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Nutrtion Work

Heather Hedrick Fink, MS, RD, CSSD Owner Nutrition and Wellness Solutions, LLC Indianapolis, Indiana

Alan E. Mikesky, PhD, FACSM Professor Emeritus School of Physical Education and Tourism Management Indiana University-Purdue University Indianapolis Indianapolis, Indiana

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Library of Congress Cataloging-in-Publication Data Names: Fink, Heather Hedrick, author. | Mikesky, Alan E., author. Title: Practical applications in sports nutrition / Heather Hedrick Fink, Alan E. Mikesky. Description: Fifth edition. | Burlington, Massachusetts : Jones & Bartlett Learning, [2018] | Includes bibliographical references and index. Identifiers: LCCN 2016048145 | ISBN 9781284101393 (pbk.) Subjects: | MESH: Sports Nutritional Physiological Phenomena | Sports–physiology | Exercise–physiology | Sports Nutritional Sciences Classification: LCC TX361.A8 | NLM QT 263 | DDC 613.2024796–dc23 LC record available at https://lccn.loc.gov/2016048145

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BRIEF CONTENTS SECTION 1 The Basics of Sports Nutrition . . . . . . . . . . . . . . . . . . . . . . . . . 1 CHAPTER 1 Introduction to Sports Nutrition . . . . . . . . . . . . . . . . . . . . . . . 3 CHAPTER 2 Nutrients: Ingestion to Energy Metabolism . . . . . . . . . . . .23 CHAPTER 3 Carbohydrates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .59 CHAPTER 4 Fats . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .91 CHAPTER 5 Proteins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116 CHAPTER 6 Vitamins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141 CHAPTER 7 Minerals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 178 CHAPTER 8 Water . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 210 CHAPTER 9 Nutritional Ergogenics . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239

SECTION 2 The Practical Application of Sports Nutrition . . . . . . . . 261 CHAPTER 10 Nutrition Consultation with Athletes . . . . . . . . . . . . . . . 263 CHAPTER 11 Weight Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 291 CHAPTER 12 Endurance and Ultra-Endurance Athletes . . . . . . . . . . . 330 CHAPTER 13 Strength/Power Athletes . . . . . . . . . . . . . . . . . . . . . . . . . . . 364 CHAPTER 14 Team Sport Athletes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 392 CHAPTER 15 Special Populations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 420 CHAPTER 16 Jobs in Sports Nutrition . . . . . . . . . . . . . . . . . . . . . . . . . . . 455 APPENDIX A You Are the Nutrition Coach – Answers . . . . . . . . . . . . . . 465 APPENDIX B The Gastrointestinal Tract . . . . . . . . . . . . . . . . . . . . . . . . . 471 APPENDIX C Major Metabolic Pathways . . . . . . . . . . . . . . . . . . . . . . . . . 474 APPENDIX D Calculations and Conversations . . . . . . . . . . . . . . . . . . . . 480 APPENDIX E Growth and Body Mass Index Charts . . . . . . . . . . . . . . . . 483 APPENDIX F Dietary Reference Intakes . . . . . . . . . . . . . . . . . . . . . . . . . 488

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CONTENTS

Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xvi How to Use This Book . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xviii About the Authors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xxiii Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xxiv

SECTION 1 The Basics of Sports Nutrition . . . . . . . . . . . . . . . . . . . . . . . . . 1 CHAPTER 1 Introduction to Sports Nutrition . . . . . . . . . . . . . . . . . . . . . . . 3

What is sports nutrition? 4 Why study sports nutrition? 4 What are the basic nutrients? 4

What are carbohydrates? 5 What are proteins? 5 What are fats? 5 What are vitamins? 5 What are minerals? 5 What is water? 6

How does the body produce energy? 6 What are the dietary reference intakes? 6 What are enriched and fortified foods? 7 What are the basic nutrition guidelines? 7

What are the Dietary Guidelines for Americans? 7 What is the MyPlate food guidance system? 9

How should athletes interpret the information on food labels? 11 Who created the food label regulations? 11 How can the ingredient list be useful to athletes? 11 How can the nutrition facts panel be useful to athletes? 12 How can the percent daily value be useful to athletes? 14 How can nutrient content claims be useful to athletes? 15 How can health claims be useful to athletes? 16

What are the factors to consider when developing an individualized sports nutrition plan for athletes? 17

Why should a sports nutrition plan consider an athlete’s health history? 18 Why should a sports nutrition plan consider a sport’s bioenergetics and logistics? 19 Why should a sports nutrition plan consider an athlete’s total

weekly training and competition time? 19 Why should a sports nutrition plan consider an athlete’s living

arrangements, access to food, and travel schedule? 19 How can sports nutrition knowledge be converted into practical applications? 20 Key Points of Chapter 21 Study Questions 21 References 22

CHAPTER 2 Nutrients: Ingestion to Energy Metabolism . . . . . . . . . . . .23 What happens to nutrients after they are ingested? 24

What are the functions of the various parts of the digestive system? 24

Contents v

How are carbohydrates digested, absorbed, transported, and assimilated in the body? 27

What happens to carbohydrates once they are put into the mouth? 27 How are the simple sugars absorbed into the intestinal wall? 29 What happens to carbohydrates once they make it into the blood? 31 What happens to carbohydrates once they make it to the cells of the body? 31

How are fats digested, absorbed, transported, and assimilated in the body? 31 What happens to fats once they are put into the mouth? 34 What happens to the fats once they are absorbed? 34 What happens to fats once they make it to the cells? 35

How are proteins digested, absorbed, transported, and assimilated in the body? 35 What happens to proteins once they are put into the mouth? 35 How are proteins absorbed into the intestinal wall? 37 What happens to amino acids once they make it to the bloodstream? 38 What happens to amino acids once they make it to the cells of the body? 39

How are minerals, vitamins, and water absorbed and transported in the body? 40 What is energy metabolism, and why is it important? 41 What is energy? 41 What is the human body’s source of chemical energy? 42 How do cells make ATP? 44 What are the three energy systems? 44

What are the characteristics of the phosphagen system? 46 What are the characteristics of the anaerobic and aerobic energy systems? 47

How do the energy systems work together to supply ATP during sport performance? 47

What metabolic pathways are involved with the energy systems? 49 Key Points of Chapter 56 Study Questions 57 References 58

CHAPTER 3 Carbohydrates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .59 What’s the big deal about carbohydrates? 60 What are carbohydrates? 60 How are carbohydrates classified? 61

What are simple sugars? 61 What are complex carbohydrates? 63 Are artificial sweeteners carbohydrates? Are they beneficial or harmful? 65

What functions do carbohydrates serve in the body? 66 How can carbohydrates affect overall health? 67

What role does fiber play in health? 67 What role do simple sugars have in health? 68

How much carbohydrate should be consumed daily? 68 What is the relationship between current body weight and carbohydrate intake? 69 How can carbohydrate needs be determined based

on a percentage of total calories? 69 What impact does the stage of training or competition

schedule have on carbohydrate intake? 70 What are the various sources of dietary carbohydrates? 70

What are the best carbohydrate choices within the grains group? 71 What are the best carbohydrate choices within the fruit and

vegetable groups? 71 What are the best carbohydrate choices within the dairy/alternative group? 71 What are the best carbohydrate choices within the protein foods group? 72

Can foods containing simple sugars or artificial sweeteners be used as a source of carbohydrates? 72

What are the glycemic index and glycemic load, and how can they be used in sports nutrition? 72

What is glycemic load? 73 How does the glycemic index relate to exercise? 74

How are carbohydrates utilized during exercise? 74 How much carbohydrate is stored within the body? 75 Why are carbohydrates an efficient fuel source? 76 Does carbohydrate intake enhance performance? 76 Does carbohydrate intake delay fatigue? 76

What type, how much, and when should carbohydrates be consumed before exercise? 77

What should an athlete eat on the days leading up to an important training session or competition? 78

What should an athlete eat in the hours leading up to an important training session or competition? 78

What type, how much, and when should carbohydrates be consumed during exercise? 81

What types of carbohydrates should be consumed during exercise or sport? 81 How much carbohydrate should be consumed during exercise or sport? 81 When should carbohydrates be consumed during exercise or sport? 83

What type, how much, and when should carbohydrates be consumed after exercise? 83

When should carbohydrates be consumed after exercise or sport? 83 What type of carbohydrates should be consumed after exercise or sport? 84 How much carbohydrate should be consumed after exercise or sport? 85 What are some examples of good meals/snacks for after exercising? 85

Key Points of Chapter 86 Study Questions 87 References 87 Additional Resources 90

CHAPTER 4 Fats . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .91 What’s the big deal about fats? 92 What are fats? 92 How are lipids (fats) classified? 92

What are triglycerides? 92 What is the molecular structure of a triglyceride? 92 What are some of the functions of triglycerides in the body? 93 What are fatty acids? 94 What are phospholipids? 98 What are sterols? 99 Is there such a thing as artificial fats? 100

How much fat is recommended in an athlete’s diet? 101 Can a diet be too low in fat? 102 Can a diet be too high in fat? 102

Which foods contain fat? 103 How much fat is in the grains group? 103 How much fat is in the fruit and vegetable groups? 103 How much fat is in the dairy/alternative group? 103 How much fat is in the protein foods group? 104 How much fat is in the oils? 104

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How can the percentage of calories from fat be calculated for specific foods? 104 What’s the big deal about cholesterol? 106

What is dietary cholesterol, and which foods contain it? 106 How is blood cholesterol classified? 106

How can fats affect daily training and competitive performance? 108 What type, how much, and when should fats be consumed before exercise? 110

Is a single high-fat meal prior to exercise beneficial? 110 Is a short-term pattern of eating high-fat meals beneficial

to exercise performance? 110 Is a long-term pattern of eating high-fat meals beneficial

to exercise performance? 110 What are the recommendations for fat intake prior to exercise? 111

What type, how much, and when should fats be consumed during exercise? 111 What type, how much, and when should fats be consumed after exercise? 112 Key Points of Chapter 113 Study Questions 113 References 114 Additional Resources 115

CHAPTER 5 Proteins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116 Why is protein important to athletes? 117 What are proteins? 117

What is the difference between a “complete” and an “incomplete” protein? 119 What are the main functions of proteins in the body? 121 What is nitrogen balance? 123 How much protein should athletes consume daily? 123

How can protein requirements be calculated based on body weight? 123 How do various dietary and training factors affect protein recommendations? 124 Can too much protein be harmful? 126

Which foods contain protein? 127 Which foods in the grains group contain protein? 127 Which foods in the fruit and vegetable groups contain protein? 127 Which foods in the dairy/alternative group contain protein? 128 Which foods make up the protein foods group? 128 Do foods in the oils and empty calories group contain protein? 128

Are protein supplements beneficial? 129 What is the quantity of protein or amino acids in the

product? Is the supplement necessary? 129 What is the cost of protein supplements? 131 Will protein supplements enhance performance? 131 Are there any risks associated with taking the supplement? 132

Why is protein essential for daily training? 132 What type, how much, and when should protein be consumed before exercise? 133

What type and how much protein should be consumed 4 to 24 hours prior to training or competition? 134

What type and how much protein should be consumed 1 to 4 hours prior to training or competition? 134

What type, how much, and when should protein be consumed during exercise? 134 What type, how much, and when should protein be consumed after exercise? 135

Which type of protein or amino acid source is most beneficial to consume after exercise? 135

Is there a recovery benefit of combining carbohydrates and proteins after exercise? 136

Contents vii

How much protein should be consumed after exercise? 136 When should protein or amino acids be consumed after exercise? 137

Key Points of Chapter 138 Study Questions 138 References 139 Additional Resources 140

CHAPTER 6 Vitamins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141 What’s the big deal about vitamins? 142 What are vitamins? 142 How are the dietary needs for vitamins represented? 142 What are the water-soluble vitamins? 142

Why is thiamin important to athletes? 144 Why is riboflavin important for athletes? 144 Why is niacin important for athletes? 145 Why is vitamin B6 important for athletes? 147 Why is vitamin B12 important for athletes? 149 Why is folate important for athletes? 151 Why is biotin important for athletes? 152 Why is pantothenic acid important for athletes? 154 Why is choline important for athletes? 154 Why is vitamin C important for athletes? 156

What are the fat-soluble vitamins? 157 Why is vitamin A important for athletes? 158 Why are the carotenoids important for athletes? 160 Why is vitamin D important for athletes? 161 Why is vitamin E important for athletes? 164 Why is vitamin K important for athletes? 166

Which vitamins or compounds have antioxidant properties? 166 What are free radicals? 166 What is the relationship between free radicals and exercise? 168 Do athletes need antioxidant supplements? 168

What are phytochemicals? 170 What are phenolic compounds? 170 What are organosulfides? 171 What is lycopene? 171 How can athletes increase phytochemical consumption through whole foods? 172

Key Points of Chapter 174 Study Questions 175 References 175 Additional Resource 177

CHAPTER 7 Minerals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 178 What’s the big deal about minerals? 179 What are minerals? 179 What are the major minerals? 179

Why is calcium important for athletes? 181 Why is phosphorus important to athletes? 183 Why is magnesium important for athletes? 184 Why is sodium important for athletes? 187 Why is chloride important for athletes? 188 Why is potassium important for athletes? 188 Why is sulfur important for athletes? 190

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What are the trace minerals? 191 Why is iron important for athletes? 191 Why is zinc important for athletes? 195 Why is chromium important for athletes? 196 Why is fluoride important for athletes? 197 Why is copper important for athletes? 199 Why is manganese important for athletes? 200 Why is iodine important for athletes? 201 Why is molybdenum important for athletes? 201 Why is selenium important for athletes? 202 Are other trace minerals important for athletes? 203

Key Points of Chapter 206 Study Questions 206 References 207 Additional Resources 209

CHAPTER 8 Water . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 210 What’s the big deal about water? 211

What are the functions of water in the body? 211 What are the sources of water? 212 What are the ways in which we lose body water? 213

What are the consequences of poor water balance? 214 Is it possible to overhydrate the body? 216 How can hydration status be monitored? 216

How much fluid do individuals need on a daily basis? 218 What are the current recommendations for daily fluid intake? 218 Can certain beverages, foods, or medications contribute to fluid losses? 219 What are some practical guidelines for consuming fluids on a daily basis? 220

What is the role of preexercise hydration? 220 How much fluid should be consumed before exercise? 220 What types of fluids should be consumed? 220 What are practical guidelines for consuming fluids before exercise? 222

What is the role of hydration during exercise? 222 What is the magnitude of water and electrolyte losses during exercise? 222 How much fluid should be consumed during exercise? 223 What types of fluids should be consumed during exercise? 225 What are some practical guidelines for consuming fluids during exercise? 230

What is the role of postexercise hydration? 233 How much fluid should be consumed? 233 What types of fluids should be consumed? 233 Are supplements beneficial after exercise? 234 What are some practical guidelines for consuming

fluids after exercise? 235 Key Points of Chapter 236 Study Questions 236 References 237

CHAPTER 9 Nutritional Ergogenics . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239 What is an ergogenic aid? 240 What are dietary supplements? 241

Why do athletes use dietary supplements? 241 What are the regulations governing dietary supplements? 242 Are some supplements better or safer than others? 244

Contents ix

Where can information on nutritional ergogenic aids be found? 246 What tools are available to research information on ergogenic aids? 246 What is doping? 248 What are some of the commonly encountered doping substances? 251

Which nutritional ergogenic aids are commonly used as anabolic agents, prohormones, and hormone releasers? 251

Which nutritional ergogenic aids are commonly used to reduce fat mass? 253 Which nutritional ergogenic aids are commonly used as anticatabolics? 253 Which vitamins and minerals are commonly used as nutritional ergogenic aids? 254

What types of dietary supplements and nutritional ergogenics are commonly used by endurance athletes, strength/power athletes, and team sport athletes? 254

Key Points of Chapter 259 Study Questions 259 References 260

SECTION 2 The Practical Application of Sports Nutrition . . . . . . . . 261 CHAPTER 10 Nutrition Consultation with Athletes . . . . . . . . . . . . . . . 263

Why is nutrition consultation and communication with athletes important? 264 How much do athletes know about sports nutrition? 264 Who provides nutrition assessment and education to athletes? 265 How does the consultation process with athletes begin? 266 What is a diet history? 266

What is a health history questionnaire? 266 Why is an inquiry about supplement use important? 268 What type of food intake information should be obtained from the athlete? 268 How is an exercise/training log used in a nutrition consultation? 271 Which clinical assessments should be conducted in

the initial consultation session? 272 How are food records analyzed? 273

How do you compare dietary intake to nutrition recommendations? 274 What are the steps for the initial consultation with the athlete? 277

How is rapport established with an athlete? 278 How can you determine the reasons for a requested consultation? 278 How is the nutrition assessment conducted? 278 How can an athlete’s readiness for change be assessed? 281 How can appropriate nutrition goals be established? 283 How can appropriate nutrition education be provided to an athlete? 284 How should a consultation be summarized and closed? 285

What are the steps for a follow-up consultation with the athlete? 285 What should walk-in or short sessions with athletes involve? 286 Are there any concerns about the confidentiality of the health, nutrition,

and exercise information provided by the athlete? 287 Key Points of Chapter 289 Study Questions 289 References 290

CHAPTER 11 Weight Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 291 What are the common weight management concerns for athletes? 292 What are the prevalence and significance of overweight and obesity? 292

What are the main health consequences and health risks of overweight and obesity? 293

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What methods are used to determine weight status? 294 What is body mass index? 294 What can measures of body fat distribution tell us? 295

Why is body composition important? 296 What makes up the composition of the body? 296 What are the methods for measuring body composition? 297 How does body composition affect sport performance? 301

What are the components of energy intake and energy expenditure? 302 What influences energy intake? 302 What are the components of energy expenditure? 303

What methods do athletes use to lose weight? 306 How are weight and body composition goals for athletes determined? 306 How are energy needs for weight loss determined? 307 What dietary changes are necessary for athletes to lose weight? 307 How do exercise and physical activity influence weight loss for athletes? 309 How does goal setting help athletes lose weight? 310 What are the summary recommendations for athletes regarding weight loss? 311

What are the weight loss issues for athletes in weight classification sports? 312 What happens when weight loss efforts develop into

disordered eating patterns? 315 What are the different types of eating disorders? 315 What are the main concerns regarding female athletes

and eating disturbances/disorders? 317 What are the main concerns regarding male athletes and

eating disturbances/disorders? 319 What are the best treatment options for eating disorders? 320 How can eating disorders be prevented? 320

How can athletes gain weight healthfully? 322 What kind of resistance training program is best for gaining weight? 322 How can an athlete achieve a positive energy balance? 323 How can an athlete achieve a positive nitrogen balance? 324 Do athletes need dietary supplements to gain weight? 324 What other dietary practices might help an athlete gain weight? 325

Key Points of Chapter 326 Study Questions 327 References 327 Additional Resources 329

CHAPTER 12 Endurance and Ultra-Endurance Athletes . . . . . . . . . . . 330 What is different about endurance athletes? 331 What energy systems are utilized during endurance exercise? 331 Are total energy needs for endurance athletes different from

energy needs of other types of athletes? 331 How are daily energy needs calculated for endurance athletes? 332 How many calories should be consumed during

endurance training or competition? 333 How many calories are required after a training session or competitive event? 334

Are macronutrient needs different for endurance athletes? 334 How important are carbohydrates to endurance athletes? 335

How are daily carbohydrate needs calculated for endurance athletes? 335 How should endurance athletes carbohydrate-load before competition? 336 Should carbohydrates be consumed in the hours or

minutes prior to endurance activities? 337

Contents xi

Should the endurance athlete consume carbohydrates during endurance activities? 338

Is carbohydrate intake important during the recovery period after endurance training or competition? 338

Are protein needs different for endurance athletes? 340 How are daily protein needs calculated for endurance athletes? 340 What is the effect of consuming protein prior to endurance activities? 341 Should proteins be ingested during endurance activities? 342 Is protein needed for recovery from endurance exercise? 343

Should endurance athletes eat more fats to meet their energy needs? 344 How are daily fat needs calculated for endurance athletes? 346 Should fats be eaten while performing endurance activities? 347 Is fat needed for recovery from endurance exercise? 348

Are vitamin/mineral needs different for endurance athletes? 348 Why are the B vitamins important for endurance athletes? 348 Why are vitamins C and E important for endurance athletes? 348 Why is iron important for endurance athletes? 349 Why is calcium important for endurance athletes? 350 Why are sodium and potassium important for endurance athletes? 350

Why are fluids critical to endurance performance? 350 How are daily fluid needs calculated for endurance athletes? 351 How are fluid and electrolyte needs during endurance activities determined? 351

What meal planning/event logistics need to be considered during endurance events? 354

How can a nutrition plan be developed for sports that are not conducive to consuming foods or fluids while exercising? 354

How can a nutrition plan be developed for sports lasting 24 hours or longer? 357 How can a nutrition plan be developed for a multiday

event that will be fully supported? 357 How can a meal plan be developed for a sport such as a long-distance

triathlon that includes a nonconducive eating environment, a length of time spanning several meals, and race course support? 358

Key Points of Chapter 360 Study Questions 361 References 361 Additional Resources 363

CHAPTER 13 Strength/Power Athletes . . . . . . . . . . . . . . . . . . . . . . . . . . . 364 What is different about strength/power athletes? 365 What energy systems are utilized during strength/power exercise? 365 Are the calorie needs of strength/power athletes different

from those of other types of athletes? 366 How are daily calorie needs calculated for strength/power athletes? 366 How are calorie needs calculated during strength/

power training and competition? 371 Are carbohydrate needs different for strength/power athletes? 372

How are daily carbohydrate needs calculated for strength/power athletes? 372 Are carbohydrates needed before and during training and competition? 373 Are carbohydrates needed for recovery from strength/power activities? 375

Are protein needs different for strength/power athletes? 375 How are daily protein needs calculated for strength/power athletes? 376 Do individual amino acids have an ergogenic effect on

muscle growth and development? 377

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Is protein needed before and during training sessions and competitions? 377 Is protein needed for recovery from strength/power activities? 378

Are fat needs different for strength/power athletes? 379 How are daily fat needs calculated for strength/power athletes? 379 Are fats needed before and during training sessions and competitions? 380 Is fat needed for recovery from strength/power activities? 380

Are vitamin and mineral needs different for strength/power athletes? 380 Do strength/power athletes need to supplement with antioxidant vitamins? 380 Should strength/power athletes supplement boron intake? 380 Should strength/power athletes be concerned about calcium intake? 381 Is chromium supplementation important for strength/power athletes? 381 Should strength/power athletes worry about iron? 381 Is magnesium supplementation important for strength/power athletes? 382 Why is zinc important for strength/power athletes? 382 Is multivitamin/mineral supplementation necessary for

strength/power athletes? 382 Are fluid needs different for strength/power athletes? 382

What issues are of concern regarding the fluid intake of strength/power athletes? 382 How are fluid needs during strength/power activities determined? 384 What should athletes drink and when should they drink it? 384 How much fluid should strength/power athletes drink after

training sessions and competitive events? 385 What meal-planning/event logistics need to be considered

during strength/power events? 385 What are high-quality options for snacks between events at meets? 385 What are high-quality options for snacks after competition? 385

Key Points of Chapter 387 Study Questions 388 References 388 Additional Resources 391

CHAPTER 14 Team Sport Athletes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 392 What is different about athletes in team sports? 393 What energy systems are utilized during team sports? 393 How are energy needs different for team sport athletes? 394

How are daily energy needs calculated for team sport athletes? 394 How can energy needs during an event be calculated? 395

Are carbohydrate needs different for team sport athletes? 395 How are daily carbohydrate needs calculated for team sport athletes? 397 What is the effect of carbohydrate consumption prior to team sport activities? 398 Is carbohydrate intake required during team sport activities? 399 Is carbohydrate intake needed for recovery from team sport activities? 400

Are protein needs different for team sport athletes? 400 How are daily protein needs calculated for team sport athletes? 400 Is protein recommended after exercise for recovery? 402

Are fat needs different for team sport athletes? 402 How are daily fat needs calculated for team sport athletes? 402 Is fat recommended after exercise for recovery? 404

Are vitamin and mineral needs different for team sport athletes? 404 How does vitamin intake of team sport athletes compare

to the dietary intake standards? 404 How does mineral intake of team sport athletes compare

to the dietary intake standards? 404

Contents xiii

How does energy consumption affect vitamin and mineral intake? 405 Are vitamin and mineral supplements recommended for team sport athletes? 406

What are the fluid recommendations for team sport athletes? 407 Why are fluids critical to team sport performance? 408 How can dehydration be prevented in team athletes? 408

What meal-planning/event logistics need to be considered during team sport events? 410

Should food be consumed during an event? 410 What should athletes consume between games and at tournaments? 410 Which foods are recommended for athletes while traveling? 412

Key Points of Chapter 416 Study Questions 417 References 417 Additional Resources 419

CHAPTER 15 Special Populations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 420 What is a “special population”? 421 What are the special considerations for athletes with diabetes? 421

What are the main types of diabetes? 422 What are the considerations related to exercise for athletes with diabetes? 423 How can athletes manage their diabetes and excel in sports? 423

What are the special considerations for athletes who are pregnant? 427 How are an athlete’s caloric requirements affected by pregnancy? 427 How are an athlete’s protein requirements affected by pregnancy? 428 How are an athlete’s B vitamin requirements affected by pregnancy? 428 How are an athlete’s vitamin C requirements affected by pregnancy? 429 How are an athlete’s vitamin A requirements affected by pregnancy? 429 How are an athlete’s magnesium requirements affected by pregnancy? 430 How are an athlete’s iron requirements affected by pregnancy? 430

What are the special considerations for child and teen athletes? 431 How does nutrition affect growth and maturation in the child

or teen athlete? 431 Are fluid needs for young athletes different from those of adult athletes? 434 Do young athletes require higher vitamin and mineral intake? 434

What are the special considerations for college athletes? 435 Are college athletes’ energy needs higher than their precollege needs? 435 What are practical tips for the implementation of a college athlete’s meal plan? 436 How does alcohol consumption affect college athletes’ nutrition? 437

What are the special considerations for masters athletes? 440 How do the nutrient needs of masters athletes change? 441 How does the presence of chronic disease affect nutrient

needs of masters athletes? 443 What are the special considerations for vegetarian athletes? 443

What are the various types of vegetarianism? 444 Which vegetarian foods are rich in protein? 446 Which vegetarian foods are rich in iron? 448 Which vegetarian foods are rich in zinc? 449 Which vegetarian foods are rich in calcium and vitamin D? 449 Which vegetarian foods are rich in vitamin B12? 449

Key Points of Chapter 451 Study Questions 452 References 452 Additional Resources 454

xiv Contents

CHAPTER 16 Jobs in Sports Nutrition . . . . . . . . . . . . . . . . . . . . . . . . . . . 455 Why should you consider becoming a registered dietitian? 456 What are the steps to becoming a registered dietitian? 456

What are the curriculum requirements for an undergraduate degree in dietetics? 456

Do individuals need a graduate degree to be a sports dietitian? 457 What do the dietetic internships entail, and how does the

experience relate to becoming a dietitian? 457 How is the board exam taken, and what topic areas are covered? 458

Is continuing education required once the RD credential is obtained? 458

What is the Board Certified as a Specialist in Sports Dietetics credential? 459

Is licensure necessary for registered dietitians? 459 What if you are not an RD and don’t have a license—can

you still give nutrition advice to athletes? 459 How can students and professionals obtain practical

experience in the field of sports nutrition? 460 What are the potential job markets in sports nutrition? 461 Key Points of Chapter 464 Study Questions 464 References 464

APPENDIX A You Are the Nutrition Coach – Answers . . . . . . . . . . . . . . 465

APPENDIX B The Gastrointestinal Tract . . . . . . . . . . . . . . . . . . . . . . . . . 471

APPENDIX C Major Metabolic Pathways . . . . . . . . . . . . . . . . . . . . . . . . . 474

APPENDIX D Calculations and Conversations . . . . . . . . . . . . . . . . . . . . 480

APPENDIX E Growth and Body Mass Index Charts . . . . . . . . . . . . . . . . 483

APPENDIX F Dietary Reference Intakes . . . . . . . . . . . . . . . . . . . . . . . . . 488

GLOSSARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 492

INDEX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 503

Contents xv

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PREFACE Sports nutrition is an exciting field that combines the sciences of nutrition and exercise physiology. The gener- ally accepted notion that proper nutrition can positively impact athletic performance has created the need for exercise and nutrition professionals to acquire knowledge that goes beyond the basics of general nutrition.

In addition, emerging career opportunities in sports nutrition require that academic programs preparing reg- istered dietitians expand the application of nutrition beyond the clinical population. Strength coaches and personal trainers also need to go beyond the nutrition basics to help their athletes achieve optimal performance. The growing research base supporting the importance of sports nutrition and the inherent interest of athletes seek- ing a nutritional edge have created an increased demand for sports nutrition courses in dietetic and exercise sci- ence programs.

In order to obtain a job in the sports nutrition field, readers need to understand current nutrition guidelines, be aware of the results of emerging research, and be able to practically apply sports nutrition knowledge to ath- letes of all ages, sports, and abilities. This text has been developed to meet these needs, providing readers with an opportunity to learn the most up-to-date informa- tion related to diet and athletic performance while also addressing consultation skills and giving readers the tools they need to educate others properly. The focus on research, current guidelines, and practical application of information makes this sports nutrition textbook unique among other texts currently on the market.

Undergraduate and graduate students as well as pro- fessionals from several different backgrounds will ben- efit from this textbook. Students in dietetics, exercise science, and athletic training programs will enhance their education with an understanding of the relation- ship among essential nutrients, energy metabolism, and optimal sports performance. Dietetics students seek- ing the registered dietitian (RD) credential will appreci- ate the thorough explanations and many helpful tips on how to guide an athlete through nutrition consultations. Exercise science and athletic training students will learn how to educate athletes regarding public domain sports nutrition guidelines as well as how to work together as a team with a registered dietitian and physician. Current professionals in the field of sports nutrition will bene- fit from adding this text to their reference library due to the straightforward and complete presentation of current sports nutrition recommendations and examples of prac- tical applications for athletes participating in endurance, strength/power, and team sports.

Organization and Enhancements The most exciting change included in this fifth edition of Practical Applications in Sports Nutrition is its new, full-color layout. There is no question that color adds a new dimen- sion to the text’s readability, and it serves to even better highlight the various features of the text.

As in previous editions, Chapters 1 through 9 pro- vide an introduction to sports nutrition, including the definition of sports nutrition and an explanation of gen- eral nutrition concepts; a review of digestion and energy metabolism; a thorough explanation of macronutrients, micronutrients, and water and their relation to athletic performance; and, finally, an overview of nutritional ergo- genics. Enhancements within Chapters 1–9 in this fifth edition include:

• Updated/revised figures and tables throughout • The introduction and discussion of new labeling

requirements and how to use them • Updated sport nutrition recommendations based

on the 2016 position statement from the American College of Sports Medicine (ACSM), the Academy of Nutrition and Dietetics (AND), and the Dietitians of Canada (DC)

• The inclusion of the new 2016 World Anti-Doping Association Prohibited Substances List

• Several new Fortifying Your Nutrition Knowledge features (e.g., Mobile Apps: Technology in Weight Management). Several of this textbook’s unique features appear in

the second half of the text, within the practical applica- tion section. Chapter 10 focuses on how to educate, com- municate with, and empower athletes to make behavior changes through nutrition consultations. Chapter 11 cov- ers enhancing athletic performance through nutrition while also focusing on weight management, including weight loss, weight gain, and eating disorders. Changes to Chapter 11 include updated statistics and graphs on obesity, as well as condensed sections covering body com- position measurement and weight loss.

In Chapters 12–14, sports are divided into three cat- egories: endurance, strength/power, and team, each cov- ered separately. Each chapter reviews the most current research as it relates to the energy systems and spe- cific nutrition needs of athletes, which as noted earlier, reflect the new sports nutrition recommendations of ACSM, AND, and DC for these various categories of sports. Chapters 12–14 serve as examples of one of the main objectives of this book: To empower individuals to excel in the sports nutrition field by teaching sports nutrition

guidelines and showing how to apply the concepts to ath- letes in various sports. These chapters demonstrate how to give advice that is practical and easy to follow.

Due to the increasing occurrence of athletes with special medical or nutritional considerations—including those who are pregnant, vegetarian, masters athletes, or have chronic diseases—Chapter 15 targets the unique nutrition requirements of these special populations. The text concludes with a chapter dedicated to helping read- ers discover and understand the pathway to becoming a sports dietitian through education and experience. Enhancements to Chapters 15 and 16 include updated tables, references, resources, and websites.

The Pedagogy Throughout the text the primary, secondary, and tertiary section headings are phrased as questions. We formatted the section headings as questions to help readers focus

their attention and to foster interest in the topic before they begin to read. In other words, they are “directed” to read about topics with the specific purpose of obtaining an answer to a question. This is an effective way of read- ing and borrows from the work of Francis Robinson, who developed the widely used “preview-question-read-recite- review” (PQ3R) reading technique. The goal is to prevent “hollow reading,” in which a person reads the words on the pages but without a specific understanding or per- spective of why he or she is reading.

Our mission is for readers to become engrossed in their reading with the hope that they will be inspired to learn more about the relatively new and growing field of sports nutrition. After all, regardless of where a reader’s academic and career paths may lead, knowledge of good nutrition is universally applicable to one’s personal health and well-being, to enjoyment of recreational and sports activities, and, in the case of dietitians and fitness profes- sionals, to career success.

Preface xvii

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HOW TO USE THIS BOOK ©

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Key Questions addressed 1. What’s the big deal about vitamins?

2. What are vitamins?

3. How are the dietary needs for vitamins represented?

4. What are the water-soluble vitamins?

5. What are the fat-soluble vitamins?

6. Which vitamins or compounds have antioxidant properties?

7. What are phytochemicals?

You are the nutrition Coach Roger is a starting guard on his college basketball team. He is a leader on his team, stays after prac- tice to work on his shots, and is busy with academic and community life on campus. Because of his hectic schedule, he has little time for meal planning, grocery shopping, and food preparation. Din- ner is usually consumed at the athletics training table during the week, and the rest of his meals are consumed either at home or at local restaurants. A 3-day food record kept by Roger recently was analyzed using a nutrition software program. the analysis revealed overall energy intake was not meeting his estimated needs, and vitamins A, c, and folate were consistently low throughout the 3-day period. the rest of the vitamins and minerals met the minimum RDA or Ai requirements.

Questions • What questions should you ask Roger about his typical daily diet?

• What recommendations do you have for Roger to improve his dietary intake of vitamins and his energy intake?

• How can you help Roger meet these recommendations?

Vitamins

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Key Questions Addressed sections open each chapter and introduce students to key material, piquing their interest in covered topics and encouraging purposeful reading.

You Are the Nutrition Coach case studies at the beginning of the chapter provide context to chap- ter material. Students are urged to carefully con- sider the case study prior to reading the chapter and reconsider it after completing their reading.

What role does fiber play in health? Fiber is a complex carbohydrate that the body cannot digest or absorb. Most fibers are made up of long chains of sugar units and thus are classified as polysaccharides. However, unlike starch, fiber polysaccharides cannot be broken down by human digestive enzymes into small enough units for the body to absorb. Thus, fiber, with the exception of some resistant starches, does not contribute energy to the body as do other digestible carbohydrates. Even though it is a minimal energy source, fiber promotes good health in many ways.8

When we eat plant foods, the indigestible fiber portion adds bulk to the intestinal contents. It does so by attract- ing water into the intestines, some of which is absorbed by the fiber itself, causing it to expand. The greater the bulk of the intestinal contents, the greater the peristaltic actions of the smooth muscles in the intestinal walls and the faster the passage of foods through the digestive sys- tem. The water drawn in by the fiber also helps soften the stools for easy passage out of the system. If fiber intake is low, there is less water and less intestinal bulk, which results in stools that are small and hard, and that pass more slowly through the length of the intestines. Con- stipation and hemorrhoids can occur more readily when stools are hard and when fiber intake is low. Constipation produces an uncomfortable full feeling, often with gas, and is particularly uncomfortable during exercise.

Active individuals who eat adequate fiber and con- sume adequate fluids will have fewer problems with constipation than those who do not exercise. Physical exercise not only strengthens the muscles used during exercise, but also tends to produce a healthier GI tract that moves food and fluids efficiently and quickly through the system. This is just another example of the importance of combining exercise with good nutrition.

Choosing foods rich in fiber may help reduce the risk of some types of cancers.8 The link between fiber and colon cancer has received much attention. Controversy exists in the research as to whether fiber has a positive or a neutral effect on the risk for colon cancer. Some studies support a positive correlation between high fiber intakes and colon cancer risk reduction,9,10 whereas others do not support this finding.11–13 The theory behind fiber’s poten- tial ability to decrease colon cancer risk is that the higher bulk of insoluble fibers may “dilute” toxins in the intesti- nal tract plus speed the passage of toxins out of the body. This decreased transit time may reduce the amount of contact between potential cancer-causing agents and the intestinal mucosal cells. More research, especially studies that control for type of fiber and food intake, needs to be conducted to determine whether there is a direct corre- lation between high fiber intake and a lowered incidence of colon cancer. Regardless of future findings, eating a diet rich in complex carbohydrates, including fruits, veg- etables, whole grains, and legumes, provides a healthful diet and can aid in the prevention of many other disease conditions (see FIGURE 3.6 ).

deficit in needed car- bohydrates. Finally, carbohydrates are the primary energy source for the ner- vous system. Nerve cells do not store carbohydrates like muscle cells do; their

source for carbohydrates is the bloodstream. When blood glucose levels fall, nerve cell function suffers, which can have a dramatic effect on exercise and sport performance.

Gaining the Performance Edge

Cutting carbohydrates from an ath- lete’s diet leads to “performance sui- cide.” Carbohydrates are the “master fuel” for all sports.

Fortifying Your Nutrition Knowledge

What Does “Low Carb” Mean? The FDA regulation for nutrient content claims allows manufac- turers to highlight and make health-related claims on their food labels regarding certain nutrients or dietary substances in their products. However, the FDA permits only specified nutrients or substances to have these nutrient content claims. The FDA has not established a set of values for descriptors identifying carbo- hydrates. Food manufacturers can put quantitative statements on labels such as “6 grams of carbohydrates” as long as they are factual. However, they cannot make a statement such as “only 6 grams of carbohydrates” because that implies the food is a car- bohydrate-reduced or low-carbohydrate food. If the label “char- acterizes” the level of a nutrient, then it is considered a nutrient content claim. Therefore, a claim of “low carbohydrate” cannot be used on food labels because it characterizes the amount of carbohydrates in that food.

Although there are no official definitions of low carbohydrate, the FDA is gathering evidence and will potentially develop a statement outlining carbohydrate food-labeling guidelines. Guidelines are likely to be similar to those established for such terms as “low fat,” “reduced fat,” or “reduced sugar.” These will list the number of grams of carbohydrates to be considered “low” and probably will include definitions of reduced carbo- hydrates as well.

How can carbohydrates affect overall health? It is widely recognized that a diet moderate to high in car- bohydrates is important for optimal daily training, high energy levels, and overall good health. Carbohydrate-rich foods contain not only energy for working muscles, but also nutrients required for proper body func- tioning, such as fiber, vitamins and min- erals, and various phytochemicals.

phytochemicals A large class of bio- logically active plant chemicals that have been found to play a role in the maintenance of human health.

Chapter 3 Carbohydrates 67

Fortifying Your Nutrition Knowl- edge boxes expand on timely topics with the intent of providing infor- mation that is beyond the basics of the sports nutri- tion topic being discussed.

Gaining the Per- formance Edge boxes provide insightful tips on how to apply sports nutri- tion knowledge when working with athletes.

Key Terms are bolded within the text and defined in a sidebar to help students quickly identify and understand new terms.

How to Use this Book xix

Food for Thought callouts refer students to web- based workbook activities to further their under- standing or engagement in nutritional topics.

Training Tables help students translate sports nutrition knowledge into actual meal planning ideas, recipes, or food selections.

In regard to athletic performance, there is no evi- dence that the ingestion of excess sulfur is ergogenic.

What are the complications of sulfur deficiency? Deficiencies of sulfur are rare, unless a protein defi- ciency is also present, which would include a deficiency in methionine and cysteine. Under normal conditions, it appears that adequate sulfur spares cysteine from the synthesis of PAPS, allowing cysteine to instead be used for protein synthesis and growth. When sulfur is present in suboptimal levels, cysteine is required for the production of PAPS, thus sacrificing protein synthesis.

What are the symptoms of sulfur toxicity? There have been reports of individuals suffering from osmotic diarrhea after consuming large quantities of sulfur.29 An association has also been suggested between high sulfur intakes and the risk of ulcerative colitis. Unfortunately, at this time there is insufficient evidence to formulate recommendations for sulfur intake, includ- ing the establishment of an upper limit.29

Which foods are rich in sulfur? Sulfur is found in a variety of foods, with the highest con- centrations found in some fruits, soy flour, certain breads, and sausages. Juices, beers, wines, and ciders also contain a significant quantity of sulfur. Drinking water is another com- mon source of sulfur; however, quantities can vary dramati- cally based on the region of the country and the water source.

What is a suggestion for a sulfur-rich meal or snack? Because no RDA/AI level has been set for sulfur, a “sulfur-rich” meal cannot be rec- ommended. Athletes should include sul- fur-containing foods on a daily basis in addition to consum- ing adequate levels of protein.

Do athletes need sulfur supplements? Because an insuf- ficient amount of information is avail- able to even draw conclusions on an RDA, EAR, AI, or UL for sulfur, recom- mending sulfur sup- plements does not appear to be war- ranted at this time.

What is a suggestion for a potassium-rich meal or snack? Snack: Summertime Salad (see TRAINING TABLE 7.3 )

Total potassium content = 457 milligrams

Do athletes need potassium supplements? Potassium supplements are not needed and can cause harm in large doses. For athletes, the emphasis should be placed on food sources of potassium because adequate potassium intake is easily attainable through a balanced diet. Large doses of supplemental potassium, at levels of 18,000 milligrams or higher, can disrupt muscle contraction and nerve transmission, ultimately leading to a heart attack.

Why is sulfur important for athletes? Sulfur is unique because it is considered an essential nutrient, but it does not have an established RDA, EAR, AI, or UL.29 Regardless of the lack of hard numbers, sulfur or sulfate is a nutrient that athletes should consume on a daily basis for proper bodily functioning.

What is the RDA/AI for sulfur? There is no RDA, EAR, or AI for sulfur because of the fact that it can be obtained from food and water, as well as be derived from specific amino acids in the body.29

What are the functions of sulfur for health and performance? Sulfur is a component of hundreds of compounds in the body. The body synthesizes the majority of these com- pounds using the sulfur consumed in the diet and from sulfur produced in the body from degradation of the amino acids methionine and cysteine. The most notable sulfur- containing compound in the body is 3-phosphoadenosine- 5-phosphosulfate (PAPS). Sulfate derived from methionine and cysteine found in dietary proteins and the cysteine component of glutathione provide sulfate for use in PAPS synthesis.29 PAPS, in turn, is then used in the biosynthesis of other essential body compounds.29 Sulfur has also been associated with the growth and development of tissues.

Gaining the Performance Edge

The major minerals include calcium, phosphorus, magnesium, sodium, chloride, potassium, and sulfur. Each of these minerals plays a spe- cific and important role in overall health and athletic performance. Athletes should strive to consume these nutrients from whole foods first, and rely on supplements only when individually indicated.