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SPECIAL POPULATIONS Lona Sandon, M.Ed., R.D., L.D. Assistant Professor Reference: Fink HH, Burgoon LA, Mikesky AE, eds. Practical Applications in Sports Nutrition. Sudbury, MA: Jones and Bartlett

Sports: Special populations lecture

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Page 1: Sports: Special populations lecture

SPECIAL POPULATIONS

Lona Sandon, M.Ed., R.D., L.D.Assistant ProfessorReference: Fink HH, Burgoon LA, Mikesky AE, eds. Practical Applications in Sports Nutrition. Sudbury, MA: Jones and Bartlett

Page 2: Sports: Special populations lecture

OBJECTIVES

Describe the unique needs of diabetic, vegetarian, pregnant, adolescent, collegiate, and masters athletes

Provide guidelines and recommendations for meeting nutritional needs in the populations listed above

Provide recommendations for managing blood glucose with exercise

Page 3: Sports: Special populations lecture

SPECIAL CONSIDERATIONS: DIABETES Complications of diabetes

Altered carbohydrate metabolism – unable to get glucose into cells for energy

Hyperglycemia Sugar in urine = higher urine output =

higher risk of dehydration Ketosis/ketoacidosis – caused by fat

breakdown for energy Protein breakdown – loss of lean body mass,

muscle weakness, weight loss Increases risk for heart and kidney disease Causes peripheral nerve damage

Page 4: Sports: Special populations lecture

SPECIAL CONSIDERATIONS: DIABETES

Exercise – Important part of

treatment for both Type I & II

Helps makes cells more receptive to insulin

Improve glucose transporter activity independent of insulin

May help lower blood glucose for several hours after exercise

Can lead to hypoglycemia More frequent monitoring

of blood glucose is needed

Page 5: Sports: Special populations lecture

COMMON SYMPTOMS OF DIABETES

Excessive thirst Excessive urination Dehydration Dizziness Headache Blurred vision

Unexplained weight loss

Excessive hunger Poor wound healing

Page 6: Sports: Special populations lecture

DIABETES AND EXERCISE

TYPE 1 TYPE 2 Requires careful self-

monitoring Timing of insulin Dosage of insulin Timing of meals Meal composition

Comparatively easier to manage

Requires some self-monitoring

Insulin not usually required because exercise enhances glucose uptake

Page 7: Sports: Special populations lecture

PRE-EXERCISE GLUCOSE GUIDELINES

Pre-exercise glucose (mg/dL)

Recommendation

<100 Eat 15-40 g CHO prior to exercise

>250 Test for ketones

>250 with ketones

Don’t exercise, adjust insulin and retest

>250 without ketones

Exercise permitted

>300 without ketones

Exercise with caution

Adapted from table 15.2 p. 463

Page 8: Sports: Special populations lecture

SIGNS AND SYMPTOMS

HYPOGLYCEMIA HYPERGLYCEMIA

Sweating Rapid heart rate Hunger Shaking Confusion Lethargy Poor coordination Slurred speech Irritable Headache Nausea

Nervousness Restlessness Thirst Fatigue Blurred vision Muscle cramps Nausea Abdominal pain

Adapted from table 15.3

Page 9: Sports: Special populations lecture

NUTRITIONAL RECOMMENDATIONS FOR ATHLETES WITH DIABETES

Maintain a consistent eating schedule

Eat same amount of CHO each day Carefully monitor BG, meal timing,

insulin, and exercise to understand individual needs and response

Page 10: Sports: Special populations lecture

DIABETIC ENDURANCE ATHLETES

Consume CHO during & after exercise Type of CHO not as important as amount & timing

Type 1 diabetes - 15 to 30 grams of CHO every 30 to 60 minutes during exercise

Ex: 8 oz of 6% to 8% sports drink 1 single serving of sport gel 1 fig bar 8 oz of 1:1 juice to water mix Sports bars Cookies

Must have CHO foods handy

Page 11: Sports: Special populations lecture

DIABETIC EMERGENCIES

Hyperglycemia during exercise – not enough insulin

Insulin secretion goes down during exercise while glucagon & other hormones increase leading to release of glucose into the bloodstream

Keep insulin and syringes available

Challenges Keeping insulin refrigerated &

sterile syringes

Page 12: Sports: Special populations lecture

DIABETIC EMERGENCIES

Hypoglycemia – too much insulin

Eat CHO during & after exercise Have glucose tablets, juice, or

regular soda available BG lowering effects of

exercise can extend for several hours, check BG 2-3 hours post exercise

Coaches, parents, & teammates must know what to do

Page 13: Sports: Special populations lecture

PREGNANT ATHLETES

Can train and compete throughout pregnancy

May need to decrease training intensity & volume

Follow MD’s recommendations

Nutrition needs increase

Page 14: Sports: Special populations lecture

NUTRITION CONCERNS FOR PREGNANT ATHLETES

Increased need for: Calories Protein B vitamins Vitamin C Vitamin A Magnesium Iron

Page 15: Sports: Special populations lecture

CALORIC INTAKE FOR PREGNANT ATHLETES

Additional 300 kcals/day needed Must consider calories needed for training Add 1-2 snacks between meals Training may decrease throughout pregnancy,

requiring an adjustment in kcals Increased kcal needs most important in 2nd &

3rd trimesters Monitor weight gain using pregnancy charts

For normal weight at start: 25 to 35 lbs gain recommended

Weight dependent sports & eating disorders put women at risk of not gaining adequately

Page 16: Sports: Special populations lecture

PROTEIN FOR PREGNANT ATHLETES

Need an extra 20 to 25 grams of PRO/d 3 cups of skim milk 3 oz of beef, chicken, or fish 1.5 cups of beans, lentils, or other legumes 3 oz of nuts

If kcal intake is adequate, usually PRO is too Recommend whole foods Vegetarians may have difficulty meeting needs Low PRO – associated with poor recovery,

fetal growth, immune functioning, fatigue

Page 17: Sports: Special populations lecture

B VITAMINS FOR PREGNANT ATHLETES

Folate critical for: DNA synthesis Red blood cell

production Development of

nervous system Recommended intake is

600 µg/day. Lack of folate may

lead to: Megaloblastic anemia Fatigue Depression, irritability

Page 18: Sports: Special populations lecture

VITAMIN C FOR PREGNANT ATHLETES

Critical for collagen formation, hormone synthesis, and immune function

Improves absorption of iron

Increase intake to 80 to 85 milligrams/day

Page 19: Sports: Special populations lecture

VITAMIN A FOR PREGNANT ATHLETES

Needed for cell differentiation and immune function

750 to 770 µg (RAE)/day

Choose foods, not supplements

Page 20: Sports: Special populations lecture

MAGNESIUM FOR PREGNANT ATHLETES

Required for muscle contraction and energy production

Increase by 40 mg to 350 to 360 mg/day

Page 21: Sports: Special populations lecture

IRON PREGNANT ATHLETES

Required for RBC production, oxygen delivery, energy level

Increase to 27 mg/day

Meats, legumes, fortified grains

May need a supplement

Page 22: Sports: Special populations lecture

CHILD/ADOLESCENT ATHLETES

Need enough calories for normal growth & development & meet activity needs

Lack of kcals may result in stunted growth

Energy & nutrient restriction may affect bone mass & normal sexual maturation

Page 23: Sports: Special populations lecture

CHILD/ADOLESCENT ATHLETES

FLUID REQUIREMENTSVITAMIN/MINERAL REQUIREMENTS

Child athletes have poor heat tolerance

Typically do not drink enough & need reminders to drink

Flavored beverages are better tolerated & likely to drink more

Sports drinks are appropriate on the field, but not off

Provide plenty of hydration breaks

Calcium - 1,300 mg/day for children 9–18 years

Iron

Age/Sex Iron (mg)

9-13 yrs, M/F

8

14-18 M 11

14-18 F 15

Page 24: Sports: Special populations lecture

NUTRITION FOR COLLEGE ATHLETES

Meal planning & cooking skills needed

May have higher kcal needs due to higher training demands

Address alcohol intake

Quick easy meals/snacks for on the go

Page 25: Sports: Special populations lecture

NUTRITION FOR COLLEGE ATHLETES

Meal planning Provide the when,

what, & how much to eat

Consider the where: dorm cafeterias, team

training tables, on the road, student apartments, vending machines

Grocery lists helpful No skipping meals

Page 26: Sports: Special populations lecture

ATHLETES & ALCOHOL

Use tends to be higher in college athletes than non-athletes

Binge drinking common

5 or more drinks for Men

4 or more drinks for Women

Males more likely to binge drink

Page 27: Sports: Special populations lecture

ATHLETES & ALCOHOL

Calories without nutrition

Does not replenish CHO stores despite what you see in adds

Can increase body fat

Stimulates appetite

Page 28: Sports: Special populations lecture

MASTERS ATHLETES

40 – 50 + yrs Nutrient needs

Kcal needs decrease Decreased need for

iron Increased need for

vitamin D, Ca++, Mg++

Chronic diseases Heart disease Diabetes High blood pressure Arthritis, etc.

Food/drug interactions

Page 29: Sports: Special populations lecture

MASTERS ATHLETES

MACRONUTRIENT NEEDS

PRO = 1 -1.2 g/kg CHO = 50-65% kcal Fat = 20-30%

Page 30: Sports: Special populations lecture

MASTERS ATHLETES

Iron = 8 mg M/F Do not use supplements

with iron Ca++ = 1200 mg M/F

Encourage foods sources Supplements may be

needed Vit D = 600 IU’s +

Less efficient synthesis as we age

Supplement may be needed Mg++ - drug-nutrient

interaction with diuretics

Page 31: Sports: Special populations lecture

FAMOUS VEGETARIAN ATHLETES

Page 32: Sports: Special populations lecture

VEGETARIAN ATHLETES

Determine type of vegetarian Semi, pesco, lacto-ovo, vegan

Plan wisely Complementing proteins Dairy & meat substitutions

Nutrients of most concern for Vegans Vitamin D and B12

Zn, Ca, Fe intake

Page 33: Sports: Special populations lecture

PROTEINS FOR VEGETARIANS

Beans/legumes Soy/soy milk Tofu Nuts/seeds Nut butters Whole grains,

fortified grains Whole wheat pasta Brown rice

Page 34: Sports: Special populations lecture

VEGETARIAN ATHLETES

Nutrient Vegetarian Food Source

Iron Tofu, nuts, seeds, fortified cereals & grains

Zinc Whole grains, fortified cereals, legumes, nuts, seeds, & dairy products (needs may be 50% higher than non-vegetarians due to bioavailability)

Calcium Dairy, yogurt, fortified juices, cereals, & breads, fortified soy milk

Vitamin D Fortified foods, sunlight

B12 Not available in plant foods, found in dairy, fortified cereals & soy milks, fish; supplement may be needed for vegans

Page 35: Sports: Special populations lecture

SUMMARY

Must individualize nutrition recommendations to accommodate unique needs

Diabetic athletes should closely monitor BG, training schedule, & food intake to establish best plan

Athletes taking insulin must be prepared to treat hyper & hypoglycemia during & after exercise

Pregnant and young athletes must eat enough calories for growth & development as well as activity

Colleges athletes benefit from help in meal planning Masters & vegetarian athletes must pay attention to

specific nutrients