Module 8 - Sport Nutrition Assessment and Nutrition Care Plan for Athletes Flashcards

1
Q

What are the parts of the nutrition care process model?

A
  1. Nutrition assessment and reassessment
  2. Nutrition diagnosis
  3. Nutrition intervention
  4. Nutrition monitoring and evaluation
    All influenced by social systems, economics, practice setting, and health care system as well as the skills of the practitioner
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2
Q

What is the purpose of a nutrition assessment and what should be identified?

A

Purpose is to collect and interpret relevant client information to identify:
- If the athlete is at risk for malnutrition and if so, why
- The potential to positively influence sport performance through dietary changes
- Nutrition assessment gives you the evidence you need to know how to care for the athlete you are working with
- Assessment data, not the athlete’s preferences or wishes, determine the nutrition care plan

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3
Q

Define malnutrition

A

The condition that occurs when the body’s requirements for one or more essential nutrients is not met

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4
Q

What are some of the causes of malnutrition?

A
  • Inadequate or unbalanced diet
  • Problems with digestion or absorption
  • Certain medical conditions
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5
Q

Explain how starvation and malnutrition are related

A
  • Starvation = just one form of malnutrition! A subset of malnutrition
  • A person can appear healthy and still be malnourished
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6
Q

What should you never assume when working with athletes?

A

Don’t assume all athletes are healthy
- There is a tendency to assume that all athletes are healthy by virtue of their participation in sport
- This is inaccurate and potentially dangerous
- There are many cases where athletes appear healthy but are subsequently diagnosed with very significant health issues, including malnutrition
- If we assume people are healthy, there is a risk that preventable or treatable illness will be missed or discounted

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7
Q

What occurred in the Capati versus crunch fitness case?

A
  • Given a herbal supplement with epheddrine that cause capati to have a stroke, excessive and uncontrollable bleeding in the brain
  • lack of health assessment skills (assumed she was healthy with no medications)
  • Lack of understanding of health history: hypertension (high blood pressure)
  • Lack of awareness of risk: assumption that the herbal supplements were “natural” and “safe”. Ephedrine increases blood pressure
  • Focus on appearance versus health
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8
Q

What happened with Sergei Grinkov?

A
  • Figure skater with olympic, worlds gold medals. Won majority of the competitions he was in
  • Not obese, obviously active, appeared to be very healthy
  • Died on the ice while training from a heart attack at age 28
  • Clogged coronary arteries and genetic risk factors linked with premature heart attack that had gone undetected (family history)
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9
Q

Nutrition Assessment involves _________________

A

Critical thinking

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10
Q

What critical thinking/steps need to be done during a nutrition assessment?

A
  • determine appropriate data to collect and selecting valid and reliable tools
  • Distinguish relevant from irrelevant data
  • Select appropriate norms and standards for comparing data
  • Organizing and categorizing the data in a meaningful way that relates to the nutrition concerns of the client
  • Identifying the absolute base nutrition issue (versus issues that are symptoms more than the base issue)
    → Low body weight in an adult with anorexia nervosa. Weight is a symptom; mental health issues are the base case
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11
Q

By the end of the nutrition assessment process what should you be able to say with confidence?

A
  • What the athlete’s specific nutrition-related concerns are
  • Why you know these are the concerns (e.g. you can cite your evidence) AKA back your diagnosis
  • What you need to do to correct or optimize the athlete’s nutritional health
    → If you can’t say with confidence why you are offering the care or advice you’re offering you should not give care
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12
Q

What are the four main elements of the nutrition care process?

A
  1. Nutrition Assessment
  2. Nutrition Diagnosis
  3. Nutrition Intervention
  4. Monitoring an evaluation
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13
Q

What are the 5 key elements of a nutrition assessment?

A
  1. Personal health, sport, and social history
  2. Dietary assessment
  3. Body weight and composition assessment (anthropometric assessment)
  4. Assessment of energy expenditure
  5. Fitness assessment
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14
Q

What is the purpose of taking the personal health, sport, and social history of an athlete?

A
  • Determine any current or potential health problems so you can determine their health risk level
  • Provide contextual info about the athlete’s life, their training habits (type, frequency, duration, and intensity)
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15
Q

What are the key elements of personal health, sport, and social history?

A
  • Demographic info: name, age, height, weight, gender
  • Family and personal history of disease or health concerns (including allergies, menstruation)
  • History of illness and injuries
  • Surgical history
  • Menstrual history (for females)
  • Medication and supplement use
  • Detailed info on their level of sport participation: type, frequency, duration, intensity, goals of sport participation
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16
Q

What is an example of how you could take an athlete’s history?

A
  • Health History Questionnaire
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17
Q

What is the purpose of a dietary assessment?

A
  • Used to assess energy (Kcal) and nutrient intakes
  • Quantity supplement use
  • Assess eating pattern (e.g. timing of meals and snacks, consistency of eating pattern)
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18
Q

What does the fitness assessment do? Who does it?

A
  • Flexibility
  • Muscular strength
  • Muscular endurance
  • Aerobic/cardiorespiratory fitness
  • Anaerobic fitness
  • Generally completed by the athlete’s trainer, coach or other qualified fitness appraiser and shared with the sport dietitian
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19
Q

When taking a social and personal history what should you find out?

A
  • Socioeconomic status, social and medical support, cultural and religious beliefs, housing situation, and social isolation/connection
  • Others involved in their Circle of Care: may include obtaining formal consent to communicate with others in the Circle
  • Age, occupation, role in family, and education level
  • ## Who is responsible for shopping for food, cooking, etc.
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20
Q

What is the purpose of finding out social/personal history?

A

Helps you understand how the athlete lives and the support they have. If parents are doing the cooking, may want to talk to them for example.

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21
Q

What are potential lab values of interest for athletes?

A

The following are good to check, if good then can move on:
- Blood lipid levels: Tchol, LDL, HDL, VLDL, LDL/HDL ratio, TG
- HbAic% (higher in diabetes)
- Blood glucose
- Urine protein
- Urine glucose
- BUN
- Serum creatinine
- Albumin

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22
Q

What should be done when doing a body weight and composition assessment?

A
  • Current (Usual) Weight - is this weight normal for them? If rapid weight loss and unintended = red flag
  • Ideal/optimal weight for sport - room for variation
  • Weight history - has it changed? What direction and over how long? The larger the magnitude of weight change over the shorter duration of time = increased risk for malnutrition
  • Body composition measures - if accessible
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23
Q

How do you calculate percent usual body weight?

A

% usual body weight = (Actual Body Weight/Usual Body Weight) x 100%

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24
Q

What are the percent usual body weights that indicate degree of malnourishment?

A
  • Weight indicator of malnourishment
  • Does not tell you how long it took to change
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25
Q

How do you calculate percent weight change? What is needed to show if this is a concern or not?

A

(Usual weight - Actual Weight)/Usual weight
E.g. Mary Jane was 150lb last time you saw her 3 weeks ago, today is is 135 lbs. = (150-135)/150 = 10%
- The importance of this change will depend on the time over which it occurred. 10% weight loss over 1 year is less of a concern, 10% weight loss over 1 month is a greater concern

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26
Q

What percent weight changes are considered significant versus severe?

A

Significant weight loss:
- 5% loss over 1 month
- 7.5% loss over 3 months
- 10% loss over 6 months
Severe weight loss:
- >5% loss over 1 month
- >7.5% over 3 months
- >10% loss over 6 months

These standards are widely used to assess significant weight changes in

Look into why these changes have occurred!!

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27
Q

What are the ideal weights for sport performance?

A
  • Dependent on the sport and sometimes the gender
  • In some sports it is advantageous to be heavy: heavy wresters can be harder to topple because of the low centre of gravity
  • In some sports it is advantagoues to be light: being ligher makes it easier for female gymnasts to keep their balance and control their momentum
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28
Q

What is an NFPE?

A
  • Nutrition focused physical findings - clinical exam. Not used on its own
  • Includes a review of key physical areas related to nutrition
  • At minimum all athlete’s should have a visual examination but looking at an athlete’s physical condition!
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29
Q

What will you look at when doing an NFPE?

A
  • Hair
  • Skin (colour, texture, integrity)
  • Nails
  • Muscle and fat mass
  • Dentition/mouth teeth
  • Eyes
  • Emaciated
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30
Q

What are common diet assessment methods and their advantages and disadvantages?

A
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31
Q

What is meant by “respondent burden”?

A
  • Get them to do all the work
  • 24 hour recalls or food frequency questionnaires have lower burden (AKA less work)
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32
Q

What are the components of a 24 hour recall/dietary history/food record review?

A
  • Includes all foods and quantities eaten, eating habits, accessibility of food, and cultural and socioeconomic factors that effect selection of food
  • Details matter: portion sizes, brand names, eating times (pattern)
  • Use the 3 pass method: Pass 1 - when and what (general), Pass 2 - portion sizes, Pass 3 - things often forgotten (condiments, items in or on things)
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33
Q

What process is followed to make a nutrition diagnosis?

A
  • Sport dietitians develop a nutrition diagnosis for each athlete they work with
  • A nutrition care process is followed!
  • A diagnostic/PES statement is created for each problem
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34
Q

What is a PES statement and what are its elements?

A
  • A PES statement is a nutrition diagnossis statement that identifies what nutrition problems the sport dietitian is working to improve
  • 3 Elements that have evidence to support them all:
    1. Problem (P)
    2. Etiology (E)
    3. Signs or symptoms (S)
35
Q

What is the best way to perform a PES statement

A
  • Work the PES State,emt process backwards before writing it forwards: S/s then etiology then problem.
36
Q

What do sport dietitians chart?

A
  • Chart the care provided to athletes exactly as they would the care provided to any other individual:
  • Formal, written account of the nutrition assessment and the data that was considered
  • PES statement(s)
  • Intervention/plan
  • Monitoring
37
Q

How should clinical documentation be stored?

A
  • Documentation is confidential!
  • Must be stored per current regulatory requirements (locked, kept for 7 years)
38
Q

What is vital to keep in mind if you are a sports nutritionist?

A
  • Keeping an open mind is critical to reliable assessment of nutritional status. If you don’t keep an open mind the sport dietitian risks anchoring on early info and not asking enough questions to get to this athlete’s absolute base issue
  • Nutrition assessment is not complete until you can say, with evidence and confidence, why your statements about an athlete’s nutritional status are accurate and reliable
  • If you can’t cite your evidence, you are not done the assessment process
  • If you are unsure how to interpret the evidence, you shouldn’t continue. The athlete needs to be referred to a more skilled practitioner
39
Q

You are given the following situation, what is your initial assessment and what more info do you need? who would you like to talk to?

A
40
Q

The same client has told you the following information, what else do you want to know and is anything you learned a concern?

A

Want to know about her menstrual cycle, iron status, family history, and diet history of what she is eating

41
Q

You did further assessments and found the followin information, what can you tell from this?

A
  • Likely has RED-S and potentially bulimia
  • Low fat deposition impacting her endocrine system and body temperature
  • Concern for iron deficiency
42
Q

When assessing energy expenditure, what methods are used?

A

Criterion methods, objective methods, subjective methods. Equations are more accessible

43
Q

Why follow a training diet?

A
  • A well structured training diet lays the foundation for peak performance
  • Eating well during training = higher quality training = enhanced results = stronger performance during competition or game play
44
Q

What does a sound training diet contain?

A
  • provide adequate energy (calories) and all essential nutrients
  • Are balanced: no one food group is over or under emphasized
  • Targeted to the individual athlete to maximize performance
45
Q

_____________ Matters

A

Consistency. Need to have consistency in order to have impacts. What you eat the majority of the time will have better effects. Start small and work up

46
Q

What is the relationship between good nutrition and training?

A
  • Training and good nutrition work hand-in-hand
  • A great diet can’t compensate for poor training
  • Training suffers when an athlete’s diet is poor or unbalanced
  • It’s how you eat most of the time that counts (Make it practical - e.g. travel eating)
47
Q

What is the athlete’s plate and why use it?

A
  • Widely used by sport dietitians because it is flexible to a range of foodways, easy-to-understand, and adaptable to different levels of training
  • Recommendation for athletes that are easy to follow based on their goals and activity levels
  • Organized into easy, moderate, and hard
  • Moderate is the baseline and may go up or down from there based on what the athlete is doing
  • Visual and teaches portions/proportions
  • Eat to match their hunger
  • Want them eating at least 3 meals a day with 2 or more snacks
48
Q

What does an “Easy” day plate look like?

A
  • An easy day may contain just an easy workout or tapering without the need to load up for competition with energy and nutrients
  • Weight management, post injury
49
Q

What does a “moderate” day look like?

A
  • May be one where you train twice but focus on technical skill in one workout and on endurance or strength in the other.
  • ## The moderate day should be your baseline from where you adjust your plate down (easy) or up (hard/race)
50
Q

What does a “hard” day look like for the athlete’s plate?

A
  • A hard day contains at least 2 workouts that are relatively hard or involve competition
  • If your competition requires extra fuel from CHO, use this plate to load up in the days before, throughout, and after the event or tournament day
51
Q

What can occur if not athletes do not properly eat before a game?

A
  • Too much food, to close to a game, performance may suffer:
    → side-stich, stomach cramps, sluggishness
  • Too little food, too far back from the start of a game, performance may suffer:
    → Hunger, lack of energy especially in the 3rd period or OT, sluggishness

Interested in amounts, and timing of foods

52
Q

What should pre-event eating foods be composed of?

A
  • Foods need to be out of the stomach before the start of competition
  • Undigested food is not a source of fuel or metabolic substrates
  • This influences the types of foods that are suitable
  • Foods that are high in fat, protein, salt, or sugar as well as large portion sizes can be a problem
  • tolerance can significantly vary from athlete to athlete. Need to trial and error and keep a training log/diary
53
Q

Appropriate pre-event food choices are:

A
  • High in CHO
  • low in fat (takes long to digest)
  • Moderate in PRO
  • Low in salt and sugar
  • Provide water or other fluids
  • No alcohol
54
Q

What glycemic index should foods be for pre-event eating?

A
  • In lead up phase want levels to gradually rise and avoid risk of rebound hyperglycemia.
  • Choose low glycemic index foods!
55
Q

When should people time pre-event eating?

A
  • Eating 2 to 4 hours prior to the event usually allows adequate time to clear the stomach
  • A pre-event (small) snack could be consumed 1 hour before the event based on athlete tolerance.
  • NEED TO TRIAL DURING TRAINING!
  • Plan to eat the pre-game meal at least 2 hours before the start of the game
  • The food has to be digested for it to fuel the athlete and digestion takes time!!
56
Q

What kind of meal should someone eat for pre-event eating?

A
  • Choose a meal that has at least 1 grain product + 1 milk and alternatives + 1 vegetable and fruit
57
Q

Give examples of larger meals an athlete can have for 2 to 4 hours pre-event

A
58
Q

Give examples of lighter meals an athlete could have 1 to 2 hours pre-event

A
59
Q

What are the recommendations for tournament eating?

A
  • Know your schedule before you get there
  • Plan to eat as soon as possible after each game
  • If there is less than 2 hours between games, aim for foods/beverages that are quick to digest (e.g. liquid meals, simple food choices)
60
Q

What could a dietitian do for athletes to support between game eating during tournaments?

A
  • During short breaks aim for a healthy “buffet” of nutritious snacks:
  • Smoothies (made with yogurt, ice, fruit/veggies)
  • String cheese
  • Cottage cheese or yogurt
  • Chocolate milk
  • Apples filled with natural peanut butter
  • Animal crackers
  • Dry cereal
  • Whole grain crackers
  • Plain (hard) granola bars
  • Water
61
Q

What is the golden rule of pre-event eating?

A
  • Never, ever eat or drink something on a game day that you haven’t already tested in training and that you know agrees with you!
  • Breakfast ideas
  • Sport drinks
  • Gels
  • Bars
  • Training is a dress rehearsal for game day
62
Q

What should be eating in game?

A
  • Sport >1 hour eating (or drinking) sources of CHO during sport can help to “top-up” blood glucose levels and spare muscle glycogen
  • Glucose available and easily absorbed
  • Sport drinks: gatorade, powerade, NOT biosteel
  • Sport gels, sport bars, granola bars (more complex but may like it more), sesame snaps, dried fruit (fructose takes longer to breakdown)

Need to keep in mind what the athletes preferences are and what is practical

63
Q

During sport > 1 hour what can occur?

A
  • Glycogen stores will start to decrease
  • If they are inadequate at the start won’t make it through
64
Q

What are the 4 Rs of Recovery eating?

A
  1. Rehydrate - to prevent dehydration
  2. Replenish - glycogen stores with CHO rich foods
  3. Repair and regenerate muscle tissues with high-quality protein sources
  4. Reinforce your immune system with nutrient dense foods

AKA Carbohydrates + Proteins + fluid in the first 15 minutes

65
Q

When putting it all together, what should a day of training/game day foods look like?

A
  • Before: hydration (fluid and sodium) and carb energy
  • During: hydration and carbohydrate when training or competing greater or equal to 60 minutes
  • After: hydration, carbohydrate when recovery time is short, and protein
66
Q

What are the goals of pre-event eating?

A
  1. Begin sport with blood glucose levels that are within the normal range
    → Provide CHO rich foods to maximize performance and prevent fatigue (prevent hypoglycemia and glycogen depletion)
  2. Maintain hydration status
    → Top up with water
67
Q

Give examples of glycemic index foods that are high, moderate, and low

A
  • Remember: glycemic indexes are not a measure of nutrient quality just how fast they are absorbed
68
Q

How does glycemic index work? How does this apply to exercise?

A
  • without exercise when you eat foods they can raise your blood sugar with high glycemic index foods doing it faster leading to high blood sugar
  • This leads to insulin release which will lower blood sugar. Low blood sugar will trigger glucagon to breakdown glycogen
  • When having high glycemic index foods they can cause a sharp increase then drop leading to low exercise performance and hypoglycemia
  • Want to gradually increase blood glucose levels and prevent a steep drop
69
Q

What glycemic index do you want for in-game eating for sport >1 hour?

A
  • High glycemic index
  • 30-60grams every hour (e.g. 250mL sport drink contains 14-24 grams)
  • Not enough will not make a difference, too much can cause stomach upset and rebound hypoglycemia
  • Need to have the proper dosage to maintain levels and have good performance
70
Q

What is the basis behind recovery eating?

A
  • Intense exercise decreases fuel stores (glycogen) and is associated with muscle breakdown
    → EPOC
71
Q

When is the optimal recovery eating time?

A
  • Optimal recovery eating starts 15-30 minutes after intense activity
  • During this time the body is “primed” to absorb carbohydrates and protein
  • The recovery process extends 24 hours after activity
  • Need to have snacks available immediately after playing and then have a meal soon
72
Q

What are the symptoms associated with chronic fatigue in adults and how many are required for you to be worried?

A
  • Two or more symptoms = caution!
  • Unusually poor performance in training and competition
  • Failure to improve performance
  • Inability to perform better in competition than during practice
  • Loss of appetite and body weight
  • Insomnia
  • Joint and muscle pains that have no apparent cause
  • Frequent colds and respiratory problems
  • Irritability and anxiety that may be accompanied by depression
73
Q

Why do athletes need to eat immediately after competing?

A
  • To maximize recovery
  • Muscle glycogen will stay low unless you have carbohydrate top ups. Need to do it as soon as possible.
  • Glycogen synthase and glycogen will work opposite of each other
74
Q

If one group of athletes immediately eats after exerise and another group has delayed eating, what will happen?

A
  • the Group immediately fed will have glycogen higher than the delayed group
  • The delayed group will then have a slight increase in glycogen afterwards when they eat
75
Q

What should be paired with carbohydrate for recovery?

A
  • Protein
  • CHO and protein together will have optimal muscle glycogen synthesis than if just done alone
76
Q

What is the function of BCAAs?

A
  • Branch-chain amino acids (BCAA) are an essential amino acid (EAA) that play an important role in muscle metabolism
  • BCAA are necessary for stimulation of molecular signaling that lead to muscle protein synthesis response
77
Q

What is the most important BCAA for molecular signaling leading to muscle protein syntheis and breakdown?

A

Leucine

78
Q

Are BCAAs effective for recovery?

A
  • Ingestion of BCAA without co-ingestion of a source of the other EAA will NOT stimulate a maximal muscle protein synthesis response
  • BCAA supplements should not be used to reduce exercise-induced muscle damage or stimulate muscle protein synthesis
79
Q

Why is chocolate milk an effective recovery food?

A
  • Good source of leucine, has fluid, carbohydrates, cheap and can get it in may places
80
Q

What are the recommendations for hydration and recovery?

A
  • Athletes should aim to drink fluids throughout the day to recover from a training session and start their next session hydrated
  • Foods with high water content (i.e. watermelon, soups, etc) contribute to meeting daily hydration needs
  • Consuming a beverage with sodium or eating salty foods, can help retain fluid if athletes have an issue with hydration
  • Checking urine color can be an indication of hydration (aim for a light, lemonade color)
81
Q

1 lb of weight lost is how much water?

A

2 cups/500mL

82
Q

Give an example of a recovery eating snack for athletes

A

1) 500mL of chocolate milk (48g CHO, 16g PRO); 1 fruit (half a banana or orane = 15g CHO); 1 bread (1/2 bagel or 1 oz pretzels = 15g CHO). Total = 78 grams carbs/16 grams PRO
2) 250mL chocolate milk (24g CHO/16g PRO); Homemaid trail mix (1 oz peanuts = 7g PRO; 1 cup dry cereal (22g CHO/3g PRO; 1/3 cup cranberries (24g CHO)). Tota = 70 grams CHO/18g PRO

83
Q

What things must you keep in mind for using these recommendations as a sport dietitian?

A
  • Calculated needs from the published recs is a starting point
  • Use recs as a guide and tweak depending on athlete’s response and likes and dislikes
  • E.g. CHO recs are 1-4g/kg 1-4 hours prior. Take into account the athlete’s hunger, nerves, game time, when the team stops for a meal on the road, etc.
  • DO NOT be a pamphlet, have to tailor
  • Know the goals of the athlete, how these vary depending on in-season and off-season.
  • Know the athlete’s circle of care.