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NUTR 380 > Module 9 - Nutrition for Specialized Athlete Groups > Flashcards

Module 9 - Nutrition for Specialized Athlete Groups Flashcards

1
Q

What is diabetes mellitus Type 1?

A
  • Destruction of insulin producing beta-cells of the islets of Langerhans in the pancreas
  • Treated with exogenous insulin or beta cell transplant
  • Formerly known as Juvenile Diabetes, Insulin Dependent Diabetes
  • Generally first diagnosed during childhood and adolescence
  • Usually autoimmune but may be idiopathic
  • Approximately 10% of people with diabetes have type 1
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2
Q

How does blood glucose levels change in type 1 diabetes?

A
  • Will have food and glucose enters blood stream
  • The pancreas makes little or no insulin thus the glucose will build up in the blood stream
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3
Q

What is diabetes mellitus, type 2?

A
  • Typified by insulin resistance rather than insulin inadequacy
  • Insulin response is blunted and blood glucose levels remain high
  • Historically diagnosed at mid-life. This is changing in response to heightened levels of overweight/obesity. Youngest reported case in Canada = age 5 years
  • Most common type of Diabetes = 90% of cases
  • Strongly related to exercise and diet (unlike Type 1)
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4
Q

How do blood glucose levels change in type 2 diabetes?

A
  • Ingest food which released glucose
  • Glucose enters the bloodstream
  • Pancreas makes insulin which enters into the bloodstream
  • Glucose cannot get into the cells of the body. Glucose builds up in the blood vessels
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5
Q

What is pre-diabetes?

A
  • Refers to blood glucose levels that are higher than normal, but not yet high enough to meet the diagnostic criteria for Type I or Type II DM:
    → Fasting plasma glucose level of 7.0 mmol/L or
    → A1C of 6.5% or higher
  • Not everyone with prediabetes will develop Type 2 DM, but left unactioned many people will
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6
Q

What are the other forms of diabetes/diabetic symptomology?

A
  • Gestational diabetes
  • Genetic defects of beta-cell function
  • Genetic defects in insulin action
  • Diseases of the exocrine pancreas
  • Endocrinopathies
  • Drug or chemical induced infections
  • Uncommon forms of immune-mediated diabetes
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7
Q

What are the health benefits of physical activity for people with diabetes?

A

Reduced risk for:
- CVD
- Obesity and overweight
- Diabetes related co-morbidities: neuropathy and nephrophathy
Increased:
- sense of well-being
- Control and self-efficacy

Outlet for getting rid of excess blood glucose

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8
Q

What are the effects of physical activity on blood glucose control?

A
  • Increases peripheral insulin sensitivity
  • Reduces insulin requirements (Endogenous and exogenous)
  • Improves glucose tolerance
  • Ability to clear glucose from the blood
  • May produce rapid fluctuations in blood glucose levels if dietary intake is not balanced with physical activity and oral hypoglycemic agents and/or exogenous insulin (especially in Type 1 diabetes)

Physical actvity + insulin can work together and can cause hypoglycemia

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9
Q

Is diabetes managed the same for type 1 and 2 diabetic athletes?

A
  • No, differences exist in the management but the overall goal is the same
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10
Q

What is the goal for diabetes management for type 1 and 2 for athletes?

A
  • In both cases is to avoid hypoglycemia and keep BG levels in the normal range
  • Normal = 4 to 7 mmol/L
  • Hypoglycemia is more likely in Type 1 cases than type 2 because it is treated with insulin
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11
Q

Why is hypoglycemia such a concern?

A

Hypoglycemia can be life-threatening if not appropriately managed. Prevention is key. Need a back up plan

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12
Q

How is type 2 diabetes managed? Who is at greatest risk of hypoglycemia during sport?

A
  • In general blood glucose levels are less labile in Type 2 DM than Type 1 DM
  • Individuals who control their diabetes with diet and exercise only are NOT at increased risk for hypoglycemia during activity
  • Individuals with diabetes who are being treated with oral hypoglycemic agents are at low to moderate risk of suffering from hypoglycemia during sport
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13
Q

For individuals with type 2 diabetes that use insulin what must be done?

A

Individuals being treated with insulin are at risk for hypoglycemia
- Monitoring is important
- Need to monitor and scale insulin dosage
- Adjust CHO intake as needed for balance
- Should follow similar guidelines to Type 1

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14
Q

Why are Type 1 athletes at risk for hypoglycemia?

A
  • Individuals lack the ability to maintain fuel homeostasis during exercise. Therefore hepatic glucose production may not match muscle glucose utilization
  • Results can be wildly fluctuating blood glucose levels
  • Significant risk for hypoglycemia is not monitored
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15
Q

How can physical activity impact blood glucose control?

A
  • Increased peripheral insulin sensitivity
  • Reduces insulin requirements (endogenous and exogenous)
  • Improves glucose tolerance
  • Ability to clear glucose from blood
  • Can produce rapid fluctuations in blood glucose levels (especially in Type 1 diabetes)
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16
Q

Explain the normal physiology when serum glucose decreases during exercise

A
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17
Q

What are the counter regulatory hormones associated with blood glucose and where are they released from? What is their net effect?

A
  1. Glucagon (alpha cells in pancreas)
  2. Growth hormone (anterior pituitary)
  3. Cortisol (adrenal cortex)
  4. Epinephrine/Norepinephrine (adrenal medulla)

The net effect of these counter regulatory hormones is to maintain glucose homeostasis

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18
Q

What is the function of glucagon?

A
  • Most efficient stimulator of gluconeogenesis
  • Requires liver glycogen stores to acutely increase BG
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19
Q

What is the function of growth hormone?

A
  • Promotes lipolysis
  • Increased hepatic glucose production
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20
Q

What is the function of cortisol?

A

Enhances gluconeogenesis

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21
Q

What is the function of epinephrine/norepinephrine?

A
  • Inhibit insulin secretion
  • Increase glucose secretion from liver and lactate from muscle
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22
Q

Why is type 1 diabetes unique?

A
  • A constant insulin supply from exogenous source is generally present
  • Variable insulin absorption
  • Suboptimal release of counter-regulatory hormones
  • Increased skeletal muscle uptake of following exercise
  • Increased insulin sensitivity after exercise
  • Psychological stress can even modify
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23
Q

What does the physiology look like during exercise for type 1 diabetes? What are the associated outcomes?

A
  • Glucose production does not equal glucose utilization
  • Counter regulatory hormones not doing their job, even in presence of hypoglycemia
  • Hypoglycemia during sport can arise quickly and severely presenting a medical emergency for the athlete if unmanaged
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24
Q

Can hypoglycemia effect anyone in sport? Why is it bad?

A
  • All athletes can experience hypoglycemia during sport but risk is significantly higher for athletes with Type 1
  • Hypoglycemia poses risk for athlete safety, creates anxiety, and compromises sport performance
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25
Q

What are the ways in preventing hypoglycemia?

A
  • Training diet - amounts and types of foods; timing
  • Pre/during sport: ExCarbs and/or insulin reduction
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26
Q

If tailoring advice to an athlete with diabetes, what must be known?

A
  • Recreationally or competitive/elite? What is their training volume, goals, are they competing?
  • Are they type 1/2 (2 is relatively rare in elite level athletes as it is age and lifestyle related)
  • Know the sport activity. Aerobic versus anaerobic activity
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27
Q

How does the risk for hypo/hyperglycemia chang with activities for diabetic athletes?

A
  • Risk for hypoglycemia with prolonged aerobic acitivity
  • Risk for hyperglycemia with high-intensity anaerobic activity (E.g. crossfit)
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28
Q

What are the CDA training diet macronutrient guidelines to limit blood glucose excursions during exercise?

A
  • 55-60% CHO (approx 8 to 10 grams CHO/kg/day).
    → Consistency is important if CHO stores (glycogen) drop off b/c not being replenished, risk for hypoglycemia increases
  • 25-30% Fat
  • 12-15% PRO
    → <1 hour/day moderate activity = 0.8-1g PRO/kg
    → > 1 hour/day = up to 1.7g PRO/kg
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29
Q

What are the CDA Pre-Event Eating guidelines to limit blood glucose excursions during exercise?

A
  • Pre-event meal 3 to 4 hours prior to start of exercise (should contain CHO)
  • Ideally, a CHO containing beverage providing 1-2g CHO/kg should be consumed 1 hour prior to exercise if BG <5mmol/L or trend is towards decreasing levels

If they are low going in, need to scale back insulin or top up CHO

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30
Q

What are the CDA Pre-Exercise Eating guidelines to limit blood glucose excursions?

A
  • Assess the timing, mode, duration, and intensity of exercise. (High intensity and/or long duration exercise present greatest risk)
  • Eat a CHO containing meal 1-3 hours prior to exercise
  • Assess hydration status and consume fluids (At least 250mL in 20 minutes prior to start of exercise)
  • Assess metabolic control (next card)
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31
Q

When assessing metabolic control for pre-exercise, what should occur when BG are low, moderate, and high? What are the cut off values for these levels?

A
  • If BG is <5 mmol/L and decreasing, extra calories may be needed
  • If BG is 5-13.9 mmol/L, extra calories may not be needed depending on the duration and individual response to exercise
  • If BG is > or equal to 14.0mmol/L and urine or blood ketones are present, delay exercise until levels are normalized with insulin administration
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32
Q

How does aerobic activity effect blood glucose levels? How do insulin and CHO need to be tailored for it?

A
  • aerobic activity typically results in a decrease in BG levels
  • Insulin dosages may need to be decreased while CHO intake may need to be increased for long duration or moderate intensities
    → Trial and monitor during training
  • CHO - if indicated by metabolic assessment, plan to give extra during exercise at rate of 1-1.5g CHO/kg/hr of estimated exercise time
    → E.g. 70kg man would need 70g CHO/hr during exercise if indicated by metabolic assessment (Approx 2 powergel packs)
33
Q

How does anaerobic activity effect blood glucose levels? How do insulin and CHO need to be tailored for it?

A
  • Anaerobic activity can produce rapid and dramatic increases in BG levels
  • Can cause acute increases in catecholamine, FFA, and ketone body levels
  • Psychological stress can have the same effect
  • Insulin dosages may need to be increased during anaerobic activity
    → Especially if temperature is high or activity is accompanied by competition stress. Need to trial and monitor during training
  • CHO adding additional CHO is not necessary unless clearly indicated by metabolic assessment
34
Q

What are the recommendations for limiting blood glucose excursions during exercise?

A
  • Monitor BG levels every 30 minutes
  • Maintain adequate fluid intake
  • If indicted by metabolic assessment, consume CHO at 20-30 minute intervals
  • 1 to 1.5g CHO/kg/h for activity lasting more than 1 hour
  • Assumes an adequate pre-event meal was consumed
  • Maintain adequate fluid intake
35
Q

What are the guidelines for limiting blood glucose excursions after exercise?

A
  • Replete liver and muscle glycogen stores by consuming complex CHO
  • Should be started as soon as possible after the end of exercise
  • Eat to match hunger and to maintain euglycemia
  • Monitor BG levels
36
Q

What are the signs and symptoms of hypoglycemia?

A
  • Early: hunger, irritability, drowsiness or confusion, rapid heart rate, sweating, dizziness, or loss of color, typically develops when the blood glucose is below 4 mmol/L
  • Late: brain neuronal glucose deprivation occurs and causes blurred vision, fatigue, difficulty thinking, decreased motor control, aggressive behavior, seizures, convulsions, and loss of consciousness
37
Q

How can you prevent hypoglycemia?

A
  • Frequent blood glucose monitoring
  • Carb intake adjustment pre-exercise or fast acting carb supplement during exercise
  • Insulin dose adjustments
  • Avoid exercising during peak of insulin
  • Prevent dehydration
38
Q

How can you treat hypoglycemia?

A
  • Check if they are alert and able to eat or drink without assistance
  • Administer 15g of fast acting carb (4 Dex4 tabs, 15gm sports gel, 4 oz juice or soda)
  • Repeat glucose check every 15 minutes until blood glucose returns to normal range
  • Once glucose is up, give complex carbohydrates snack (bagel sandwich)
  • If athlete is unconscious keep athlete on their side (hypoglycemia an glucagon can often cause nausea)
  • Call 911
39
Q

What are the signs and symptoms of hyperglycemia?

A
  • Nausea, dehydration, decreased cognitive performance, decreased visual reaction time, sluggishness, fatigue
  • Ketosis: also may have rapid breathing, fruity odor to breath, unusual fatigue, sleepiness, inattentiveness, loss of appetite, increased thirst, and frequent urination
40
Q

How can hyperglycemia be prevented?

A
  • Frequent blood glucose monitoring
  • Pre-exercise insulin dosage adjustments
  • Frequent blood glucose testing
41
Q

How can hyperglycemia be treated?

A
  • administration of small bolus of rapid acting insulin
  • When blood glucose is greater or equal to 13.9mmol/L, test urine or blood for ketones; if ketones are moderate or high, exercise is contraindicated
  • When blood glucose is greater or equal to 16.6 mmol/L no activity is allowed
42
Q

What are ExCarbs? What is the goal of using them?

A
  • Extra Carbs for Exercise (ExCarbs)
  • Goal: to match the amount of CHO the body will burn during activity to the amount of CHO taken in at fixed intervals during activity. (Think fuel injection)
43
Q

What is the basic method for ExCarbs?

A
  • 15 to 30g “dose” of CHO every 30 to 60 minutes of exercise
  • Generalized - does not factor in known differences in exercise intensity and related rates of glucose disposal in muscle
  • Athlete should monitor BG every 30 minutes and adjust ExCarb intake as needed
44
Q

What is the ExCarbs Semi-Quantitative Method?

A
  • ExCarb “dose” based on body mass
  • Based on an estimated glucose disposal rate into muscle of 1g glucose/kg body weight/hour of activity
    → 55kg women would supplement with 55g of CHO every hour of activity
45
Q

What is the ExCarbs quantitative method?

A
  • ExCarb “dose” based on body mass and type and intensity of activity
  • Published, standardized tables used to guide “dosing’ of ExCarbs
  • Assumes NO adjustments to insulin dosing for exercise
46
Q

What ExCarbs method should you be utilizing in practice?

A
  • Recommend the method that the athlete can understand and manage
  • Encourage frequent monitoring, self-assessment, journaling/record keeping
  • Collaborate with a Sport Dietitian to obtain guidance on portable, sport-friendly, food sources of ExCarbs
47
Q

For bodybuilders how do diets typically look?

A
  • Diets and macronutrient partitioning varies with phase of training
  • Keep in mind that self or trainer prescribed body-building diets may not be nutritionally sound
  • Low in fibre
  • Supplementation may be warranted
  • Ethical dilemma for the RD
48
Q

What are the nutrient requirements for body builders?

A
  • Data that clearly define the nutrient requirements of body builders are lacking (Estimates exist)
  • Nutrient requirements vary by:
    → Phase and volume of training
    → Gender, weight, body composition
  • Tapering and Cutting Diets are often nutritionally imbalanced or inadequate
    → Energy, macro, and micronutrients
49
Q

How is body building training periodized?

A
  1. Maintenance phase (maintain weight)
  2. Building phase (put on muscle mass)
  3. Tapering phase (starting to get ready to show what you have built)
  4. Cutting phase (accentuate appearance of muscle)
50
Q

What is the goal of periodization for body building diets?

A

Goal is to mesh diet with phase of training and promote adequate nutrient intakes

51
Q

What are the diet recommendations for body builders when doing diet phase transitions? How does the diet usually change for these athletes?

A
  • Diets transition slowly from a caloric surplus to a caloric deficient (ideally)
  • Most of the calories that will eventually be cut come from the elimination of carbs and fat
  • Protein intake tends to increase (as a percentage of total energy) over time
52
Q

What does a maintenance phase typically look like?

A
  • Goal: maintain body composition
  • Avoid loss of LBM or fat gain
  • Off-season training
  • Workouts: 1x/day, 4-6 days/week
53
Q

What does a muscle building phase look like?

A
  • Goal: Build LBM and minimize fat gain
  • Start of competitive season
  • Workouts: 1-2x/day, 5-6 days/week
  • NEED calories
54
Q

What does a tapering phase look like?

A
  • Goal: slight gains in LBM, fat loss, gain muscular definition
  • 12 weeks prior to competition
  • Workouts: 1-2x/day, 6-7 days/week
  • Increased aerobic activity to promote fat loss
55
Q

What does a cutting phase typically look like?

A
  • Goal: fat loss, gain muscular definition
  • 1 week prior to competition (if needed)
  • Workouts: 1-2x/day, 6-7 days/week
  • Some individuals don’t cut because tapering may be enough
56
Q

What are the maintenance diet targets for men and women?

A
57
Q

What are the building phase diet targets for men and women?

A
58
Q

If a 200lb (91kg) make is in a building phase, what are their requirements?

A

Often need liquid meals to get calories in (protein shakes)

59
Q

What should a tapering diet look like for men and women?

A
60
Q

What are the requirements for a tapering diet of a 200 lb (91kg) male?

A
61
Q

What are the targets for cutting diets for men and women?

A
62
Q

What are the requirements for a cutting diet of a 200 lb (91kg) male?

A
63
Q

What are the typical sources of PRO, CHO, and fat for cutting diets?

A
64
Q

When is hypohydration used for body builders? Why?

A
  • Widely practiced by bodybuilders in the days leading up to competition
  • Goal: muscular definition. Skin thins and adheres more to muscle
65
Q

Why is hypohydration dangerous?

A
  • Need to caution the athletes about cons
  • General health
  • Diminished sense of balance; inability to pose with confidence
  • Emaciation vs definition
  • Ethically cannot do this as an RD
66
Q

What will an athlete do when prepping for a competition?

A
  • About 6 months before a bodybuilder competes they will have identified a show or competition to target
  • The athlete will determine the BF% they want to be at during competition and will then estimate how many weeks it will take to reach it (based on current wt/composition)
  • will then go through building/tapering/cutting
67
Q

What is recommended when working with body builders?

A
  • Keenly interested in nutrition. But they may be misinformed. Present strong evidence for recommendations
  • Be familiar with common ergogenic aids used by body builders.
  • Be aware of training phases and diets
  • Decide when to say “no”
68
Q

Are children’s physiology the same as adults?

A
  • Children have heightened metabolic needs and nutrient requirements relative to adults (still growing)
  • “Children are not short adults” when it comes to sport nutrition recommendations
69
Q

What are the key physiological differences between children and adults?

A
  • Bone health/development
  • Glycogen utilization
  • Energy expenditure
  • Thermoregulation
70
Q

How is bone health/development different for children?

A
  • Children’s bones are more porous and cartilaginous than adults
  • Bones (epiphyseal plates) are not “sealed” together until after puberty
  • Childhood and adolescence are also key periods for bone development
  • Heightened calcium requirements need to be factored into diet planning and recommendations

Some physical activity and training volume not appropriate for kids because of structure
Need to increase bone mass density to prevent osteoporosis

71
Q

How is glycogen utilization different for children?

A
  • Cardiac stroke volume is lower while heart and respiratory rate, oxygen consumption, and glycogen storage capacity are lower in children
  • Children less efficient at aerobic metabolism than adults and less able to draw upon glycogen stores to fuel endurance activity
  • Need to have high glucose levels going into sport and can top up during sport
72
Q

How is energy expenditure different for children?

A
  • Not as efficient at movement and do not adapt to training as efficiently as adults
  • Net results is a relative increase in energy expenditure per kg body weight versus adults
    → Kids burn more calories/kg than do adults performing the same activity at the same relative intensity
  • Children and youth also have heightened energy expenditure related to growth
73
Q

How is thermoregulation different for children?

A
  • Children produce more body heat but tend to sweat less due to immature sweat gland system
    → Sweat glands do not mature until well into puberty
  • Fluid needs to support the increased metabolic needs associated with growth must also be considered
  • Children can also lack awareness of the sensation of thirst - may not drink enough as a result

Fixed times to drink because they can’t recognize it

74
Q

How can estimate energy requirements for children?

A
  • Specific calculations of energy cost per sport or activities in kids
  • Also limited data on the cost/kg of specific activities in kids
  • EER are a starting point for estimation
  • Monitoring is important: weight changes, hunger, sport performance

If weight is staying static, being underfed because they are supposed to have growth
Fatigue and illness if energy is low

75
Q

What is the calculations for children and adolescents 3-18 years?

A

Estimated energy requirement (Kcal/day) = total energy expenditure + energy deposition

76
Q

What are the tips for meeting fluid requirements for children?

A
  • Pre-training or competition hydration is critical:
  • Encourage use of water fountains at school or water bottles in the classroom
  • Make water bottles mandatory at all practices/training sessions
  • Work with coaches to ensure they recognize and honour the athlete’s fluid needs
  • Encourage extra fluids at lunch in prep for afterschool training
77
Q

What is the canadian pediatric society position statement for fluid replacement beverages of young kids?

A
  • “Sports drinks are generally unneccessary for children engaged in routine or play-based physical activity”
  • This does not mean that child athletes should not use fluid replacement beverages
  • Children’s thirst can be enhanved by adding sodium chloride (NaCl) and CHO in amounts typically found in sport drinks
78
Q

What are the approximate sweat losses in children?

A
  • Sweat losses in children range from 0.5L to 1.0L/day ABOVE daily fluid turnover of non-athletic children
79
Q

How can you calculate fluid requirements for children and what is the goal?

A
  • Best way is to calculate sweat and urinary fluid losses and provide fluid to replace
    → Difficult with children - requires ++ tracking
  • Goal: Meet DRI for fluid for children/youth (by age/gender) then top up based on sweat losses
    → Estimate and monitor

Talk to teachers because they may be going to the restroom often. Try to prevent disruption

NUTR 380 (12 decks)

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