Cherise Russo D.O. Primary Care Sports Medicine Northwestern Orthopaedic Institute, LLC

 Stores of energy are required to fuel the body during activity  Most activity is fueled by carbohydrates and fat  Protein is used when carb stores are too low  Key Factors: ◦ Intensity ◦ Duration ◦ Level of training

 Inadequate nutrition may cause fatigue and affect performance  Influential factors that may affect fatigue ◦ Fluid Intake ◦ Calorie Intake vs. Calorie Expenditure ◦ Carbohydrate Intake ◦ Protein Intake ◦ Iron Levels ◦ Vitamin/Mineral Levels

 Need to be individualized (gender, age, level of training, health status)  While training, do not try to “diet” or restrict calories  Decreasing calories inappropriately may result in injury  Over-eating may adversely affect performance

 The Institute of Medicine Food and Nutrition Board  Female Athletes >30 years old ◦ TEE= X age x ((9.36 x weight(kg) +726 x height (m)  Example : 35y/o 5’4” female who weighs 145lb TEE =2722 calories/day  Male Athletes >30 years old ◦ TEE= X age X (15.91 x weight kg x height (m))

 Mix of carbohydrates, protein and fat  Fad diets are often restrictive  Optimal carbohydrate intake is fundamental! ◦ Primary fuel for working muscles ◦ Prevents low blood sugar during training ◦ Aids in post-exercise recovery

 Carbohydrates stored as glycogen in the body  Use increases with intensity but decreases with duration  Higher the glycogen stores the longer an athlete can exercise at a given intensity  Carb requirements are higher during training than competition  Carb requirement based on daily training regimen

Number of Training Hours Grams of Carbs/lb of Body Weight ◦1◦2◦3◦4◦1◦2◦3◦4 ◦ gm ◦ 3.6 gm ◦ 4.5 gm ◦ gm

 3-5 days of carb loading to achieve max glycogen levels  Type of exercise should be the same as the athlete’s event  Only beneficial for endurance events longer than 90 minutes

 1.8 gm of carbs/lb of body weight  Example: 130 lb athlete requires 234 gm of carbs ◦ 12 oz glass of cranberry juice = 54 gm carb ◦ 8 oz yogurt with ½ cup granola = 96 gm carb ◦ 4 oz bagel=76 gms Total = 226 gm of carb

.5 gm carbohydrate/lb of body weight  Example: 130 lb athlete requires 65 gm of carbs ◦ 12 oz Gatorade = approximately 70 gm of carbohydrates

 gm of carbohydrate/hour  Example: 5-10 oz of a sports drink every minutes

 20-24hrs required to restore muscle stores of glycogen  Most effectively replaced within 15 minutes .7 gm of carbs/lb within 30 minutes and again 2 hours later for greater than 90 minutes of exercise  Adding protein may enhance stores of carbs (1:3)  Examples: Trail mix, cheese crackers, chocolate milk  Must be part of the training regimen

 Muscle growth and repair  Provides 15% of fuel during exercise when carb stores are low and only 5% when stores are adequate  Too little protein-risks of injury, suppressed immune system, fatigue  Too much protein- risks of dehydration, increased fat stores, calcium loss and risk of a diet low in carbs

 More protein in the early stages of training  Maximum useable amount 1 gm/lb of body weight/day  Recreational athlete: gm/lb body weight/day  Competitive athlete:.6-.9 gm/lb body weight/day  Food sources are ideal  Powders can be costly and may have palatability problems

 Good source of fuel for low-intensity, long duration activity  Fat intake recommendations may vary from % of daily calories  Estimate: Weight (lb) x.45 =number of gm of fat per day

 Consume a mix of carbs, protein and fat  Important during training for fuel and recovery  Do not try to lose weight during training  Choose palatable foods  Choose foods that do not cause distress and use throughout training, not just race day

 McKeag, Douglas B. and James L. Moeller. ACSM’s Primary Care Sports Medicine, 2 nd Ed. Philadelphia: Wolters Kluwer Lippincott Williams & Wilkins, 2007.

 Indicates the affect on blood sugar and insulin levels  Blood glucose response compared to a food that provides 50gm of carbs (rate of digestion and absorption)  Low, Moderate, High

 Low Glycemic Index Food-may allow for sustained availability  High Glycemic Index Food-may be useful one hour event before if the athlete is not sensitive to glucose changes