Chapter 5: Nutritional Considerations

Report
Chapter 5: Nutrition and
Supplements
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• Proper nutrition can positively contribute
to:
– Strength
– Flexibility
– Cardiorespiratory Endurance
• Performance vs. Food consumption
– Myths and habits vs. physiological benefits
– Psychological vs. physiological
considerations
• In a clinical, corporate or industrial setting
the ATC may be responsible for providing
nutritional counseling
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Nutrition Basics
• Science of substances found in food
that are essential to life
– Carbohydrates (CHO)
– Protein
– Fat
– Vitamins
– Minerals
– Water
Macronutrients
Micronutrients
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Nutritional Considerations
Science of substances found in food that
are essential to life
Nutrients
• Carbohydrates
• Protein
• Fat
• Vitamins
• Minerals
• Water
Roles
• Growth, repair &
tissue maintenance
• Regulation of body
processes
• Production of
energy
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Carbohydrate
• Body’s most efficient energy source
• Accounts for 55-60% of total caloric intake
• Sugars
– Simple (sugars) and complex (starch and fiber)
– Monosaccharides
• single sugars (fruits, syrup and honey)
• Glucose
– Disaccharides
• 2 sugars combined (milk sugar, table sugar)
– Should account for <15% of caloric intake
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• Starches
– Complex CHO
– Long chain glucose units
– Rice, potatoes, breads
– Body cannot use starch directly
• Broken down in simple sugars
• Unused starches and sugars are stored as
glycogen to be used by the body later
• Inadequate CHO intake results in protein
utilization for energy
• Protein sparing action of glucose occurs if
adequate CHO in the system
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• Fiber
– Structural part of plants and is not digestible in
humans
– Soluble
• Gums, pectin
• Oatmeal, legumes, and some fruits
– Insoluble
• Cellulose
• Grain breads and bran cereal
– Aids normal elimination of waste (bulk)
– Reduces risk of colon cancer and coronary
artery disease
– Reduces incidents of obesity, constipation,
colitis, appendicitis, and diabetes
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– Intake should be approximately 25 grams
per day
– Most only consume 10-15 grams per day
– Excessive consumption may lead to
intestinal discomfort and increased loss of
calcium and iron
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Fats
• Most concentrated source of energy
– Should account for 25-30% of caloric intake
• Serves to make food flavorful and
contains fat soluble vitamins
• Essential for normal growth and
development
• Saturated vs. unsaturated
– Saturated (fatty acids derived from animal
products
– Unsaturated (plant derivatives - liquid at room
temperature)
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• Other Fats
– Phospholipids
• Lecithin
– Sterols
• Cholesterol (consume <300mg/day)
– Omega-3 fatty acids (unsaturated fat) aids in
reduction of heart disease, stroke, hypertension)
• Found in cold-water fish
• Fat Substitutes
– Simplese and Olean
– Contain 80% fewer calories than fat and no
cholesterol
– May cause abdominal cramping and diarrhea
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• Trans Fatty Acids
– Physical properties resembling fatty acids
– Found in cookies, crackers, dairy and meat
products, fast foods
– Increase levels of bad cholesterol
– No safe level
– People should eat as little of them as
possible
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Proteins
• Required for growth, maintenance, and
repair of the body
• Aid with enzyme, hormone, and enzyme
production
• Should encompass ~15% of daily
caloric intake
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• Amino Acids
– Basic units that compose protein
– 20 amino acids compose the majority of
body protein
– Most can be produced by the body while
others (essential) must be consumed
– Animal products contain all essential amino
acids
– Incomplete sources (i.e. plants sources) do
not contain all essential amino acids
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• Protein sources and needs
– Most diets are rich in protein and often
athletes consume twice the amount that is
recommended
– Excess protein is converted to fat and may
result in dehydration and potential kidney
damage
– Increased physical activity results in
increased need for protein in the diet
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Regulator Nutrients
• Vitamins (13) serve as regulators in many
body processes
• Fat soluble
– Vitamins A, D, E , K
– Found in fatty portion of foods and oils
• Water soluble
– Vitamin C, B-complex vitamins
– Help to regulate metabolism but cannot be
stored
– Each serves a series of roles
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• Antioxidants
– May prevent premature aging, cancers,
heart disease and other health problems
– Help protect cells from free radicals
– Include vitamins A, C, E
– Found in a number of dark green, deep
yellow and orange fruits and vegetables
– Supplements
• Vitamin Deficiencies
– Illness that results from a deficit in a
particular vitamin/mineral
– Are avoidable if an adequate diet is
consumed
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Minerals
• More than 20 minerals have essential
roles in the body
• Many are stored in liver and bones
• Examples
– Iron (energy metabolism and oxygen
transport)
– Magnesium (energy supplying reactions)
– Calcium (bone formation, clotting, muscle
contractions)
– Sodium and Potassium (nerve conduction)
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Water
• Most essential nutrient and most
abundant in body (60% of body weight)
• Essential for all chemical processes
• Lack of water (dehydration) can lead to
illness and death
• Body has mechanisms to maintain
homeostatic levels of hydration (kidneys
and solute accumulation)
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• Electrolyte Requirements
– Involve minerals of the body - must
maintain adequate levels for optimal
functioning
– Excess sweating can lead to depletion of
these electrolytes
– Help to maintain levels of hydration
– Can generally maintain through proper
diet, however, additional salts may need to
be added periodically
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Nutrient Requirements and
Recommendations
• Amount of nutrient required to prevent
deficiency diseases
• Vary among individuals and across
populations
• Requirements vs. Recommendations
– RDA (Recommended Daily Allowance) vs.
DRI (Dietary Reference Intake)
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• DRI includes:
– RDA
– UL’s (upper intake levels)
– EAR (estimated average requirements)
– AI (adequate intake)
• Food Labels
– Aids consumers in determining levels of
nutrients in foods
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Figure 5-2
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MyPyramid
• Replaced Food Guide Pyramid in 2005
• Emphasizes more individualized
approach for diet and lifestyle
– Stresses benefits of improvements in
nutrition, lifestyle behavior and physical
activity
• Identifies amounts of food to consume
depending on energy expenditure
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• Represents recommended proportions of
every food group while focusing on the
importance of making smart food choices
daily
• MyPyramid Symbol illustrates
– Gradual improvement
– Physical activity
– Variety
– Moderation
– Proportionality
– Personalization
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Figure 5-3
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Dietary Supplements
• Activity increases need for energy not
necessarily all vitamins, minerals and
nutrients
• Vitamin Supplementation
– Athletes believe large doses can lead to
superior health and performance
– Common megadose practices
• Vitamin C
– For prevention of common cold and to slow aging
– May cause kidney stones and diarrhea
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• Vitamin E
– Protects cell membranes from damage
– Little evidence to support enhancing performance or
life expectancy
• B-complex vitamins
– Aid in release of energy from CHO, fat, and protein
– If additional energy is required, increased caloric
intake is necessary
• Mineral Supplementation
– Calcium and iron tend to be low and diets
may need to be modified
• Particularly in those that do not consume dairy
products, red meat or enriched breads/cereals
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• Calcium Supplements
– Most abundant mineral in body
– Over time additional levels of calcium are
required for bone maintenance
• Without, bones become weak and brittle resulting in
osteoporosis
– Young adult requires 1000mg/day
– Females tend not to get enough calcium in diet
– While exercise helps bones to retain calcium,
extreme levels of exercise, causing hormonal
imbalances, can disrupt calcium retention
– Supplementing with calcium carbonate or
citrate is advisable
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– Milk products are the most reliable source of calcium
– Some athletes complain it causes upset stomach due
to a build up of intestinal gas
• May be lactose intolerant and lack the enzyme lactase
(lactase deficient)
• Can supplement with lactase (scientifically produced)
• Iron Supplements
– Common in females
– Results iron-deficiency anemia, limiting oxygen
carrying capacity of blood
• Athlete feels tired and weak due to muscles’ inability to
generate energy
– Excess supplementation could be toxic and may
result in constipation
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• Protein Supplementation
– Approximately 1-1.5g/kg body weight of
protein should be consumed for increasing
muscle mass
– Often times exceeded with normal diet and
supplementation is not necessary
• Creatine Supplementation
– Naturally occurring substance in body
produced by kidneys, pancreas and liver
– Found in meat and fish
– Role in metabolism
– Two types (free creatine and
phosphocreatine)
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– Phosphocreatine is stored in skeletal muscle
and works to re-synthesize ATP during activity
– Positive effects
•
•
•
•
increase intensity of workouts
lactic acid buffer
stimulates protein synthesis
decreases total cholesterol and total triglycerides
and improves HDL-LDL ratio
• increases fat free mass
– Negative effects
• weight gain
• muscle cramping
• gastrointestinal disturbances and renal dysfunction
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• Loading Phase
• Consists of ingesting .3 grams of creatine/kg of body
weight per day
• Should be split over 4-5 times per day with 16
ounces of water per dose
• Loading phase last for 5 days
• Research has shown that loading is not always
required
– Maintenance
• Consuming .03 grams/kg body weight for one month
– Wash-out phase
• No supplementation for 1 month
• Creatine is not a banned substance, however,
distribution by NCAA institutions is banned
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• Herbal Supplements
– Trend - natural alternatives to drugs and
medications
– Safe to ingest as natural medicines with
few side effects (occasional allergic
reaction)
– Offer nutrients that nourish brain, glands
and hormones
– Don’t need to consume with food - contain
own digestive enzymes
– Work with the body’s functions (whole
body balancers)
– Caution must be exercised as there is no
governmental control or regulation
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• Ephedrine
– Stimulant used in diet pills, illegal recreation
drugs and legitimate OTC medications
– Similar to amphetamine
– FDA has posted warning concerning use; 2003
its use in supplements was banned
– NCAA, NFL, NBA, minor league baseball and
the USOC have banned use by athletes
– Potential dangers associated with use and has
been known to cause numerous problems
•
•
•
•
Heart attack, stroke, tachycardia
Paranoid psychosis, depression, convulsions, coma
Fever, vomiting, palpitations, hypertension
Hypertension and respiratory depression
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• Glucose Supplements
– Ingesting large quantities of sugar prior to
activity causes an increase glucose in the
blood
– Release of insulin stimulated, allowing cells
to utilize free circulating glucose, sparing
blood glucose
– Positive effect on performance
– However, some athletes are sensitive to high
CHO feedings and have problems with
increased levels of insulin
• May lead to upset stomach or diarrhea
• Athletes should test themselves with various food
combinations prior to competitive events
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Popular Eating and Drinking
Practices
• Caffeine
– Central nervous system stimulant found in
carbonated beverages, coffee, tea (chocolate
contains compounds related to caffeine)
– Increase alertness and decrease fatigue
– Not detrimental to performance
• Enhances fat utilization and endurance
performance
• Makes calcium more available allowing muscles to
work more effectively
• May cause slight headaches
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• Caffeine (cont.)
– Too much causes nervousness, irritability,
increased heart rate and headaches
– Headaches may result when ceasing caffeine
use (withdrawal)
– Olympic officials consider it to be a drug
• Should not be present in a drug test at levels
greater than 5-6 cups of coffee
– Energy Drinks
• Contain high levels of caffeine
• Also contains some legal herbal supplements
• Use may result in increased HR, BP, dehydrate
the body and interfere with sleep
• Should not be combined with exercise as fluid
loss from exercise and diuretic quality of
caffeine can result in severe dehydration
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• Alcohol
– Provides energy for the body
– Little nutritional value
– Central nervous system depressant
• decreases coordination, slows reaction time,
decreases mental alertness
• increases urine production (diuretic effect)
– Alcohol consumption is not recommended before,
during or after activity
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• Organic, Natural, of Health Foods
– Claim to be safer and nutritionally
superior due to absence of pesticides and
fertilizers
– All foods are organic due to presence of
carbon
– More expensive no increased benefit
physiologically
– Processing (preservatives) helps to
maintain nutritional value
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Vegetarianism
• Utilize plants to form foundation of diet animal foods are either excluded or
included in a variety of eating patterns
• Economic, philosophical, religious,
cultural, or health reasons
• While practiced intelligently (not a fad) a
vegetarian diet can result in deficiencies
• Diet must be carefully planned
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– Total vegetarian (vegan)
• all plant diet, no animal products
• must be certain to consume enough calories
and vitamin B12, calcium, zinc, and iron
– Lactovegetarian
• Consume plant foods and milk products
• Must watch iron and zinc levels
– Ovolactovegetarian
• Consume plant foods, milk products and eggs
• Iron is still a concern
– Semivegetarian
• Still primarily plants but all other products are
consumed except red meat.
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Pre-event Nutrition
• Importance and content pre-event meal
vs. traditional rewarding that may
hamper performance
– Traditional steak and eggs
• Long term food consumption is more
important than immediate consumption
• Purpose should be to provide
competitor with nutrients/energy and
fluids for competitions (taking
digestibility into consideration
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• Encourage athletes to be conscious of diet
• Diets are also individual to each athlete
• Individual is the best judge of what should
or should not be consumed
• What is the individual comfortable with
• Liquid Supplementation
– Extremely effective and successful
– 225-400 calories per serving
– Successful in reducing pregame symptoms of
dry mouth, abdominal & leg cramps, nervous
defecation and nausea
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– Food generally takes 4 hours to clear
stomach and upper GI tract
– Liquid supplements clear stomach and
upper bowel before game time, settling the
stomach and making available nutrients
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Eating Fast Foods
• Way of life in America --world of fast
food junkies
• Often meal of choice during travel
• Big concern is the amount of fat (4050% of calories from fat)
• Size vs. supersize
• Increased menu size is a plus (variety)
• Nutritional information posting
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Low Carbohydrate Diets
• While fat reduction had been the trend in
dieting, new recommendations for CHO
reduction have come forth
• Numerous versions
– Most replace CHO intake with protein and fat
• Unused CHO is readily turned into fat
– CHO consumption increases insulin production
– Insulin while allowing cells to use blood glucose
also encourages fat to be deposited and a
hunger response to be triggered
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– Tendency becomes to consume more
CHO’s as a result
• Hyperinsulinemia
– Elevated insulin in the blood which
contributes to individuals becoming
overweight
– CHO restriction halts insulin cycle and
improves glucagon production, enhancing
fat burning and cholesterol removal from
blood vessels
– Dietary changes result in ketosis, which
stabilizes blood glucose, a reduction in
insulin levels and rapid weight loss
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Glycogen Supercompensation
• Increase muscle and liver glycogen stores
prior to major event by altering eating and
training habits
• Decrease training at least 48 hours prior
to event
– Allows for clearance of metabolic waste
products
• Increase CHO loading to increase
glycogen stores and positively impact
muscle glycogen and muscle endurance
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• Six-day period
– Phase I (Days 1-2): hard training with
reduced CHO intake
– Phase II (Days 3-5): decrease training and
increase CHO (potentially increasing
glycogen stores 50-100%)
– Phase III (Days 6-7): resume normal diet
• Not clearly demonstrated as being
beneficial in endurance activities
• Do not perform more than 2-3 times per
year
• Ideally for prolonged duration events
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Recommendations for
Restoring Muscle Glycogen
After Exercise
• When the time period between events is <8
hours
– Consume CHO ASAP to maximize recovery
• Complete restoration requires 20-24 hours
• Consume 0.45-0.55 grams of CHO per pound
of body weight for each of the first 4 hours
– Utilize nutrient rich carbohydrate foods
• For a 24 hour period, 2.3 – 5.5 grams of CHO
should be consumed per pound of BW
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• Pasta, potatoes, oatmeal and sports
drinks are recommended
• The addition of protein to carbohydrate
supplements has been shown to enhance
aerobic endurance
– The reason behind this is unknown
– Evidence supports a 4:1 ratio of CHO:PRO
• Other ratios (1:1; 3:1) have also been suggested
• Peanut butter and tuna are good sources of
protein
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Fat Loading
• Fat loading vs. carbohydrate loading
• Intent = better energy source
• Negative side effects
– cardiac protein and potassium depletion
– development of arrhythmias, increased
serum and cholesterol
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Body Composition and Weight
Control
• Gains and loss of weight in athletes can
be problematic
• Intelligent and conscientious approach
involves some knowledge of what is
involved on the part of the athlete and
athletic trainer
• Results in individual displaying
discipline relative to types and
quantities of food
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Body Composition
• Ideal body weight = age-related
height/weight chart
– Inaccurate due to broad ranges and failure
to take individual body types into
consideration
• Health and performance may be best
indicators
• Fat vs. nonfat components of body =
body composition
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• Non-fat or lean tissue (lean body
weight)
– bone, muscle, tendon, connective tissue
• Body comp is the relationship between
fat tissue and lean body tissue
• Averages
– Female 20-25% body weight = fat
– Male 12-15% body weight = fat
– Should not fall below 3% and 12 % for
males and female respectively
• Results in loss of essential fat padding for
organs
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• Overweight = excess body weight relative to
size and stature
• Overfat = excessively high percentage of
total body weight is fat
• Obesity = extreme amount of excessive fat
– Female >30% and male >20% percent body fat
• Factors that determine amount of fat
– Number of cells
• Proliferation or hyperplagia of fat cells occurs from
birth to puberty
– Size of cells
• Increase/decrease over time until adulthood relative
to caloric balance
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– Change of weight = change in size of
adipose cell not the number of cells
• Adipose cell stores triglycerides (liquid
fat)
– Moves in and out of cells according to
energy demands
• Moderate, long term activity uses
greatest amount of fat
• One pound of fat = 3500 calories,
stored as triglycerides
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Assessing Body Composition
• Several methods
– Hydrostatic weighing, bioelectrical
impedance, skinfold thickness measures
– Skinfolds based on the fact that 50% of
body fat is subcutaneous
• Utilize skin fold calipers
• Relatively low accuracy but is easy to learn and
utilize
• Error is + 3-5%
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Figure 5-5
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• Hydrostatic Weighing
– Utilizes underwater tank to determine body
density
– Establishes relationship between lean
mass (more dense) and fat mass (resulting
in more buoyancy)
– Very accurate method
– Not always available, expensive equipment
– Time consuming
– Requires exhaling all air
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• Bioelectrical Impedance
– Measures resistance of electrical current
flow between points
– Based on principle that electricity will flow
through path of least resistance
– Fat = good insulator
– Water = good conductor
– Impacted by levels of hydration
– Expensive equipment
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Determining Body Mass Index
• Determine extent of overweight or
obesity using height and body weight
• BMI (body mass index) is a ratio of
height and weight
• Utilized to measure health risks
associated with obesity
• BMI >25 indicate excess body fat
• BMI 25-30 indicates overweight
• BMI >30 indicates state of obesity
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Assessing Caloric Balance
• Caloric balance = Calories consumed - calories expended
• Positive caloric balance results in weight gain
and vice versa for negative caloric balance
• Can be calculated through accurate record
keeping of calories consumed and expended
relative to metabolic and activity needs
– Calories are expended through:
• basal metabolism (calories expended at rest) = BMR
• work (activity that requires more energy than sleeping)
• excretion
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– Must calculate total time engaged in all 3
areas over a 24 hour period
– BMR is determined in laboratory setting
through indirect calorimetry which
measures oxygen uptake
– Work (type, intensity, duration) must be
determined
– Body size also factors in
– Energy expenditures can be consulted to
determine average energy expenditures
per activity (kcal/min/lb)
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• Caloric Intake
– Carbohydrate = 4 calories/gram
– Protein = 4 calories /gram
– Fat = 9 calories/gram
– Alcohol = 7 calories/gram
– College athletes consume 2000-5000
calories/day
– Endurance athletes may consume as many
as 7000 calories
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Methods of Weight Loss
• Exercise or dieting alone is ineffective over
the long run
• Dieting alone results in lean body tissue loss
– Should not drop below 1000-1200 calories for
women and 1200-1400 for men
• Exercising, while resulting in loss of fat
mass, will also enhance strength,
cardiorespiratory endurance and flexibility
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• The key is moderation
– A combination of dieting and exercise
– A negative energy balance must be
achieved
– Loss of 1.5-2.0 pounds per week is
adequate
– Weight loss of more than 4-5 pounds per
week can be attributed to dehydration
– It takes time to put weight on and also
takes time to take it off
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Methods of Weight Gain
• Aim should be to increase lean body
mass
• Increased physical activity (muscle
work) and dietary modifications
• Approximately 2500 calories is required
per pound of lean body mass, an
increase 500-1000 calories per day
• A 1-2 pound per week gain is adequate
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Disordered Eating
• Spectrum of abnormal eating habits
– Mild food restriction, binging, purging,
bulimia, anorexia nervosa
• Multi-factorial
– Social, familial, physiological,
psychological components
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• More prevalent in athletic populations
– Control over body weight/composition for
performance
– In addition to the emotional and social
pressures characteristic of eating
disorders, physiological effects can impact
health and performance of the athlete
– Education of athletic trainers in this area is
critical
• Prevention and management strategies
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• Bulimia
– Generally identified in females (can also be
found in males) ranging in age from
adolescence to middle age
– Periods of starvation, bingeing (thousands
of calories) and purging through vomiting,
fasting and laxatives/diuretics
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– Characteristics
• Typically bulimic athletes are white, middle to
upper-middle class
• Perfectionist, obedient, over-compliant, highly
motivated, successful academically, well-liked,
and a good athlete
• Gymnastics, track, dance
• Occasionally seen in male gymnasts and
wrestlers
– Bingeing and purging can result in stomach
rupture, heart rhythm, liver damage, tooth
decay from acids, chronically inflamed
mucous lining of mouth and throat
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– Binging does not include celebratory
overeating that may occur during the
holidays or other events
– Binging is a loss of control over one’s
eating; the resultant guilt drives he/she to
vomit
• Bulimics experience this scenario repeatedly
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• Anorexia Nervosa
– 30-50% of anorexics also suffer from
bulimia
– Characterized by distorted body image and
constant concern about weight gain
– Impacts mostly females
– Starts often with adolescents and can be
life threatening
– While the individual tends to be too thin
they continue to feel fat
– Deny hunger and are hyperactive
– Highly secretive
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• Early intervention is critical with eating
disorders
– Empathy is a must
• Psychological counseling is key
• Must have individual recognize the
problem, accept the benefits of
assistance and must voluntarily accept
help for treatment to work
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• Anorexia Athletica
– Condition specific to athletes
– Characterized by features common in
anorexia nervosa
• No self-starvation practices
– Signs
•
•
•
•
•
•
•
•
Disturbance of body image
Weight loss >5% of body weight
Gastrointestinal complaints
Primary amenorrhea
Menstrual dysfunction
Absence of illness explaining weight reduction
Fear of becoming obese
Binging, purging, compulsive eating, or caloric
restriction
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Female Athlete Triad
• Potentially fatal problem
• Combination of eating disorder,
amenorrhea and osteoporosis
• Some suggest eating disorders may
exist in 62% of females in certain sports
and amenorrhea found in 60%
• Major risk is the fact that bone lost may
not be regained
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