ACSM and Egg Nutrition Center recently hosted a webinar entitled Nutritional Myths and Practices of the Elite Athlete: Implications for Active, Non-Elite Performance. To watch a free recorded version of the webinar click here. The webinar is also available for two (2) CECs via ACSM ceOnline.
Several questions were asked by attendees during the webinar and presenter Dave Ellis provides his answers below. Viewpoints presented in this blog reflect opinions of the author and do not necessarily reflect positions or policies of ACSM.
Q: As the elimination trend continues, affecting microbiome health. How would/could probiotics help or hinder? What's the process that you go through to evaluate microbiome make up?
As the ability to define enterotype or microbiome signature evolves so will the ability to more precisely intervene with pre or probiotics. Like any intervention, you can probably overdo a good thing so getting that signature in range to avoid dysbiosis without overshooting the balance is where we have yet to dial things in with some promising biomarkers.
Q: Can you address the concept of "Male athlete triad" characterized by low body-fat and low testosterone levels. How can nutrition correct this problem?
It is real. We see NBA athletes get so lean and so active that their appetites don't keep pace with their energy demands and thus energy availability might be in a deficit where bone health and an assortment of hormonal dysregulation can occur. I have witnessed testosterone drop along with vitamin D levels under these circumstances.
Q: Do protein requirements change with injury?
On a percentage basis of total calories, yes because feed rates on sugar, starch and fat drop relative to inactivity that comes with injury. On an absolute level, the feed rates with normal athletic related injuries probably doesn't move that much. We are not talking about burn victims when we are looking at strained muscle. Preoperatively we should build up some body stores of amino acids that play a stronger role in tissue remodeling as well as vitamin D and glycogen status. This paper is not athlete specific, but makes the point on leucine relative to inactivity.
Q: Do you find that many athletes who say they are on "low carb" diets are just on adequate carbohydrate diets and not the standard American overconsumption diet, that includes too many carbohydrates?
Most athletes who take a training low or keto diet pledge fudge on carb intake in a big way. Pizza crust must not register on their carb counting scale when a fresh box is delivered after study hall ends about 10 p.m. and beef calories on weekends! In post-collegiate athletic life, you might find some athletes who have managed to hold true on training low or keto adapted diets to lean out in the offseason and who are first, reluctant to come back to an in-season feed-rate on CHO that supports performance and minimizes vulnerability for injury during eccentric loading. Staying lean to be quick in power sports and dead legs from low CHO intake in-season seems to be a new dilemma that needs a name for the mental conflict athletes seem to find themselves battling. It's offseason guru induced speak and think to lean out and look the part at the expense of in-season fueling realities. While most Americans consume non-protein calories (sugar, starch and fat) in excess relative to their chronic inactivity, these athletes are consuming in an opposite fashion relative to their chronic in-season energy demands.
Q: Do you think a bioelectrical impedance analysis is a good way to find an athletes body composition? Like a Inbody520 machine.
Bio impedance units like that are non-invasive and quick, but still have some vulnerabilities with populations who have big swings in fluid status incidental to training and competition. It just comes down to what you can afford to use to track body composition changes in your athletic population. I would not typically make it my A-Line assessment tool that goals were set from or athletes at the Pro level were monitored with to levy fines for not complying with contractual body composition metrics. They are getting better and so for a rapid screening tool between DEXA assessments I do see Impedance units gaining traction.
Q: Does pre/post workout supplements or protein use truly depend on what type of training an athlete is involved in to enhance their performance? If so what would be best for particularly a volleyball athlete to use?
Power and endurance sports alike need some protein post workout. Volleyball athletes are no exception when it comes to protein source post workout. If the workout is not too intense the athlete's appetite will be good right after practice and we just go eat a meal. When they are hot and dehydrated post intense training or competition a cold-liquid protein intake works as a better solution while appetites are suppressed. Those high leucine yielding protein sources are the best post workout so we get as big an anabolic bang for our buck as possible. Protein blends that take advantage of some fast digesting high leucine protein like whey combined with some intermediate digesting (maybe egg white or soy isolate) and slow digesting (like casein) might have some advantages for elevating essential amino acids in blood for a longer period post workout.
Q: How accurate is the Omron body fat scale to estimate FFM?
We don't use home units like that to assess body composition changes in athletic populations. They are not as reliable as we require where changes in body composition that are expected with training, diet and lifestyle are closely monitored from a compliance standpoint. For home use, it's better than nothing.
Q: How long after working out or trainings should protein be taken? Is there a best time frame? Is there a time recommendation when to intake a protein shake post exercise?
Most researchers will say that the fluid and carb refuel is the priority post workout and that as muscle rehydrates and normalizes pH / redox insults that the muscle protein synthesis upregulates in recovery mode and that delay makes protein a secondary priority from a timing perspective. In simple terms, it may translate to drinking a sports drink and water first before showering and getting to the protein recovery beverage, bar or snack. Having said all of that I have watched many a team call a group of athletes up to a cooler full of cold protein recovery drinks as they finish working out and make them drink one as a team just to make sure athletes get one down to gap up until they get cooled down enough to eat a hot meal.
Q: How would you work with an athlete who has a lifestyle where they don't eat red meats or chicken?
Happens a bunch and it's best to not over-react as many of these restrictions are transient in nature. Often, they have made the move on some ethical level or they feel that animal proteins digest too slowly. If the slow digesting is the focal point you can bet, they won't probably stick with the restriction as long and will come back to their favorite foods during the offseason when they are not competing. On the ethical front, it could be a change that last a lifetime and you will have to make some accommodations for issues like iron for female athletes or male endurance athletes. Still, if they are eating eggs, dairy, fish and seafood your worries challenges are fractional compared to accommodations that need to be made for a true vegan athlete.
Q: I know how important body comp testing is. I had an instructor who recently suggested using calipers over a tee shirt. What do you think?
Was it with a female population at risk of body dissatisfaction and eating disorders? Well, maybe that argument could lead to rationalization that not testing or doing it with clothing on could be the route to go. I would argue that having solid data from something like DEXA that can spot bone demineralization and drops in fat free mass will help spot potential restrictive or purging habit before they are disclosed by disordered eating populations. Fear that the episodic assessment of body mass with any technique is going to be a trigger for all female athletes (old argument) has lost traction and always struck me as very sexist in nature. Female athletes are tough and want feedback as long as the health professional doing the assessment has reliable longitudinal data and keeps the information private. The abuse of the information by a vocal coach that might use the information for conformity that is unreasonable relative to the time of year where we can make substantial changes or just off on the realities of the athlete's frame to make changes that are normative to the position they play can be a problem for all athletes, male or female.
Q: In regards to endurance athletes, Ironman's, half Ironman's, what is your recommendation to calorie breakdown? % of carb, fat, proteins etc.
That is a good question as I don't work with the individual endurance types much. I am a team sports guy, but feed rates have to be 20-22 kcals per pound of body wt. per day with those athletes and CHO feed rates have to be 3-5 g per pound of body weight. The 3 g or less folks would be those who have attempted to be fat adapted and are plugging in some coconut oil snack items during the ride when they chew things up. The protein story during a long event would be one of plugging in some super easy to digest, essential amino acid rich sources and maybe even some sources that can help keep gut barrier intact under extreme heat stress.
Q: Is there a max about of protein our bodies can handle at one feeding?
Yes, there is a point where in one feeding excess amino acid is oxidized and can't push anabolic responses any further. This paper used whole egg protein to illustrate that point.
Q: Of the variable mentioned regarding monitoring load for UUPS/overreaching/OT, is there a variable that you would like to see more research?
Lots of ways to fatigue and lots of biometrics that could be used as an early warning system that an athlete's external load vs. internal load are not matching up. These various load monitoring frontiers are the real battle grounds of High Performance analytics where key learnings are protected and not shared in the world of forward based conjecture that we live navigate in sports. Of course, the formula for spotting a problem between declining work with external load biometrics vs. high stress markers from internal load biometrics is going to vary in different sports models (endurance vs. power, sea level vs. altitude, hot vs. cold, male vs. female, young vs. old). It is a brave new world and it will be a while before accurate disclosures are made on best practices in this space. Good read on the topic here.
Q: There is a lot of literature about water intake throughout the day. What do you recommend for high performance athletes on a training day as far as amount of water to intake and timing of that intake?
I like to use more than just water to build up plasma volume leading up to a competition. Those that just drink water seem to not retain as much of the fluid build we are after to give us a margin for error once they begin to compete (especially in hot humid conditions). The challenge I see with using hydration build formulas with a substantial carbohydrate content is, most athletes will get full and quit drinking before we have the build maximized. As a result, you may want to have a low or no carbohydrate plasma build strategy for your biggest sweaters (check out The Right Stuff, NASA patent). Lot of solid position stands on heat and hydration leading up to competition like this one from ACSM and others from groups like NATA.
Q: What are the best resources/practices to encourage developing varsity high school athletes to eat responsibly (especially without access to an RD)?
This a great question. We inherit all kinds of eaters as student-athletes when the show up to compete for a spot on a collegiate roster. Certainly, those who grew up eating at home in a family setting have an advantage on the variety of foods they have been exposed to and the pattern of daily intake. Many from modest socio-economic settings have survived on whatever they could get when they could get it. It's not until we stabilize them all in a feeding environment with solid variety and opportunity to feed with a frequency that is characteristic of an athletic pattern of feeding that is all comes together for the vast majority of athletes. That is not to say it can't happen at home, home just can't be the rate limiting issue in the process! Even the most motivated HS athlete will only be able to execute what is available to them at home when it comes to the food supply available. If that is hot mess or dramatically limited, the option most HS athletes will resort too is fast food and that is for sure a hot mess! So, it goes beyond motivating HS athletes to take fueling seriously. I think we know how to do that by showing them what high performance fueling looks like. The challenge is showing their parents or guardians what high performance fueling looks like so they can engage as part of the solution and not the rate limiting step in being part of the solution. When the HS athlete and parent walk out of an education session motivated and together on the commitment to improve, that is the beginning of change for the better. When they have the resources to do better and they see results in their health, body composition and performance, that is when the changes become lifelong habits.
Q: What are your opinions/advantages/disadvantages of "carb backloading" rather than eating a more constant levels of carbs and calories throughout the day?
I sure wish I could go eat a tall stack of pancakes before bed, dripping with syrup and butter before bed and not swell up like a tick, but it's just not true. If you are an NHL or NBA athlete and you compete late in the evening more liberal late feedings conforms to the duty cycle of the work you are doing, but I don't believe in the concept of carb backloading popularized by John Kiefer. Keifer's story is all about losing weight and not performance. "Carb Backloading is a technique where a user follows a strict eating regimen for a specific number of days before they're allowed to indulge. Precisely, a user is required to consume a maximum of 30 grams of carbohydrates for the first 10 days of the program. After that, they are allowed to consume as much carbohydrates as they please and they will still be able to lose weight." Still, the data manipulation of meal patterns (typically big early and light late) is intriguing for most Americans fighting a losing battle with their body mass relative to their sedentary lifestyles.
Q: What does "bone mineralization" mean?
It is a concept behind the density of bone and subsequently the vulnerability of bone to fracture if the density is low (demineralized). We all lose bone with age, starting in the late 30's so we better have some "bone in the bank" to from which we can make gradual withdrawals! Lots of things can hurt bone mineralization that come with diet and lifestyle. For sure athletes training hard with very low total kcal intake is a problem on more rapidly demineralization of bone when they should have been building bone! This is just a taste of some of the dietary work behind bone mineral content.
Q: What foods have the highest leucine content?
That list I had on the slide was a comprehensive list of animal, dairy and vegan protein sources (red, blue and green sources) - see image.
Q: What is your take on combat sport athletes and fasting?
Well I think we have the genes to cope with times of plenty and times of famine. We don't exercise the famine genes much anymore and so the concept of fasting or time restricted feeding might have some merit for those who just hate to exercise. People who train are constantly challenging those same genes during the calorie deficits that comes with working out on something as simple was water or unsweetened tea. That will do the job without fasting, but the vast majority of Americans are destined to look like Jabba the Hutt if they keep sitting still all day. See here or here.
Q: What's best for cramp mitigation and/or treatment of in-game cramps?
I know one thing for sure. You can drink all the sports drink you want once someone starts to cramp it won't help resolve the problem, thus we have had to look beyond water and electrolytes for contingencies in this space. I mentioned the blood borne source bicarbonate and citrate that have worked well. Now you have concepts based on drinking a beverage containing natural TRPV1 and TRPA activators producing long-lasting inhibition of electrically-induced muscle cramping, but they are noxious tasting formulas that will be a tough sell for most to stomach (until they start to cramp). Ultimately, it's a too much too quick story for Exercise Associate Muscle Cramping (EAMC) and the solutions may be multiple, too.
Q: With regards to protein (Whey and Soy) what are trusted brands to recommend to athletes and non-athletes?
The world is buying from a few select pools of whey and soy isolate / concentrate vendors. Thus, finished brands tell stories about their products that are from the same supply chain of sources globally. Not all of those supply chains are of equal quality. One in the whey space that is the best of both, a top shelf supplier with a retail face is BiPro brand. The top supplier of soy protein is Dow-Dupont and they make several soy protein fractions that show up in brands at retail as the sole source of protein or in blends (look for Supro® on the ingredient list).
Q: Would there be a benefit to starting a nutrition program at the high school level?
I know the Sports RD's who work in the collegiate ranks would thank you for starting a HS sports nutrition education program! It's a new frontier that we hope gains tractions sooner rather than later! The professional team Sports RD's can spot an athlete in short order who has worked with a Sports RD in college. They are not suckers for the pitch from the supplement industry over food and they a solid grasp on what a good quality meal and dietary pattern looks like. I know the Sports RDs who work full-time in sports hope to help stimulate a vision of value for what a Sports RD could deliver in a HS setting much like we have done at the Collegiate, Olympic, Pro and Special Operations ranks - www.sportsrd.org.
Q: You mentioned Gatorade, simple sugars. What are your thoughts and experience on UCAN, a super starch?
The modified starch in UCAN is great or helping athletes who need to mobilize their body fat stores for energy do so vs. working out using high glycemic carbohydrate loads. I am a fan of UCAN and travel with their bars to gap up on not being able to eat correctly when stuck on airplanes (ugh). Still the rate that glucose appears in your blood stream for the UCAN Super Starch® will not support the needs of an athlete who you have to keep on the field in a pinch, taking on the high minutes at a high intensity with emotion so don't try to use it as a sole source of carbohydrate kcal incidental to competition. It can however be layered in for time released glucose during workouts or competition and might be very helpful with sports who can't get off the pitch to drink/consume like soccer.
Q: You touched on the issue of fad diets and misconceptions that make their way into performance nutrition. Do you have any strategies for materials and talking points when dealing with limited resources and large groups you may only see 3-4 times a week?
Ultimately, we cope with the never-ending supply of fat diets with the relationships we create with athletes and coaches who trust our opinions enough to check-in with us before they buy-in! Sadly, once an athlete has bought-in, they are semi-reluctant to admit they bought into something that was a waste of time and money and may even try to defend it in the face of failure. I do know that when I can objectively size up a diet or supplement and tell the athlete of its potential shortcomings, in a way that they might feel before they feel it, and it comes true (let's say dead legs on a low CHO diet in season) that is when the real magic happens and buy-in occurs that will be long lasting. A handout won't cut it to cover the next big thing they will come calling about. You have to take them on, one at a time, with the same objectivity each time. Just being dismissive won't cut it as they often get the idea from a family member, teammate or coach that they respect.
Dave Ellis (RD, CSCS) is the President of Sports Alliance Inc., and the first President of the Collegiate and Professional Sports Dietitians Assn. (www.sportsrd.org). With over 30 years of experience working with top athletes and numerous collegiate and professional teams, Dave is widely recognized as one of the key influencers in the world of sports nutrition and an innovator for his training table designs and approach to body composition and frame assessment of athletes. A dedicated educator, Dave speaks regularly at various health and nutrition conferences and blogs on a variety of sports nutrition-related issues.