Source: Nutrition and Athletic Performance. American College of Sports Medicine.Medicine & Science in Sports & Exercise. 2016; 48(3), 543- 568.  https://journals.lww.com/acsm-msse/Fulltext/2016/03000/Nutrition_and_Athletic_Performance.25.aspx. Accessed March 17, 2018.

Fat is a necessary component of a healthy diet to provide energy, essential fatty acids and to facilitate the absorption of fat-soluble vitamins. Athletes are recommended to consume the same amount of fat in the diet as the general population, 20-35% of their energy intake. Although these recommendations are in accordance with public health guidelines, athletes should individualize their needs based on their training level and body composition goals. Athletes who choose to excessively restrict their fat intake in an effort to lose body weight or improve body composition should ensure they are still getting the minimum recommended amount of fat. Fat intakes below 20% of energy intake will reduce the intake of fat-soluble vitamins and essential fatty acids, especially omega 3’s. ^[4]

Although protein accounts for only about 5% of energy expended, dietary protein is necessary to support metabolic reactions (that generate ATP), and to help muscles with maintenance, growth, and repair.  During exercise, these metabolic reactions for generating ATP rely heavily on proteins such as enzymes and transport proteins. It is recommended that athletes consume 1.2 to 2.0 g/kg/day of proteins in order to support these functions. Higher intakes may also be needed for short periods of intense training or when reducing energy intake.^[5] See Table 16.2 “Recommended Protein Intakes for Athletes” below for a better representation of protein needs depending on extent of training and dietary sources.

Table 16.2 The Recommended Protein Intakes for Individuals

Source: Dietary Reference Intakes, 2002 ACSM/ADA/Dietitians of Canada Position Statement: Nutrition & Athletic Performance, 2001. Accessed March 17, 2018.

It is important to consume adequate amounts of protein and to understand that the quality of the protein consumed affects the amount needed. High protein foods such as meats, dairy, and eggs contain all of the essential amino acids in relative amounts that most efficiently meet the body’s needs for growth, maintenance and repair of muscles. Vegetarian diets contain protein that has lower digestibility and amino acid patterns that do not match human needs as closely as most animal proteins. To compensate for this as well as the fact that plant food protein sources also contain higher amounts of fiber, higher protein intakes are recommended for vegetarian athletes. (See Table 16.2 “The Recommended Protein Intakes for Individuals” )

Micronutrient Needs

Vitamins and minerals are essential for energy metabolism, the delivery of oxygen, protection against oxidative damage, and the repair of body structures. When exercise increases, the amount of many vitamins and minerals needed are also increased due to the excess loss in nutrients.  Currently, there is not special micronutrient recommendations made for athletes but most athletes will meet their needs by consuming a balanced diet that meets their energy needs. Because the energy needs of athletes increase, they often consume extra vitamins and minerals. The major micronutrients of concern for athletes include iron, calcium, vitamin D, and some antioxidants. ^[6]

Common Nutrient Deficiencies for Athletes

Energy deficiency

For athletes, consuming sufficient amounts of calories to support their energy expenditure is vital to maintain health and body functions. When the energy intake for athletes does not meet the high demands of exercise, a syndrome referred to as relative deficiency in sport (RED-S) occurs. RED-S has a negative effect on performance and health in both male and female athletes as shown in Table 16.7 “Relative Energy Deficiency in Sport Effects”. Athletes in sports with weight classes, such as wrestling, may put their health at risk by rapid weight loss in order to hit a specific weight for a match. These athletes are vulnerable to eating disorders due to sporadic dieting (several of which will restrict energy intake). The long term effects of these practices can not only impair performance but also have serious repercussions such as heart and kidney function, temperature regulation and electrolyte balance problems.

Figure 16.7 Relative Energy Deficiency in Sport Effects

Iron

Iron deficiency is very common in athletes. During exercise, iron-containing proteins like hemoglobin and myoglobin are needed in great amounts. An iron deficiency can impair muscle function to limit work capacity leading to compromised training performance. Some athletes in intense training may have an increase in iron losses through sweat, urine, and feces. Iron losses are greater in females than males due to the iron lost in blood every menstrual cycle. Female athletes, distance runners and vegetarians are at the greatest risk for developing iron deficiency.^[8] See Table 16.3 “The Potential Iron Loss in Endurance Athletes” for the potential amounts of iron loss each day in male and female athletes. An increased recommendation for both genders are shown below. These recommendations are based on the assumption that iron has a 10%  absorption efficiency. As noted above, women athletes have a greater iron loss due to menstruation and therefore must increase their dietary needs more than male athletes.

Table 16.3 The Potential Iron Loss in Endurance Athletes

Source: Weaver CM, Rajaram S.Exercise and iron status. J Nutr. 1992 Mar;122(3 Suppl):782-7. https://www.ncbi.nlm.nih.gov/pubmed/1542048. Accessed March 23, 2018.

Sports anemia, which is different from iron deficiency anemia is an adaptation to training for athletes. Excessive training causes the blood volume to expand in order to increase the amount of oxygen delivered to the muscles. During sports anemia, the synthesis of red blood cells lags behind the increase in blood volume which results in a decreased percentage of blood volume that is red blood cells. The total amount of red blood cells remains the same or may increase slightly to continue the transport of oxygen. Eventually as training progresses, the amount of red blood cells will increase to catch up with the total blood volume.

Vitamin D and Calcium

Vitamin D regulates the calcium and phosphorus absorption and metabolism and plays a key role in maintaining optimal bone health. There is also growing evidence that vitamin D is important for other aspect of athletic performance such as injury prevention, rehabilitation, and muscle metabolism. Individuals who primarily practice indoors are at a larger risk for a vitamin D deficiency and should ensure they are consuming foods high in vitamin D to maintain sufficient vitamin D status.^[9]

Calcium is especially important for the growth, maintenance, and repair of bone tissue. Low calcium intake occurs in athletes with RED-S, menstrual dysfunction, and those who avoid dairy products. A diet inadequate in calcium increases the risk for low bone mineral density  which ultimately leads to stress fractures.

Antioxidant nutrients

Antioxidant nutrients play an important role in protecting cell membranes from oxidative damage. During exercise, the amount of oxygen used by the muscles increases and can produce free radicals which causes an increase in antioxidant systems in the the body. These antioxidant systems rely on the dietary antioxidants such as beta-carotene, vitamin C, vitamin E, and selenium that can be obtained through a nutrient dense diet.