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. 

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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.

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

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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.

If you’ve ever lost and then regained weight, what’s the best way to stop overeating and keep weight off for good?

Rather than starting yet another diet, try tasting, really tasting your food—or meditating for a moment before eating. In other words, think outside the diet.

Welcome to the wonderful world of overeating research!

Our original research on Whole Person Integrative Eating (WPIE)^1,2 unlocks some truly remarkable reasons you overeat and gain weight—and, conversely, how to overcome overeating, overweight, and obesity. Want to reap the rewards? Here are 10 tips—from our research and that of others—that could help you overcome overeating and reduce odds of being overweight or obese.

#1. Choose Chocolate

Savoring some chocolate might remind you of something you’d like to overeat—but don’t write off chocolate just yet as a (heavenly) food that could help you lose weight (yes, you read that right). In a study published in Archives of Internal Medicine, researchers showed that it’s possible to eat chocolate and weigh less if you choose the right kind—a cocoa content that’s 70% or higher, and the right amount—an ounce a day, about the size of a credit card. (Sorry, but more isn’t better `cause if you overeat chocolate, the calorie-count climbs too high to reap the rewards.) The secret to chocolate’s metabolic mystery? The antioxidant epicatechin, which revs up your metabolism.

#2. Feed Your Senses

Here’s your excuse to buy that favorite gourmet olive oil you’ve sniffed in one of those fancy olive-oil boutiques. Scientists in Germany have linked an aroma—specifically, the scent of olive oil—to eating and weighing less. Somehow, the scent of olive oil lead research participants to feel satiated sooner than those in the canola-oil scented group. And it gets better: those in the olive-oil group lost weight, while the canola-oil folks gained weight. Can “sense-filled” dining really up your odds of eating less? Yes, according to my research on Whole Person Integrative Eating,^1,2“Sensory Disregard” is one of the 7 overeating styles we identified. To find out if aroma is a stay-slim tool that works for you, try your own experiment with scent-sory olive oil and other scintillating scents. 

#3. Nix Night Eating 

Call it nighttime hunger, nocturnal eating, or night eating syndrome (NES). Regardless of what it’s called, if you do a lot of overeating after you’ve had dinner or well into the wee small hours, it’s a triple weight-gain whammy! Researchers at the University of Pennsylvania reveal why: 1) your metabolic rate and digestion slow down at night; 2) consuming a lot of food at night wreaks havoc with hormones that control appetite, and; 3) eating when your body is meant to relax and restore itself busts your body’s built-in biological clock. The take-away: Simply put, human beings aren’t meant to eat a lot in the evening hours. It’s a formula for gaining weight and making it hard to lose weight.

#4. Dine by Design

When you eat in emotionally (think eating while surrounded with angry people) and aesthetically (visualize eating in your car in a traffic jam) unpleasant surroundings, my Whole Person Integrative Eating research^1,2revealed you’re more likely to overeat. So think about the atmosphere in which you’ll be eating ahead of time. As often as possible, each time you eat, design a pleasing dining experience by creating an emotional and physical atmosphere that’s as pleasant as possible.

Which leads to…

#5. Pay Attention to How You Feel

Emotional eating—turning to food to soothe negative emotions or out-of-control food cravings—is the #1 predictor of overeating and weight gain, according to my Whole Person Integrative Eating research.^1,2 To get control, try this: First, commit to getting in touch with your feelings before, during, and after eating. Next, make a conscious choice to eat when your emotions are balanced—not negative. Then recognize that one of the best reasons for eating is a healthy appetite, meaning, don’t let yourself get too hungry. The bottom line: Commit to eating for pleasure, with a healthy desire for food, and experience feel-good emotions when you eat and enjoy!

#6. Eat with Others

A famous study that began in the early 1960s in the small town of Roseto, Pennsylvania, explores the influence of human relationships and social support on the metabolism of high-fat, high-cholesterol, calorie-dense foods. Amazingly, this study suggests that when social support is present in our lives, especially when we eat, what we eat is somehow metabolized differently—so much so that it can keep you from getting sick. My more recent research on overeating^1,2 revealed that eating alone more often than not—what I call Solo Dining—is yet another “new normal” eating style that strongly increases the odds of overeating. When it’s time to eat a meal, invite others to join you. Share mealtimes with friends, family, or coworkers as often as possible. Or if you have a pet, consider eating at the same time as your furry friend!

#7. Don’t Diet

Although dieting, judging food as “good” or “bad,” and thinking a lot about the “best” way to eat may not seem to have much in common, they are all characteristics of the overeating style I describe as “Food Fretting.”^1,2If you see yourself in the food-fretter scenario, you’re at increased odds of overeating and weight gain. To get off the food-fretting treadmill, first and foremost, stop dieting. Instead, perceive food and eating as one of life’s greatest pleasures, and choose Integrative Eating as your most-of-the-time dietary lifestyle. Choose wisely (see “Get Fresh,” below) and enjoy.

#8. Get Fresh

If your most-of-the-time way of eating is, say, a donut and coffee for breakfast; a burger, fries, and coke for lunch; pizza for dinner; and chips as a snack, my research on Whole Person Integrative eating suggests that “fast foodism” is your main overeating style.^1,2If a diet of mostly fast and processed foods is typical for you, consider getting in touch with your inner fresh-food fairy. You can do this by replacing sugar-, fat-, and salt-laden foodish foods—ingredients that can amp up your “overeating engine”—with more fresh fruits, veggies, whole grains, beans, and nuts and seeds, and lean, free-range, chemical-free animal foods. Worth a try, don’t you think?

#9. When You Eat, Eat

Do you ever eat while watching TV? Or while working at your computer? Or when you’re driving? If you eat while doing other things, you’re doing “task snacking,” a Whole Person Integrative Eating overeating style that is linked with overeating and increased odds of weight gain.^1,2The antidote? Mindfulness eating. Give up eating while doing other activities. Instead, stay mindful, keep focused on your food, and do one thing at a time. In other words, eat when you eat!

#10. Quit Chemical Cuisine

Obesogens are the manmade chemicals—plastics and pesticides—which have found their way into our food supply and beverages. They wreak their havoc on both appetite and weight by mimicking estrogen, a hormone that can make you fat. The solution? One quick tip for avoiding “chemical cuisine” is to stay away from bisphenol A (BPA) found in canned foods, bottled beverages, meat packed in plastic, and more.

The key take-away is this: To attain and maintain weight loss…for life, think outside the diet by changing beliefs you have about dieting, losing weight, and keeping it off. Replace limiting weight-loss “think” with insights into the underlying reasons you overeat and gain weight—some of the overeating styles we just told you about. The 10 key weight-loss solutions are your first step in jump-starting a relationship to food and eating that can help you turn overeating into optimal, whole person integrative eating…and attaining and maintaining weight loss…for life.

Visit Deborah’s website, makeweightlosslast.com, for free evidence-based, credible information and education about optimal eating for weight loss and well-being. You can also visit her blog, integrativeeating.com.

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Originally printed on integrativeeating.com. Reprinted with permission from Deborah Kesten. 

Deborah Kesten, M.P.H., is an award-winning author, specializing in preventing and reversing obesity and heart disease. Her expertise includes the influence of epigenetics and diet on health, Lifestyle Medicine, and research on the Whole Person Integrative Eating dietary lifestyle to treat overeating, overweight, and obesity. She and her husband, behavioral scientist Larry Scherwitz, Ph.D., collaborate on research and writing projects. 

References:

1. Scherwitz L, Kesten D, “Seven Eating Styles Linked to Overeating, Overweight, and Obesity,” Explore: The   Journal of Science and Healing 1, no. 5 (2005): 342–59.
2. Kesten D, Scherwitz L. “Whole Person Integrative Eating: A Program for Treating Overeating, Overweight, and Obesity,” Integrative Medicine: A Clinician’s Journal 14, no. 5 (October/November 2015): 42-50.

“I thought I was supposed to use gels during long runs. Can candy work just as well..?”

 “Are electrolyte tablets the best way to replace sodium loses from sweaty workouts?”

 “I get diarrhea when I use some commercial sports foods…help!”

If you are among the many athletes who have no idea which commercial sports foods are best to support your workouts, welcome to the club! Advertisements have led many active people—from serious competitors to anyone who breaks a sweat—to believe that pre-workout drinks, energy gels, and electrolyte replacers (among the many other commercial sports foods) are a necessary part of a sports diet. Guess what? Real foods can often work just as well.

While there is a time and a place for commercial sports foods, many athletes needlessly spend lots of money on them. The purpose of this article is to help you become an informed consumer, so you know what these products are (convenient, expensive)—and what they are not (essential for all exercisers). Whatever you do, test them during training, so you can learn if they settle well in your gut. You don’t want surprises during competitions!

Pre-Workout Supplements

When you feel low on energy and are dreading your afternoon training session, pre-workout products that promise explosive energy, sharp focus, and incredible results can be very tempting to buy. While simply eating a heartier breakfast, lunch, and pre-exercise snack can help prevent an afternoon droop, many athletes fail to appreciate the power of food. Instead, they look for “magic.”

• The “magic” ingredient in most pre-workout products is caffeine. You could just as easily get stimulated with coffee or NoDoz. True energy comes with eating a pre-exercise banana, granola bar, or carb-based snack.
• The best pre-workout snacks digest easily and don’t talk back to you. Standard supermarket foods (e.g., toast, oatmeal, animal crackers, dried pineapple, dates, banana, even a swig of maple syrup) are likely more familiar to your gut (less likely to cause intestinal upset) than unfamiliar commercial sport fuels.
• Some pre-workout products tout they are sugar free, as if sugar is evil for athletes. Sugar (carbohydrate) is a true energizer in comparison to caffeine, which is just a stimulant. Carbs + caffeine will offer a better workout (for those who tolerate caffeine, that is)!
• Some pre-workout products contain creatine, vitamins, beta-alanine, and/or other stuff that looks good on the label. The dose may be inadequate to make a significant difference in your performance. Do your homework to learn what is an effective dose.
• Buyer beware, pre-workout products are poorly regulated. Who knows what the products contain. Claims that sound too good to be true should raise an eyebrow. Be sure your choice says NSF Certified for Sport or Informed Sport on the label.

Gels

During hard exercise lasting 1 to 2.5 hours, you’ll perform better if you consume ~30 to 60 grams (120-240 calories) carbohydrate per hour. Take your choice of gel, sport drink, or gummi bears!

• During extended exercise lasting more than 2.5 hours (ultra-marathon, long bike ride), you want to target 60 to 90 g carb/h (240-360 calories), depending on the intensity of your exercise, your body size, sport, and intestinal tolerance.
• Most gels offer 100 calories (25 g carb) in the form of some type of sugar, such as maltodextrin, sucrose, fructose, or glucose. The Nutrition Facts on the gel’s label can you help determine the right amount to consume.
• Many athletes love the convenience of gels because they come in a good portion-size and are easy to carry. Others dislike them due to their consistency. For some athletes, gels digest poorly because they contain a type of sugar that can trigger bloat, diarrhea, and undesired pit stops. Always experiment with new gels during training!!!
• Some popular alternatives to the 100 calories of carb (sugar) in a gel include gummy bears, Twizzlers, Swedish fish, gum drops, peppermint patties, maple sugar candy, even chocolate (though it melts in hot weather). The trick with choosing “real food” is to figure out how to carry it. Pockets help.

Electrolyte tablets

Electrolytes (electrically charged particles, most often known as sodium, calcium, magnesium, and potassium), are minerals abundant in food.

• For sweaty athletes, sodium (a part of salt) is the main electrolyte of concern. Salty foods enhance fluid retention and help keep you better hydrated than plain water, which goes in one end and out the other.
• Many electrolyte replacers are lower in sodium than you may think. By reading food labels, you’ll discover a slice of bread can have more sodium than 8-ounces of Gatorade.
• Athletes who sweat heavily might lose about 500 to 1,000 mg sodium in an hour of vigorous exercise. Some options for replacing these sodium losses include:

Commercial Sports Food	Sodium (mg)	Salty food	Sodium (mg)
Propel Electrolyte water, 8 oz	105	String cheese, 1 stick	220
Gatorade, 8 oz	110	Beef Jerky, 1 oz	600
Gu Salted Caramel, 1 gel	125	Salt sprinkled on food, ¼ tsp	600
Nuun, 8 oz	175	Broth, from 1 cube Herb-ox	1,100

• Replacing sodium is most important for athletes who sweat heavily for extended periods in the heat. Yet, these athletes generally consume foods that contain sodium before, during and after exercise. For example, football players who refuel from morning practice with a high-sodium ham and cheese sandwich with mustard and dill pickles can bypass the Gatorade at lunch.
• Consuming 500 mg. sodium before you exercise helps retain fluid, delay dehydration, and enhance endurance. Sprinkle salt on that pre-exercise omelet, pasta, or sweet potato before you exercise in the heat!

The Bottom Line

While commercial sports foods have their time and place for intense exercisers, not every athlete needs to pay the price for pre-wrapped convenience.

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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 more info.