7.10- Eat to Compete

Energy Needs

To determine an athlete’s nutritional needs, it is important to revisit the concept of energy metabolism. Energy intake is the foundation of an athlete’s diet because it supports optimal body functions, determines the amount of intake of macronutrients and micronutrients, and assists in the maintaining of body composition. Energy needs for athletes increase depending on their energy expenditure. The energy expended during physical activity is contingent on the intensity, duration, and frequency of the exercise. Competitive athletes may need 3,000 to over 5,000 calories daily compared to a typical inactive individual who needs about 2,000 calories per day. Energy needs are also affected by an individual’s sex, age, and weight. Weight-bearing exercises, such as running, burn more calories per hour than non-weight-bearing exercises, such as swimming. Weight-bearing exercises require your body to move against gravity which requires more energy. Men are also able to burn more calories than women for the same activity because they have more muscle mass which requires more energy to support and move around.¹

Bodyweight and composition can have a tremendous impact on exercise performance. Bodyweight and composition are considered the focal points of the physique for athletes because they are able to be manipulated the most. Energy intake can play a role in manipulating the physiques of athletes. For individuals competing in sports such as football and weight lifting, having a large amount of muscle mass and increased body weight may be beneficial. This can be obtained through a combination of increased energy intake, and protein. Although certain physiques are more advantageous for specific sports, it is important to remember that a single and rigid “optimal” body composition is not recommended for any group of athletes.

^{1Thomas, DT, Erdman, KT, Burke, LM. Position of the Academy of Nutrition and Dietetics, Dietitians of Canada, and the American College of Sports Medicine: Nutrition and Athletic Performance. J Acad Nutr Diet. 2016;116 (3): 501-528. Accessed June 30, 2019.} 

Macronutrient Needs

The composition of macronutrients in the diet is a key factor in maximizing performance for athletes. Carbohydrates are an important fuel source for the brain and muscle during exercise. Carbohydrate storage in the liver and muscle cells is relatively limited and therefore it is important for athletes to consume enough carbohydrates from their diet. Carbohydrate needs should increase about 3-10 g/kg/day depending on the type of training or competition. See Table 7.10.1 for carbohydrate needs for athletes depending on the intensity of the exercise.

Table 7.10.1: Daily Needs for Carbohydrate Fuel.

Source: Nutrition and Athletic Performance. American College of Sports Medicine. Medicine & Science in Sports & Exercise. 2016; 48(3), 543- 568.
Fat is a necessary component of a healthy diet to provide energy, essential fatty acids, and to facilitate the absorption of fat-soluble vitamins. Athletes are recommended to consume the same amount of fat in the diet as the general population, 20-35% of their energy intake. Although these recommendations are in accordance with public health guidelines, athletes should individualize their needs based on their training level and body composition goals. Athletes who choose to excessively restrict their fat intake in an effort to lose body weight or improve body composition should ensure they are still getting the minimum recommended amount of fat. Fat intakes below 20% of energy intake will reduce the intake of fat-soluble vitamins and essential fatty acids, especially omega 3’s.

Although protein accounts for only about 5% of the energy expended, dietary protein is necessary to support metabolic reactions (that generate A.T.P.), and to help muscles with maintenance, growth, and repair. During exercise, these metabolic reactions for generating A.T.P. rely heavily on proteins such as enzymes and transport proteins. It is recommended that athletes consume 1.2 to 2.0 g/kg/day of protein in order to support these functions. Higher intakes may also be needed for short periods of intense training or when reducing energy intake.

It is important to consume adequate amounts of protein and to understand that the quality of the protein consumed affects the amount needed. High protein foods such as meats, dairy, and eggs contain all of the essential amino acids in relative amounts that most efficiently meet the body’s needs for growth, maintenance, and repair of muscles. Vegetarian diets contain protein that has lower digestibility and amino acid patterns that do not match human needs as closely as most animal proteins. To compensate for this as well as the fact that plant food protein sources also contain higher amounts of fiber, slightly higher protein intakes are recommended for vegetarian athletes.

Micronutrient Needs

Vitamins and minerals are essential for energy metabolism, the delivery of oxygen, protection against oxidative damage, and the repair of body structures. When exercise increases, the amount of many vitamins and minerals needed are also increased due to the excess loss in nutrients. Currently, there are not special micronutrient recommendations made for athletes but most athletes will meet their needs by consuming a balanced diet that meets their energy needs. Because the energy needs of athletes increase, they often consume extra vitamins and minerals. The major micronutrients of concern for athletes include iron, calcium, vitamin D, and some antioxidants.

Common Nutrient Deficiencies for Athletes

Energy Deficiency

For athletes, consuming sufficient amounts of calories to support their energy expenditure is vital to maintain health and body functions. When the energy intake for athletes does not meet the high demands of exercise, a syndrome referred to as relative deficiency in sport (R.E.D-S) occurs. R.E.D-S has a negative effect on performance and health in both male and female athletes as shown in Figure 7.10.1. Athletes in sports with weight classes, such as wrestling, may put their health at risk by rapid weight loss in order to hit a specific weight for a match. These athletes are vulnerable to eating disorders due to sporadic dieting (several of which will restrict energy intake). The long term effects of these practices can not only impair performance but also have serious repercussions such as heart and kidney function, temperature regulation and electrolyte balance problems.

Relative Energy Deficiency in Sport health effects include: Menstrual dysfunction, Bone density, Nutrient deficiencies, cardiovascular risk, stress, depression, immune function, growth and development, metabolic rate. The performance effects include: Endurance, Muscle strength, glycogen stores, training response, coordination, concentration, judgement, injury risk, irritability.

Of the R.E.D-S consequences that occur from an energy intake deficiency, the two health effects that are of the greatest concern to female athletes are menstrual dysfunction and decreased bone density. Menstrual dysfunction and low bone density symptoms of R.E.D-S can create hormonal imbalances that are described in Figure 7.10.2. The low energy intakes will lead to bone loss, stoppage of menstrual periods, and eating disorders.

Between R.E.D.-S and Low bone density is the following text: Low energy intake can lead to nutrient deficiencies like calcium and other molecules essential for bone health.
Between R.E.D.-S and menstrual dysfunction in the following text: Energy restriction with RED-S combined with Exercise creates a psychological condition similar to starvation. This contributes to the drop in estrogen levels and causes amenorrhea.
Between menstrual dysfunction and low bone density in the following text: Low estrogen levels reduce the absorption of calcium and increase calcium loss from bones.

Iron Deficiency

Iron deficiency is very common in athletes. During exercise, iron-containing proteins like hemoglobin and myoglobin are needed in great amounts. An iron deficiency can impair muscle function to limit work capacity leading to compromised training performance. Some athletes in intense training may have an increase in iron losses through sweat, urine, and feces. Iron losses are greater in females than males due to the iron lost in blood every menstrual cycle. Female athletes, distance runners, and vegetarians are at the greatest risk for developing iron deficiency. See Table 7.10.3 for the potential amounts of iron loss each day in male and female athletes. An increased recommendation for both sexes is shown below. These recommendations are based on the assumption that iron has a 10% absorption efficiency. As noted above, women athletes have a greater iron loss due to menstruation and therefore must increase their dietary needs more than male athletes.²

Sports anemia, which is different from iron deficiency anemia is an adaptation to training for athletes. Excessive training causes the blood volume to expand in order to increase the amount of oxygen delivered to the muscles. During sports anemia, the synthesis of red blood cells lags behind the increase in blood volume which results in a decreased percentage of blood volume that is red blood cells. The total amount of red blood cells remains the same or may increase slightly to continue the transport of oxygen. Eventually, as training progresses, the number of red blood cells will increase to catch up with the total blood volume.

Table 7.10.2: The Potential Iron Loss in Endurance Athletes. Approximate Daily Iron Losses in Endurance Athletes (mg/day) and Increased Dietary Need

Source: Weaver CM, Rajaram S.Exercise and iron status. J Nutr. 1992 Mar;122(3 Suppl):782-7. https://www.ncbi.nlm.nih.gov/pubmed/1542048. Accessed March 23, 2018.

Vitamin D and Calcium Deficiency

Vitamin D regulates calcium and phosphorus absorption and metabolism and plays a key role in maintaining optimal bone health. There is also growing evidence that vitamin D is important for other aspects of athletic performance such as injury prevention, rehabilitation, and muscle metabolism. Individuals who primarily practice indoors are at a larger risk for a vitamin D deficiency and should ensure they are consuming foods high in vitamin D to maintain sufficient vitamin D status.

Calcium is especially important for the growth, maintenance, and repair of bone tissue. Low calcium intake occurs in athletes with R.E.D-S, menstrual dysfunction, and those who avoid dairy products. A diet inadequate in calcium increases the risk for low bone mineral density which ultimately leads to stress fractures.

Antioxidant Nutrient Deficiency

Antioxidant nutrients play an important role in protecting cell membranes from oxidative damage. During exercise, the amount of oxygen used by the muscles increases and can produce free radicals which cause an increase in antioxidant systems in the body. These antioxidant systems rely on dietary antioxidants such as beta-carotene, vitamin C, vitamin E, and selenium that can be obtained through a nutrient-dense diet.

^{2 Sim, M., Garvican-Lewis, LA., Cox, GR. et al. Iron considerations for the athlete: a narrative review. Eur J Appl Physiol 2019. https://doi.org/10.1007/s00421-019-04157-y Accessed June 30, 2019.}