, adjust insulin and retest
>250 without ketones
Exercise permitted
>300 without ketones
Exercise with caution
Adapted from table 15.2 p. 463
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SIGNS AND SYMPTOMS
HYPOGLYCEMIA HYPERGLYCEMIA
Sweating Rapid heart rate Hunger Shaking Confusion Lethargy Poor coordination Slurred speech Irritable Headache Nausea
Nervousness Restlessness Thirst Fatigue Blurred vision Muscle cramps Nausea Abdominal pain
Adapted from table 15.3
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NUTRITIONAL RECOMMENDATIONS FOR ATHLETES WITH DIABETES
Maintain a consistent eating schedule
Eat same amount of CHO each day Carefully monitor BG, meal timing,
insulin, and exercise to understand individual needs and response
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DIABETIC ENDURANCE ATHLETES
Consume CHO during & after exercise Type of CHO not as important as amount & timing
Type 1 diabetes - 15 to 30 grams of CHO every 30 to 60 minutes during exercise
Ex: 8 oz of 6% to 8% sports drink 1 single serving of sport gel 1 fig bar 8 oz of 1:1 juice to water mix Sports bars Cookies
Must have CHO foods handy
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DIABETIC EMERGENCIES
Hyperglycemia during exercise – not enough insulin
Insulin secretion goes down during exercise while glucagon & other hormones increase leading to release of glucose into the bloodstream
Keep insulin and syringes available
Challenges Keeping insulin refrigerated &
sterile syringes
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DIABETIC EMERGENCIES
Hypoglycemia – too much insulin
Eat CHO during & after exercise Have glucose tablets, juice, or
regular soda available BG lowering effects of
exercise can extend for several hours, check BG 2-3 hours post exercise
Coaches, parents, & teammates must know what to do
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PREGNANT ATHLETES
Can train and compete throughout pregnancy
May need to decrease training intensity & volume
Follow MD’s recommendations
Nutrition needs increase
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NUTRITION CONCERNS FOR PREGNANT ATHLETES
Increased need for: Calories Protein B vitamins Vitamin C Vitamin A Magnesium Iron
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CALORIC INTAKE FOR PREGNANT ATHLETES
Additional 300 kcals/day needed Must consider calories needed for training Add 1-2 snacks between meals Training may decrease throughout pregnancy,
requiring an adjustment in kcals Increased kcal needs most important in 2nd &
3rd trimesters Monitor weight gain using pregnancy charts
For normal weight at start: 25 to 35 lbs gain recommended
Weight dependent sports & eating disorders put women at risk of not gaining adequately
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PROTEIN FOR PREGNANT ATHLETES
Need an extra 20 to 25 grams of PRO/d 3 cups of skim milk 3 oz of beef, chicken, or fish 1.5 cups of beans, lentils, or other legumes 3 oz of nuts
If kcal intake is adequate, usually PRO is too Recommend whole foods Vegetarians may have difficulty meeting needs Low PRO – associated with poor recovery,
fetal growth, immune functioning, fatigue
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B VITAMINS FOR PREGNANT ATHLETES
Folate critical for: DNA synthesis Red blood cell
production Development of
nervous system Recommended intake is
600 µg/day. Lack of folate may
lead to: Megaloblastic anemia Fatigue Depression, irritability
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VITAMIN C FOR PREGNANT ATHLETES
Critical for collagen formation, hormone synthesis, and immune function
Improves absorption of iron
Increase intake to 80 to 85 milligrams/day
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VITAMIN A FOR PREGNANT ATHLETES
Needed for cell differentiation and immune function
750 to 770 µg (RAE)/day
Choose foods, not supplements
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MAGNESIUM FOR PREGNANT ATHLETES
Required for muscle contraction and energy production
Increase by 40 mg to 350 to 360 mg/day
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IRON PREGNANT ATHLETES
Required for RBC production, oxygen delivery, energy level
Increase to 27 mg/day
Meats, legumes, fortified grains
May need a supplement
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CHILD/ADOLESCENT ATHLETES
Need enough calories for normal growth & development & meet activity needs
Lack of kcals may result in stunted growth
Energy & nutrient restriction may affect bone mass & normal sexual maturation
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CHILD/ADOLESCENT ATHLETES
FLUID REQUIREMENTSVITAMIN/MINERAL REQUIREMENTS
Child athletes have poor heat tolerance
Typically do not drink enough & need reminders to drink
Flavored beverages are better tolerated & likely to drink more
Sports drinks are appropriate on the field, but not off
Provide plenty of hydration breaks
Calcium - 1,300 mg/day for children 9–18 years
Iron
Age/Sex Iron (mg)
9-13 yrs, M/F
8
14-18 M 11
14-18 F 15
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NUTRITION FOR COLLEGE ATHLETES
Meal planning & cooking skills needed
May have higher kcal needs due to higher training demands
Address alcohol intake
Quick easy meals/snacks for on the go
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NUTRITION FOR COLLEGE ATHLETES
Meal planning Provide the when,
what, & how much to eat
Consider the where: dorm cafeterias, team
training tables, on the road, student apartments, vending machines
Grocery lists helpful No skipping meals
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ATHLETES & ALCOHOL
Use tends to be higher in college athletes than non-athletes
Binge drinking common
5 or more drinks for Men
4 or more drinks for Women
Males more likely to binge drink
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ATHLETES & ALCOHOL
Calories without nutrition
Does not replenish CHO stores despite what you see in adds
Can increase body fat
Stimulates appetite
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MASTERS ATHLETES
40 – 50 + yrs Nutrient needs
Kcal needs decrease Decreased need for
iron Increased need for
vitamin D, Ca++, Mg++
Chronic diseases Heart disease Diabetes High blood pressure Arthritis, etc.
Food/drug interactions
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MASTERS ATHLETES
MACRONUTRIENT NEEDS
PRO = 1 -1.2 g/kg CHO = 50-65% kcal Fat = 20-30%
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MASTERS ATHLETES
Iron = 8 mg M/F Do not use supplements
with iron Ca++ = 1200 mg M/F
Encourage foods sources Supplements may be
needed Vit D = 600 IU’s +
Less efficient synthesis as we age
Supplement may be needed Mg++ - drug-nutrient
interaction with diuretics
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FAMOUS VEGETARIAN ATHLETES
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VEGETARIAN ATHLETES
Determine type of vegetarian Semi, pesco, lacto-ovo, vegan
Plan wisely Complementing proteins Dairy & meat substitutions
Nutrients of most concern for Vegans Vitamin D and B12
Zn, Ca, Fe intake
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PROTEINS FOR VEGETARIANS
Beans/legumes Soy/soy milk Tofu Nuts/seeds Nut butters Whole grains,
fortified grains Whole wheat pasta Brown rice
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VEGETARIAN ATHLETES
Nutrient Vegetarian Food Source
Iron Tofu, nuts, seeds, fortified cereals & grains
Zinc Whole grains, fortified cereals, legumes, nuts, seeds, & dairy products (needs may be 50% higher than non-vegetarians due to bioavailability)
Calcium Dairy, yogurt, fortified juices, cereals, & breads, fortified soy milk
Vitamin D Fortified foods, sunlight
B12 Not available in plant foods, found in dairy, fortified cereals & soy milks, fish; supplement may be needed for vegans
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SUMMARY
Must individualize nutrition recommendations to accommodate unique needs
Diabetic athletes should closely monitor BG, training schedule, & food intake to establish best plan
Athletes taking insulin must be prepared to treat hyper & hypoglycemia during & after exercise
Pregnant and young athletes must eat enough calories for growth & development as well as activity
Colleges athletes benefit from help in meal planning Masters & vegetarian athletes must pay attention to
specific nutrients