Learn how food is powerful for performance, injury prevention and recovery!

1. Nutrition for the
Tennis Athlete
Stephan Esser MD, USPTA
Follow Me @EsserHealth or
@EsserSports
on
Social Media

2. Goals
• Introduce nutritional topics related to injury prevention, health and
performance
• Provide you tangible tools to apply nutrition to your on and off court
training

3. Tennis
• 10,680 steps in an hour of singles tennis
• 100-200 serves per match
• 200-300 ground strokes per match
• 400-600 calories per hr of play
• Bake in the Sun
• Sweat up to 2.0-3.0L/h. (6.6lbs of fluid)

4. Coach Goals
• Maximize Performance
• Minimize Injury
• Accelerate Recovery

5. Hydration

6. Hydration
• > 2% of weight loss impairs performance (Thirst??)
• blood volume, decreased skin blood flow, decreased sweat rate, increased
core temperature, and an increased rate of muscle glycogen use
• Increases risk of cramping
• Increases risk of delayed onset muscle soreness
• Impairs skin, tendon, cartilage and ligament health

7. Signs of Inadequate Hydration ??
• Headaches
• Fatigue
• Reduced Effort
• Slowed speed
• Prolonged recovery
• Negative Attitude
• Slowed Cognitive reaction/planning

8. Hydration

9. Hydration
• Pre-hydrate
• 20 ounces 2 hrs before sport
• 20 ounces 15 minutes before
• Maintain
• Drink 10oz every 15 minutes ( 4-6 big gulps)
• Consider electrolyte/carb(6-8%) beverage if high risk of cramping or high heat
and prolonged play > 1.5 hrs
• Rehydrate
• Weighing themselves before and after practice. For every kilogram (pound)
lost during the workout, drink ~1.5 liters (~three cups) of fluid in order to
rehydrate the body.
• Monitor Urine Changes

10. Hydration

11. Hydration

12. Tips
• ”Eat your water”
• Make Water readily accessible
• Remind to Pre-hydrate and to drink during play
• High level or high risk players consider pre and post weigh ins
• Educate, Remind, Educate again, Remind again
• Performance vs Pain vs Recovery

13. “Food is Medicine”

14. Food as Medicine
The effect of dietary anthocyanins on
biochemical, physiological, and subjective
exercise recovery: a systematic review and
meta-analysis CRFSN 2021
• To summarize, ACN were shown to have an overall
beneficial effect on reducing CK, muscle
soreness, strength loss and
improving power after exercise. This
was accompanied by attenuated inflammation and
increased antioxidant capacity/status following the
intake of ACN, suggesting a potential causal link.

15. Food is Information
Reduce Inflammation Replete Calories

16. Tendon Injury and High Cholesterol
• Serum Lipids and risk of Tendon Injury
• Impaired micro-perfusion
• Increased risk of injury
• Increased risk of re-tear and slowed healing
• Patients with rotator cuff tears were more likely to have hypercholesterolemia when compared with the
control group. The Effect of Hypercholesterolemia on Rotator Cuff Disease Clinical Orthopedics and
Related Research 2010
• The present study found a significant association between moderate and high perioperative total
cholesterol and LDL levels and the rate of revision surgery after primary arthroscopic rotator cuff
repair. Perioperative Serum Lipid Status and Statin Use Affect the Revision Surgery Rate After
Arthroscopic Rotator Cuff Repair AJSM 2017
• Total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) concentrations of the patients with
ATR were higher (p<0.001), and their high-density lipoprotein cholesterol (HDL-C) was lower than the
control group (p<0.05). Moreover, the concentrations of triglyceride (TG) and very low-density
lipoprotein cholesterol (VLDL-C) were significantly higher than controls (p<0.05). Is high concentration of
serum lipids a risk factor for Achilles tendon rupture?
• People with altered tendon structure or tendon pain had significantly higher total cholesterol, low-
density lipoprotein cholesterol and triglycerides, as well as lower high-density lipoprotein cholesterol. Is
higher serum cholesterol associated with altered tendon structure or tendon pain? A systematic review
BJSM 2015
• One intrinsic factor that appears to have an association with tendinopathy is body composition; more
specifically central adiposity Adiposity and tendinopathy Disability and Rehabilitation 2008

17. Osteoarthritis and High Blood Pressure
• Association of Hypertension with Knee
Pain Severity Among People with Knee
Osteoarthritis 2022
• Zhang YM, Wang J, Liu XG. Association
between hypertension and risk of knee
osteoarthritis. Med (United States).
2017;96:e7584.
• Hypertension meets osteoarthritis —
revisiting the vascular aetiology
hypothesis 2021
• Accumulation of metabolic risk factors
such as overweight, hypertension,
dyslipidaemia, and impaired glucose
tolerance raises the risk of occurrence
and progression of knee osteoarthritis: a
3-year follow-up of the ROAD study.
Osteoarthr Cartil. 2012;20:1217–26.
• Lo GH, McAlindon TE, Katz JN, Driban JB,
Price LL, Eaton CB, et al. Systolic and
pulse pressure associate with incident
knee osteoarthritis: data from the
osteoarthritis initiative. Clin Rheumatol.
2017;36:2121–8
• Association between hypertension and
osteoarthritis: A systematic review and
meta-analysis of observational studies
2022

18. Nutrition for Performance
• Fuel the body for sport and performance
• Fuel the body for recovery
• Prevent Injury and early degeneration

19. Basics

20. Basics

21. American Diet - < 4% Achieve Veg goals
-Adolescents 70% UPF
-40+% Adults Obese

22. Glycemic Index

23. Nutrition Pre-Match
• Recreational player with < 2 hrs on the court
• Hydration is the focus
• Competition player: Hydration AND

24. Example
7am Breakfast 10-1230pm Match 1pm Post Match
930am Snack
30-60g Carbs/Hr
Eg: 2 dates
or
1 banana
or
1 apple
or
20 oz Gat.

25. Nutrition for Performance
• Concepts
• Carbs throughout the day and match and higher protein and fats post
workout
• Note: High fat/protein meals slow gastric emptying and carb
absorption

26. Concepts
• Experiment during training and practice
• Don’t try new things on match day
• Modify based on performance, recovery and GI symptoms

27. Nutrition and Self Care
• You are grinding on the Court
• You are getting older 
• You want to stay healthy to share your passion and live a vibrant life
• Food is a foundation of your health

28. “A global response to a global problem: the
epidemic of overnutrition.” WHO
It is estimated that by 2020 2/3rds of the global burden
of disease will be attributable to chronic non-
communicable diseases, most of them strongly associated
with diet. The nutrition transition towards refined foods,
foods of animal origin, and increased fats plays a major
role in the current global epidemics of obesity, diabetes
and cardiovascular diseases, among other non-
communicable conditions. Sedentary lifestyles and the use of
tobacco are also significant risk factors. …….. A concerted
multi-sectoral approach, involving the use of policy, education
and trade mechanisms, is necessary to address these matters.

31. Added Fats

34. Cal Fat Cho Na Fib/Carb Prot
CF Br Bur 440 19 245 950 2/43 23
We Ck Sal 380 13 90 960 6/33 36
Chipotle
Beef
Burrito
1050 52 150 2360 20/92 46
Total 1870 84g 485mg 4270mg 26/168 105g
Sodium < 1500 mg

35. Cal Fat Cho Na Fib/Carb Prot
Pan. Ham/Swiss
Sand.
730 32g 105mg 2050mg 10/68 33g
OG Chicken
Parm.
660 29g 75mg 1740mg 5/65 35g
S52 Cedar Plank
Salmon
440 19g 85mg 880mg 6/25 44g
Total 1830 80g 265mg 4670mg 21/158 112g
Sodium < 1500 mg
Cholesterol < 200mg

36. 8% from Fruits
and Vegetables
≈ 50% from Added
fat/oil and
processed flour

37. Michelangelo’s David:
12 month 20 city tour of the US

38. Associated Pathology
• CVD:
• Hypertension
• Congestive Heart Failure
• PVD
• Impotence
• Claudication
• Endocrine:
• Diabetes
• PCOS
• Hypothyroidism
• Infertility
• Orthopedics:
• Osteoarthritis
• AVN
• Hepatic:
• #1 cause of liver dz in US
• Obstetrics:
• Gestational DM
• Macrosomia
• Inc. C Section rate
• Inc. Perinatal Morbidity
• Inc. Pre/Eclampsia
• Cancer:
• Prostate
• Colon
• Breast
• Endometrial
• Renal Cell
• Gallbladder
• Esophageal Adeno.
• Other:
• Hyperuricemia, Pancreatitis, Gallstones,
Sleep Apnea, Alzheimer’s, Dyslipidemia,
Metabolic Syndrome, COVID19

39. Nutrition
Think about Calorie Density
and less about individual
Calories

41. Goals
• Lower calorie density program
• High nutrient density program / High water content foods
• Increase minimally processed whole foods
• Increase water consumption > 64 oz/day
• Increase Blues/Reds/Greens/Purples
• Monitor your markers of health
• BMI/WHC/Body Fat%/Blood pressure/Lipids/HR etc

42. Conclusion
• Food is powerful information at the cellular level
• What we eat can affect performance, injury risk and recovery
• Identify individuals where nutrition is most likely to have + effect
• Consider BOGO’s
• Maximize the nutrient quality and quantity of your food and beverages
• Track your food and hydration for a week without making changes
• Then make it easy to get healthy food and Hard to get unhealthy food
• Keep Learning!!

43. Thank You!
Stephan Esser MD, USPTA
Follow Me @EsserHealth or
@EsserSports
on
Social Media