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April 19, 2017

A baseball player wants to gain weight, a basketball player looks to maintain, and a runner seeks to lose weight. The case studies in this three-part article explain the nuances of knocking each scenario out of the park.

This article first appeared in the April 2017 issue of Training & Conditioning.

By Lizzie Kuckuk

Lizzie Kuckuk, MS, RD, LN, is the Dietitian at Sanford Sports Science Institute in Sioux Falls, S.D. She can be reached at: Elizabeth.Kuckuk@SanfordHealth.org.

Many athletes want to gain muscle mass but don’t realize how much goes into achieving this goal. While they usually work hard in the weightroom, they often overlook the nutritional component. This leads to underestimating how many calories they need to consume, not knowing which types of foods to eat, and not allotting time to grocery shop and cook.

Ben, a 5-foot-9-inch college baseball player, struggled in all of these areas. Last May, he came to the Sanford Sports Science Institute in Sioux Falls, S.D., looking for the best way to gain weight over the summer and fall before his senior season. As an upperclassman, he wanted to set an example by working hard, eating well, and getting the most out of strength and conditioning workouts. At the time, he weighed 173 pounds, and he wanted to reach at least 185 pounds.

Looking at an athlete’s overall diet can expose gaps in their eating routine, so my first order of business was to have Ben do a diet recall. It revealed that he simply wasn’t consuming sufficient calories to support his active lifestyle and regular workouts—let alone to promote muscle growth.

To help us visualize the deficient areas of Ben’s diet, we filled in a chart that split his daily meal components into columns for carbohydrates/starches, protein, vegetables, fruits, and healthy fats. We saw that although Ben usually ate healthy foods, his meals were heavily protein-focused and didn’t contain enough calories or carbohydrates.

Along with not eating the right things, Ben wasn’t eating at the right times. He wasn’t planning ahead to have meals on the go and didn’t snack throughout the day. As a result, he often went hours without eating while training regularly and working an active, 40-plus-hour-a-week summer job.

To tackle these issues and help Ben meet his ultimate goal of weight gain, I developed a more balanced fueling strategy for him. I gave Ben four specific tasks to focus on:

• Eating more complete meals by including carbohydrates, protein, a fruit and/or vegetable, and a healthy fat at each one.

• Eating more often by increasing snacks and treating them as “mini-meals” that contained a carbohydrate and a protein. Good snack ideas that fit this recommendation are: Greek yogurt with berries and nuts or granola, grapes and string cheese, a banana with peanut butter, trail mix made with dried fruit and mixed nuts, chocolate milk and peanuts or almonds, tuna and whole grain crackers, or a peanut butter and jelly sandwich.

• Preparing food ahead of time and having easy staples on hand, such as frozen vegetables, quick-cooking rice, canned tuna, eggs, and frozen meat. This would ensure that Ben could eat well-balanced meals throughout his busy summer.

• Adding high-calorie—yet healthy—foods to his diet, such as nut butters, nuts and seeds, avocados, full-fat dairy, and olive oil.

Once we established Ben’s new fueling approach, we developed a sample eating plan for him to follow. It was based off his original diet recall, but we added a variety of higher-calorie foods to it. The aim was for Ben to take in roughly 2,700 to 3,200 calories per day, depending on his workout schedule.

We also discussed strategies for easy meal preparation, taking into consideration Ben’s kitchen skills and financial constraints. He agreed to set aside one night a week to make meals he could eat on the go. These would include a protein, grains, and a serving of frozen or fresh vegetables.

Ben’s new meal plan involved eating every few hours. Starting with breakfast, he would follow a morning lift with his usual protein-rich eggs and add oatmeal, yogurt with granola, and a fruit smoothie. Instead of working all day without eating, he started packing a well-balanced lunch of chicken, rice, and vegetables or a turkey and cheese sandwich, with peanut butter and jelly sandwiches to snack on throughout the day. For dinner, he would usually eat some of the food he had prepared ahead of time.

After six months, Ben returned to our facility and reported that he had been consistent with his eating plan for the entire summer and into the school year. He had already exceeded his weight gain goals and was feeling more energized.

Despite these positive results, Ben admitted it took a while to get used to his new eating plan. It took him more than a month to buckle down and get into a good routine where he was consistently grocery shopping, making meals ahead of time, packing his lunches, and bringing plenty of snacks to eat at work. He said the biggest challenges were trying not to eat so lean all the time, allowing himself to eat a larger variety of foods—including higher-fat foods and more carbohydrates—and eating every few hours.

After all of Ben’s hard work and dedication, he continues to gain strength in the weightroom and set a good eating example for the rest of his teammates. With his weight gain goals achieved, I am confident Ben’s last season has been the best of his college career.

MAINTENANCE REQUIRED

By Emily Edison

Emily Edison, MS, RD, CSSD, ACSM EP-C, is the owner and founder of Momentum Nutrition and Fitness in Seattle. She has more than 22 years of experience working with athletes, coaches, athletic trainers, and parents. Edison is available for on-site interactive sports nutrition workshops anywhere in the world and can be reached at: Emily@momentum4health.com.

Meet Sarah, a 5-foot-9-inch high school basketball player. On the court, she was a force to be reckoned with her freshman year, but this took a turn at the beginning of her sophomore season. Sarah’s energy levels started to decline, as did her athletic performance. She told her parents she was feeling fatigued, had constantly sore muscles, and was falling asleep in school.

Concerned, they took her to a sports medicine physician. An evaluation showed that Sarah’s weight had dropped from 155 pounds to 145 pounds, she had lost normal menstruation, and she was suffering from a stress fracture in her leg.

Sarah’s physician recommended she visit a sports dietitian to assess her fueling strategies, so she came to see me soon after. By this point, she had regained the weight she had lost, and my goal was to help her maintain it for the rest of her sophomore season.

My initial evaluation revealed Sarah’s food intake was too low for her activity level, leaving few calories leftover for healing and normal bodily functions like menstruation. To delve deeper into the issue, I had Sarah record her food intake and physical activity for three consecutive days.

Although she had no history of disordered eating and had a “great appetite,” her recall showed that she was consuming an average of only 2,500 calories a day when her needs were over 3,000. She was eating balanced meals but rarely had breakfast or snacks and occasionally forgot to eat when she was busy. Plus, she had heard somewhere not to eat after 7 p.m., so she wasn’t snacking before bed.

In short, Sarah’s high energy demands were not being met by her diet. This is called low energy availability (EA). In both men and women, low EA can cause fatigue, irritability, difficulty recovering from workouts, and low desire for sport. In women specifically, low EA can cause loss of menstrual cycle or amenorrhea, which can lead to decreased bone density.

Low EA also explained why Sarah was having trouble maintaining weight during the season. Furthermore, her performance decline, muscle loss, ammenorhea, and potential bone compromise were all consequences of her inadequate nutrition. In this way, she was showing all the symptoms of the Female Athlete Triad.

When athletes lose weight during their competitive season, it is important to address it as a symptom of a more profound problem. In Sarah’s case, the bigger issue was regaining energy balance. This meant that increasing EA, as opposed to just weight on a scale, would play a major role in her success.

But before we could reestablish Sarah’s energy balance, we had to overcome a few roadblocks that were keeping her from getting adequate calories. For starters, like most high school athletes, Sarah liked to sleep in as late as possible, leaving little or no time for breakfast.

Breakfast, the foundation for an athlete’s day, is made easier with grab-and-go options. One of Sarah’s favorites involved pre-making a large batch of oatmeal squares (prepared oatmeal chilled in a square baking dish) early in the week. I had her mix in peanut butter, bananas, and dark chocolate for sustained energy (and yumminess). Then, she simply had to scoop a few into a bowl and heat them quickly in the morning. Other go-to breakfast options included whole grain toaster waffles with peanut butter and apples, yogurt parfaits, and egg sandwiches.

Another vital piece of Sarah’s fueling puzzle was providing her body with enough energy during the day to sustain her through after-school practices and post-exercise recovery. To accomplish this, we focused on mid-morning snacks, a properly timed lunch, eating before practice, and recovery fuel.

We had to get creative when it came to mid-morning snacks. Sarah’s school had strict rules about eating in class, so we had to come up with portable, quick-to-eat options she could consume between periods. These included trail mix, fruit and nut bars, and banana and peanut butter tortilla roll-ups.

Managing Sarah’s 10:40 a.m. lunchtime proved to be a different obstacle. Because it was so early in the day, she wasn’t always hungry for her full meal. Our solution was to divide her meal between her real lunchtime and a free study period she had at 12:30 p.m. This helped her get the necessary energy into her tank while respecting her personal hunger and fullness cues.

After lunch, she typically had several hours before practice. In the past, she never liked to snack during this gap because she was fearful of getting side aches during training. However, with time, she learned that eating an easily digestible sports bar before practice actually increased her energy levels and ability to focus.

Immediately following practice, it took Sarah more than an hour to stretch, shower, and drive home to have dinner with her family. Studies show that consuming post-practice recovery fuel in the hour immediately following exercise is an effective way to maintain weight. So Sarah started drinking a portable chocolate milk box or carbohydrate/protein recovery shake after practice.

Finally, I had to address the myth about not eating after 7 p.m. I told Sarah recent research suggested that eating a carbohydrate/protein snack before bed could help replenish, repair, and rebuild the body during sleep, which are all vital when trying to maintain weight and stay strong. Taking this advice, Sarah came up with some snack ideas, like plain Greek yogurt and cereal, whole grain toast with peanut butter and milk, and turkey slices with crackers. These all had energy-packed carbohydrates and at least 15 grams of muscle-building protein.

Once we addressed all of these hurdles, Sarah had a brand new fueling plan to help her maintain weight throughout the rest of her sophomore season. Here’s what a sample day looked like:

Breakfast: 1 cup of oatmeal with 2 tablespoons of peanut butter, 1 cup of 2 percent milk, 1 banana

Mid-morning snack: 1/3 cup of trail mix

Lunch: 1 turkey and cheese sandwich, 1 peach, 1 fruit-sweetened yogurt, 1/4 cup of granola

Afternoon snack: Sports bar or 1/2 of a peanut butter and jelly sandwich

Dinner: 1 large burrito (1 wheat tortilla, 1/2 cup of pinto beans, 3 ounces of lean meat, 1 ounce of cheddar cheese, 1/2 cup of rice), 1 cup carrots or broccoli

Before bed snack: 4 graham cracker halves with 2 tablespoons of peanut butter, 1 cup of 2 percent milk

Total: Approximately 3,000 calories.

One lingering issue I had to address with Sarah was the importance of her menstrual cycle health. She had been told skipping her period was “normal” for athletes. However, normal menstruation is an indicator that a female athlete is getting enough fuel to maintain health and build proper bone mass. 

Throughout the rest of Sarah’s sophomore season, she worked hard to stick with her new fueling plan. She was able to keep her energy levels high, stabilize her weight, regain normal menstruation, and avoid additional stress fracture issues. The next year, following the same diet, her performance skyrocketed, and she was her team’s MVP.

More information on the Female Athlete Triad can be found by searching the topic at: Training-Conditioning.com.

RETHINKING WEIGHT LOSS

By Monica Van Winkle

Monica Van Winkle, MS, RD, is the owner of Nutrition in Action in Seattle, where she consults with athletes from recreational to professional levels. She is also the Sports Dietitian for the Seattle Mariners, Seattle Pacific University, and TN Multisports. Van Winkle currently serves as a board member for the International Association of Eating Disorders Professionals and can be reached at: monica@nutritioninaction.net.

The conversation around weight loss in athletes is tricky because it has the potential to do more harm than good. When weight or body fat percentage becomes the focus, performance often suffers.

This happened to Eric, a 5-foot-11-inch, 180-pound recreational distance runner in his early 20s. Eric was referred to me by his club coach after complaining that his legs felt like bricks during runs, and he couldn’t keep up with his teammates on hill workouts.

During Eric’s initial evaluation, he revealed he had been trying to lose weight. He wanted to be 155 pounds because he read this was the ideal weight for a runner his height. Yet, he also admitted that this number came from an unscientific blog, and he last weighed 155 pounds as a much shorter high school freshman.

In an attempt to reach his goal weight, Eric had adopted the Paleo diet, which emphasizes protein, fruit, and vegetable consumption, while eliminating grains and dairy. Two weeks in, his weight dropped from 178 to 170 pounds. However, over the next several weeks, it rebounded to 180 pounds. He disclosed having relentless cravings for high-sugar and high-fat foods at night and even described feeling out of control while he was eating.

At our first visit, I took Eric’s measurements and recorded his medical history. He had 23 percent body fat, which correlated to 138.6 pounds of fat-free mass and 41.4 pounds of fat mass. His estimated resting metabolic rate (RMR) was 1,872 calories, while his actual RMR was 1,600. Eric indicated that his family had a history of heart disease and said he was taking 1,000 milligrams (mg) of vitamin C a day to avoid getting sick, as he had been experiencing more colds. He was also taking 600 mg of calcium citrate twice a day to make up for the lack of dairy on the Paleo diet.

To get a detailed look at what Eric was eating, I had him do a 24-hour food recall. His results are listed below:

Before morning run: 8 ounces of water

Breakfast: 3 egg whites, 2 cups of spinach, 1 cup of black coffee

Lunch: 8 ounces of grilled chicken, 1/2 cup of sweet potatoes, 1 cup of steamed broccoli, 8 ounces of water

Afternoon snack: 2 sports bars, 12 ounces of water

Dinner: 8 ounces of grilled chicken, kale salad with lemon, 12 ounces of water

Before bed snack: 3 pieces of dark chocolate, a handful of dried fruit, 3 sports bars, 8 large spoonfuls of peanut butter, 12 ounces of water.

From this, I determined that Eric had fallen victim to one of the most common weight loss mistakes—calorie restriction. Although he experienced temporary weight loss and increased energy when he first switched to Paleo, this was due to the fact that his body was upregulating hormones that delayed fatigue during starvation. Eventually, Eric’s body couldn’t keep up, his performance and health suffered, and he regained the lost weight.

My solution was to have a frank discussion with Eric about the realities of calorie restriction. If any weight loss is achieved through a way of eating that cannot be sustained, that weight loss understandably cannot be sustained. Examples of this include cutting out entire food groups or a rigid focus on clean eating. The most ironic consequence of dieting is increased body fat and future weight gain.

To get Eric’s diet back on track, I designed a new meal plan that focused on supporting Eric’s lean muscle mass and improving his metabolic rate. To start, I took him off the Paleo diet and saved him a little money by stopping vitamin C and calcium supplementation. I then suggested he increase carbohydrate intake before and after training, as carbohydrates are the primary fuel for muscle. When athletes don’t consume enough, glycogen levels deplete, and muscle endurance and recovery suffer.

Furthermore, reduced glycogen levels prompt the release of cortisol, a catabolic hormone. Consuming carbohydrate before and after exercise blunts this response, minimizing muscle breakdown.

Cortisol can also suppress antibody production and the immune system. So smart carbohydrate timing can ward off illness, and it can be more effective than supplementing with vitamins, as long as the individual is consuming fruits and vegetables, which Eric was doing.

Because Eric attributed his initial weight loss to cutting back on carbs, he was fearful of adding them back into his meal plan. I explained that much of the weight he originally lost was not body fat. Rather, he had just depleted his glycogen stores, which were stored fuel and water weight. Once his body got used to having carbs in the tank again, he would see how quickly he could turn them into energy to support performance.

To achieve our goal of boosting Eric’s metabolism, we had to better meet his energy needs. One way to do this was by increasing his fat intake. Given his family history of heart disease, Eric was hesitant to add in more fat and felt it contributed too many calories to aid in weight loss. To ease his fears, I showed him the research connecting unsaturated fats to a decreased risk for heart disease, and we looked at three other benefits of fat:

• It creates comfortable fullness, which helps counter urges to binge.

• It helps make hormones to support lean muscle, including testosterone.

• It helps absorb fat-soluble vitamins, which help the body heal and recover.

I also suggested Eric continue consuming high amounts of protein, as muscle is a key player in determining metabolic rate. Since the body can only use around 25 grams of protein toward muscle synthesis at one time, I decreased Eric’s protein portions at lunch and dinner and increased them at breakfast and snacks.

Here’s what Eric’s new diet plan looked like:

Before morning run: 20 ounces of carb/electrolyte drink

After morning run: 16 ounces of low-fat chocolate milk

Breakfast: 3 whole eggs, 1/4 of an avocado, 1 cup of spinach, 1 cup oatmeal with cinnamon, 16 ounces of water

Mid-morning snack: Apple and peanut butter; carrots and hummus; or trail mix with nuts, dried fruit, and dark chocolate; 12 ounces of water

Lunch: 5 ounces grilled chicken, 1 to 2 cups of sweet potatoes, 1 cup of roasted veggies with olive oil, 1 medium chocolate chip cookie, 16 ounces of water

Afternoon snack: Trail mix with nuts, dried fruit, and dark chocolate; 12 ounces of water

Dinner: 5 ounces of grilled chicken, 1 to 2 cups of brown rice, kale salad with lemon and vinaigrette dressing, 1 ounce of cheese, 16 ounces of water

Before bed snack: Full-fat Greek yogurt and berries or 2 pieces of dark chocolate and a handful of almonds, 12 ounces of water.

Following this meal plan, Eric’s weight settled at 178 pounds. He dropped to 20 percent body fat, correlating to a fat-free mass of 142.4 pounds and fat mass of 35.6 pounds. When nutrient quality, timing, improved hydration, and flexibility became the focus, Eric’s intense late-night cravings disappeared.

As Eric’s strength-to-weight ratio improved, so did his running times. His legs no longer felt like bricks, and he could keep up with his running partners. Most importantly, Eric rediscovered the joy he had in running and learned how much energy he had when he made performance, not weight, his priority.

If an athlete has adopted weight loss habits that don’t support performance—such as Eric’s calorie restriction—their weight might be above their genetic set point. Changing their diet to better support their energy needs may result in a decrease in body fat, as was the case for Eric.

And if an athlete has adopted a high performance fueling plan and does not lose weight or body fat, it’s key that they seek self-acceptance. Although it’s a revolutionary concept, it will take any athlete’s performance to the next level by reminding them of all the reasons they became an athlete in the first place—learning to stand after falling, becoming part of something bigger than themselves, and pushing their body and mind past the limits. The number on the scale cannot change this.

To view the references for this three-part article, go to: Training-Conditioning.com/References.