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Helping Athletes with Eating Disorders

An estimated 30% to 60% of female athletes struggle with food, as do 10% to 33% of male athletes. Many of these athletes believe they are not “sick enough” to seek treatment. Others are too ashamed to ask for help. And some believe getting treatment will hinder them from reaching athletic goals. They fear:

1) they will gain weight, and any added weight will impair their performance.
2) they will not be able to participate in training or competitions during treatment, hence will lose status with their team; and
3) they might displease their coaches and teammates.

But the questions they want to ponder are:

What do you think your future will look like with the eating disorder?
Are you satisfied with your current quality of life?

At the October 2022 Food and Nutrition Expo and Conference of the Academy of Nutrition and Dietetics (the nation’s largest group of nutrition professionals), sports nutritionist Page Love MS RD CSSD (nutrifitga.com) of Atlanta and psychologist Ron Thompson PhD of Bloomington IN (rthomps2@att.net) addressed the topic of Athletes with Eating Disorders. They shared insights from their years of professional experience. This article passes along some of their words of wisdom and offers insights into why some athletes struggle with food, body image, and weight issues. and hopefully will nudge athletes’ friends, family, and loved ones to encourage these athletes to seek help.

• When dieting goes awry and eating disorders take hold, relationships and quality of life suffer, to say nothing of longevity as an athlete. Athletes with eating disorders (ED) can easily believe they have more reasons to keep the eating disorder than they do to give it up. Eating disorders can distract from difficult emotions; offer a source of power and control; give a sense of security; provide an excuse for anything and everything; sustain an identity; offer a way to be angry, self-abusive, special, rebellious, and competitive inside and outside of sport.

• Given many athletes with EDs are in denial of the seriousness of this mental health disease, Dr. Thompson has asked his clients, “Do you realize that people with your disorder sometimes die?” Indeed, athletes can—and have—died from eating disorders, often via suicide. Looking from the inside out, an athlete’s life can feel very stress-filled, despite the athlete appearing happy, bubbly, and “just fine” on the outside.

• Ideally, food should be one of life’s pleasures, as well as an enjoyable source of energizing fuel that enhances performance. If you stop eating at mealtimes just because you think you should, or because your allotted portion of food is all gone (but you are still hungry), you might want to ask yourself a few probing questions:

–What are your food rules and nutrition beliefs that restrict your food choices and portions?

For example, do you forbid yourself to eat second helpings?

–What percent of your time do you spend thinking about food and weight?

Thinking about food includes shopping for food, preparing food for yourself and others, reading cookbooks or other food- and diet-related publications, binge-eating, purging, and thinking about how much you ate at your last meal. When the answer is “I spend way too much time thinking about food; it dominates my thoughts”, you likely have a problematic relationship with food and are living in a state of hunger. That’s no fun, and also limits your ability to fully recover after a hard workout, heal the micro-injuries that occur during hard workouts, and perform optimally. “Normal eaters” think about food as they appropriately get hungry before a meal or snack.

–Do you enjoy eating socially with friends and teammates?

Or do you avoid such situations?

–Are your food allergies and intolerances real?

Or are they convenient excuses to avoid certain foods?

–Ladies, do you currently have regular menstrual periods?

Amenorrhea—loss of menses—can be a sign of under-eating, to the point of disrupting normal body functions.

–Gentlemen, are you experiencing reduced sex drive?

Loss of morning erections can be a sign of under-eating, to the point of disrupting normal body functions.

–Does your family have a history of eating issues, dieting practices, and/or mental health concerns?

If yes, how have those issues influenced your food habits?

• Chronically underfed bodies can end up “hibernating,” with slowed metabolic processes. Symptoms related to inadequate fueling include fatigue, lack of energy, dehydration, anemia, frequent injuries, amenorrhea, stress fractures, and “weird” eating habits. These are all good reasons to seek help from a registered dietitian who specializes in sports nutrition (RD CSSD). The referral network at eatright.org can help you find a local RD CSSD).

• Most of my clients report, “I know what I should eat. I just don’t do it.” Given today’s confusing food environment, any athlete with nutrition questions and weight concerns would be wise to meet with a sports RD to learn how to overcome barriers that limit optimal fueling. Don’t let (self-imposed) shame or embarrassment stop you. Eating “right” is not as simple as it once used to be.

• All food can fit into a balanced sports diet—even fatty foods. Athletes should consume at least half of their calories from (preferably nutrient-rich) carbohydrate, and at least 20% of calories from (preferably health-promoting) fat. A fat intake less than that increases the risk of inadequate energy intake.

• If you live in Food Jail and consume a very repetitive but “safe” diet, a sports RD can help you expand your menu so you can consume a wider variety of nutrients. If you want to try to do this on your own, start by making a list of your fear-foods (foods you are afraid to eat because they lack nutrient-density or because you deem them to be “fattening”). Challenge yourself to include at least one food each day into your meals and snacks, starting with the easiest and ending with the hardest foods. With time, you’ll be able to enjoy social eating with your friends and teammates.

• Notice that other athletes look forward to, let’s say, a special holiday gathering like a New Year’s Brunch—but you don’t because the foods will be way too fattening or you’re afraid you’ll end up eating way too much. Other athletes can eat holiday treats; why can’t you? Your body is not different from everyone else’s and will not “get fat on you.” The problem isn’t the food or your body, but more likely your self-imposed food rules.

• Few athletes will ever achieve a perfect body. Please don’t measure your self-worth as an athlete by your body weight or size. You may be an athletic person, but you are also a human, like the rest of us, and are excellent the way you are.

Nancy Clark MS RD CSSD counsels both fitness exercisers and competitive athletes in the Boston-area (Newton; 617-795-1875). Her best-selling Nancy Clark’s Sports Nutrition Guidebook is a popular resource, as is her online workshop. Visit NancyClarkRD.com for info.


Restrictive Diets vs. Informed Dieting

Dieting has become so popular that it seems like I know someone who is on a diet of some sorts. While allergies can play a role in what choices you make in regards to your food intake, most of us make decisions based on clever sales tactics from the social media platforms, enthusiasts that claim it’s worked for them and some misinformed medical professionals who assert they have it all together.

The truth is there isn’t a one size fits all “diet” out there. Not everyone will receive the benefits of a keto, paleo, vegetarian, low carb, low fat, sugar free, intermittent fasting, detox, gluten free, dairy free, etc. diet. Listening to what others are promoting has little effect on it working for you. This is called restrictive eating.

Restrictive Eating

Restrictive eating is telling yourself you “can’t” have this or “shouldn’t ” eat that based on what everyone else is selling you. Restrictive eating messes with the cortisol and growth hormones in your body that ultimately make you want that food even more because you “can’t” have it. I’m not talking about allergies, I’m talking about the choices that we make because the most popular celebrities are promoting it, or your best friend from high school is improving her health and sharing it with the world on every social media platform. Restrictive eating often leaves your body depleted of important nutrients and minerals. Restrictive eating creates an unhealthy relationship with food, which is essential to our existence. Restrictive eating can also create social barriers as you refuse to eat others offerings or become judgmental towards what others are choosing to eat.

Informed Eating

Informed eating is a journey of listening to your body. It’s not listening to your brain, but your body. Let me share the difference. Your brain thrives on increasing the “feel good” hormones, even if it doesn’t make the best choice in doing so. For example, the brain loves addiction of any kind and it’s harmful to your health simply because you aren’t displaying command of your brain. Listening to your body takes time and skill, of which a lot of people aren’t willing to commit to for THEIR own good! Let me give you an example from my life…


I love bread! I mean LOVE it! I could literally sit on the couch with a whole loaf of French bread and eat it without thinking twice, UNTIL I learned to listen to my body. I wasn’t willing to listen to the discomfort that followed, nor was I willing to make any changes. I want to help you understand what I did about it. I HAVE NOT taken bread out of my diet, however, I have made informed decisions about the consequences that could result if I ate the whole loaf. Now instead of questioning, I know exactly why I feel rotten or why I feel great when given the opportunity to indulge.

My point is, EVERYONE’S body is different BUT there is a diet that fits everyone. Wait for it…

No More “Dieting”

It’s called the informed diet! Not intuitive eating, not restrictive diets, not overloading or cutting out. It’s listening to your body and knowing how to care for it. BUT IT’S NOT EASY!

MODERATION is key to nutritional success. With an informed eating diet, it becomes your lifestyle and your choices are more congruent with how you feel, not how you look to others. Your emotions are regulated better, not suffering from indulging in some “bad” food that others have deemed “bad”. You learn to appreciate how food works for you in increasing your energy.

My charge to YOU

Clean up the habit of restrictive dieting. Clean up the habit of eating too much food. Clean up the habit of calling food “good” or bad”. Stand up and be a healthier YOU by truly listening to what your body needs and how it reacts to those foods. Be honest with yourself!

We should be seeking a way of life that will increase our ability to perform all that we desire with energy and health.

Diana Smithson is Owner of Stronger Today Fitness, a Small Group/Personal Training Studio in Surprise, AZ. Her passion for Fitness and Health creates excitement and encouragement to all she trains with. She enjoys being in the mountains, hanging with her family and sleeping.

Originally printed on strongertodayfitness.com. Reprinted with permission.


New-Trition: Cleaning Up Your Act

The winter holidays are often a barrage of non-stop feasting that spans from Thanksgiving to the Super Bowl. Week after week, you indulge yourself with goodies, justifying your poor food choices in the name of holiday cheer. You promise yourself to mend your ways as soon as the excitement dies down, but meanwhile the pounds creep on and bad nutrition becomes the new normal. Cleaning up your act is a process, but you can speed it up by taking some proactive steps.

Let It Go

Gifts of food abound during the holidays, and if you are like me, you still have plenty of sweets, snacks and junk food in your fridge and cupboards. To get your diet back on track, begin by banishing the bad stuff. If you cannot bear to throw perfectly good food in the trash, donate to your local food bank or homeless shelter. Or throw one final bash, featuring your holiday stash of goodies as the main course. Clean and organize your refrigerator to make room for fresh produce, filtered water and whole foods. Rearrange your cupboards so that healthy food options are at eye level.

Clean Routine

Sugary foods and carbohydrate-laden snacks and meals are holiday mainstays that can wreak havoc with your insulin balance. Going cold turkey on the simple carbs can cause discomfort and cravings that last for two or three days, but it is one of the quickest ways to normalize your blood sugar and reset your metabolism. Adding high intensity exercise can speed up the process. Create a menu plan for your week that includes fresh fruits and vegetables and healthy proteins, and stock your fridge with ingredients. Planning and preparing healthy snacks and meals ahead of time will keep you from being tempted to grab fast food.


The end of the Holiday Season does not necessarily mark the end of the eating season. Valentine’s Day and Girl Scout Cookies loom on the horizon. Prepare for the onslaught by making committed decisions in advance. Instead of preparing special foods for Valentine’s Day, plan a romantic getaway or a movie date night. Ask your sweetie for flowers or jewelry instead of candy. Decide ahead of time to purchase only one box of Girl Scout cookies, and ration them out at the rate of one cookie per day. If you want to help out the Scouts, they accept donations in lieu of a cookie purchase.

Jay Del Vecchio is the Founder and CEO of the World Instructor Training Schools (W.I.T.S.). Jay is an advocate for establishing national standards for the health and fitness training industry. 



Chocolate and Athletes

During a long bike ride, I snack on chocolate to boost my energy.

After a hard workout, chocolate milk is my go-to recovery food!

How bad—or good—is chocolate for me?

Most athletes love chocolate in any form: candy bars, chocolate chip cookies, squares of dark chocolate. Over 60% of all US candy sales are chocolate-based. But how good—or bad—is chocolate for our health? Is it as health-promoting as we want it to be? What about all the sugar and caffeine that comes with the chocolate? Is dark chocolate a far better choice than milk chocolate? Below are answers regarding chocolate and your sports diet.

Is dark chocolate really a “health food”?

Chocolate is made from the fruit of cacao trees. Like all fruit, the cacao bean is a rich source of health-protective phytochemicals (flavonoids) that are antioxidants and fight inflammation. Roasted beans are used to create cocoa. Two tablespoons of natural cocoa powder (the amount in one cup of homemade hot cocoa) offer the antioxidant power of 3/4 cup blueberries. Impressive!

The darker the chocolate, the better in terms of health-protective flavonoid content. Unfortunately, dark chocolate has a bitter taste, and many athletes prefer milk chocolate; it’s sweeter. That said, epidemiological surveys of large groups of people indicate those who regularly enjoy chocolate of any kind consume more flavonoids than non-chocolate eaters. This reduces their risk of heart disease. For example, in the Netherlands, elderly men who routinely ate chocolate-containing products had a 50% reduced risk of dying from heart disease (1).

Shouldn’t we stay away from sugary foods, like chocolate?

The US Dietary Guidelines recommend a limit of 10% of calories from refined sugar per day. For most athletes, that’s about 200 to 300 calories of carbohydrate (sugar) to fuel muscles. The better question is: What nutrients accompany the sugar? For example, “sugary” chocolate milk comes with high quality protein, calcium, vitamin D, riboflavin, and other life-sustaining nutrients. When used as a recovery fluid, it is far healthier than a sports drink, which is just sugar, water, and a dash of salt.

What about sugar spikes…?

Chocolate has a high fat content. Fat slows the rate sugar enters the blood stream and thus reduces the risk of sugar spikes. The Glycemic Index ranks from 0 to 100 the blood glucose response after consumption of 200 calories (50 grams) of carbohydrate (sugar, starch). Gatorade ranks high on the Glycemic Index (78), M&Ms rank lower (33), and dark chocolate ranks even lower (23). Given most of us—well, some of us—don’t eat 200 calories of sugar from just one food at one time, a preferable ranking is the Glycemic Load, based on a standard serving of the food. For example, the Glycemic Load of a standard serving (8-ounces) of Gatorade is 12, chocolate milk is 3.5, and an ounce of M&Ms is 3.

What about chocolate milk for post-exercise recovery?

Chocolate milk can be an enjoyable and nourishing treat that boosts intake of nutrients important for athletes. It has a low glycemic effect and is unlikely to contribute to sugar spikes Drinking chocolate milk after a hard workout effectively refuels and repairs your muscles, boosts your blood sugar, and replaces electrolytes lost in sweat. It’s a nutritionally preferable choice to a carb-only, sugar-based sports drink (2). And it is yummy chocolate—with purpose and meaning, and no guilt!!!

How much caffeine is in chocolate?

The amount of caffeine in chocolate depends on how much cocoa powder is in it. Milk chocolate is only 10 to 20% cocoa, regular dark chocolate is 50-69% cocoa, and strong dark chocolate has more than 70% cocoa. The higher the percentage of cocoa, the higher the caffeine. That said, the 20 milligrams of caffeine in an ounce of dark chocolate pales in comparison to the 200 mg. in a mug of coffee. Chocolate’s energy boost comes from sugar, more so than caffeine.

Is chocolate fattening?

Like any food that is eaten in excess, chocolate can be fattening. That said, data from 13,626 adults (>20 years old, nondiabetic) suggests chocolate consumption was not associated with obesity.

Is there a best time of the day to eat chocolate?

If you are destined to eat a treat, such as chocolate cake, enjoy it earlier in the day, as opposed to indulging at 8:00 p.m. when you are tired and lack the mental energy needed to stop yourself from over-indulging. You are going to eat the chocolate eventually, so why not enjoy it sooner than later?

Believe it or not, eating chocolate cake with breakfast might actually help dieters reach their weight loss goal. Research (3) with 193 adults on a reducing diet suggests those who had cake with breakfast had fewer cravings for carbohydrates and sweets later in the day. By front-loading their calories, they were less hungry and less likely to stray from their diet plan. They ate either a 300-calorie protein-based breakfast or a 600-calorie breakfast that included protein plus chocolate cake (or another dessert).

In the first 16 weeks, both groups lost an average of 33 pounds per person. But in the second half of the study, the no-cake group had poor compliance and regained an average of 22 pounds per person while the cake-eaters continued to lose another 15 pounds each. By 32-weeks, the cake eaters had lost about 40 pounds more than their peers. Does chocolate make for a more sustainable diet?

The bottom line

By no means is chocolate the key to a healthy sports diet, nor is eating lots of dark chocolate preferable to snacking on apples and bananas. It’s no secret: chocolate contains primarily nutrient-poor calories from sugar and fat. A Hershey’s Bar (43 g) has 220 calories—of which about 40% are from 21 grams of added sugar and about 55% of calories from fat. Hence, you want to enjoy chocolate in moderation, so it does not crowd-out other nutrient-dense foods. But even if you are a weight-conscious, health-conscious athlete, you can balance chocolate into your overall wholesome sports diet—and add a taste of pleasure to your day.

Nancy Clark MS RD CSSD counsels both fitness exercisers and competitive athletes in the Boston-area (Newton; 617-795-1875). Her best-selling Sports Nutrition Guidebook is a popular resource, as is her online workshop. Visit NancyClarkRD.com for info.


1. Buijsse B, Feskens EJ, Kok FJ, Kromhout D. Cocoa intake, blood pressure, and cardiovascular mortality: the Zutphen Elderly Study. Arch Intern Med. 27;166(4):411-7, 2006.

2. Lunn WR, Pasiakos SM, Colletto MR, Karfonta KE, Carbone JW, Anderson JM, Rodriguez NR. Chocolate milk & endurance exercise recovery: protein balance, glycogen and performance. Med Sci Sports Exerc. 44(4):682-91,2012.

3. Jakubowicz D, O Froy, J Wainstein, M Boaz. Meal timing and composition influence ghrelin levels, appetite scores and weight loss maintenance in overweight and obese adults. Steroids 77(4): 323-331, 2012.

athlete riding indoor cycle

Fretting about Food & Physique?

Many athletes feel pressure to have a perfect body, perfect diet, and ideally, perfect performances. The stress-inducing trait of perfectionism often pushes athletes to not only become stronger and faster, but also leaner and food-phobic. We have seen perfection play out with football phenom Tom Brady. While he is a poster child for the benefits of eating ”perfectly,” he also has great mental strength that keeps him focused on his goals without getting side-tracked by comparisons.

Most of us are a bit more insecure than Tom and end up comparing ourselves to others. Take note: To compare is to despair! Please stop comparing your physique and your food choices to those of your teammates, friends, and family! Here are strategies to help you fret less and instead gain confidence with your food choices and your physique.

Body Comparisons

She’s leaner than I am…   
He’s got bigger muscles than I do…  
She’s prettier than I am…
He’s got a better 6-pack ab than I do

How often do you find yourself comparing your body to that of your teammates, friends, and social media influencers? If the answer is too often, just STOP IT! Your body is yours; it is good enough the way it is. You want to stop criticizing your body for being too fat, too slow, too short, too freckled—and instead be grateful for all the good things it does for you, like run marathons, row in regattas, win soccer games, and/or compete in triathlons. Those “thunder thighs” contribute to your ability to be a strong, powerful, and successful athlete. Thank them!

Few athletes have the “perfect body”; even the leanest athletes complain about undesired bumps and bulges. Athletes who whine about feeling fat are more likely feeling imperfect, inadequate, anxious, and/or out of control.

Recommendations: To achieve body acceptance, practice living on a fantasy island where you and your body are good enough—if not excellent—the way you are. If you wander off your island and start comparing yourself to others, you’ll undoubtedly end up despairing. Stay on your island!

When you look in the mirror, greet yourself with a welcoming smile and grateful words. With time, you will start to internalize that your body is indeed good enough the way it is. While you may never attain the perfect physique, you can still be grateful for all your body does for you. 

Portion Comparisons

Do you eat like a bird compared to your teammates? Or maybe you feel self-conscious because you need to eat twice as much as your peers just to maintain your desired weight?  At team meals/social gatherings, many athletes monitor the quantity of food others are eating. Salads and small portions tend to get praised more than lumberjack servings. (I wish I had your discipline vs. You sure do eat a lot….) For athletes recovering from restrictive, dysfunctional eating, eating a sandwich, fruit, yogurt &pretzels for lunch seems embarrassing—way too much food—when it’s really what is needed to properly fuel up for an after-school practice or after-work trip to the gym.

When I educate my clients how many calories they “deserve” to eat, most are flabbergasted to learn athletic females commonly require 2,400+ calories to maintain weight; athletic males may require 2,800+ calories. That’s 600-700 calories four times a day: breakfast, early lunch, second lunch/afternoon snack, and dinner.

Recommendation: Please don’t start counting calories; your body is your best calorie counter. Rather, listen to your innate hunger and fullness cues. Eat when hungry; stop when content. Pay attention to why you stop eating: Do you think you should?  Is the food all gone? Or are you actually feeling content and comfortably fed?

Food Comparisons

I eat only healthy foods… 
I avoid sugar like the plague…
I won’t touch the pies at Thanksgiving.  

In the world of “clean eating”, athletes feel pressure to choose the “right” foods. That translates into no sugar, salt, red meat, white flour, packaged foods, fat, and no fun foods. The E in Eating stands for Enjoyment; you want to be able to enjoy (in appropriate portions) the foods you truly want to eat!

Believe it or not, it’s OK to balance fun foods into an overall good diet. The goal is 85-90% nutrient-rich whole grains, fruits, veggies, lean proteins and 10-15% fun food. You need not eat the perfect diet to have an excellent diet.

You want to eat a foundation of about 1,500 calories from a variety of nutrient-dense foods to consume the vitamins, minerals, and protein required for an effective sports diet. Because your body needs at least 2,400-2,800 calories a day, you have space in your diet for both health-promoting food and fun food. While you want to enjoy more of the best foods and less of the rest, you can balance fun foods into your sports diet. That is, an apple is a healthy food; a diet of all apples is a very unhealthy, unbalanced diet.

Recommendation: If you find yourself being judgmental about food, the problem is unlikely the food, but rather your relationship with the food—and fears it will make you get fat or ruin your health. Eating out of the same pot as your pals is a very healthy thing to do! A few fun meals will not ruin your health forever.

Nutrition Supplement Comparisons

I often counsel athletes who wonder if they can nourish their bodies with real food instead of taking supplements. As one athlete sheepishly asked, “I don’t take any vitamin pills. Should I? My teammates takes a handful of them..” Let me reassure you that opting out of supplements is okay (and can save you bundles of money). If you eat wisely 85-90% of the time, you are likely getting the vitamins and minerals and protein you need, with a few possible exceptions (iron, vitamin D).

Recommendation: If you question the adequacy of your diet, consult with a registered dietitian (RD) who is board certified as a specialist in sports dietetics (CSSD). Make an appointment today to learn how to choose food based on facts, not fears, and can fret less and enjoy better quality of life.

Nancy Clark MS RD CSSD  counsels both fitness exercisers and competitive athletes in the Boston-area (Newton; 617-795-1875). Her best-selling Sports Nutrition Guidebook is a popular resource, as is her online workshop. Visit NancyClarkRD.com for info.

athletes gym

News from ACSM: Tools to Enhance Performance

The American College of Sports Medicine (ACSM)  is the nation’s largest group of exercise physiologists, sports nutritionists, and a multitude of other sports medicine professionals. 

Each year, at ACSM’s Annual Meeting, members gather to share their latest research. Here are highlights of two talks (June 2022 meeting in San Diego) that might be of interest to serious athletes intent on improving their performance.

Coffee, Caffeine and Caffeinated foods: What Do Athletes Need to Know?

Speakers: Louise Burke PhD. Australian Catholic University and Ben Desbrow PhD, Griffith University, Australia

Guidelines regarding caffeine used to enhance athletic performance have changed significantly. Caffeine was once believed to be a diuretic, beneficial in high doses primarily for marathoners, and most effective when consumed an hour pre-event. Almost every aspect of those ideas has been replaced with newer knowledge

• Caffeine is not just for endurance athletes; it offers a three-percent improvement in performance in many real-life sporting events including shorter races and team sports. In addition, caffeine may help athletes such as body builders train harder.

• Caffeine offers similar benefits whether you take it one hour pre-exercise or only during exercise. Even low doses of caffeine are effective when consumed just prior to the onset of fatigue.

• Caffeine helps athletes train better when they are jetlagged or when their circadian rhythms are out of line.

• Caffeine comes in many forms, including caffeinated water, potato chips, gums, gels, sprays, pouches, strips, medications, pre-workout supplements, and pills. The caffeine content of commercial pre-workout supplements can vary from batch to batch (~40 mg difference per serving) Of the top 15 most popular pre-workout supplements, caffeine content ranged from about 90 to 390 mg/serving —and often contained more—or less—of what was listed on the nutrition facts panel.

• Each individual needs to learn from their own personal experiences the right caffeine source and dose for their bodies. Genetics influences the enzymes that break down caffeine.

• If you consume 1 cup of coffee in the morning, most of the caffeine will have dissipated by lunchtime. In general, caffeine stays in the body for about 7 hours. Its half-life (time taken for caffeine in the body to drop by half) ) might be five hours (or less) for some people, but ten hours (or more) for others.

• Female athletes should know that birth control pills almost double the half-life of caffeine, making it more effective for longer.

• If you happen to be a slow metabolizer and then take a pre-workout caffeine boost before your afternoon workout, you might have some caffeine “overlap” from your morning cup of brew. Even if you abstain from caffeine for 12 hours, circulating caffeine might still be detected in your blood due to caffeine accumulation with repeated caffeine consumption.

• Habitual caffeine intake does not seem to influence its ergogenic effect across a range of different sports. That means, if you regularly consume coffee every day, there’s no need for you to stop consuming caffeine for a few days prior to a competitive event. Caffeine withdrawal feels horrible and you’re unlikely to gain any benefits!

Biomarkers That Impact Training and Performance

Speaker: Shawn Arent, PhD, CSCS, FACSM, University of South Carolina

While caffeine is a drug that can be consumed to influence performance, biomarkers are substances in your body that are indicators of physiological processes. Endocrine biomarkers measure stress and adaptations to training.  Biochemical biomarkers measure muscle damage and inflammation. Nutritional biomarkers measure the impact of diet, such as on blood glucose and iron levels.  

Biomarkers are best used to document changes over time (as opposed to taking one measurement, such as serum ferritin, to see if the measurement simply falls within normal limits). Biomarker data can help assess changes in performance, recovery, and training optimization. Biomarkers might be able to predict and prevent illness. In an 8-week basic training study, a third of the soldiers whose biomarkers classified them as being over-reached experienced illness.

Biomarker research

The military and some professional athletes and teams are very interested in measuring biomarkers. Connecting biomarkers to measurables like performance, training, sleep, and diet provides context and meaning to the measurements. By keeping athletes healthy and in the game, the likelihood of a winning season improves.

• With biomarker research, we now know that food deprivation can be more detrimental to performance than sleep deprivation. Many markers can take a full month post-dietary restriction to get back to normal. With Army ranger training, a 1,000 calorie per day deficit reduced testosterone and increased cortisol.

• Biomarkers can document the physiological impact of restrictive food intake and show how much better athletes can recover when they are adequately fueled.

• Both physical and psychological stress impact biomarkers, as does travel through time zones. Seeing sleep data can help athletes learn the value of prioritizing sleep.

Wave of the future?

Athletes interested in getting their biomarkers measured should know this is an emerging field with yet unanswered questions, including:

What is the best time to measure biomarkers? (Should recovery markers be measured right after exercise or a day later?) 

How often should measurements be taken? (Might depend on who is paying the bill!)

Should athletes not exercise the day before blood draws/data collection?

Do biomarkers differ when measured under research conditions? (That is, does lab data compare to data collected at real-life competitive events?)

What is the minimal performance-enhancing level of a biomarker? Is higher better?  When is a level too low?

 Can biomarkers predict and prevent illness? And very importantly,

Will coaches (and athletes) be willing to alter their training schedules based on biomarkers? Coaches’ buy-in is essential, as is the athlete’s willingness to alter training plans.

With time and well-established protocols for measuring biomarkers, this evolving field will have a significant impact on improving the health and performance of members of the military, professional athletes, as well as curious consumers who can afford this luxury. 

Sports nutritionist Nancy Clark MS RD CSSD has a private practice in the Boston area. She is author of the best-selling Nancy Clark’s Sports Nutrition Guidebook and co-leader of an online sports nutrition workshop. Visit www.NancyClarkRD.com for more information.

athlete riding indoor cycle

ADHD and (Adult) Athletes: Can diet help with management?

As a sports nutritionist, I commonly counsel athletes who have Attention Deficit Hyperactivity Disorder—generally referred to as ADHD (or ADD). ADHD is characterized by hyperactivity, impulsivity, and/or inattention. It affects 4-10% of all American children and an estimated 4.4% of adults (ages 18-44 years). ADHD usually peaks when kids are 7 or 8 years old. Some of the ADHD symptoms diminish with maturation but 65-85% of the kids with AHDH go on to become adults with ADHD.

Ideally, athletes with ADHD have gotten the help they need to learn how to manage their time and impulsiveness. Unfortunately, many youth athletes with ADHD just receive a lot of negative feedback because they have difficulty learning rules and strategies. This frustrates teammates and coaches. Older athletes with ADHD often use exercise to reduce their excess energy, calm their anxiety, and help them focus on the task at hand.

This article offers nutrition suggestions that might help coaches, friends, and parents, as well as athletes with ADHD, learn how to calm the annoying ADHD behaviors.

  • To date, no clear scientific evidence indicates ADHD is caused by diet, and no specific dietary regime has been identified that resolves ADHD. High quality ADHD research is hard to do because the added attention given to research subjects with ADHD (as opposed to the special diet) can encourage positive behavior changes. But we do know that when & what a person eats plays a significant role in ADHD management and is an important complimentary treatment in combination with medication.
  • ADHD treatment commonly includes medications such as Concerta, Ritalin & Adderall. These medications may enhance sports performance by improving concentration, creating a sense of euphoria, and decreasing pain. These meds are banned by the World Anti-Doping Agency (WADA) and the International Olympic Committee (IOC). Hence, athletes who hope to compete at a high level are discouraged from taking ADHD medications.
  • To the detriment of ADHD athletes, their meds quickly blunt the appetite. Hence, they (like all athletes) should eat a good breakfast before taking the medication.
  • The medication-induced lack of appetite can thwart the (teen) athlete who wants to gain weight and add muscle. Teens taking ADHD meds should be followed by their pediatricians, to be sure they stay on their expected growth path. If they fall behind, they could meet with a registered dietitian (RD) with knowledge of sports nutritionist (CSSD) to help them reach their weight goals.
  • An easy way for “too thin” athletes to boost calories is to swap water for milk (except during exercise). The ADHD athlete who does not feel hungry might find it easier to drink a beverage with calories than eat solid food. Milk (or milk-based protein shake or fruit smoothie) provides fluid the athlete needs for hydration and simultaneously offers protein to help build muscles and stabilize blood glucose.
  • A well-balanced diet is important for all athletes, including those with ADHD. Everyone’s brain and body need nutrients to function well. No amount of vitamin pills can compensate for a lousy diet. Minimizing excess sugar, food additives, and artificial food dyes is good for everyone.
  • Eating on a regular schedule is very important. All too often, high school athletes with ADHD fall into the trap of eating too little at breakfast and lunch (due to meds), and then try to perform well during afterschool sports. An underfed brain gets restless, inattentive, and is less able to make good decisions. This can really undermine an athlete’s sports career
  • Adults with ADHD can also fall into the same pattern of under-fueling by day, “forgetting” to eat lunch, then by late afternoon are hangry and in starvation mode. We all know what happens when any athlete gets too hungry – impulsiveness, sugar cravings, too many treats, and fewer quality calories. This is a bad cycle for anyone and everyone.
  • All athletes should eat at least every four hours. The body needs fuel, even if the ADHD meds curb the desire to eat. ADHD athletes can set a timer: breakfast at 7:00, first lunch at 11:00, second lunch at 3:00 (renaming snack as second lunch leads to higher-quality food), dinner at 7.
  • For high school athletes with ADHD, the second lunch can be split into fueling up pre-practice and refueling afterwards. This reduces the risk of arriving home starving and looking for (ultra-processed) foods that are crunchy, salty, and/or sweet.
  • Athletes with ADHD are often picky eaters and tend to prefer unhealthy snacks. For guidance on how to manage picky eating, click here for adults and here for kids.
  • Fiber-rich fruits, vegetables, and whole grains can be low on an ADHD athlete’s food list. Their low fiber diet can lead to constipation. Fiber also feeds the zillions of microbes in their digestive tract that produce chemicals that can positively impact brain function and behavior. Everyone with ADHD should eat more fiber-rich foods like beans (hummus, refried beans in a burrito), seeds (chia, pumpkin, sunflower, sesame), and whole grains (oatmeal, brown rice, popcorn). They offer not only fiber but also magnesium, known to calm nerves.
  • With more research, we’ll learn if omega-3 fish oil supplements help manage the symptoms of ADHD. No harm in taking them. At least eat salmon, tuna, and oily fish as often as possible, preferably twice a week, if not more.
  • Picky eaters who do not eat red meats, beans, or dark leafy greens can easily become iron deficient. Iron deficiency symptoms include interrupted sleep, fatigue, inattention, and poor learning and can aggravate ADHD. Iron deficiency is common among athletes, especially females, and needs to be corrected with iron supplements.
  • While sugar has the reputation of “ramping kids up”, the research is not conclusive about whether sugar itself triggers hyperactivity. The current thinking is the excitement of a party ramps kids up, more so than the sugary frosted cake. Yes, some athletes are sugar-sensitive and know that sugar causes highs and crashes in their bodies. They should choose to limit their sugar intake and at least enjoy protein along with sweets, such as a glass of milk with the cookie, or eggs with a glazed donut. Moderation of sugar intake is likely more sustainable than elimination of all sugar-containing foods.

For more information about ADHD in kids, teens, and adults, please use these resources:

  • Feeding the Child with ADHD—a podcast with Jill Castle RD
  • Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD) – a national resource center

Nancy Clark MS RD CSSD counsels both fitness exercisers and competitive athletes in the Boston-area (Newton; 617-795-1875). Her best-selling Sports Nutrition Guidebook is a popular resource, as is her online workshop. Visit NancyClarkRD.com for info.


The (Current) Truth About Vitamin D

There are more health claims made about vitamin D than perhaps any other vitamin.  Media stories touting vitamin D for this ill or that are common, particularly in the age of COVID-19. We’re also frequently told Americans don’t get enough vitamin D, with surveys showing as many of 40% of individuals have below optimal amounts in the blood. So how do we get vitamin D and what claims are true and backed by research?  Let’s take a closer look at vitamin D to flesh out what we know for sure and where more research is needed. 

What is Vitamin D and How Do We Get It?

Molecularly, vitamin D is a group of fat-soluble compounds with a four ringed cholesterol backbone. What’s most important to know is that it comes in two forms — as vitamin D2 in food and as vitamin D3 in our skin.

Vitamin D3
Our skin is our primary source of vitamin D, but it begins there as an unorganized and inactive form, requiring UV exposure to convert to usable vitamin D3. Conversion via UV light is exceedingly efficient, and it’s estimated brief exposure of the arms and face is equivalent to ingesting 200 international units day. Conversion varies however with skin type (darker skin converts more), latitude, season and time of day. Infants, disabled persons and older adults often have inadequate sun exposure as well, and the skin of those older than 70 also does not convert vitamin D as effectively. Interestingly, vitamin D also requires temperature to be activated, so you may not get as much of a benefit from sunlight in the winter months as you might expect.  

Vitamin D2
Because it is fat-soluble, dietary vitamin D2 is best absorbed with fat in the diet and fish is a common source. Uptake can be negatively impacted by disorders associated with fat malabsorption such as celiac disease, Crohn’s disease, pancreatic insufficiency, cystic fibrosis, short gut syndrome and cholestatic liver disease.

Vitamin D in the Body: What We Know It Does

Once activated and in the bloodstream — either by UV exposure or absorption through the diet — the liver converts vitamin D to 25-hydroxyvitamin D (25[OH]D), and then the kidneys further convert it to 1,25 hydroxyvitamin D, the most active form of vitamin D in the body. For this reason, kidney and/or liver problems can also negatively impact vitamin D levels.

Interestingly, all cells in our bodies have receptors for vitamin D, and this has in part fueled the varying claims as to how it might impact health. What we know for certain is that it helps with calcium absorption in the gut, regulating calcium levels via the kidneys, and regulating parathyroid hormone. Vitamin D’s role in calcium regulation and absorption means it has a direct impact on healthy bone growth and turnover. For this reason, you often see it in calcium supplements.

Research has also shown a clear correlation between Vitamin D and muscle health, including research showing improved lower body strength. Some research has also shown vitamin D can help prevent falls in the elderly.

Notable Areas Where the Jury is Still Out

  • Vitamin D has been thought to lower the risk of cancer, but currently, there is insufficient evidence to support this, though there are many ongoing studies.
  • There is also insufficient evidence showing that vitamin D helps improve autoimmune conditions and respiratory conditions such as asthma, COPD and acute viral respiratory diseases.  In a large study from the UK, no association was found between vitamin D levels and risk of mortality from COVID-19.
  • Although low vitamin D levels have been associated with an increased risk of cardiovascular disease in some studies, there is no evidence that vitamin D supplementation improves cardiovascular outcomes.
  • Similarly, a growing number of trials examining the effects of vitamin D supplementation on pregnancy and birth outcomes show conflicting results, with some showing reduction in risk of low birth weight, but more data is needed.

Webinar with Dr. Albertson

Naomi L. Albertson M.D. is Board Certified by the American Academy of Family Physicians and specializes in the non-surgical management of musculoskeletal problems, sports injuries, concussions, and the treatment of osteopenia and osteoporosis.  A graduate of Tufts University School of Medicine, Dr. Albertson’s interest in bone health, exercise physiology and maximizing performance led her to develop Dr. Ni’s OC2, a bone health and muscle strength supplement for the unique frame support needs of adults over age 35. Visit her website, boneandmuscle.com.