Nutrition for Sport and Fitness Melinda Re January 22, 1999 Final Assignment for "A Grade" Project # 1

The following "Nutrition and Fitness" lesson was developed and

delivered to cluster 9 nutrition program staff as the result of an

independent study course that I just completed for 25 CE Hours for

mandatory continuing education as related to my State of Minnesota

license as a dietitian. This licensing requires the submission of 45 CE

units in the three year reporting period between December 1, 1997 and November 30, 2000.

To receive the credit hours I was required to read Nutrition For Sport & Fitness by Jacqueline R. Berning and Suzanne Nelson Steen and complete the "Self-Study Course for Nutrition for Sport and Exercise" by Kathy King Helm. The course consisted of a 128 question open-book exam.

I have completed the course and have submitted the exam for grading. Upon passing the course, the State of Minnesota Board of Dietetics and Nutritional Practice will receive notification of my CE units earned, and I will receive a Certificate of Completion.

This course was extremely challenging for me. It was very technical and I literally had to read the book out loud and follow along with my finger. I took 26 pages of notes. In converting the course into the lesson to be presented to the cluster 9 nutrition education staff, I had to purchase a second book to help me put it in lay terms enough to be able to teach it!

I originally became interested in this topic as I was training for the Northshore In-line Marathon from March to September 1998. In addition to my daily 3 mile walk, I was rollerblading several hours per week, sometimes for very long stretches of time. As a hypoglycemic, this additional activity forced me to take acute notice of my nutrient intake. On several occasions early in my training, I underestimated the amount of food that I would need prior to heading out for a long period of intensive exercise and had difficulty keeping my blood sugar stable. I deliberately did not take carbohydrate foods with me and I would not consider sports drinks or some other glucose replacing fluid because I thought it would cause my blood sugar to go down after an initial rise. I also underestimated my fluid requirements, but learned very quickly that water must be carried on the body during endurance training.

I only wish I had taken this course prior to the marathon in September. As a result of the blood sugar difficulties I had experienced during training, I was worried about keeping my blood sugar stable during the race. I decided to carry carbohydrates with me in case I got into trouble. I packed enough granola bars so that I could replenish my glucose about every half an hour. What I did not anticipate was that there was no way I could skate as fast as I humanly possibly could and eat a dry granola bar at the same time! Sure enough, as the race headed toward its second hour, I started to feel weaker and weaker. I literally went over the finish line and as quickly as possible, shoved food into my mouth. I could not have gone another 5 minutes! For several hours afterward, I felt awful and had to lie down. My racing partners were all feeling fantastic and went for an afternoon hike in the hills and a trip to shop in town!

Had I taken this course prior to training and competing, I would have learned (and been able to put into practice) that during intense activity, the body adjusts its insulin/glucose systems. I could (and should) have made glucose available to myself without causing a dangerous drop in my blood sugar as I feared. Also, it's very common for athletes to be unable to eat during an intense workout, hence the development of glucose replacing fluids.

I now know that I need to carry a glucose replacing fluid with me when I attempt endurance exercise. I made and enjoyed the homemade version that is included in the lesson I developed for the cluster staff. My new motto is "don't leave home with out it." (Hey, what a great slogan!)

What a valuable lesson I learned. I only hope that I can continue to spread the wealth around and encourage people to learn a little bit about what they're doing before attempting to make a drastic change in their lifestyle. I guess that's what a dietitian is supposed to do, isn't it?!

Nutrition and Fitness

University of Minnesota Extension Service Cluster 9 Nutrition Education Programs NEA Training January 1999

Lesson Outcomes:

1) NEAs will increase their knowledge of the general nutrition guidelines for exercising individuals under normal health and environment conditions.

2) NEAs will increase their knowledge of the fluid needs of active people.

3) NEAs will increase their knowledge of the pros and cons of ergogenic (energy enhancing) aids.

The Goal of Exercise

Physical activity is beneficial to everyone's health, regardless of their initial level of fitness. The most significant benefits are experienced by those at the lowest fitness levels who become more active. For those who wish to begin a new exercise program, it is important to consider current health status, current level of fitness, interests and skill level. A doctor's consultation is recommended for men over age 45, women over 55 and anyone with certain clinical conditions, such as diabetes. The goals of exercising are to:

7 Develop and maintain cardiorespiratory fitness 7 Build muscular strength and endurance 7 Reach and maintain optimal body composition 7 Improve mental outlook and vitality

The outcomes of exercising is the reduction of:

7 Cardiovascular disease 7 Stroke 7 Symptoms of diabetes 7 Colon cancer 7 Depression 7 Anxiety 7 Obesity

The benefits of exercise, for the general population, can be reached with aerobic activities lasting from 20-30 minutes (with an additional 5 minute warm-up and 5 minute cool-down) performed at least 3 times per week.

Nutrition for Active People

These dietary guidelines are designed for "recreational exercisers" who exercise a minimum of 60-90 minutes at a time. Elite athletes who train and compete as well as the occasional "weekend warrior" have different nutritional needs. However, people of all athletic abilities can benefit from a diet that is:

7 High in carbohydrates 7 Adequate in protein 7 Low in fat

Energy Needs

Active people have varied energy needs depending on the frequency, duration and intensity of their exercise and their age, metabolic rate, and lifestyle. There are 3 components of the daily energy requirements:

7 Resting energy expenditure (metabolic rate - 65-70% of daily energy expenditure) 7 Thermic effect of food (energy used for digestion, absorption, transportation and storage of nutrients - 10-15% of daily energy expenditure) 7 Thermic effect of activity (energy used for activities - 20-35% of energy expenditure)

Energy needs vary from person to person, but everyone needs to consume enough energy to meet their needs. A lack of energy consumption results in weight loss, an abundance of energy results in weight gain. A balance in energy consumption results in long term weight maintenance.

The ideal distribution of carbohydrate, protein, and fat for active people is similar to the recommendations in the Dietary Guidelines for Americans. A diet that provides adequate nutrients is attainable by following the Food Guide Pyramid (but not the "typical" American diet which is too low in carbohydrates and too high in protein and fat). Quantities of food needed may be more, however, because of the increased energy needs of active people.

Carbohydrates for Fuel

Carbohydrates are the prime and preferred energy source for muscles. Muscles burn carbohydrate (glucose) that is stored in the blood stream, muscles, and liver (as glycogen). The average 150 pound man will store about 1400 calories worth of carbohydrate in his muscles, 320 calories worth in his liver and 80 calories worth in his blood. This is enough energy for about 90 minutes of exercise. Consuming adequate amounts of carbohydrates before, during and after exercise enhances stamina and endurance. Carbohydrates are a source of calories from starch and sugars. In general, it is recommended that 60-65% of total energy come from carbohydrates for the active person. The basic guidelines for getting enough carbohydrates to provide energy for exercise is:

7 Eat adequate amounts of carbohydrates every day 7 Eat a high carbohydrate meal 3-4 hours prior to exercising (up to 8 calories/pound of body weight) 7 Eat a small amount of carbohydrate 30-60 minutes prior to exercising (2 calories/pound) 7 Consume carbohydrate every 2 hours during exercise (100-300 calories) 7 Eat carbohydrate immediately after exercising, within 15 minutes and again after 2 hours

Protein and the Exerciser

A diet inadequate in protein results in compromised health. Excess protein will be converted to fat and puts stress on many of the body's systems. The protein requirement for exercise is determined by the type of activity - muscle building, endurance or aerobic - and the intensity of the activity. Protein is used by the body to build muscle and as an energy source. Some amino acids, unlike the others, can directly provide energy. Protein provides about 10% of the body's energy both at rest and during activity. If the diet is low in carbohydrate, the body will burn protein during activity. Protein consumption should be 10-15% of total calories.

Active people need more protein than the Recommended Dietary Allowance for sedentary people of .4 grams/pound of body weight. If the diet consumed is like the typical American diet, the extra protein is probably already being consumed. A basic guideline on the amount of protein required is:

7 Recreationally active adult - .5-.75 grams/pound of body weight 7 Teen athlete - .8-.9 grams/pound of body weight

The consumption of 2 cups of milk and 6 ounces of meat, along with the other foods eaten throughout the day, easily meets these protein needs. For a teen, the addition of 2 cups of milk can meet the extra protein (and calcium) needs.

Fat as the Secondary Energy Source

Dietary carbohydrate and protein needs should be met first. Fat can then be added to the diet to provide additional calories, but only to a maximum level of 30% of total calories. After about 20 minutes of exercise, the available carbohydrate (glycogen) is depleted and fat will be converted to fuel. In activities lasting over 2 hours, about 90% of the energy burned is from fat. Fat provides twice the energy of carbohydrates (9 calories/gram VS 4 calories/gram). An average 150 pound man stores about 110,000 calories worth of fat which can provide enough energy for 119 hours of exercise. A 130 pound women can store up to 550,000 calories in fat cells, enough for a 595 hour jog! Vitamins and Minerals

Vitamins and minerals play an important role in the metabolism of protein, carbohydrate, and fats and in muscle function. Although physical activity increases the need for some vitamins and minerals, this increased requirement typically can be met by consuming a balanced high-carbohydrate, moderate-protein, low-fat diet providing adequate calories.

Drink, Drink, Drink and Then Drink Some More

Body-fluid balance is essential for optimal health and athletic performance. The general fluid consumption "golden rule" is to drink 1 quart of fluids for every 1,000 calories consumed per day. This should result in a trip to the bathroom every 2-4 hours.

For active people, the fluid balance can be compromised because the increased need for fluids is difficult to replenish for some. Typically, a person will only replace 50-75% of their fluid loss if depending upon thirst as an indicator of fluid balance.

Increased activity leads to an increase in heat production, which is in part, dissipated through sweat. If this heat is dissipated faster than it can be replaced, dehydration can result. Dehydration has an adverse effect on muscle strength, endurance, and coordination and increases the risk of cramps, heat exhaustion, and life-threatening heat stroke. Guidelines for fluid consumption for an active person include:

7 2 cups fluid 2 hours before exercising 7 2 cups fluid 30-60 minutes before exercising 7 = to 1 cup fluid every 15 minutes during exercise 7 2 cups fluid for every pound of body weight lost during exercise, beginning immediately following activity

For most people who exercise for 1 hour or less, water is the appropriate fluid. For longer activities or activities performed in extreme environmental conditions, such as a high temperature/humidity index, a 6-8% glucose, glucose polymer, or sucrose drink with a small amount of sodium are absorbed quickly and help maintain blood glucose levels. The beverage of choice should be one that tastes good to promote consumption, not cause gastric upset, and not contain substances that promote dehydration like caffeine or alcohol.

Water, commercial sports drinks, diluted fruit juices or homemade sports drinks (see recipe) are all appropriate fluids for replacement before, during, and after exercise.

Ergogenic Aids

Studies show that athletes consume a number of nutritional supplements and other compounds that promise improved strength and endurance in relatively high doses. Many of these compounds are down-right dangerous and many others, while not necessarily harmful, are not healthful or helpful. There are many of these compounds on the market. The following have not been proven to have any effect on performance:

7 Boron 7 Branched-chain amino acids 7 Choline 7 Chromium picolinate 7 Collodial minerals 7 Conjugated linoleic acid (CLA) 7 Creatine monohydrate (Cr) 7 DHEA 7 Mexican yams 7 Ephedra/Ma Huang 7 Gamma-oryzanol 7 Ginseng 7 Glandulars 7 Glycerol 7 L-carnitine 7 Medium-chain triglycerides 7 Phosphatidylserine 7 Yohimbe

These compounds have been shown to enhance exercise performance:

7 Beta-hydroxy beta-methylbutyrate (HMB) - increases muscle size and strength with weight training.

7 Caffeine - people report that exercising is easier and they can exercise longer to exhaustion. Use caution as caffeine can cause dehydration and stomach upset. Recommendation is no more than the equivalent of 1 cup of coffee 1 hour before exercising for 150 pound person.

7 Glucose Polymer Drink with dihydroxyacetone and pyruvate (DHAP)- shown to increase muscle glycogen stores more effectively than regular sport drink in people who are not trained athletes. Check labels carefully when purchasing these products for levels of "DHA" at 75 grams and "P" at 25 grams per serving.

7 Sodium Bicarbonate (baking soda) - buffers the build up of lactic acid in sprinters. Recommend .3 grams/kilogram of body weight 2-3 hours before activity diluted in water. Warning: = of all athletes using it experienced urgent, explosive diarrhea one hour after drinking it. Long term effects are unknown.

References:

1) Berning JR, Steen SN. Nutrition for Sport & Exercise. Gaithersburg, Maryland: Aspen Publishers, Inc.; 1998.

2) Clark N. Nancy Clark's Sports Nutrition Guidebook. 2nd ed. Brookline, MN: SportsMedicine Brookline; 1997.

3) Position of The American Dietetic Association: Nutrition for Physical Fitness and Athletic Performance for Adults; 1999.

4) Sizer F, Whitney E. Nutrition Concepts and Controversies. 6th ed. St. Paul, MN: West Publishing Company; 1994. 10:357-376.

Homemade Sports Drink

Yield: 1 quart

4 tablespoons sugar < teaspoon salt < cup boiling water < cup orange juice or 2 tablespoons lemon juice 3-3/4 cups cold water

1. In the bottom of a pitcher, dissolve the sugar and salt in the boiling water. 2. Add the juice and the remaining water; chill.

Activities

1. Administer Knowledge Survey (Pre-Test) to participants.

2. Using paper food models, have participants identify "carbohydrate foods", "fat foods" and "protein foods". Participants then place the foods along an activity continuum, showing which foods are burned for energy. Discuss using Handout # 1 Fuels for the Body. (Activity continuum made on freezer paper.)

Activity Continuum:

Rest 20 minutes After 20 minutes 2 hours Longer

3. Using Handout # 2 Fueling the Body, have participants plan an appropriate diet and fluid regimen for the 4 activity scenerios. Discuss.

4. Administer Knowledge Survey (Post-Test) to participants.

5. Administer Evaluation to participants. Handout # 1: Fuels for the Body

At rest: Fat (fatty acids) - Provides up to, and over 50% of energy Carbohydrate (glucose) - 40% Protein (amino acids) - 10%

The first 20 minutes of exercise:

Carbohydrate (stored glucose = muscle glycogen) - 100%

After 20 minutes of exercise:

Carbohydrate (blood glucose, muscle and liver glycogen) - Fat Protein

After 2 hours of exercise:

Fat - 90% Carbohydrate Protein

Longer: Fat Carbohydrate (glycogen depleted and must be furnished!) Protein

The fuel that is used during exercise is determined by the intensity and duration of the activity.

Intensity: Low - burns fat High - burns carbohydrate

Duration: Short - burns carbohydrate Long - burns fat

Best activity to burn fat and spare glycogen = a long fast walk (fast = talk, but not sing)

Handout # 2 - Fueling the Body

Plan an appropriate diet and fluid regimen for the following:

8 am Brisk Morning Walk - 1 hour

2 pm Tennis Match - 2 hours

8 pm Volley Ball Game - 1 = hours

10 am - 4 pm Bike Trip Along the Paul Bunyon Trail - 6 hours

Pre and Post Test - Knowledge Survey

T F Exercisers need more protein than is supplied by the typical American diet.

T F A 130 pound woman can store enough energy to jog for 595 hours.

T F The general rule for fluid consumption is one quart for every 1,000 calories eaten.

T F To replace fluid when active, it is necessary to drink 1 cup of fluid for every pound lost during exercise.

T F Drinking a water/baking soda mixture before exercise can help muscle performance.

Evaluation

1. Was this training valuable to you in your work? How?

2. Was this training valuable to you in your personal life? How?

3. What could have made this training more valuable to you?

4. What additional information would you like related to nutrition and fitness?

Teaching the Nutrition and Fitness Lesson

5 Nutrition Education Assistants and 1 Extension Educator participated in the 2-hour training on January 21, 1999. The training was part of the on-going staff development that is offered to cluster 9 nutrition education staff at monthly staff meetings.

The lesson was well received and was really quite fun. There was a lot of questions and discussion. The activities went off as I had imagined them and stimulated a lot of thinking and working together.

Knowledge Surveys and Change in Knowledge

On the pre-tests, 4 of the staff had at least 1 answer wrong. The average score for the group was 4 out of 5. As a group, they answered correctly 22 out of 30 questions, or 73% of the time. The group rated their nutrition and fitness knowledge at an average of 2. On the post-tests, only 2 staff members missed 1 question. As a group, they answered correctly 28 out of 30 questions, or 93% of the time. They raised the rating of their knowledge of nutrition and fitness to 4. This indicates that they weren't just imagining they increased their knowledge, they actually did increase their knowledge!

Evaluation of the Lesson

On the evaluations, all 6 staff members indicated that the lesson had been valuable to them in their work. Their comments on how the training was of value included: "We get questions from either wanna-be athletes or real ones - mostly youth."; "For people who start spring yard work, etc., for long periods of time. Knowing the amount of fluid needs."; "The importance of fueling your body for what ever you're going to do in a day, whether you are active or not. For performance of life!"; "I get questions about water - how much and why."

All 6 staff members indicated that the lesson was valuable to them in their personal life. Their comments, included: "I will see if better fluid consumption will prevent me from getting as red-faced and hot when doing manual labor. Also, I will become more active."; "I never think about eating and fluid consumption related to an exercise activity - now I will."; "I needed to know how long it took to start burning fat. I have done everything opposite to burning it off."

The training could have been more valuable to some with the inclusion of the cost of sports drinks and more explanation of carbohydrates. One person wondered why the lesson couldn't have been offered 4 years ago!

Other comments indicated that the lesson was fine as it was. Comments included: "It was great. I appreciate knowing the information well enough to answer questions that are related in a different context."; "Good job; combination of lecture and activities."

Additional information that the lesson participants would like included a weight-training program for women that could be done at home, simple ideas for senior fitness, and inexpensive meals that are easy to make and take.

I will follow up with these staff members to get them the information that they requested.

-- Anonymous, January 22, 1999

Answers

Absolutely wonderful synthesis of information. I printed it out and shared it with my 3 sons...soccer fanatics who are just beginning to pay attention to nutrition (until about a year ago they considered me just "psycho" when I tried to teach them!). Also, I'm working with an MED student here at UMD who is doing research along these lines, if you'd ever like to contact her, let me know.

-- Anonymous, January 31, 1999