Coaches Corner: Nutrition
Hear from USA Basketball Men’s and Women’s National Teams physician Dr. Lisa Callahan (Hospital for Special Surgery), who also works with the New York Knicks, on nutrition.
"The basics stay the same, but the age and intensity of activity do influence your recommendations to some degree.
"In general, with nutrition you have to think of three different things – one is what we call the macro-nutrients. Those are carbohydrates, protein and fat. The second are the micro-nutrients, and the ones we think about most commonly with athletes are calcium, vitamin D and iron. And then, the third thing is fluids.
"Those are the categories that parents and coaches should be aware of."
Macro-nutrients (Carbohydrates, Protein and Fat)
"Carbohydrates include grains, particularly whole grains, fruits and vegetables, and then dairy products like milk and yogurt. Roughly half of an athlete’s diet should come from carbohydrates, because those are our number one energy source.
"And especially in children who are in school, getting carbohydrates and getting carbohydrates fairly regularly throughout the day, impacts their energy, not just for sport but their ability to perform academically in school. It’s important, because we have a lot of kids who go to school without eating breakfast. The concept that you’re eating for your athletic performance but also for your academic performance is one that I think resonates with a lot of parents, especially for young kids.
"The recommendations for kids from 4 to 18 for carbohydrates are really very similar. They are 45-65%, and I tell parents about half of the diet should come from carbohydrates. They are not going to measure percentages, but about half should come from fruits, vegetables and grains.
"Protein should be between one quarter and one third of their diet. Protein is really important for building tissue, especially muscles. Protein sources include all meats, and we recommend lean meats, because they are generally healthier as they are lower in fat, as well as poultry, fish, eggs, dairy, beans, nuts and nut butters. And, fat tends to come along with protein. It’s not like you have to think about all these separate food groups. Similar to protein, one quarter to one third of the diet should come from fat, and that’s healthy fats, like the ones found in many proteins, seeds and oils.
"There is some overlap, particularly in the dairy products."
Macro-nutrients for Elite/Advanced Athletes
"What really changes at the elite or advanced level in the macro-nutrients tends to be in the frequency and the timing. Probably the most important thinking about some of the macro-nutrients is that you need to get them as recovery foods.
"The more elite you are, the more you really need to pay attention to the frequency and the timing of those macro-nutrients.
"There are two concepts for recovery food timing. The first is within 30 minutes of being active, and the second window is within one to two hours. So, having some sort of a carbohydrate and protein snack within 30 minutes is really useful. It helps your muscles refuel as in the first 30 minutes or so after exercise, your muscles are the most primed to receive an influx of energy. After that first 30 minutes, it drops off a little bit, but between one and two hours later, your body is very receptive to filling up your “fuel tank”.
"So, what we like to see athletes do is, within that first 30 minutes, get something like a fruit and yogurt shake, or crackers and peanut butter, or string cheese and fruit. Something quick and simple like that. And then, try to get them to eat a bigger meal within one to two hours of exercise."
"This is where the age recommendations have some important differences.
"I think everybody knows that calcium and Vitamin D are important in building strong bones, but they do much more, including optimizing muscle function. The Vitamin D recommendations are generally the same for all ages of athletes, but the calcium recommendation increases with age. Between 4 and 8 years old, the recommendation is 1,000 milligrams of calcium, and from 9 to 18 it is 1,300 milligrams of calcium.
"This is where dairy is so important in kids. There aren’t many food sources for Vitamin D, primarily milk, and/or some fortified foods. Yogurt and cheese are good sources of calcium, but they don’t have Vitamin D. Calcium you can get from green leafy vegetables, but again, you don’t get Vitamin D there. Your body can make Vitamin D from the sunshine hitting your skin, but parents are so vigilant about keeping their kids slathered up with sunscreen, there are more and more kids who don’t get Vitamin D that way. So, it is important for parents to think about dietary Vitamin D to support bone and muscle health.
"The other micro-nutrient we think about is iron. Iron is usually known for its role in helping oxygen circulate in the bloodstream, but it is also really important for growth and for muscle function as well as for blood. And, everybody loses iron through sweat as well as through the kidneys and bowels, in addition to any blood loss.
Iron is another one that kids 9 to 13 need less than kids 14 to 18, and girls actually need more than boys once they are post-pubertal, because of menstrual losses.
"Really the best sources of iron are darker meats — red meats, but also darker pieces of poultry, like a chicken thigh. Iron typically gives meat it’s red, or darker, color. Eggs are also a good source of iron, as are leafy greens and fortified whole grains.
"So, fortified whole grains can give you a lot of the nutrients that you need. The little choices can add up!"
"Fluids are interesting, because the younger the kids, typically the smaller the body, the more mass to surface area ratio. A lot of times parents might not realize the importance of hydration in the young kids. They often tend to think of it in the older kids.
"The concept is even young athletes need to pay attention to their fluid intake. Fluids are important for replacing your sweat and regulating your body temperature. Small children can actually be at risk for heat illness if they are not getting enough fluids. As they get bigger, older, and more consistent in sports, the issue also becomes dehydration impacting performance."
How Much Fluid Is Needed?
"The older the kid and the more elite the kid, the more access they likely have to measurement tools. So, if you are at an elite training center or high school, you might weigh pre and post practice, and you may know how to replace fluids related to how much weight you lost — the rule for that is generally 15-20 ounces of fluid per pound of body weight lost.
"Younger kids or recreational athletes are probably not going to get reliable weights pre and post practice. Then, it’s really important that they learn to pay attention to the color of their urine. Lemonade color is good. Apple juice color is bad. They want their urine to be a light yellow color, and that’s an easy thing for kids to learn."
How to Tell if You Are Getting Enough Fluids
"A couple of things I would say for parents and coaches of young kids: especially in the younger kids, keep the messaging as simple as possible. And that is, water is good. You should drink some fluids an hour or two before you practice. You should drink a few ounces of water every 15-20 minutes while you are exercising, and then you should drink fluids after, and then you should pay attention to the color of your urine.
"As you get older and more elite, you can actually do pre and post weights, that can be really helpful."
Water vs. Sports Drinks
"If the exercise is under an hour, then water is preferred. Water is the best thing. If it is over an hour of exercise, or if it is in a hot, humid climate, that is when it is worth considering a sports drink. Because in addition to replacing the water, you are replacing some electrolytes and glucose. The electrolyte that we lose the most of in our sweat is sodium, which is salt, and you need to replace your salt."
Cold Water is Best
"Pre practice fluid should always be water, cold water, which absorbs quickly.
"Of course, use common sense — you don’t want somebody to drink a whole bunch of cold water right before they are getting ready to exercise, you want to drink a couple of hours before exercise.
"And then every 15 or 20 minutes, they should be drinking three, four, six, eight ounces, depending on how big they are and how hard they are going. And, it’s not hard to have three or four ounces of fluid."
At the Grocery Store
"With a little practice, parents can get pretty good at reading labels. There are so many different products, including whole grain cereals and crackers, that are fortified and can be helpful. Simple choices that parents make by reading the labels and looking for things that are lower in fats and sugars, and fortified with iron and Vitamin D, can make a real difference in their child’s nutrition."
Keep it Simple and Model the Behavior
"Keep in mind your child’s body size and intensity of training, and target your message to their age group. With kids you have to keep the message simple, and you have got to be consistent.
"The other thing I would say is, parents and coaches need to be role models, because kids model their behavior. You can’t tell your child to eat well, and you don’t. You can’t get the fried food and tell you kid to get the baked thing. That doesn’t work. So, I think encouraging parents and coaches to practice what they preach is key."
"It depends on the nutrient, but I would say one of the number one things I see is that kids are really busy with school, and they don’t eat often enough, or frequently enough. That is one of the things – it is not just what they eat, it is when they eat and how often they eat. I think one of the things you often see is performance issues in school before you see performance issues in athletics, and often times kids simply are not getting enough nutrients. They are not eating frequently enough, and they are not eating enough when they do eat.
"For example, fatigue or lackluster performance may be a clue to not getting enough fluids or macronutrients, or not getting them often enough. Or it could be a sign of a micro-nutrient deficiency, like iron deficiency, which in a more advanced state may present as an athlete appearing pale and tired. Proper nutrient intake is also important to the immune system, so young athletes who push themselves physically but don’t maximize their nutrition may be more likely to get recurrent illnesses.
"So while there are many factors influencing a young athlete‘s health and performance, nutrition is a critical issue for parents and coaches to optimize."
This content is meant to serve as general knowledge and advice. Please consult your child’s physician with any concerns.