Oct 30, 2017
Low on Fuel
Emily Edison

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.

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.

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