Nutritional Support and Banned Substances

Chapter 7


Nutritional Support and Banned Substances




Objectives


After completing this chapter, the student will be able to perform the following:


1 Explain general dieting recommendations.


2 Describe an antiinflammatory diet.


3 Describe the sport performance–related diet.


4 Explain why fluid intake is important.


5 List the components necessary for weight management.


6 Describe nutritional supplements.


7 List the risks and benefits for athletes of using nutritional supplements.


8 List banned substances.


9 Explain the relationship between eating disorders and exercise or sport performance.


10 Define the three major eating disorders of athletes.


11 List the symptoms of eating disorders.


12 Report life-threatening substance abuse behavior and eating disorders to the appropriate professional.



Key Terms


































The massage therapist needs to understand the nutritional needs of the athletic client. Nutrients and/or the use of nutritional supplements and banned substances can influence massage outcomes and present contraindications. Proper nutrition is necessary for recovery, healing, and performance. Appropriate use of various nutritional supplements can support, but not replace, a nutritious diet (Figure 7-1).



Unfortunately, much dietary advice in the sport and fitness world is exaggerated or inaccurate, and can be downright harmful. Certain substances are illegal, and their use can jeopardize an athlete’s career.


Nutrition is not an exact science. The massage therapist is not usually a nutritional expert. Therefore, it is important for the athlete to consult a reputable person, such as a registered dietitian, preferably one who specializes in sports and cardiovascular nutrition. For a reliable reference, contact the American Dietetic Association, which lists more than 3000 specialized dietitians across the country.



General Dietary Recommendations



Objective




A healthy diet consists of appropriate portions of healthy fats such as olive, grapeseed, and flaxseed oils and healthy carbohydrates (whole-grain foods) such as whole wheat bread, oatmeal, and brown rice. Vegetables and fruits should be eaten in abundance. A balanced diet includes moderate amounts of healthy sources of protein such as nuts, legumes, fish, poultry, lean meat, eggs, and dairy products.


A healthy diet minimizes the consumption of fatty red meat, refined grains including white bread, white rice and pasta made with white flour, and sugar. It eliminates food containing trans fats, including many fast foods and prepared foods. A high-quality multiple vitamin that breaks down quickly in the digestive system is suggested for most people.


Fruits and vegetables reduce the risk of cardiovascular disease. Folic acid and potassium appear to contribute to this effect, which has been confirmed in several epidemiologic studies. Inadequate consumption of folic acid is responsible for higher risks of serious birth defects, and low intake of lutein, a pigment in leafy green vegetables, is associated with increased risk for cataracts and degeneration of the retina. Fruits and vegetables are also primary sources of many vitamins needed for good health.


High consumption of red meat has been associated with increased risk of coronary heart disease (most likely because of the high saturated fat content of red meat) and of type 2 diabetes and colon cancer. It may aggravate the inflammatory response and may increase pain sensitivity. The elevated risk of colon cancer may be related in part to the carcinogens produced during cooking and to the chemicals found in processed meats such as salami and bologna.


Poultry and fish, in contrast, contain less saturated fat and more unsaturated fat than red meat does. Fish is a rich source of the essential omega-3 fatty acids as well. Eggs do not appear to have adverse effects on heart disease risk, probably because the effects of a slightly higher cholesterol level are counterbalanced by nutritional benefits. This is especially true of eggs from chickens fed special vegetarian diets to increase nutritional value. Many people avoid nuts because of their high fat content, but the fat in nuts, including peanuts, is mainly unsaturated, and walnuts in particular are a good source of omega-3 fatty acids. Also, people who eat nuts are actually less likely to be obese. Nuts are more satisfying to the appetite, and eating them seems to have the effect of significantly reducing the intake of other foods.


People need to eat clean and fresh food as much as possible. Organic foods and free-range/hormone-free meat, poultry, and fish are becoming easier to obtain. Even though the cost is higher, the value is usually worth the investment.



Antiinflammatory Diet



Objective




An important aspect of caring for the athlete and for those in various rehabilitation programs is management of inflammation. Therefore, eating a diet targeted to reducing inflammation is prudent. An antiinflammatory diet follows the recommendations given in this section. In addition, foods especially high in antioxidants are valuable.


A typical antiinflammatory diet is high in vegetables, fruits, and legumes and low in refined carbohydrates (including sugar) and undesirable fats, such as saturated fats; most important, it includes the elimination of trans fats.


Antiinflammatory foods include most colorful fruits and vegetables, oily fish (which contain higher levels of omega-3 fatty acids), extra-virgin olive oil, nuts, seeds, and select herbs and spices, such as cinnamon, ginger, rosemary, and turmeric. Pineapple is high in an antiinflammatory enzyme called bromelain.



Sport Performance–related Diet



Objectives




Various opinions exist about the components of a diet needed to support athletic performance and recovery. The quantity of carbohydrates included in a sport performance–related diet is one area of discussion. In one research study, volunteers were placed on a normal diet composed of 50% carbohydrates, 34% fats, and 16% proteins. The maximum amount of time their muscles could work continuously was 114 minutes. On a noncarbohydrate diet composed of 46% fats and 54% proteins, the maximum was 57 minutes. However, on a high-carbohydrate diet of 82% carbohydrates and 18% proteins, the maximum was 167 minutes, nearly three times as long as for the noncarbohydrate diet.


Endurance athletes know that a high-carbohydrate diet helps performance by storing more fuel (glycogen) in the muscle, but a high-carbohydrate diet seems to be relevant to all sports. People in stop-and-start sports, such as tennis, after consecutive days of hard training deplete their muscle glycogen stores. After each day’s workout, a diet that contains sufficient carbohydrates is necessary to replace the glycogen used during activity.


A diet high in complex carbohydrates, moderate in proteins, and adequate in good fats can help keep the energy level up during a weight loss program. Complex carbohydrates also have a fair amount of fiber, so the calories are more filling and fewer calories are consumed. Many foods high in carbohydrates have small amounts of protein and large numbers of vitamins and minerals. Sources of complex carbohydrates include whole-grain breads, cereals, and grains; legumes such as beans, peas, and lentils; fruits; and vegetables.


Children need a relatively high level of protein in their diet because they are still growing, whereas adults need only enough protein to maintain tissue repair. Although protein cannot be metabolized for energy, it contains amino acids, the building blocks for body tissue. During exercise, a breakdown of body tissue occurs, especially during contact sports such as football, but this also occurs during general exercise such as jogging. Continued use of muscle fibers breaks them down, and the body needs protein to repair them.


Eating foods high in fats and proteins slows down the stomach-emptying process. Therefore, it makes sense to eliminate high-fat, high-protein foods from pre-event meals. Instead, an athlete may benefit from eating high–complex carbohydrate, low-fat foods, such as whole-grain breads and pasta, at least 2 hours before a workout or competition so that the stomach empties before exercising. The athlete should allow 3 to image hours between eating and an upcoming competition because competition anticipation slows down digestion, and an upset stomach may occur.


If a person has not eaten for 6 to 8 hours, his or her blood sugar level will be low. Symptoms of low blood sugar include dizziness, inability to think clearly, shakiness or weakness, and difficulty concentrating. Eating carbohydrates can restore and maintain blood sugar levels during exercise and can prevent hunger and exhaustion after a workout. All people should avoid eating foods with high sugar content such as candy because they cause a sharp increase in blood sugar levels. The body responds to this increase by releasing insulin, which burns up blood sugar reserves and depletes overall energy, rather than providing an extra boost.


High-potassium foods such as leafy dark green vegetables, citrus fruits, bananas, and melons are good for athletes because they are great sources of carbohydrates and proteins, contain no fat, and provide lots of vitamins and minerals.


Fluid intake is important because people can suffer heat problems from inadequate fluid replacement. Heat exhaustion or heatstroke can be life-threatening for both professional and amateur athletes. To prevent dehydration, 16 ounces of water should be consumed 15 minutes before a workout. Replenish fluids with water, electrolyte drinks, and diluted 50/50 fruit juices after exercise, and eat salty and high-potassium foods such as pickles. Thirst is not a good guide for fluid replacement.


During the 2 hours before exercise, it is best to drink only plain, noncarbonated water. The bubbles in carbonated water make a person feel full, so plain water is better. During warm-up, cold water is always appropriate. Cold water empties from the stomach faster than warm water. If an athlete has stomach cramps, this is probably the result of taking too much water at once. If an athlete experiences muscle cramps, an electrolyte sport drink diluted (50/50) with warm water may help.


The athlete should drink 4 to 8 ounces of water every 15 minutes during demanding performance, especially if he or she is sweating.


After a workout, cold water or a watered-down electrolyte drink is advisable. Within 2 hours after exercise, and preferably within 15 minutes, a high-carbohydrate snack is appropriate. Ingesting carbohydrates within that time frame seems to accelerate the replacement of muscle glycogen reserves.


Because high-carbohydrate drinks slow fluid replacement, it is best to get some fluid replacement under way first. A good rule of thumb is to take:



Limit caffeinated drinks such as coffee, cola, and iced tea. Although caffeine produces a feeling of increased energy, too much caffeine is a diuretic, and fluids are lost because of excessive urination. The same goes for alcohol. Athletes should limit intake of caffeine or alcohol to 2 or fewer drinks daily because both promote water loss.



Weight Control



Objective




Weight control includes weight gain, weight loss, and weight maintenance. Body weight and body composition should be evaluated as part of a weight control program. With a diet or exercise program, the scale is not what determines the progress made. Muscle weighs more than fat, and as muscle mass is increased with exercise, body weight may increase, even though total body fat is decreasing.


An athlete’s weight may stay the same during off-season training, but during training, 10 pounds of muscle may be added and 10 pounds of fat may be lost. The athlete will not see a change on the scale but will see a dramatic change in body composition.


The gold standard for determining body fat is hydrostatic weighing. This is a rather complicated procedure that involves full-body immersion in water. A simple yet reliable method is to have a trained professional measure skin thickness in several areas of the body using calipers. This provides a reading of body fat percentage within a narrow range under controlled conditions.


Many people who exercise are overweight but not overfat. Being overweight alone is not a health risk, but being overfat is. A “thin” person may have lower than normal weight for his or her age and sex owing to one or more of the following factors: shorter height (shorter bones), a smaller frame (smaller, lighter bones), less muscle, and less body fat. A “heavy” person’s weight could be the result of one or more of these same factors if he or she is heavier than normal. Once the current body weight versus body fat is calculated, an ideal body weight goal can be established.


The more muscle and less fat, the faster and quicker the athlete. A higher tolerance for exercising in the heat should also apply. The heart and muscles will not have to work as hard and a thin individual will be less prone to injury because he or she carries less dead weight on the lower back, hip, knee, and ankle joints.


Athletes who are trying to lower body fat levels must maintain a certain level for general health. The essential body fat level for men is at least 3%, with 5% body fat being optimal because of possible hydration problems. For women, the optimal body fat level is between 15% and 20% for athletes and about 15% for elite athletes. Some women athletes, particularly runners and gymnasts, try to get their body fat levels as low as a man’s. This can be dangerous. A woman needs a higher level of body fat to maintain normal menstrual function and reproductive capabilities. The standard weight status categories associated with body mass index (BMI) ranges for adults are shown in Table 7-1.


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Jun 22, 2016 | Posted by in MANUAL THERAPIST | Comments Off on Nutritional Support and Banned Substances

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