1. Nutrition for the High Performance
Athlete:
An Evidence Based Approach
JORDAN FEIGENBAUM MS, CSCS, HFS, CISSN,USAW CC
WWW.BARBELLMEDICINE.COM
STRENGTHMD@GMAIL.COM

2. What is Nutrition?
 Macronutrtients
 Protein
 Carbohydrates



Fiber??
Fat
Calories = Macros or Macros= Calories?

Are these equivalent?
Calories
2000
2000
Protein
100
250
Carbohydrates
300
150
Fat
44
44

3. What is Nutrition?
 Micronutrients



Vitamins
Minerals + Trace elements
Multivitamin?

“Our results suggest that administration of vitamins C and E to individuals with no
previous vitamin deficiencies has no effect on physical adaptations to strenuous
endurance training.”


“In older women, several commonly used dietary vitamin and mineral supplements may
be associated with increased total mortality risk”


Mursu et al. Dietary supplements and mortality rate in older women: the Iowa Women’s Health Study. Archives of Internal
Medicine. 2011 Oct. 10; 171 (18). 1625-33
“These results suggest that multivitamin use is associated with an increased risk of breast
cancer. This observed association is of concern and merits further investigation.”


Yfanti et al. Antioxidant Supplementation Does Not Alter Endurance Training Adaptation. Medicine in Sports and Exercise. July 2010. 42 (7).
1388-1395
Larsson et al. Multivitamin use and breast cancer incidence in a prospective cohort of Swedish women. American Journal of
Clinical Nutrition. 2010 May; 91 (5): 1268-72
By performing a meta-analysis of RCTs, the current study provides the highest level
of evidence to indicate that MVMM supplementation has no significant effect on the
risk of all-cause mortality, mortality of vascular etiology, or mortality due to cancer.

Macpherson et al. Multivitamin- multimineral supplementation and mortality: a meta-analysis of randomized controlled trials.
American Society for Nutrtion. 2013.

4. What is Evidence Based Practice?
 Evidence Based
 Evidence based behavioral practice
Science + Experience
 A disclaimer
 Biased population?
 Personal beliefs/values?


5. What is the role of nutrition in performance?
 Fuel Training
 Increased performance in training > increased performance in
competition?
 Fuel Recovery
 Increased ability to recover > increased potential training
volume > increased performance?
 Facilitate optimal body composition and weight
 Individualized for each person
 Individualized for each sport
 Better strength to weight ratio > better performance?

6. Why do we even eat in the first place?
 Each feeding is an opportunity to stimulate MPS
 MPS= muscle protein synthesis

Protein intake

“In fact, the reduced model revealed that total protein intake was by far the most
important predictor of hypertrophy…”
•


Schoenfeld et al. The effect of protein timing on muscle strength and hypertrophy: a meta analysis.
Journal of the International Society of Sports Nutrition. 2013
Carbohydrates are synergistic
 “..in our lab we have always found that there is about a 5-10% better response when carbs
are added to protein compared to protein alone. Now that response was never
STATISTICALLY different, however, we have observed it several times and do believe that
while we could not statistically show a significant different, that it does enhance the effect
slightly, and for athletes and bodybuilders, a 5-10% difference is actually a big deal”- Layne
Norton
Tl;dr

RECOVERY!!!

7. Why do we even eat in the first place?
 Fuel Training
 Active skeletal muscle

Glycogen/Glucose/Lactate
 Spares liver glycogen
 ~Spares skeletal muscle glycogen
 Central effects (CNS?)
• “trained cyclists received a CHO solution or an identical- tasting placebo. The subjects were
asked to use the solution as a mouth rinse and spit it out rather than swallow the solution.
Similar, additional time trials of approximately 60-min duration were performed, and it was
found that the CHO solution improved performance by 2.8%. These results suggest that
receptors exist in the oral cavity that communicate with the brain.”
 Jeukendrup et. al. Carbohydrate Intake During Exercise and Performance. Nutrition.
2004
Fatty acids contribute
 Only to basal level
 Protein metabolism isn’t fast enough


8. Why do we even eat in the first place?
 Enjoyment
 Satiety index
Satiety/calorie
 Fiber/Protein/Water content +
low palatability and low fat



Holt SH, Miller JC, Petocz P, Farmakalidis E. A Satiety index of
common foods. European Journal of Clinical Nutrition. 1995
Sep; 49 (9); 675-90
Food Reward


Emotions + social cues +
mouth feel/palatability
 Similar pathway to drug
abuse
Hans-Rudolf Berthoud, Natalie R. Lenard, Andrew C
Shin. Food Reward, hyperphagia, and obesity. American
Journal of Physiology. June 2011. Vol. 300.

9. Designing an Optimal Nutrition Template
 Endurance Athletes

Intraworkout/Competition Considerations

Hydration Status


“Typical drinking practices appear to limit body mass (BM) losses to ~2 % in non-elite competitors.
There are events, however, in which mean losses are greater, particularly among elite competitors and
in hot weather, and evidence that individual participants fail to meet current guidelines by gaining
BM or losing >2 % BM over the competition activity. Substantial (>5 %) BM loss is noted in the few
studies of elite competitors in endurance and ultra-endurance events”
• Garth et al. What do athletes drink during competitive sporting activities? Sports Medicine. July
2013
GI effects/availability of Nutrients
 Individual variability
 Carbs?
• “There was a significant negative relationship between energy intake and time taken to
complete the race …. Only carbohydrate and fat intake were associated with time taken to
complete the race”
 Black et al. Energy intakes of Ultraendurance cyclists during competition, an observational
study. Iner
• “High CHO intake during exercise was related not only to increased scores for nausea and
flatulence but also to better performance during IM races.”



Beate et al. Nutritional Intake and Gastrointestinal Problems during Competitive Endurance Events. Medicine and Science in Sports and Exercise.
February 2012.
BCAAS?
Non peri-workout meals

Remarkably similar to strength/power athletes
 i.e. 3-5 meals/day spread 3-5 hours apart
• Optimal levels of protein
• Correct amount of carbohydrates and fat to support optimal body comp/weight

10. Designing an Optimal Nutrition Template
 Strength Power Athletes
 Protein Dosing



Hypertrophy
 Muscle CSA correlated to force production
Recovery
 Supports training volume
Muscle glycogen replenishment

Anabolic “Window?”
 “The current meta analysis does not support the presence of a limited anabolic
window..”
•

Schoenfeld et al. The effect of protein timing on muscle strength and hypertrophy: a meta analysis. Journal of the International Society of
Sports Nutrition. 2013
Carbohydrate timing
• Synergistic with increased MPS rates PWO

Making Weight

In conclusion, data from this study suggest that athletes who want to gain LBM
and increase 1RM strength during a WL period combined with strength training
should aim for a weekly BW loss of 0.7%.
 Bench Press improved 13.6% in slow loss group vs. 6.4% in fast loss group.
 Squat 1RM improved 12% in slow, 9% in fast.

Garthe et. al. Effect of Two Different Weight Loss Rates on Body Composition and Strength and Power
related Performance in Elite Athletes. International Journal of Sport Nutrition and Exercise Metabolism.
2011.

11. What about losing weight for health?
 Is achieving a “healthy” BMI really a useful goal?
 Study: Association of All-Cause Mortality With Overweight
and Obesity Using Standard Body Mass Index Categories*
Results: “Relative to normal weight, both obesity (all grades) and
grades 2 and 3 obesity were associated with significantly higher
all-cause mortality. Grade 1 obesity overall was not associated
with higher mortality, and overweight was associated with
significantly lower all-cause mortality.”
 Healthy=18.5-24.9
 Overweight= 25-29.9
 Grade 1= 30-34.9
 Grade 2= 35-39.9
 Grade 3= >40

*Flegal, Katherine M. Association of All-Cause Mortality With Overweight and Obesity Using Standard Body Mass Index
Categories. JAMA. 2013. January. http://jama.jamanetwork.com/article.aspx?articleid=1555137

12. Maybe it’s not a fad….
 We don’t know that much, really.

Restrictive diets (e.g. Twinkie or Potato diet)


Mark Haub nutrition professor decreased BMI from 29-25, LDL went down, HDL went up 20% and triglycerides decreased by 40.
Low Carbohydrate and Ketogenic diets
 Ketogenic diets in ASD*
• Reduces seizure frequency by > 50% in ½ patients and by > 90% in 1/3 of pts

Low carb diet**
•
•


311 overweight/obese premenopausal women were randomized to 4 diets: A low-carb Atkins diet, a
low-fat vegetarian Ornish diet, the Zone diet and the LEARN diet. Zone and LEARN were calorie
restricted.
The Atkins group lost the most weight, although the difference was not statistically significant (though
it was at least double). The Atkins group had the greatest improvements in blood pressure, triglycerides
and HDL. LEARN and Ornish (low-fat) had decreases in LDL at 2 months, but then the effects
diminished.
Vegetarian/Vegan/Paleo/DASH/Ornish/Intermittent Fasting, etc.
 If it produces calorie restriction and compliance, it doesn’t matter.
 The Mediterranean Diet is okay too 
Requiring eating “clean” is borderline Orthorexia*

*Bratman, Steven. What is Orthorexia? www.orthorexia.com. June 4, 2010
**Gardner CD, et al. Comparison of the Atkins, Zone, Ornish, and LEARN diets for change in weight and related risk factors among
overweight premenopausal women: the A TO Z Weight Loss Study. The Journal of The American Medical Association, 2007
*Kossoff EH, Zupec-Kania BA, Rho JM. Ketogenic diets: an update for child neurologists. J Child Neurol. 2009 Aug;24(8):979–88.

13. Supplementation for Performance
 Whey Protein
 Protein quality spectrum
 Branched Chain Amino Acids
 Decreases RPE and increases time to fatigue in endurance
athletes
 Improves recovery/strength in strength athletes
 Creatine
 Carbohydrates
 Vitargo= Low molecular weight, high tonicity= isotonic (gastric
emptying)
 Beta alanine
 Increases Muscle carnosine levels- a buffer of acid

14. Supplementation for Performance
 Vitamin D 3




“Vitamin D may improve athletic performance in vitamin D-deficient athletes. Peak athletic performance may occur
when 25(OH)D levels approach those obtained by natural, full-body, summer sun exposure, which is at least 50
ng·mL-1”
Vitamin D also increases the size and number of Type II (fast twitch) muscle fibers. Most cross-sectional studies show
that 25(OH)D levels are directly associated with musculoskeletal performance in older individuals
Very recently, Melamed et al., using population data, found that total mortality was 26% higher in those with the
lowest 25(OH)D levels compared with the highest.
Betaine

Six-weeks of betaine supplementation improved body composition, arm size, bench press work capacity, attenuated the rise in
urinary HCTL, and tended to improve power and muscular endurance.


Cholewa et. al Effects of betaine on body composition, performance, and homocysteine thiolactone. Journal of International Society of
Sports Nutrition 2013.
Hoffman et al. Effect of betaine supplementation on power performance and fatigue. Journal of International Society of Sports
Nutrition. 2009.
 HMB
 “Thirty-eight mg·kg·BM-1 daily of HMB has been demonstrated to enhance
skeletal muscle hypertrophy, strength, and power in untrained and trained
populations when the appropriate exercise prescription is utilized.”


Wilson et al. International Society of Sports Nutrition Position Stand: beta hydroxy-beta-methylbutyrate (HMB). Journal
of the International Society of Sports Nutrition 2013.
Pre workout?

After 8 weeks of training, MIPS supplementation significantly contributed to a LBM increase of 7.8%, which was
significantly greater than the increases resulting from the placebo group of 3.6%. After 8 weeks of training, the MIPS
contributed to bench press strength increases of 18.4%, which was significantly greater than the increases resulting
from the training alone in the placebo group of 9.6% .

Lowery et al. Effects of 8 weeks of Xpand 2x pre workout supplementation on skeletal muscle hyperrophy, lean body mass, and
strength in resistance trained males. JISSN 2012

15. Practical Application
 Develop some initial macronutrient goals

Download MyFitnessPal


http://www.myfitnesspal.com/
 Sign up/log in
Track dietary habits for 5-7 days to get baseline
Food scale is more accurate, but on the whole…probably not 100%
accurate anyway
 All food information on label is for the food in the form it’s sold
(besides bacon)

 After initial data collection, setup diet within isocaloric
framework
Calories
Protein
Carbohydrates
Fat
Fiber
Before
2000
100
300
44
25
After
2000
200
200
44
35

16. Measuring Progress
 Objective Measures
 Weight
 Waist/hip/etc. measurements
 Body Fat
 Performance
 Subjective Measures
 Mood/Feelings
 Visual changes
 Clothes fitting differently
 Performance
 Use all feedback to figure out the next move!

17. Questions?