1. Nutrition for XC and the Role of Coaches in Disordered Eating, Prevention and Intervention
Jenna Stangland MS, RD, CSSD, LDN, CLT
Registered Licensed Sports Dietitian
Prepared for : Regional Cross Country Coaches Association

2. Outline
Highlight of what we are covering

3. Outline Prevalence Female Athlete Triad Signs and Symptoms Prevention
Nutrition For XC and Role of Coaches
Outline
Prevalence
Female Athlete Triad
Signs and Symptoms
Prevention
Intervention
Tips

4. Nutrition for Performance
Nutrition for XC and Role of Coaches
Nutrition for Performance
Runners bodies need to continuously be fueled and refueled to sustain energy and support all workouts and races.
Proper nutrition is essential for performance, progress and health throughout the season and year round.
Supporting healthy habits sets the tone for lifelong success and well being.

5. High School Running Nutrition Goals
Nutrition for XC and Role of Coaches
High School Running Nutrition Goals
Refuel
Rehydrate
Recover
Ideal day starts off with:
Prioritizing sleep
Having a balanced breakfast

6. High School Running Culture
Nutrition for XC and Role of Coaches
High School Running Culture
Performance
Perfectionism
Pressure
Typical day starts off with:
Lack of sleep and/or
Lack of fuel

7. Influential Factors Affecting Eating
Numbers driven
Teammate starts “diet”
Initial weight loss with faster time
Nutrition for XC and Role of Coaches
Body image, leanness
Influential Factors Affecting Eating

8. Nutrition for XC and Role of Coaches
In spite of this, I had my best year of track to date, and the best year I may ever have. I was an All-American in the 10k, runner up in the 5k and 10k at the Big 12 Conference meet, and ran USA nationals, ending the season with a personal best.
Eating disorder or not, I was fast, and I was not about to change my habits that were working so well.
Things hurt, my body couldn’t recover from anything, and the life was being sucked out of me. 
My last track seasons were filled with a stress fracture, loads of cross training, and a lot of self-disappointment. 

9. Eating Behaviors
What we see in high school running community

10. Nutrition for XC and Role of Coaches
Prevalence
Eating disorders in 31% of elite female athletes in “thin build” sports compared to 5.5% of control population
Disordered eating behavior as high as 62%
Prevalence of secondary amenorrhea as high as 65% in long distance runners
21.8% of female high school athletes met at least one criteria of Female Athlete Triad

11. school year, over 769,000 female athletes in high school interscholastic running sports in US
Cumulative seasonal incidence of injury for female runners ranges from 34.0% to 52.0%!
1 in 5 runners will sustain stress fracture each year.
Evidence shows the three Triad components may place female runner at greater risk for musculoskeletal injury

12. Interrelationships among - energy availability - menstrual function
Nutrition for XC and Role of Coaches
Female Athlete Triad
Interrelationships among
- energy availability
- menstrual function
- bone mineral density

13. Relative Energy Deficiency in Sports
Nutrition for XC and Role of Coaches
Relative Energy Deficiency in Sports
Goal of ACSM is for every girl and woman’s physical condition to be coincident with the green triangle, which represents the healthy athlete who adjusts her dietary energy intake to compensate for exercise energy expenditure
Thick arrows indicate that energy availability promotes bone health and development indirectly by preserving eumenorrhea and estrogen production that restrains bone resorption, and directly by stimulating production of hormones that promote bone formation.
Red triangle = low energy availability impairs bone health and development by inducing amenorrhea and removing estrogen’s restraint on bone resorption, and directly by suppressing hormones that promote bone formation.

14. Triad Components Energy Availability
Nutrition for XC and Role of Coaches
Triad Components
Energy Availability
dietary energy intake minus exercise energy expenditure normalized to fat-free mass ( )/51 = 27.5 kcal/kg of FFM/day
Menstrual Function
Eumenorrhea to amenorrhea. Pituitary gland not secreting pulses of LH (within 5 days of low EA)
Bone Mineral Density
density and internal structure of bone mineral and quality of bone protein measured by Z score

15. Mountjoy M et al. Br J Sports Med 2014;48:491-497

16. Types of Eating Disorders
Nutrition for XC and Role of Coaches
Types of Eating Disorders
Anorexia
consistent restriction of energy intake, distorted perception of body image
Bulimia
binge eating, loss of control compensating via laxatives, purging, exercise, etc
Other specified feeding and eating disorders (OSFED)
Psychological and biological based and triggered by emotional and cultural factors

17. Consequences of Negative Energy Balance
Nutrition for XC and Role of Coaches
Consequences of Negative Energy Balance
Delayed recovery
Inability to adapt to training regimen
Diminished performance
Loss of the cushioning and insulation in the body
Decrease in fat and lean tissue used for fuel
Compromised immune function, respiratory infections
Nutrient deficiency
Psychological problems associated with eating disorders
Loss of the enjoyment of eating and social dining occasions
Overtraining syndrome

18. Negative Energy Balance
Nutrition for XC and Role of Coaches
Negative Energy Balance
Well fueled athlete will always outperform the under fueled athlete
“In athletes, dieting may not lead to clinical eating disorder but rather situation when athlete is told to lose weight and the availability (or lack thereof) weight loss guidance” – ACSM on Female Athletes

19. Consequences of menstrual dysfunction
Nutrition for XC and Role of Coaches
Consequences of menstrual dysfunction
Hormonal imbalance, endocrine dysfunction
Low hormones influences bone formation and remodeling and encourages the withdrawal of calcium from bone
Stress fracture 2-4x higher in amenorrhea athletes
Infertility
Impaired endothelium vasodilation
Impaired skeletal muscle metabolism
Elevated LDL

20. How to Recognize Behavior Change
For the health and success of your athletes

21. Risk Factors Nutrition for XC and Role of Coaches
At risk for low energy availability:
Restrict dietary energy intake
Exercise for prolonged periods
Vegetarians and vegans
Limit types of food intake
Low self esteem
Family dysfunction
Abuse
Biological and/or genetic factors
Injury
Change in “rank” on team

22. Signs and Symptoms Nutrition for XC and Role of Coaches
Anyone is susceptible so be aware of your athletes
Preoccupied with food, weight and/or body
Dehydration
Gastrointestinal problems
Intolerance to cold
Mood swings
Fatigue
Weight loss
Difficulty concentrating
Refuse to eat with teammates
Frequent injury

23. Nutrition for XC and Role of Coaches
NCAA – “coaches have considerable influence with their athletes…their motivational climate can influence the risk of disordered eating.”
Create community of psychological support and openness
Not to criticize (judgement in sport)
Provide resources/guidance
Encourage optimal fueling for prevention and performance in sport

24. Prevention
How to be proactive with your athletes

25. Prevention Education on fueling for performance Open communication
Nutrition for XC and Role of Coaches
Prevention
Education on fueling for performance
May need up to 3,500 calories
Open communication
Set expectations to train hard and eat healthy
Deemphasize weight, focus on other aspects that make up running
Pre season physical, biomarkers, growth curves
Screening tool (EAT-26)
Self report measure of symptoms and concerns characteristic of disordered eating

26. Runner Performance Screen
Nutrition for XC and Role of Coaches
Runner Performance Screen
Do you currently or have you ever had a stress fracture?
Do you ever feel abnormally fatigued during the day or have noticed a decline in your energy at practice?
Have you gained or lost 15 pounds or more in the past 3 months?
Do you think you need or want to gain or lose weight in the next couple months?
Are you experiencing any recurring GI distress, bloating, diarrhea, constipation, etc?
Do you exclude any food groups from your diet?
Do you skip breakfast or any other meals during the day?

27. De Souza MJ, et al. Br J Sports Med 2014;48:289
Nutrition for XC and Role of Coaches
Cumulative Risk Assessment
De Souza MJ, et al. Br J Sports Med 2014;48:289

28. Intervention

29. Intervention as Coach When: Nutrition for XC and Role of Coaches
Frequent injuries
Stress fractures/low BMD
Absent menstrual periods
Compromised immune system
Inflammation
Negative body image/food talk
Rapid weight changes
Blood work indicative of nutritional deficits
(vitamin D, electrolytes – sodium/potassium, ferritin, thyroid, cortisol, insulin, LDL, growth hormones)

30. Intervention as Coach:
Nutrition for XC and Role of Coaches
Intervention as Coach:
HOW:
Meet in private
Express concern
Respect your athlete
Tie to performance (main goals for the season, for race day, recovery)
Provide tangible benefits (bone healing, faster recovery from injury, increase in energy levels, concentration)

31. Tips for the season Know the components of the Triad
Nutrition for XC and Role of Coaches
Tips for the season
Know the components of the Triad
Recognize signs and symptoms early on
Initiate open communication and positive reinforcement
Coaches are the front line for identifying early signs and influencing the athlete!

32. Nutrition Education for your runners
Nutrition for XC and Role of Coaches
Nutrition Education for your runners
Jenna Stangland
(952) option 3
Education session with parents & athletes
Nutrient timing, quality of fuel, supplementation, affects of hydration/dehydration, nutrient deficiencies

33. Thank you!
Good luck with your upcoming season!