Nutrition for athletes

For any athlete, nutrition is an essential part of reaching health and performance goals.

Proper nutrition helps to power the brain, heart, lungs, and muscles through the demands of training. Proper nutrition also supports growth and development.

Sport performance and recovery

Choosing the right fuel before, during, and after exercise can support training adaptations and enhance sport performance. Your sports registered dietician (RD) can help you develop personalized nutrition strategies to reach your performance goals.

Athletic injuries and recovery

Nutritional intake has a significant impact on the risk of athletic injuries and the speed of the recovery process. Whether you’re focused on prevention or return to play, your sports RD can help you develop a plan to support bone, muscle, tendon, and ligament health.

Bone health

Proper nutrition can play a role in building strong bones and reducing an athlete’s risk for stress-related injuries. Your sports RD can assess your nutritional intake to determine if you’re consuming enough calories, protein, calcium, vitamin D, and other nutrients that support optimal bone health.

Menstrual health

Female athlete’s menstrual cycle is a crucial component of overall health, performance, and injury prevention. Maintenance of a healthy menstrual cycle requires adequate nutrition. Your sports RD can help you optimize nutritional intake to restore or maintain your menstrual cycle.

Disordered eating and relative energy deficiency in sport (RED-S)

Sometimes athletes make choices that are not always best for balanced nutrition and overall health. These choices may be the result of:

  • A drive to achieve goals such as improving performance or changing body composition
  • External pressure or prevailing attitudes about weight or body composition

These can lead to disordered eating or relative energy deficiency in sport (RED-S).

Disordered eating

What is disordered eating?

Disordered eating is characterized by attitudes about weight, food, and body size and shape that cause a person to follow strict eating and exercise habits. These behaviors are used to achieve or maintain a low body weight and can impair mental and physical health.

If you are concerned about signs of disordered eating in your or someone you know, speak to a medical professional.

What are eating disorders?

Eating disorders are clinically diagnosed psychological conditions involving disordered eating behaviors that can be classified into the following categories:

Anorexia
Low body weight, intense fear of weight gain, body dysmorphia, and loss of menstrual cycle
Bulimia
Recurrent episodes of binge eating, followed by purging (vomiting, fasting, laxative abuse)
Binge eating disorder
Recurrent episodes of compulsive overeating without purging
Orthorexia
Pre-occupation with healthy food and refusal to consume foods deemed as unhealthy

All eating disorders may be accompanied by depression, anxiety, shame, guilt, and other psychological symptoms.

Why are athletes at higher risk for developing disordered eating and eating disorders?

Athletes may set out to improve performance by losing weight or changing their body composition. Athletes are also more likely to have perfectionistic tendencies that support development of disordered eating behaviors. Athletes have higher energy needs to support training and growth, so they require more food than their non-athlete peers.

What are some of the emotional and behavioral signs of disordered eating?

  • Preoccupation with weight, food, and dieting
  • Denying feelings of hunger
  • Refusing to eat certain foods or food groups
  • Making consistent excuses to avoid mealtimes or situations involving food
  • Cooking meals for others without eating
  • A strong need for control
  • Maintaining a rigid exercise routine regardless of weather, fatigue, or illness
  • Showing inflexible thinking
  • Withdrawing from friends and activities and becoming more isolated, withdrawn, and secretive
  • Expressing concerns about eating in public
  • Dressing in layers to hide weight loss or to stay warm

What are some of the physical signs of disordered eating?

  • Bloating and constipation
  • Difficulty falling or staying asleep
  • Muscle weakness
  • Impaired immune function
  • Weight loss
  • Thinning, dry, or brittle hair
  • Dry or brittle nails
  • Dry or yellow skin
  • Dental problems, such as enamel erosion, cavities, and tooth sensitivity
  • Dizziness and lightheadedness
  • Lack of focus or difficulty concentrating

Relative energy deficiency in sport (RED-S)

What is RED-S?

RED-S occurs when athletes expend more energy than they consume. Energy is obtained from food and expended to power the brain, heart, lungs, muscles, and other organs. Energy availability is the amount of energy left over after exercise. This energy is required for essential functions like growth and development.

Some athletes with RED-S may experience female athlete triad symptoms, which include disordered eating, amenorrhea (loss of menstrual cycle), and low bone mineral density. Not all athletes experience all symptoms.

What causes RED-S?

RED-S is caused by underfueling, or eating fewer calories than the body requires. This may be intentional or unintentional. Intentional underfueling may include skipping meals, limiting portions, and restricting foods or food groups. It may be related to body image concerns or weight pressures in sport.

It occurs with the goal of controlling body weight or composition. Unintentional underfueling may include increasing training volume without increasing food intake, skipping meals due to scheduling, or undereating due to limited food access. It occurs without the goal of controlling body weight or composition.

What are the health consequences of RED-S?

  • Impaired growth and development
  • Impaired immune health
  • Impaired bone health (reduced bone density and increased risk of stress fractures)
  • Impaired digestive health (bloating, constipation)
  • Impaired heart health (low heart rate and blood pressure)
  • Impaired hormonal health
  • Depression, mood changes, and body dysmorphia

What are the performance consequences of RED-S?

  • Decreased muscular strength
  • Decreased endurance performance
  • Decreased training response
  • Reduced focus, concentration, and coordination
  • Fatigue and lethargy
  • Increased risk of injury and illness

Who is at increased risk for RED-S?

The most common risk factors for RED-S include:

  • Athletes in sports placing an emphasis on weight
  • Athletes experiencing weight-related pressure from coaches or support staff
  • Athletes following vegan or vegetarian diets
  • Athletes with medical conditions that restrict foods or food groups
  • Teenage athletes going through puberty or periods of growth
  • Athletes with disordered eating behaviors
  • Athletes with limited access to food

How is RED-S treated?

Treatment strategies for RED-S are dependent on the cause.

Athletes who are unintentionally underfueling can benefit from nutrition education (increased portion sizes, increased meal frequency, changes in food choices) and changes in training (reduced training load and increased recovery time).

Athletes who are intentionally underfueling should work with a multidisciplinary team of medical, nutritional, and mental health support. These athletes may need to suspend training until RED-S symptoms have improved.

What are some strategies to reduce the risk of RED-S?

Fueling:

  • Work with your sports RD to determine how much energy your body needs to support training.
  • Create a fueling plan with at least three meals and three snacks per day.
  • Consume adequate portion sizes; athletes will need to eat more than their non-athlete peers.
  • Incorporate nutrient-dense, high-calorie foods, especially during periods of intense training.
  • Incorporate a balance of carbohydrates, protein, fat, fruits, and vegetables.
  • Avoid restricting foods or food groups without guidance from your sports RDN.

Training:

  • Incorporate rest days into your training plan.
  • Avoid training through illness or injury.
  • Discontinue training and consult your health care professional if you experience weight loss, missing or irregular periods, frequent illness or injury, or excessive fatigue.

When is it time to seek help for RED-S?

Parents and coaches who notice the following signs and symptoms should refer their athletes to a sports medicine team for evaluation. RED-S can occur in any athlete. Signs and symptoms should be taken seriously, regardless of age, gender, sport, or body size.

  • Preoccupation with food or body image
  • Skipping meals or limiting portion sizes
  • Weight loss
  • Engaging in additional training outside of practice
  • Changes in mood or personality
  • Cold hands and feet
  • Dry skin, nails, and hair
  • Repetitive injuries or illness
Last reviewed: 
January 2021

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