Olympics 2012: Nutrition Advice for the Athletic Patient
Editor's Note:
With the 2012 Olympic games in full swing, it's a good time to review how best to advise the athletic patient on proper nutrition. Medscape interviewed Nancy Clark, a registered dietician and author of Nancy Clark's Sports Nutrition Guidebook, who offered advice on how to set up nutrition plans for athletes. A board-certified specialist in sports dietetics, Clark's clients have included players from the Boston Red Sox and Boston Celtics, as well as elite and Olympic athletes from a variety of sports.
Medscape: What are the first steps a clinician or healthcare provider should take in setting up a nutritional plan for an athletic patient?
Ms. Clark: The first thing I do is figure out their protein needs because protein needs are based on body weight. Athletes need about 1.2-1.7 g of protein per kilogram or 0.5-0.8 g protein per pound of body weight. From there, I figure out what the rest of their caloric needs are and fill in the plan with fruits, vegetables, and grains to make a balanced diet.
I advise even fueling throughout the day. Generally when I work with clients, I give them 4 food buckets. Every 4 hours they have a food bucket, so they are always fueling up or refueling. The food buckets are their breakfast, lunch one, lunch two, and dinner. If they train in the morning then they have part of their breakfast bucket before they work out and then the rest of it afterwards. If they are training in the afternoon, they might divide up the lunch one or lunch two buckets so that they are fueling and refueling around that training session. Regardless of when they work out, the plan evens out throughout the day so there is always a constant infusion of protein to build and repair muscles and carbs to fuel the muscles.
Medscape: Are the nutritional needs different according to the age and sex of the patient you're working with?
Ms. Clark: For certain, a 200-lb athlete has different needs from a 100-lb gymnast. But even though their food plates might look a lot different, they still have similar protein needs based on their body weight. Their calorie needs would vary. Their fluid needs would vary according to their body size. They just need different quantities of food.
Medscape: How should a provider determine how many calories a person needs? Is it just based on body weight? Or is it a combination of body weight and the type of athletic activity the patient is involved in?
Ms. Clark: I look at how many calories they need to breathe, which is their resting metabolic rate. Then I look at what they do when they're not training. Many athletes are very sedentary, so there is something called sedentary athlete syndrome. If they are doing double workouts, which a lot of them do, they train in the morning and then they lounge around and rest and recover. Then they train in the afternoon and then they lounge around and rest and recover. So even though they are training hard, when they're not training they're doing nothing and that can certainly affect their energy needs. That's the sedentary athlete as opposed to the athlete who trains and is not sedentary. That person trains and then is taking care of a family and doing the gardening, the laundry, the food shopping, and bringing the groceries in.
Medscape: How should providers figure out how much protein an athlete needs as opposed to their carbohydrate or healthy fat needs?
Ms. Clark: They need about 1.2-1.7 g of protein per kilogram or 0.5-0.8 g of protein per pound of body weight. Most people are already getting that, so it's a matter of distributing it evenly throughout the day, because generally a breakfast might be a bowl of oatmeal and dinner would be 3 chicken breasts. But I want them to more evenly divide their protein throughout the daytime so that they have protein with their oatmeal, or maybe instead of oatmeal they have some Greek yogurt with some nuts and toast with peanut butter, or they have a couple of poached eggs or some cottage cheese and fruit; this helps them even out how much protein they are eating. That is important for athletes who are weight conscious, because protein is very satiating, but also for athletes who want to optimize their muscle development and repair.
Medscape: Intense exercise tends to make people really hungry, so what kind of advice should physicians and healthcare providers give athletes so that they don't put on unwanted weight while training?
Ms. Clark: That is a common problem, particularly in women, because women tend to get hungrier than men do. This is where they really need to make sure they have protein at each meal and that they eat evenly throughout the day to prevent hunger. A lot of weight-conscious athletes will diet at breakfast and diet at lunch and then train on empty. Later, they end up starving and they blow it in the afternoon or evening because they have become too hungry; so, again we have to look at meal timing. Have them fuel by day and then lose weight at nighttime when they are sleeping. But they don't want to try to lose weight when they're training.
Medscape: And what advice should be given when the opposite happens and an athlete experiences unwanted weight loss while training?
Ms. Clark: I look at what they are drinking for fluids. Most of them are drinking a lot of water, and I just have them trade that water in for some kind of a healthy juice. Maybe they have more orange juice or grape juice or some low-fat chocolate milk. Juices and milk are 90%-95% water, but there is also some energy in it, and that energy adds value to fuel their muscles and be an additional source of calories to their sports diet.
Medscape: Why is eating so important to an athlete? How can it make or break somebody's performance?
Ms. Clark: Well, how important is gas to a car? You have a car; you put gas in it and it goes. You have a body; you put food in it and it goes a lot better. Certainly, it enhances stamina and endurance. Food is the sparkplugs that are needed for health, with the vitamins and minerals and the chemicals that fight inflammation.
Medscape: Olympic swimmer Ryan Lochte said in a recent interview that he ate poorly during the Beijing Olympics, adding that he ate at McDonald's almost every day. He mentioned this because he's since removed junk food from his diet with the hope of enhancing his performance. What type of effect does eating poorly have on an athlete's performance? Some of these Olympic athletes seem to be able to eat junk food but maintain a healthy body weight. Are these foods still damaging their bodies on the inside, even if you don't see any damage on the outside?
Ms. Clark: Definitely. If an athlete is filling up on Big Macs and French fries and fatty, greasy foods, the fat will fill the stomach but the muscles will remain unfueled. Only carbohydrates get stored in the muscles as glycogen; depleted muscle glycogen is associated with fatigue. You can go to McDonald's and you can get oatmeal, English muffins, juice, and fruit parfaits, so you can get a healthy carbohydrate-based diet if you look for it. But you can also go and choose the totally wrong things, and if your muscles aren't well fueled day after day after day, then you just get increasingly tired. When you are trying to perform at your best, you really want a foundation of healthy carbs at each meal.
But just as food can be powerfully bad for you, it can be powerfully good for you. If you put quality, premium nutrition in your tank, it makes a big difference -- not just in terms of energy level, but also in terms of health and vitality.
Medscape: How should clinicians advise patients who aren't currently athletic but are inspired by the Olympics or some other event to begin working out? How should they approach their nutritional needs?
Ms. Clark: I start at breakfast. As I mentioned, if you have a car, you put gas in it and it goes, so you want to have a quality breakfast so you can go. Research suggests that people who have a high-protein breakfast end up eating fewer calories at the end of the day. If you have a dinner-size portion of protein at breakfast, it feeds you throughout the day and it keeps you fed so that it is easier to bypass the doughnuts, the Danish pastry, and the so-called junk food that manages to creep into people's lives when they haven't had much of a good breakfast. If you start out with a substantial breakfast, you'll have good energy, and it keeps you satiated so you feel like going to the gym. Even at the end of the workday you'll still have some energy to go to the gym.
With the workout, the place to start is to do some strengthening exercises to strengthen your muscles. If your muscles are stronger, it's easier to walk farther, run farther, bike farther. But first you get stronger and then you add the more aerobic exercise. Unfortunately most people start out with, "Oh, I'm going to run a mile," but it's much more important to get strong first.
The Olympics is a great time for people to take a look at how sedentary they are, how they could get in shape even if they just got up and marched in place during TV commercials, or if they kept little weights by their chair and got up to lift some weights a couple of times each day. There is a lot that can be done if people get creative and just figure out how they can move their bodies more. And certainly sitting around, even sitting all day at work, is an occupational health hazard. We know that smoking and being around smoke is a health hazard, but if people look at sitting as being hazardous to their health as well, then they can take small steps to move a little more.
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