CSCS Chapter 9: Basic Nutrition Factors in Health

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Chapter Goals

• Learn where you need to refer athletes.
• Know the Protein, Carbohydrate, and Fat recommendations for athletes.
• Write down dietary recommendations regarding the prevention of diseases and the overall health of athletes.
• Know the guidelines for hydration and electrolytes for age groups and different scenarios. Also, help athletes to develop their own plan for hydration.

Sport Nutrition Professionals’ Roles

Team physicians are in charge of looking after the medical care for athletes.

Sports dieticians are registered dieticians that provide personalized dietary advice.

Sport nutrition coaches are not registered dieticians but have standard nutrition and exercise science training.

Sports nutritionists have advanced degrees and potentially work in the sports nutrition industry or research sports nutrition. They can discuss topics in great detail.

All sports nutrition professionals must follow their state’s laws of nutrition licensure. All states have varying rules and have the right to say who can provide nutrition counseling and medical nutrition therapy.

Sport Dietician Competencies

They counsel one person or group on standard daily nutrition required for performance and health.

They translate current evidence into recommendations.

They track and take note of the nutrition service outcomes. They oversee food and nutrition resources and convey information to coaches, trainers, and parents.

Analyzation and Assessment of athletes’ dietary practices, energy balance, and body composition regarding health and performance are tracked by them.

Sports dieticians counsel athletes on optimal nutrition for exercise, competition, hydration, weight management, recovery, immune health, travel, disordered eating, and supplements.

They also counsel on achieving and maintaining current physical levels consistent with good health and performance.

Personalized meal and snack plans for long and short term goals are provided.

Hydration protocols that maintain optimal fluid and electrolyte needs are developed.

They address any nutritional challenges athletes have.

They collaborate with family physicians, coaches, and other health care professionals while following HIPAA.

They develop and look over the policies and procedures regarding nutrition.

Nutrition Counseling

Advisement on rather increase or decreasing nutrients within diets.

Ability to change the timing and composition of meals.

Modification of food textures.

Administration routes can be changed.

The first step is to define the athlete’s goals and identify the coach’s goals.

The Next steps are looking at the current diet, the athlete’s food preferences, their cooking skills, the access they have to foods, their money constraints, the barriers they have, their use of supplements, the weight and body comp history, their medical history, their current training programs, and any injuries they have or have had.

Sports Dietician plans include these four things:

• A good number of calories.
• Both macro and micro nutrient levels are in the recommended levels.
• The required fluid and electrolyte levels.
• The supplements someone may need to make up for deficiencies.

Standard Nutrition Guidelines

Found on MY PLATE – www.choosemyplate.gov

These contain a recommended starting point for people. 

If you are physically active, you should adjust your nutrition based on these basic guidelines.

• A diet with foods from each group likely has all the needed vitamins and minerals.
• A diet excluding specific food groups entirely may lack something major.
• Athletes, excluding dairy, may not get enough calcium, potassium, or vitamin D.
• Athletes excluding animals from their diet may not have enough vitamin B12.

Dietary Reference Intakes

RDA, or recommended dietary allowance, is the daily average nutrient requirement most people need to be healthy at each stage of life and sex.

Adequate intake, or AI, is the daily average nutrient level recommended for uptake when RDA can’t be established.

The tolerable upper intake level is the maximum daily average of nutrients you can intake without any adverse effects. 

The EAR, or estimated average requirement, is the average daily intake of nutrients sufficient to meet half the healthy population’s needs within each life stage and sex.

Nutrients that are not consumed by large parts of the population

Males and females of all levels have many inadequacies of Vitamin E. Oils, seeds, and nuts are the best for this.

Males and females in all groups have inadequacies of magnesium. Nuts and seeds are best for this.

Most people over 2 years old have low intakes of fiber and potassium.

Calcium levels are a concern for a lot of people. Dairy foods and fortified beverages are best for this.

Vitamin D is a concern. Fatty fish and fortified beverages are best for this.

Iron and Folate are a concern for many women and adolescent females. Red meat and iron fortified cereals are best for iron. Beans, peas, peanuts, and sunflower seeds are best for Folate.

Vitamin B12 absorption is affected badly by low levels of hydrochloric acid in the stomach. This happens in older adults. B12 is found in animal foods and fortified cereals, and yeast. 

A Macronutrient is a nutrient that we require in large amounts in our Diet

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Macronutrients: Proteins

Basics

Proteins are made up of carbon, hydrogen, oxygen, and nitrogen.

Proteins give 4 kcals per gram.

Amino acids join into groups to make up thousands of proteins in nature. Amino means “nitrogen containing.”

Human proteins contain different combinations of 20 amino acids.

We can synthesize 4 different amino acids in our body; thus, they are “nonessential.” These are Alanine, Asparagine, Aspartic Acid, and Glutamic Acid.

We cannot synthesize 9 amino acids; Thus, we call these “Essential” because we must receive them in our diet. These include Histidine, Isoleucine, Leucine, Lysine, Methionine, Phenylalanine, Threonine, Tryptophan, and Valine.

We are unable to produce 8 other amino acids, but they are really only needed in times of illness and stress. They are conditionally essential. These are Arginine, Cysteine, Glutamine, Glycine, Proline, Serine, and Tyrosine.

Protein Quality and Dietary Recommendations

The amino acid content and protein digestibility determine this.

The higher quality proteins are highly digestible and contain all essential amino acids.

Animal-based proteins contain all of these essential amino acids, and Soy is the only plant protein that contains them all.

Plant proteins are less digestible than animals and they can be made more easily digestible through processing and prep.

Vegetarians and vegans can still meet their needs with different plant foods containing various essential amino acids.

Dietary Recommendations

Amino acid needs in healthy sedentary adults are the result of cell turnover.

The RDA for protein in men and women 19 years old is 0.80 grams of good quality protein per each kilo of body weight per day.

Children, teenagers, and pregnant and lactating women need higher dietary protein levels.

Protein needs are inversely related to caloric needs since we can synthesize some in a negative caloric intake.

When calorie intake rises, the requirement for protein goes up.

The acceptable macronutrient distribution range for protein is:

• 5 – 20% of total calories for children 1 – 3 
• 10 – 20% of total calories for children 4 – 18
• 10 – 35% of total calories for adults over 18

Sports dieticians first need to establish protein needs and then determine carbohydrate and fat needs next.

Concerns about the RDA for Protein

Some suggest that adults need to take in more than the recommended daily average of protein for their bone health, weight management, and muscle build and repair.

Research also says that higher protein, low carb diets can positively affect blood lipids.

Supplemental protein increases calcium loss via urine for healthy people consuming between 0.7 and 2.1 grams of protein per kilogram. Absorption of calcium in the urine, excrement, and intestines increases.

Low protein intake suppresses absorption in the intestines.

More protein leads to greater satiety.

We burn more calories digesting protein than we do for other nutrients.

High protein in reduced-calorie diets spares the loss of muscle.

Protein Requirements

Many adults can consume 0.8 – 1.0 g of protein per kg of body weight and meet their requirements.

Aerobic endurance athletes eating many calories may need 1.0 – 1.6 g per kg.

Strength athletes may need 1.4 – 1.7 g per kg. The same is true when combining endurance and strength training.

Protein following exercise increases the synthesis of muscle protein. This is enhanced for two days following the exercise.

A ratio of 4:1 or 3:1 for carbs to protein is recommended.

Macronutrients: Carbohydrates

Basics

The primary source of energy for us.

They are made up of carbon, hydrogen, and oxygen.

They provide about 4 kcals/g.

Broken down into three different groups based on the number of sugar units within.

Monosaccharides

These sugars are single sugar molecules. They include glucose, fructose, and galactose.

Glucose circulates through the blood.

Fructose causes less secretion of insulin than other sugars.

Galactose and glucose combine to make lactose, the sugar in milk.

Disaccharides

These sugars are made of two simple sugars. They include sucrose, lactose, and maltose.

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Sucrose is common table sugar, and it’s made of glucose and fructose.

Lactose is a combination of glucose and galactose and it is found in milk from mammals.

Maltose is the combination of two glucose molecules and is the main carb in beer.

Polysaccharides

These are complex carbs with thousands of glucose molecules. Starch, Fiber, and Glycogen are the most common.

Starch is the storage form of glucose within plants.

Fiber makes up the plant cell walls.

Glycogen Is in the human liver and muscles. There are about 15 grams of glycogen per every kg of body weight.

Glycemic Index and Glycemic Load

The Glycemic Index, or GI, ranks carbs based on how quickly they digest and are absorbed in the body. Basically put, it’s their ranking based on how they raise blood glucose levels within 2 hours of a meal.

As a reference, we use white bread or glucose, which has a GI level of 100.

The faster a food digests and absorbs, the higher the GI. 

The opposite is true for foods that digest slowly. They have a lower GI.

Glycemic Load is similar, but it considers the number of carbs in a portion of the food.

Because portion size is considered, GL is a much more realistic gauge of the glycemic response.

Higher GL-containing foods will have a higher increase in blood sugar and release more insulin.

Low GL diets and exercise improve insulin sensitivity in obese and older adults.

Fiber

Fiber deficiencies often accompany constipation, colon cancer, heart disease, and type 2 diabetes.

The recommended daily fiber intake is 21 – 29 grams for women and 30 – 38 grams for men.

Carbohydrate Requirements for Athletes

Aerobic endurance athletes that train for 90 minutes or more days at a moderate intensity need 8 – 10 grams more per kg of body weight.

Strength sprint and skill athletes require 5 – 6 grams of carbs per body weight daily.

Low carb diets lead to a greater reliance on using fat for energy.

Macronutrients: Fats

Basics

Fats and lipids are used interchangeably, but lipid is a broader term.

The most significant lipids are triglycerides, fatty acids, cholesterol, and phospholipids.

This text typically refers to fats as triglycerides.

Fats give about 9 kcals/g of energy.

Fatty acids without double bonds are saturated. The body can make these.

Fatty acids with just one double bond are known as mono-unsaturated.

Fatty acids with two or more double bonds are known as polyunsaturated.

The body is unable to make omega 3 and omega 6 fatty acids.

These are required for good cell membranes to form, produce hormones, and develop and function in the nervous and brain systems.

Omega 6 is found in soybeans, corn, safflower oil, or any product made with these types of oil.

Omega 3 is found in fish.

Fat is used for many bodily functions. The storage of energy in the form of adipose tissue and small amounts of fat in skeletal muscle. Body fat is also used to protect and insulate organs, regulate hormones, and for carrying and storing the fat soluble vitamins A, E, D, and K

Relationship with Cholesterol

Abnormally high levels of total cholesterol, triglycerides, and LDL cholesterol are associated with a higher risk for heart disease.

Greater levels of saturated or trans fats, weight gain, and even anorexia can increase our LDL levels.

High HDL levels can protect us from heart disease.

Refined carbs, weight gain, excess intake of alcohol, and low fat diets may increase our triglycerides too.

Saturated fats should comprise less than 10% of our calorie intake. 

LDL levels

• < 100 is optimal
• 130 – 159 is borderline high
• 160 – 189 is high
• And > 190 is a very high

Total Cholesterol levels

• < 200 is what we should desire
• 200 – 239 is pretty high
• > 240 is high

HDL levels

• < 40 is low
• > 60 is high

Fats and Performance

When resting and doing low intensity exercise, a lot of the energy produced comes from the oxidation of fatty acids.

When the intensity gets higher in intensity, the body shifts

Training aerobically will increase the capacity of muscles to use fatty acids.

Alcohol

1 drink for women and 2 drinks for men is recommended. Pregnant women shouldn’t drink, and breastfeeding women need to be cautious. Alcohol reduces muscle protein synthesis, so it must be avoided after exercise.

Vitamins

Vitamins are organic, which means they contain carbon.

Vitamins are needed in very small amounts and are used for performing specific metabolic functions.

The water-soluble vitamins, B vitamins and Vitamin C dissolve in water and get transported through the blood. Vitamin B12 is, however, stored within the liver for many years. 

Vitamins A, D, E, and K are all soluble in fat. They are then carried through the blood and stored in the body’s fat tissues. Excessive intake of these vitamins can lead to problems.

Minerals

Minerals are needed for many different metabolic functions.

In athletes, minerals are important for their bone health, oxygen-carrying capacity, and electrolyte and fluid balance.

Iron is a constituent of hemoglobin and myoglobin; thus, it has a role in transporting oxygen and energy use.

People who do not get enough iron in their diet may develop a deficiency.

Iron deficiencies are the most common nutrition-related deficiencies in the world.

16% of teen girls between 16 and 19 and 12% of women 20 – 49 are deficient in iron.

Nonheme iron is iron that is found in non-meat food like vegetables, grains, and iron-fortified cereals.

Calcium is essential for reaching peak bone mass, and a deficiency can impair this.

Fluid and Electrolytes

Water

The largest component of the body, equaling 45 – 70% of total body weight.

Sweat losses exceeding the fluid intake can lead to a state of hypohydration, with a following increase in core temperature, decrease in blood plasma volume, and increased heart rate and perceived exertion.

Exercise in hot environments helps in adapting the body to heat stress.

Some athletes are more prone to dehydration and heat stress at the beginning of the season before regularly exercising.

Less trained athletes are more prone to heat stress.

Elderly people are at a greater risk of dehydration.

Children are also at an increased dehydration risk.

People with sickle cell, cystic fibrosis, and other diseases will have a higher risk of dehydration.

Hydration risk is higher in hot and humid environments.

Diuretics may increase your risk.

Too many clothing layers contribute to the loss of sweat and dehydration.

Mild dehydration, which is represented by a loss of 2 – 3% of your weight, will increase core temps and affect athletes by increasing fatigue and decreasing blood press, reducing blood flow, increasing heart rates, and increasing the risks of stroke and death.

Fluid Balance

The average water intake is 3.7 L per day for guys and 2.7 L for women.

All fluid sources count toward this total, not just water.

Preventing Dehydration

It is important for athletes to prevent water losses greater than 2% of weight and also to restore lost electrolytes.

Measuring body weight changes before and after workouts is an easy method to estimate your hydration status.

Each pound lost is the equivalent of about 16 ounces of water.

If you calculate the sweat rate, you can better calculate the fluid needs.

Urine color is another thing you can look at to watch hydration levels. But this is more subjective.

Electrolytes

The primary electrolytes that are lost in sweat are sodium chloride, potassium, magnesium, and calcium, in that order.

Exercising at intense rates for hours and only taking in water may cause their blood sodium levels to drop to dangerous levels. Hyponatremia is what it is called when it is 130 mmol/L.

Blood sodium lower than 125 mmol/L causes headaches, muscle cramps, nausea, vomiting, restlessness, swollen hands and feet, and disorientation.

Athletes should make it a goal to receive more sodium rich foods within their diet.

Fluid Intake Guidelines

Exercise should begin in an already hydrated state and you shouldn’t lose more than 2% of body weight while exercising. They should rehydrate completely after the session.

Heavy sweaters may be able to use thirst as a reliable indicator.

Strength coaches must ensure athletes have cool drinks and are given adequate time to drink.

Fluid Replacement Guidelines

Before Activity: Prehydrate in advance several hours before exercise.

During Activity: Children weighing 88 pounds should get 5 ounces of cold water every 20 minutes, and children 132 pounds should drink 9 ounces of cold water every 20 minutes. Adults exercising in hot environments for 20 – 30 minutes need to receive 20 – 30 mEq of sodium per liter, 2 – 5 mEq of potassium, and carbohydrate concentration should be 5 – 10%.

After Activity: Food and fluids should be eaten and drank to restore hydration. If exercising again in less than 12 hours, they should consume 1.5L of fluid for each kilogram of lost body weight.

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