The Health AthleteNutrition, Hydration, & Sleep in Youth Sports

Marc Kowalsky, MD

January 16, 2018

Key Questions

• Is it a good idea for me (or my child) to specialize early in a given sport?

• What should I eat before competition?• What should I eat after practice/competition?• How do I hydrate effectively?• Are sports drinks and energy bars a good

idea?• How much sleep do I need?• Which supplements should I consider or avoid?

Is It A Good Idea to Specialize?

• Is early sport specialization safe? Does early sport specialization increase the risk of injury in youth athletes?

• Is early sport specialization effective or necessary in achieving elite performance?

Sport Specialization: Definition

• Participation in intensive training and/or competition in organization sports > 8 months per year

• Participation in 1 sport to the exclusion of participation in other sports

• Involvement of prepubertal children (seventh grade, or 12 years old)

• Limited overall free play

Effect of Early Sport Specialization

• Execute less age-appropriate sport skills

• Do not develop protective neuromuscular patterns

• Increased organized play over free play doubles injury risk

• Specializing before age 12 years increases injury risk

Effect: Psychological Burnout

• Adult-driven specialized training

• Characteristics

– Loss of (intrinsic) motivation

– Lack of enjoyment (younger)

– High perceived stress, anxiety

– Ineffective stress coping strategies

– Fear of reinjury at young age

Effect: Psychological Burnout

• Manifestations

– Mood disturbances

– Social isolation

– Eating disorders

– Dropout

Evidence

• Early Specialization

– Does not lead to elite performance

• Late Specialization

– Elite athletes typically specialize later

• Diversification

– Elite athletes participate in multiple sports

Benefits of Early Diversification

• Enhance physical literacy

• Motor skill development

• Protective neuromuscular patterns

• Crossover effect of multiple sports

• Psychosocial and cognitive skills

• Accommodates psychological well-being

Protective Strategies

• Provide opportunities for free, unstructured play

• Ratio of weekly hours of organized sport to free play should remain below 2:1

• Weekly hours of sports participation should not exceed child’s age, or total 16 hours

• Avoid specialization before age 13 years

• Structured strength & conditioning program

What Should I Eat Before Competition?

• Key Concepts

– Adequate calories

– Balanced nutrients

– Consistent meals

– Fuel timing

Energy BalanceCaloric Requirements

Age 14-18 ♂ ♀

Sedentary 2200 2000

Moderate 2800 2000

Active 3200 2400

Calories In Calories Out

• Digestion

• Metabolism

• Physical Activity

• Carbs = 4 kcal/gram

• Protein = 4 kcal/gram

• Fat = 9 kcal/gram

Balance Nutrients

Carbohydrates45 – 55%

Protein10 – 30%

Fat25 – 35%

Carbohydrates

• Major source of energy

• Synthesized into glycogen

• Guidelines

– Endurance:

• 7.0 – 10.0 g/kg per day

– High Intensity

• 5.0 – 8.0 g/kg per day

– Pre-training

• 1.0 – 4.0 g/kg 1-4 hrs prior

– Post-event refueling

• 1.7 g/kg within 2 – 3 hours

Protein

• RDA for protein is 0.8 – 1.2 g/kg per day

– Strength athletes: 1.6 – 1.7 g/kg per day

– Endurance athletes: 1.2 – 1.4 g/kg per day

– Youth athletes age 14 – 18

• Girls Æ 46g

• Boys Æ 52g

• Diets exceeding 1.7 g/kg/day have not been proven to provide additional benefits

Protein

• 35-50 g meat, fish

• 1/2 chicken breast

• 1 c breakfast cereal

• 1 c oatmeal

• 2 small eggs

• 1¼ c cow’s milk

• 1¾ c soy milk

• 1/3 c cheese

• 1 c yogurt

• 4 slices bread

• 2 c broccoli

• 2 cups cooked pasta

• 3 cups rice

• ½ c nuts or seeds

• ½ c tofu or soy meat

• ½ c legumes or lentils

• ¾ cup fruit smoothie

• 2 c spinach

• ½ c quinoa

• ¾ c farro

10g of Protein are found in:

Fat

• 25 – 35% calories

should come from fat

• Healthy fats

– Plant oils

– Soft margarines

• Unhealthy fats

– Saturated fats

– Trans fats

Meal Planning

• Pre-exercise

– 1 – 2 hours in advance

– 200 – 500 kcal

– Easily digestible

carbohydrates

– Avoid high fat, fiber

– Familiar foods

What should I eat after competition?

• Within 30 minutes, and again within 1 – 2 hrs

• Allows glycogen synthesis

• Content– High carbohydrate

– Moderate protein

– Nutrient Dense

• Examples– Yogurt, almonds and fruit

– Banana with peanut butter

– Sports bar + orange slices

– Nut butter on whole grain toast

– Veggies and hummus

– Whole-grain breakfast cereal, milk, fruit

– Sandwich (meat, cheese, veggie)

– Salad and hard boiled egg

– Quinoa salad with roasted veggies

How Do I Hydrate Effectively?

• Optimal Athletic Performance

– Loss of 1% body weight has detrimental effect

• Heat Illness

– Loss of 3% body weight increases risk

• Up to 75% of youth athletes age 8 – 18 arrive to practice already dehydrated!

Hydration

• Symptoms of dehydration

• Objective assessment of hydration status– Pre- and post- participation weight

– Urine specific gravity

– Thirst scale

– Thirst

– Irritability

– Fatigue

– Weakness

– Nausea

– Headache

– Muscle cramping

– Dizziness or lightheadedness

– Dark yellow urine

– No desire to urinate

– Difficulty paying attention

– Decreased performance

Hydration

• Pre-exercise (WATER)– 1 – 2 hrs prior: 16 – 20 oz.

– 15 – 30 min prior: 8 – 16 oz.

• During exercise– 4 – 8 oz. every 15 – 20 min

– If > 60 min Æ dilute sports drink

• Post-exercise (WATER)– 16 oz. for each pound lost

• Avoid over-hydration

Are Energy Bars A Good Idea?

• Ingredients

– Seeds

– Nuts

– Peanut butter

– Whole grains

– Dried fruit

• Content

– Sugar < 10 – 12 g

– Protein = 5 – 10 g

Are Sports Drinks A Good Idea?

• For exercise > 60 minutes

– Replace sweat nutrients

– Replenish carbohydrates

• Guidelines

– 6 – 8% carbohydrate

– 0.5 – 0.7g/L sodium (Na)

How Much Sleep Do I Need?

• Adequate sleep essental for peak performance

Recommendations for Sleep Duration

Age Duration

3 – 5 Years 10 – 13 hours

6 – 13 Years 9 – 11 hours

14 – 17 Years 8 – 10 hours

18 – 64 Years 7 – 9 hours

Sleep

• Sleep Hygeine

– Consistent waking and bedtimes

– Avoid regular napping

– Do not lie in bed awake > 10-15 min

– Use the bed only for sleep

– Avoid physical activity within 2-3 hrs of bedtime

– Limit evening caffeine or other stimulant intake

– Eat breakfast consistently, stay well hydrated

– Schedule one hour of relaxation prior to bedtime

Sleep Aids

• Medication

• Carbohydrates

• Tryptophan

– Increases serotonin

– Food or supplement

• Valerian root

– Herbal remedy

– 400-900mg bet 30 -120 min prior to bedtime

• Melatonin

– 1mg or less about 90 min prior to bedtime

What Supplements Should I Consider/Avoid?

• 66% of student-athletes > 16 years old use dietary supplements

• Most commonly used– Protein

– Caffeine

– Creatine

• Most common reasons– Muscle strength

– Endurance

– Performance

– Appearance

Protein

• Mechanism of Action– Builds, maintains and repairs

muscle

• Evidence– Numerous trials

– Optimizes muscle training response during exercise and recovery

• Safety– 2.0g/kg

– No adverse effects

• Whey– fast digesting

• Casein– slow digesting

• Soy-based– least effective

Beet Juice

• Mechanism of Action– Dilates blood vessels in exercising muscle

– Reduces oxygen use, improves energy production

• Evidence– Limited clinical trials

– Conflicting results

– Might improve performance and endurance

• Safety– No safety concerns for short-term

– Recommended dose: 16 ounces

– No adverse effects reported

Creatine

• Mechanism of Action– Helps supply muscles with energy for

short-term, anaerobic activity

• Evidence– Numerous trials

– Beneficial for high-intensity, intermittent activity

– May increase strength, power, and work

– Of little value for endurance sports

• Safety– Safe at typical doses

– Loading dose of 20 g/day for up to 7 days

– 3 – 5 g/day for up to 12 weeks

– Weight gain due to water retention;

– Nausea, diarrhea

– Muscle cramps, muscle stiffness, heat intolerance

Caffeine

• Mechanism of Action– Blocks activity of the neuromodulator

adenosine;

– Reduces perceived pain and exertion

• Evidence– Numerous trials

– Might enhance performance in endurance activities

– Might enhance performance in intermittent, long-duration activities

• Safety– Safe up to 400 – 500 mg/day for ADULTS

– Insomnia, restlessness

– Nausea, vomiting

– Tachycardia, arrhythmia

– Risk of death with acute dose of 10 – 14g

Performance-Enhancing Drugs

• Anabolic Agents– Anabolic Steroids

– Testosterone

– Steroid Precursors• Dehydroepiandosterone

• Androstenedione

• Stimulants– Ephedrine

• Human Growth Hormone

• Erythropoietin

• Propranolol

• Diuretics

Orthopaedic & Neurosurgery Specialists

Resources

• American Academy of Pediatrics

• American College of Sports Medicine

• American Orthopaedic Society for Sports Med

• American Dietetic Association

• NIH Office of Dietary Supplements

THANKS

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