BY DR. ANTHONY D. ELKINS
Let’s face it — most of us and our children have terrible diets. For many families, fast food or takeout, sugary drinks, and food “on the go” to keep up with our hectic lifestyles are the norm rather than the exception.
Convenient food is usually high-calorie and lownutrition but can honestly taste good. However, there’s a catch.
The food industry has engineered foods to be more processed to keep us wanting to eat more often and with larger portions. This has resulted in an epidemic of overweight and obese children, adolescents, and adults. According to the CDC, in North Carolina, an estimated 15 percent of adolescents are overweight (BMI 25-29), and 13 percent are obese (BMI > 30). Only 26 percent of adolescents get 60 minutes of physical activity per day.
Sports participation has many benefits, including fostering teamwork, competition, an active lifestyle, goal achievement, stress reduction, and self-esteem. Not to mention the benefits sports have on health, such as weight loss and lowering the risk of chronic diseases like diabetes and high cholesterol. Some athletes may even choose to dedicate themselves at a high level in hopes of participating in college or a professional level.
As a sports medicine physician, I see athletes of all levels, and almost all of them focus more attention on exercise and training and less on nutrition. “You can’t outrun a bad diet” is a common adage in the sports nutrition field. Part of successful sports participation is a healthy diet that facilitates optimal performance. For many of our kids, they do not have a healthy diet or even a healthy relationship with food, so where do we start?
First, it’s important to note that there is not one “right” diet or “best” diet. Each child will have specific needs and preferences, and each sport will have different nutritional needs. For instance, a marathon runner will have a significantly different diet than a football player. Also, the term “diet” is probably misused as it evokes a sense of deprivation or starvation. A better term is “eating plan” or “food plan.”
In this article, I’ll discuss some of the basics of healthy eating that pertain to sports participation and how families can support their young athletes to even adopt healthier eating habits.
For some athletes, strict adherence to an eating plan is essential and even expected. For some, it can be too restrictive, radical, and even anxiety-provoking when they aren’t successful. Some children can even develop eating disorders when food becomes too important and tied to their success. Extreme calorie restriction or excessive weight loss can result in hormonal abnormalities and altered pubertal development. The great majority of young athletes participate for fun and not because they plan to become competitive athletes at higher levels. Thus, most children should not be held to unreasonably strict or regimented diets. Those highly competitive athletes warrant consultations with their physician, personal trainer, or dietician to ensure they are following an eating plan that promotes optimal performance. So parents need to monitor their children to ensure they are realistic and safe in their eating plans.
Below, I will answer a few questions about sports nutrition for your child athlete:
Why is it important for a child athlete to have nutritious meals?
Food for the athlete may be thought of as optimal fuel for the machine. Eating the right nutrients in the right amount and at the right time can facilitate better performance and reduce the risk of injury. There are eating plans that can facilitate gaining strength, speed, endurance, and aid in weight loss or weight gain. It’s also important to remember that a proper eating plan will facilitate academic success. Nutritious foods will promote a healthy weight and enable physical, emotional, and pubertal development.
How can a healthy diet help athletes lower the risk of injury and perform better?
Some of the most common injuries in young athletes are heat illness (exhaustion/dehydration) and muscle damage, including strains and muscle breakdown, known as rhabdomyolysis. This is often seen in “new” athletes who exercise too hard or overexert themselves before their bodies have become properly conditioned. Rhabdomyolysis is potentially dangerous and often requires hospitalization. However, these injuries are entirely preventable with proper nutrition, hydration, and an appropriate training program. Coaches want to push their athletes to perform at their best, but sometimes above that athlete’s ability. Parents need to monitor their child to ensure they are not overtraining.
What are some of the key nutritional needs for an active child?
♦ Hydration. Most of us do not get enough water even for non-physical activities. It is recommended to drink ½ ounce of fluid per pound of body weight. Thus, a 160-pound athlete should drink 80 ounces per day. Water is the most basic hydration fluid, but actively exercising athletes will lose electrolytes (sodium and potassium), so these need to be replaced as well.
Sports drinks such as Gatorade and Powerade are sufficient. Sports drinks also contain carbohydrates to provide fuel for actively exercising muscles. However, sports drinks have as many calories as soda. It is not recommended to drink sports drinks unless you are actively exercising. Two to three hours prior to exercise, the athlete should consume 16 ounces of water or sports drink, followed by 8 ounces 10 to 20 minutes prior to exercise. Appropriate hydration during exercise will depend on levels of exertion, sweating, and urination but generally means another 8 ounces every 10-20 minutes.
♦ Calories. Calories represent the energy content of food and how much it will fuel the muscles, organs, and brain. Everyone needs a basic number of calories for basic bodily function, even if you are sitting in bed all day with no physical exertion at all. This is known as basal metabolic rate, or BMR. The BMR is influenced by age, sex, weight, and height. Formulas to calculate this are complex but are available online at www.calculator.net. The BMR is then multiplied by a factor representing how physically active you are, known as total daily energy expenditure (or TDEE). More physical activity requires more calories and has a higher TDEE. BMR x TDEE = total daily calorie need. This is only an estimate and is influenced by many factors, but it is a good baseline to start from. As an example, a 16-year-old, 110-pound, 5-foot-7 female exercising daily with vigorous exercise 3 or 4 times per week has a daily calorie need of 2,000 calories.
There are good calories (fruits, vegetables) and bad calories (chocolate, soda). There are three basic calorie sources known as macronutrients: carbohydrates, protein, and fats. The macronutrient ratio indicates the percentage of each macronutrient one consumes. The ratio depends on nutrition and fitness goals. Carbohydrates are readily available fuel for the body to utilize for energy. Protein is the building block of muscle. Fat is where energy is stored. All macronutrients are important for different activities.
♦ Protein. Protein intake will vary based on the type of exercise and if there is a goal to increase muscle mass. A general rule of thumb is to consume 0.8 – 1.8 g/kg of body weight for a person who is minimally active. For one who is highly active, 1.8 – 2g/kg might be appropriate. As an example, a 160 pound football player (70 kg) might need 140 grams of protein per day.
♦ Carbohydrates. Carbohydrates are the most readily available source of fuel for the body. Not all carbs are healthy, however. Sugars, like those in soda or candy, are referred to as simple carbohydrates and have lower nutritional value. Carbohydrates in starches or fiber are complex carbohydrates and have higher nutritional value. These include vegetables, fruits, and whole grains. “Good carbs,” which have higher nutritional value, generally contain a low or moderate number of calories, do not contain refined sugars, are high in natural fibers, and are low in saturated fats. The amount of carbs your young athlete needs varies on the amount and type of exercise, as well as fitness and weight goals.
What are some nutrition tips for my child athlete?
Don’t skip meals. Too often, kids are busy, late, and run out of the house to school without breakfast. Inadequate calories will impair physical and academic performance. Make sure to have a plan. A successful student and athlete will know when and where each meal is coming from. Plan meals for the week on Sunday. At a very basic level, make sure your child athlete has at least three meals per day.
♦ Cook food at home. You can make food for your child at home and have them bring it to school instead of buying it at the cafeteria or bringing food from a restaurant. This way, the nutritional content of the meal can be individualized and ensured it meets their needs.
♦ Pack a nutritious lunch. Make sure to pack water in your child’s lunch. You can also include low calorie sports drinks (Gatorade G2 or Zero) and flavored water. Avoid carbonated drinks, juice, or caffeinated drinks. Pack healthy proteins, such as chicken breast, lean beef, tuna, Greek yogurt, hummus and pita bread, or peanut butter on celery sticks. Include healthy carbs such as whole grain bread, fruit (especially berries), or carrots. Avoid sweetened drinks, juice, candy, pasta, white breads, and potatoes. You can also add quick grab-and-go options like cheese sticks, carrot sticks, Greek yogurt cups/tubes, protein bars or granola bars (careful not to get those higher in sugar), fruit (apple, berries), beef jerky (again, be careful to avoid those higher in sugar), or mixed nuts.
♦ Fuel your child on game day. The actual event will perhaps involve the highest intensity, longest duration, and focus of the week. Thus, the nutritional recommendations I have provided below are especially important on game day. These recommendations are:
• Hydrate! Drink sports drinks such as Gatorade, or water 16 ounces 2-3 hours before play, 8 ounces 10-20 minutes before, 8 ounces every 10-20 minutes or when possible during breaks.
• The day before or of the game can be a higher carbohydrate day, often known as “carb loading.” Increase the carbohydrate amount by about 100g/d over the usual amount. This will provide readily available energy to use and increase the glycogen stores in the body, which is used for a quick source of reserve energy when blood sugar levels get expended. Have a carbohydrate-containing snack 1 hour before participation (healthy carbs, such as a piece of fruit, energy bar, or milk).
• Heavy foods which take extra time to digest should be minimized. These include processed foods (fast food), coffee drinks, candy, and pasta. The goal is to have an empty stomach but not an empty energy reserve at the time of play. Otherwise, the athlete may feel sluggish, less flexible, or more prone to nausea.
• Specific sports will have their own nutritional needs. I do have a word of caution for sports that are dependent on weight, such as wrestlers, boxers, weightlifters. These athletes are often coached to adopt an extreme diet approach on the day of competition to gain or lose weight quickly to qualify for a specific weight class. These practices are potentially dangerous for the young athlete. They should not be followed during noncompetition days. They are not sustainable. They may result in an unhealthy relationship with food or eating disorders. Such athletes need to be monitored carefully.
Recovery nutrition after the game. After a period of high-intensity or prolonged activity, the body will have expended carbohydrates, fluid, and electrolytes that need to be replenished. Muscles will be fatigued or even broken down by high levels of activity. This period represents an especially important time for proper nutrition to ensure recovery and repair. Below are my recommendations for nutrition after the game.
• Commercially available “recovery” drinks and supplements are popular and, for the most part, are helpful. These generally include protein and carbohydrates to repair muscle and
• Eat carbohydrates that are easily digested, such as milk, bananas, low-sugar juices, and peanut butter.
• Hydrate! Drink 16 ounces of water or sports drink in the hour following the event.
Should my child use sports supplements?
Sports supplements are a $6 billion/year industry. Promises of better performance, reduced risk of injury, bigger muscles, and better recovery are emphasized in the media. However, for all but the most competitive athletes, sports supplements provide little additional benefit. Talk to your child’s physician if you’re interested in learning more about what would be appropriate for your child athlete.
In summary, sports nutrition is a complex topic and needs to be individualized for each athlete. For the great majority of young athletes, sports participation is fun and has physical and mental benefits. I encourage my young patients to consider sports participation simply for the benefit of regular physical activity. For these, the sport can prompt healthy eating habits to improve performance. Benefits can be obtained even with a basic understanding and emphasis on healthy eating habits. It does not have to be complicated, time-consuming, radical, or extreme. Those competitive athletes or those very dedicated to their sport are best served by consultation and regular follow-up by a sports medicine physician, certified athletic trainer, or sports nutritionist.
Dr. Anthony Elkins practices at Iredell Primary Care in Mooresville and is accepting new patients. He treats patients of all ages, from babies to seniors. Though Elkins can treat all your primary care needs, he also provides specialty sports medicine consultations. If your child experiences an injury on or off the field, Elkins can help. To schedule an appointment with Dr. Anthony Elkins, please call the office at 980-435-0406. Online scheduling is also available at IredellPrimaryCare.com.
About Iredell Health System
Iredell Health System includes Iredell Memorial Hospital; Iredell Mooresville; two urgent care centers; Iredell Home Health; Iredell Wound Care & Hyperbaric Center; Community and Corporate Wellness; Occupational Medicine; the Iredell Physician Network and more. Iredell Memorial Hospital is the largest and only nonprofit hospital in Iredell County. The comprehensive healthcare facility has 247 beds; more than 1,800 employees; and has 260 physicians representing various specialties. Centers of excellence include Women’s and Children’s; Cardiovascular; Cancer; Surgical Services and Wellness & Prevention. The Health System’s second campus, Iredell Mooresville, is home to the area’s only 24 hour urgent care facility, as well as an ambulatory surgery center, imaging center, rehabilitation services, and physician practices. The mission of Iredell Health System is to inspire wellbeing. For a comprehensive list of services and programs, visit www.iredellhealth.org.