In this lecture we will discuss a few of the special populations within the athletic community that pose some unique nutrition needs. Certainly this is not an exhaustive list of special populations, but are the ones we know the most about when it comes to sports nutrition.
Upon completion of the lecture and readings, you will be able to provide sports nutrition recommendations for child, adolescent, collegiate, or masters athletes as well as vegetarian, pregnant or diabetic athletes. As you have already learned, each athletes nutrition needs should be individually assessed but you will find some general guidelines apply to these special populations.
The good news is that exercise helps make cells more sensitive to insulin which helps get glucose out of the blood stream and into the cells needing it for energy. This effect may last for several hours after exercise which is a great benefit for helping people with type II diabetes maintain lower blood glucose levels. However, it poses a risk for hypoglycemia particularly in people with type I diabetes although it can be a problem for type II as well. Those taking insulin to control their blood glucose need to monitor blood glucose carefully and will also need to adjust their insulin doses before or after exercise to prevent dropping dangerously low.
Aside from calories, young athletes do not tolerate heat well and need reminders to drink adequate fluids. Flavored sports drinks will help encourage fluid intake but should be reserved for during exercise or training not at the lunch table. As the nutrition coach, you may need to remind coaches and trainers of the importance of taking regular fluid breaks. There is no good reason for child athletes to die of hyperthermia or dehydration, yet we often hear of it. Calcium and iron are key minerals to be sure young athletes are getting enough of. This is a time of rapid bone growth and calcium must be present to help lay the foundation for strong bones for the rest of their lives.
College athletes will do best with very specific instructions and concrete examples of the when, what, and how much to eat. Do not just give numbers in grams and percentages but show them what an actual plate of food or snacks looks likes in order to get the grams and percentages they need.
To get the recommended amount of Calcium and vitamin D a supplement may be needed although food and limited exposure to the sun should be encouraged. Iron supplements are not advised in the older adult population as they may increase risk for toxicity.Active older adults will likely find they need to pay close attention to getting quality nutrition within the calories their body needs to avoid gaining excess body fat.
Providing a table such as this one can help athletes choose food sources that will ensure adequate nutrient intake. Another thing to assess with vegetarian athletes is their actual consumption of vegetables and fruits. It is not uncommon to come across an athlete who has vowed to become a vegetarian and is consuming mostly carbohydrate rich foods but is actually lacking in fruit and vegetable intake.
In summary, you will run into active adults and athletes that fall into these special population categories. In working with diabetic athletes, stress the importance of consistent meal timing and amount of carbohydrate and monitoring of blood glucose before, during, and after training in order to establish a pattern of how they respond to exercise. With pregnancy and young athletes calories and protein are extremely important for growth on top of what is needed for the physical activity. Both collegiate athletes can benefit from assistance in meal planning, preparation, and shopping. And finally, masters and vegetarian athletes need to pay close attention to potential short fall nutrients. A multivitamin and mineral supplement may be warranted.
SPECIAL POPULATIONS Lona Sandon, M.Ed., R.D., L.D. Assistant Professor Reference: Fink HH, Burgoon LA, Mikesky AE, eds. Practical Applications in Sports Nutrition. Sudbury, MA: Jones and Bartlett
OBJECTIVES Describe the unique needs of diabetic, vegetarian, pregnant, adolescent, co llegiate, and masters athletes Provide guidelines and recommendations for meeting nutritional needs in the populations listed above Provide recommendations for managing blood glucose with exercise
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
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
TYPE 1 TYPE 2 Requires careful self- Comparatively easier to monitoring manage Requires some self- Timing of insulin monitoring Dosage of insulin Insulin not usually Timing of meals required because Meal composition exercise enhances glucose uptakeDIABETES AND EXERCISE
PRE-EXERCISE GLUCOSEGUIDELINES Pre-exercise Recommendation glucose (mg/dL) <100 Eat 15-40 g CHO prior to exercise >250 Test for ketones >250 with Don’t exercise, adjust insulin ketones and retest >250 without Exercise permitted ketones >300 without Exercise with caution ketones Adapted from table 15.2 p. 463
NUTRITIONAL RECOMMENDATIONS FORATHLETES 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
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
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
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
PREGNANT ATHLETES Can train and compete throughout pregnancy May need to decrease training intensity & volume Follow MD’s recommendations Nutrition needs increase
NUTRITION CONCERNS FORPREGNANT ATHLETES Increased need for: Calories Protein B vitamins Vitamin C Vitamin A Magnesium Iron
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
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
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
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
VITAMIN A FOR PREGNANT ATHLETES Needed for cell differentiation and immune function 750 to 770 µg (RAE)/day Choose foods, not supplements
MAGNESIUM FOR PREGNANT ATHLETES Required for muscle contraction and energy production Increase by 40 mg to 350 to 360 mg/day
IRON PREGNANT ATHLETES Required for RBC production, oxygen delivery, energy level Increase to 27 mg/day Meats, legumes, fort ified grains May need a supplement
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
FLUID REQUIREMENTS VITAMIN/MINERAL REQUIREMENTS Child athletes have poor Calcium - 1,300 mg/day for heat tolerance children 9–18 years Typically do not drink Iron enough & need reminders to drink Flavored beverages are better tolerated & likely to Age/Sex Iron (mg) drink more 9-13 yrs, 8 Sports drinks are appropriate M/F on the field, but not off 14-18 M 11 Provide plenty of hydration 14-18 F 15 breaks CHILD/ADOLESCENT ATHLETES
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
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, vendin g machines Grocery lists helpful No skipping meals
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
ATHLETES & ALCOHOL Calories without nutrition Does not replenish CHO stores despite what you see in adds Can increase body fat Stimulates appetite
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
MACRONUTRIENT NEEDS PRO = 1 -1.2 g/kg CHO = 50-65% kcal Fat = 20-30%MASTERS ATHLETES
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
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
PROTEINS FOR VEGETARIANS Beans/legumes Soy/soy milk Tofu Nuts/seeds Nut butters Whole grains, fortified grains Whole wheat pasta Brown rice
VEGETARIAN ATHLETESNutrient Vegetarian Food SourceIron Tofu, nuts, seeds, fortified cereals & grainsZinc 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 milkVitamin D Fortified foods, sunlightB12 Not available in plant foods, found in dairy, fortified cereals & soy milks, fish; supplement may be needed for vegans
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