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Performance Nutrition Considerations for Service Members and Veterans

Connecting military family service providers and Cooperative Extension professionals to research

and to each other through engaging online learning opportunities

militaryfamilies.extension.org

MFLN Intro

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Kim Feeney, MS, RD, CSSD, LD, CSCS

•Served just under seven years as an active duty Army officer

•Experience working with tactical, collegiate, amateur, and recreational athletes

•Master’s research project investigated body composition changes in Soldiers attending Ranger School

Today’s Presenter

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Disclaimer

• No conflicts of interest

• Any views expressed are mine and do not necessarily reflect the official policy or position of the Department of the Air Force, Department of Defense, or the U.S. Government

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Learning Objectives

• Accurately assess energy and nutrient needs and provide a nutrition prescription based on physical activity level

• Identify potential benefits and risks of popular dietary trends in athletes

• Objectively evaluate dietary supplements for safety and effectiveness

5Licensed by J Chilek from AdobeStock

Assessing Energy Needs - RMR

• Indirect calorimetry

• Mifflin-St. Jeor– Males: RMR = 10W + 6.25H – 5A +5– Females: RMR = 10W + 6.25H – 5A – 161

• Cunningham– RMR = 370 + 21.6FFM

• Owen– Female athletes: RMR = 50.4 + 21.1W

Where W is weight in kg, H is height in cm, A is age, and FFM is fat free mass in kg6

Assessing Energy Needs - TDEE

• Use Physical Activity Levels (PAL) to account for normal daily activities

• Utilize Metabolic Equivalents (METs) to account for exercise

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METs

• Ratio of working metabolic rate to resting metabolic rate– Oxygen uptake in ml/kg/min

– 1 MET = 3.5 ml/kg/min O2 = 1 kcal/kg/hour

• Does not account for body composition, age, sex, environment, etc.– Not a perfect estimate of energy cost

Ainsworth BE, Haskell WL, Herrmann SD, Meckes N, Bassett Jr DR, Tudor-Locke C, Greer JL, Vezina J, Whitt-Glover MC, Leon AS. The Compendium of Physical Activities Tracking Guide. Healthy Lifestyles Research Center, College of Nursing & Health Innovation, Arizona State University. Retrieved [date] from the World Wide Web.

https://sites.google.com/site/compendiumofphysicalactivities/

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Using METs

MET x kg x hr

75 kg patient who spends 30 minutes running 7.5 mph

–METs: 11.8 kcal/kg/hr

–11.8 kcal/kg/hr x 75 kg x 0.5 hr = 443 kcal

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Using METs

MET x kg x hr

65 kg patient completing an Army Physical Fitness Test (14 min 2 mile)

–METs: 8 kcal/kg/hr (calisthenics); 12.3 kcal/kg/hr (run)

–8 kcal/kg/hr x 65 kg x 0.05 = 25 kcal

–12.3 kcal/kg/hr x 65 x 0.23 = 184 kcal–25 kcal + 184 kcal = 209 kcal

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Assessing Macronutrient NeedsProtein•1.2-1.4 g/kg for endurance

•1.4-1.7 g/kg for strength

•1.5-2 g/kg for weight loss or injury

Fat•1 g/kg for most athletes

•2 g/kg for endurance

•3 g/kg for ultraendurance

Carbohydrate

•3-5 g/kg for light training

•5-7 g/kg for moderate training

•6-10 g/kg for 1-3 hours moderate- to high-intensity

•8-12 g/kg for 4+ hours moderate- to high-intensity

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Macronutrient TimingProtein•Limit pre-workout•0.3 g/kg post-activity

•Remainder divided into meals/snacks every 3-5 hours

Fat•Limit pre-workout•Distribute throughout day

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Macronutrient Timing

CarbohydratesAdequate intake benefits both endurance and stop-and-go sports•1-4 g/kg 1-4 hours prior to prolonged activity

•1-2 hr → 30 g/hr, 2-3 hr → 60 g/hr, 2.5+ hr → ≤90 g/hr

•Replenish with 1-1.2 g/kg/hr for 4 hours after activity if multiple daily activity sessions

– Meeting goal daily CHO intake is adequate for one session a day

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Assessing Fluid Needs

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Assessing Micronutrient Needs

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• Typically similar to non-athlete needs• Vitamin D >40 ng/ml may be associated with

better performance • Sweating may increase electrolyte needs

– Cl, Na, K, Ca, Mg– May use sweat patch to assess

• Iron deficiency is a risk for females• Some nutrient needs increase at altitude

Licensed by J Chilek from AdobeStock

Alcohol• Metabolism

– Impairs glycogen storage

– Decreases muscle protein synthesis

• Thermoregulation– Delays rehydration– Increases peripheral vasodilation

• Skills/balance– Impaired motor skills & strength/power

up to 72 hours after intake

• Injury/illness– Depresses immune function & delays

healing16

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Question Break

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Dietary Trends - Paleo• Diet modeled after foods available for Paleolithic humans

– Include grass-fed meat/organs, seafood, most fresh fruits/veggies, eggs, nuts/seeds, certain oils

– Exclude grains, legumes, dairy, refined sugar, potatoes, processed food, refined vegetable oils, salt

– Hard to find consistent definition/rules

• Many health claims– Short-term may have health benefits;

risk of deficiency long-term

• Expensive

• Lack of research in athletes

• Often encourages exceptions for athletes18

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Dietary Trends – IIFYM

• Freedom to eat whatever fits into your daily macronutrient needs

• Can be high-effort

• Risk of nutrient deficiency

• Ensure appropriate macronutrient distribution

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Dietary Trends - IF

• Limit intake or fasting for a period (16-24+ hours) with refeed periods– Ramadan most frequently studied

• Does result in energy restriction for most

• May require strategic fueling for some athletes

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Dietary Trends - Ketogenic• Diet focused on fueling from fats rather than carbs

– High fat, adequate protein, low carb (4:1 fat to protein+carb)

• Many health claims– Short-term changes in arteries, lipid panel

• Requires time commitment to “adapt”; cannot cheat• Drastic weight fluctuations when starting/stopping• No performance benefit/performance decrements

– May make calorie intake easier for some athletes

– Inadequate protein for strength athletes

• Future research: gut flora

Burke LM, Ross ML, Garvican-Lewis LA, et al. Low carbohydrate, high fat diet impairs exercise economy and negates the performance benefit from intensified training in elite race walkers. The Journal of Physiology. 2017;595(9):2785-2807.

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Dietary Trends – Train Low

• Exercising in a glycogen-depleted state to enhance fat oxidation– 2-a-days, training fasted, training without exogenous

CHO

• Perform glycogen-reducing activity followed by higher intensity activity

• Designed for endurance training (<70%VO2 max) – not high intensity or resistance exercise

• Results in metabolic changes but limited performance changes

Jeukendrup AE. Periodized Nutrition for Athletes. Sports Medicine. 2017;47(S1):51-63. 22

Case Study• 36 yo male – 170.2 cm, 72.3 kg, 8% BF (per BodPod)

• Lifts 60-90 min 5-6x/week (3.5 METs) + low-intensity cardio 20 min 3x/week (5.3 METs)– Goal of gaining muscle mass/strength with limited body fat gain

• Desk job with some walking (PAL ~ 1.5)

• RMR: 1730 kcal (BodPod), 1805 (Cunningham), 1610 (Mifflin St. Jeor), 1670 (HB)

• Nutrition Rx: 3100-3200 kcal, 360-506 g carbohydrate, 101-123 g protein, 72 g fat

– Nutrition Rx from “nutritionist”: 250 g carbohydrate, 250 g protein, 60 g fat

• Back-check to make sure macros fit into calorie needs

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Question Break

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Dietary SupplementsUp to 61% of military men and 76% of military women use supplements

– Vitamins/minerals, sports drinks, protein, energy drinks, creatine

– General health, performance enhancement

Knapik JJ, Steelman RA, Hoedebecke SS, Farina EK, Austin KG, Lieberman HR. A systematic review and meta-analysis on the prevalence of dietary supplement use by military personnel. BMC Complementary and Alternative Medicine. 2014;14(1).

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Supplement Benefits

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DietWorkout program

Rest/Recovery

Supplement Benefits

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DietWorkout program

Rest/Recovery

Supplements

Supplement Benefits

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Supplements

Supplement Red Flags

• Proprietary blends• Unrealistic claims• Hormone-related mechanisms• Alternative to FDA-approved medication• Quick fixes• “May cause a positive result on a

performance-enhancing drug test”

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Common Supplements

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Low High

Arginine, glutamine, chromium, carnitine, quercetin, ribose

Aromatase inhibitors, DHEA, growth hormone

Amino acid blends, beetroot extract, beta-alanine, HMB,

BCAAs, proteinEPO, citrus aurantium (bitter orange),

ephedra

Caffeine, creatine, omega-3s

Risk Level

Ben

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Leve

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Mod

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igh

Third Party Certification

• Sport-specific certification:– NSF Certified for Sport®: http://nsfsport.com/listings/certified_products.asp– Informed Choice: http://www.informed-choice.org/certified-product-brands– BSCG Certified Drug Free®: https://www.bscg.org/certified-drug-free-dietary-supplements/– Consumer Lab®: https://www.consumerlab.com/results/brands_vitamins_supplements_list.asp

• General certification– USP™: http://www.usp.org/verification-services/program-participants

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Case Study

• 24 yo M deployed service member

• Goal: increase muscle mass/gain weight

• Eating low CHO, inadequate calories, “clean” foods

• Lifting 90-120 min 5+x/week

• Taking preworkout, BCAA,AA blend, mass gainer, Vitapak, etc

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Supplement Resources

• Operation Supplement Safety– https://www.opss.org/

• Natural Medicines Database– Linked through OPSS & SCAN

• NIH Office of Dietary Supplements– https://ods.od.nih.gov/

• US Anti-Doping Agency– https://www.usada.org

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Licensed by J Chilek from AdobeStock

Take Away Points

• Prioritize carbohydrate and protein volume and distribution

• Fad diet may be acceptable if sustainable for patient and nutrient needs are met

• Push smart supplement use

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Questions

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Connect with MFLN Nutrition & Wellness Online!

MFLN Nutrition @MFLNNW

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Evaluation & Continuing Education Credits

MFLN Nutrition & Wellness is offering 1.0 CPEU for today’s webinar.

Please complete the evaluation at: https://vte.co1.qualtrics.com/jfe/form/SV_3CTEwye8O9BE901

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MFLN Intro

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We invite MFLN Service Provider Partners to our private LinkedIn Group!

https://www.linkedin.com/groups/8409844

DoDBranch Services

ReserveGuard

Cooperative Extension

MFLN Nutrition & WellnessUpcoming Event

• Plant based eating: Enhancing health benefits, minimizing nutritional risks• Tuesday, January 23, 2018• 11:00 am – 12:00 pm Eastern• https://learn.extension.org/events/3203

For more information on MFLN Nutrition & Wellness go to:

https://militaryfamilies.extension.org/nutrition-and-wellness

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www.extension.org/62581

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