Nutrition for Training by Dr. Paul Stricker (2008)


[Introduction] My name is Mary Anne Gerzanick-Liebowitz. I am the Assistant Women’s Swimming Coach at Oregon State University, and I am the First Vice-President of ASCA, and I am here to introduce our next speaker for this afternoon, Dr. Paul Stricker. He is Board Certified in both Pediatrics and Sports Medicine. He is a past All American Swimmer at the University of Missouri-Rolla. His primary focus is promoting and educating our young athletes on having a positive experience in swimming. He has been a team physician at UCLA and at Vanderbilt University. His involvement with USA Swimming began in 1988 and then in 1992 he became involved with the USOC as he was selected as a US team physician for the 2000 Sydney Games. He currently resides in San Diego, California at the Scripps Clinic, and would you please help me in welcoming Dr. Paul Stricker.

[Dr. Stricker] Thank you so much. I am amazed and impressed at people sticking around until 4 o’clock so thank you for doing that. I really appreciate it and I hope that as usual, we both have a good time and that you learn something that you can take home to your teams and apply and optimize some performances for your kids that you work with. We spent the last lecture talking about specific developmental aspects of sports and now we are going to talk more about nutrition and how that specifically applies to sport as well. So hopefully, these are more – some general terms – some a little bit specific. There will be some numbers in there that you might want to jot down at some point so I will hopefully try to not breeze over them too quickly for you.

This is something that I think is super important. You all know that you have kids that can have great talent, but if you want to optimize that they certainly cannot do their talent optimally without enough fuel. It is like trying to drive that car on empty. So, we all know kids that do that and they can only go so far so I hope that this will be something helpful for you today. Over many years of dealing with varsity athletes at the collegiate level, as well as the Olympic teams and the National teams – you can only imagine that I have seen bags and bags and bags of different supplements and things come across my desk. The important thing for us to realize in this day and age is that we still need to always go back to the powerful basics of just what good nutrition is, and why our food itself is so important for the requirements that our body needs to perform. Food was the original thing that we had and clearly our bodies were made to adapt to using food rather than to different chemicals. The thing that is important for us to also know is the necessity of how nutrition plays a role in recovery, because clearly swimming is one of those sports where you have to be able to recover from those multiple practices a week and those multiple hours in the pool. We have all either personally experienced or have had swimmers who have experienced over-training where they are just overly fatigued and can’t produce for either themselves or for you.

The other thing I want to go over today are the new views on nutrition from a medical and a science standpoint that I think are very exciting because it really boils down to a new area of science that talks about the chemical nature of exercise and how we have to use nutrition to protect us from some of those chemical effects after we exercise very hard. Swimming is also definitely a sport where the intensity and the volume of exercise is very tremendous in many cases – even at younger ages. I love this quote from a couple of years ago – out of a medical journal – that really sums up I think a lot of what I agree with in this talk: Nutrition itself can super-influence the molecular and the cellular processes that occur during exercise and recovery in our muscles. That is so important because we think about from a big standpoint of – well we need the carbohydrates and stuff – that is kind of the big 35,000 feet view, but we also have to get down to the cell level because clearly what happens at our cell level is what affects our ability to perform overall. So this statement really makes the foundation for this talk today.

This kid is not happy that he has just stolen some produce, but he is happy because he understands the value of what he is holding and my purpose, when I give talks to athletes and to parents and to coaches, is to inform them about the beauty of nutrition and of our food so much that you don’t do this – you don’t look at your food the same way anymore and that you do rush to the produce department to really help give your body some of the things that it needs. When we talk about some of the current issues we deal with – we really deal with a supplement industry that is fairly out of control, without much regulation. We have athletes certainly that are going into the realms of the danger zone into illegal drugs of course, but also some supplements that sometimes we don’t have good information on or that they contain substances in them that are dangerous to them or will test them positive on a drug test. We know more – so much more about exercise chemistry now – which I am going to really try to help impart to you guys today, and then I want to end up on talking about the solutions of how again – nutrition works for our energy fuel, our recovery fuel and then for protection from all of the potentially harmful effects of the chemical nature of exercise.

So when we talk about increased supplement use – in general – you know – the same thing – it doesn’t matter what sport, people want the magic pill. They want to take that thing that is going to help give them that great performance. I think the reason there are so many new ones that come on the market so quickly is because the other ones have not all worked and they have really not had a big basis so they just move on to the next one. Part of it is, for an athlete, you know – they talk about training and technique and eating right, but that is just not something that is really exciting to them. They want something that is new and different and that they have never heard of before so they go for the pill without a lot of information or knowledge about it. It is certainly not backed by a lot of credible research which is where we get into a lot of the problem because they get out there before medicine and science have a chance to really say – hey – is this okay? Is it good? Is it going to do anything or not?

The other thing I find very interesting is when you look at the bottles and the labels on many of these things – they really promote a specific isolated area of your body – like one thing is to support just your immune system. One is supposed to support just the blood vessel dilation in your muscles. One is just to support the protein in the muscles and it is very fragmented. And our bodies are not meant to work in a fragmented fashion. They are meant to work as a whole and so you want something that is going to do that. The only thing that we have found that really does that is again – our food and our nutrition because it is kind of a package deal. Every cell in your body recognizes the nutrients that are found in your food better than any other thing that you can put in your body. The other thing is that many athletes – young athletes especially – synonymously use the word supplement for substitute and they supplement in order to substitute eating correctly which can become a real problem as well.

The other thing is that, of course, they are poorly regulated. Most of them – the huge majority are ineffective. Some do have temporary benefits and some are obviously flat out dangerous, like our Ephedra scare of many years ago so we do have to be concerned and aware. If you don’t know about it – – it is an independent website that looks at different random supplements and analyzes them to value their content. They come out with a report card on whether they have passed and contain everything they say they contain, or they fail because they contain things they are not supposed to have or that they do not have on their label so that could be a good resource for you. When we talk about that – how many of you all grew up with the vitamin thing right on your table? I certainly did. My dad was a doctor and he felt that that was critically important and when I asked him why – once I got older and wiser – and had finished medical school and thought I knew all the answers – he didn’t really have an answer for me and he said that is just because that is what we are supposed to do so yes, vitamins are absolutely critical.

Your body cannot function without them, but what we need to know is that the source of those vitamins is the critical defining point. Research, over time, especially recently, has shown that in general and I am not bashing vitamins, but I am saying we need to think about the source. When you take a fragmented isolated synthetic pill, our bodies do not recognize that well and in many long-term huge volume studies they have really seen that on multiple occasions they have had to stop the study early because of some negative effects, and that is where the controversy is because we know vitamins are helpful, but why is that a problem? Part of that is because of – as we change our recommendations we see that the vitamins that you get in your food are extremely valuable and your body does utilize those tremendously well because of how they come in nature.

What I mean by that is when you buy a vitamin E capsule – it is one of eight forms of vitamin E that is found in nature – so your body wants all eight forms. It doesn’t just want one in high volume – that is why you get toxic and can get problems so we have to remember that. When you talk about an apple, for instance – they have identified already over 12,400 plant nutrients in just an apple. So if you can imagine that massive volume of nutrients in just that apple you can see why 5mg in an apple is incredibly effective in your body. That is why the “apple a day keeps the doctor away,” but it has only got 5mg of Vitamin C – that is so little, but it is so powerful. That is why the 1,000 mg horse pill that you chuck down – all it does is create that wonderful bright yellow expensive urine and so think about where you are putting your money.

I think this boils down to what – the concept is called bio-availability. If you put something in your body – does your body utilize it and can it utilize it or does it just excrete it? And that is going to be a very important thing that we talk about later on because our food is obviously totally bio-available. Anything else that is synthetic sometimes is in question. From one of the Sports Medicine Journals a few years ago – it just talked about this because of the contradictions – now we are really saying that the most beneficial prescription is again – just a high diet of fruits and vegetables. You can tell that even in six years this is very out-dated because now the recommendations are not 5-7 anymore – they are 7-13 and it can probably just keep going up.

The American Heart Association in 2004 really came out with a big statement for the medical community when they said we no longer recommend synthetic vitamins as being heart protective, but it is the vitamins in our food that have been found now to give us the potential healthy benefit of the anti-oxidants. Soon after that the American Cancer Institute followed suit in recommending again that our diet be solely based on many fruits and vegetables – whole grains, etc. Part of that is because they had evaluated over 7,000 studies that have been done on different things such as our diet, fruit and vegetable intake, exercise, weight control and cancer prevention, and what they found out is some of the stuff that we already knew – that if you have a high diet of fruits and vegetables your cancer risk is reduced, but they also found some things we didn’t know. For example, in early life there is a much more profound effect on cancer risk and other diseases in children as they mature into adults. That is something that we really did not know or suspect, because we just thought hey – young kids are healthy. They can eat whatever they want, but now we are finding that no – there is a long-term profound effect of nutrition and what it does to a young body and I think that is where the issues becomes important for athletes.

I still work at the Olympic Training Center down in San Diego, and we have to review all the blood tests of all the athletes that come in there and you have got these incredible specimens of athleticism standing right before you and they still have a cholesterol of 280 or an LDL – that is really, really high – that is the bad cholesterol. So you can look fantastic, but still what is going on inside is still an incredibly important thing and we have to know that sometimes that started in childhood. Sometimes it is your genetics and sometimes it is things that you are able to control with your diet. So again – the American Institute Research has totally recommended now that we increase our fruit and vegetable intake. The reason it is important is that over half the college athletes I have ever dealt with fall in this category and have taken something, but I think that what is important is how this is filtering down. We now have over 70% of high school kids using supplements; this was just done in 2007, and that is up 30% from a study done in 2000 so we are already seeing this big shift – 15% under 10 using supplements so again – they are really having this push to try to use things. I think where it gets – where I draw the line is that now it is getting into the danger zone. We see a lot of kids putting un-guaranteed success over their health and that becomes really a big point for me as a doctor.

This originated in a study by a Sports Psychologist that worked with the Olympic teams and he did a study quite a few years ago that looked at the national teams – all the way up from Junior Nationals to Olympic teams – how to question about – if you could take something that would guarantee you a Gold Medal and a world record, but would kill you within 5 years – would you take it and you have 52% of them saying that yes, they would. Now, that frightens me. It may not frighten you, but it certainly frightens me, but what is even more incredible is that now – just in 2008 – this year was published a study that looked at this similar thing with kids and they asked them two separate questions about if you took something, but it was possibly unhealthy for you – would you take it if it would guarantee success and 14.7% said yes. The next question: If you could take something and it would endanger your life, would you still do it? You are still seeing that high school kids – 8.5% – almost 10% of them said they would. That is a big shift in the mindset of some of our young people so we need to remind them again how important their nutrition can be and know that these are the things that they are dealing with.

We talk about the power of food as fuel itself. Some of this is common knowledge, but I want you to know – don’t get caught with your pants down. Kids and college kids alike – they don’t necessarily know how important it is for them to perform based on using food as fuel. They are really going on just the fact that they can go, go, go and you know – put whatever in my mouth and I am just going to eat it. So, what we want to talk about is that we have all heard of the low-carb/high-carb, low-protein/high-protein, low-fat/high-fat diet – all these diets that are very specific, but we need all of these things. That is what is so important for the athlete. You have got to have them all to optimally perform. You have to also have adequate fluids and we know that people just don’t necessarily think about the fluids. It is really difficult in swimming because you are in a body of water. You do not see yourself sweat. It doesn’t look like you need water and yet – fortunately now – most kids are having water bottles on the pool deck so that they can continue to drink while they are swimming. I used to remember that I was just drinking the pool water as I swam and didn’t realize how stupid that was. The important thing is that you also have to not only fuel, but you have to re-fuel and a lot of kids do not get that and we will talk specifically why that is so important.

The other thing is if you are dealing with age-groupers, and I know a lot of you in here deal with the little kids and the pre-puberty kids and the puberty kids – this is another important point. These kids – not only have to have calories to perform exercise – they have to have good nutrition and calories to repair and recover for the next time, but they have to have a tremendous amount of calories and nutrition to grow so that is another variable that a lot of your college kids may not have to have and so these kids need to know how to eat properly. The thing that is important is that you have two ways that you store your carbohydrate: first, you store in the muscle and it is just used for that muscle itself, and then second, you also have it stored in your liver. That carbohydrate in your liver then produces the blood sugar that floats around and gives you that energy.

Calories – obviously critical – you cannot perform without calories, but again – when we talk about that long-term effect of what food does for your health – you want to make sure that those calories are really good sources of calories so they are not just randomly throwing just anything in there, but you are really just trying to get optimal calories that are good rich foods that are dense in calories, but also dense in nutrients. Fat – believe it or not – is a very major fuel source for – especially sports like swimming – where you are swimming long distances and many hours in the pool. Protein is not used for an energy source unless you are doing like ultra-marathon work or a kid is just not eating at all – then yes – the body will break down the muscle for energy because it has to have something, but protein is more significant after exercise because of how it helps you restore that carbohydrate into the muscle.

Carbohydrate is our primary source of energy because it releases energy much more quickly than from fat, but we all know that our carbohydrate stores are limited so you have to have a diet that is very high in carbohydrates to sustain a high aerobic sport like swimming. The problem is always more from a lack of carbohydrates than it is from a lack of fat, and that is why the really super high fat diet is still not necessarily a recommendation for swimming athletes, because they don’t ever really run out of a fat source of energy, but they can always run out of a carbohydrate source of energy. We have become much more efficient at using fat as an athlete, so again – that goes against needing a high amount of fat in your diet. When we are doing short activities – certainly your less than 10 second burst of speed – just are good from your body’s own creatine, but we don’t have the – you know – 9 second 100 meter dash equivalent in swimming – I mean – the 50 is as close as we get, but that is still something that you are going to even break over into using some carbohydrates so anything in that 5-10 minute range – which is most of the swimming events – you are going to use mostly carbohydrates, but in training and in practices where they are going for hours at a time – you are starting to use both fats and the blood sugar that is produced from your liver. After that, a lot of the energy does come from the fat stores and still of course, from your circulating blood sugar.

So, when you think about all the swim practices that the kids do, they are really using a lot of different sources of energy. Again, as we talk about if you are doing a lot of endurance, protein is necessary – also for strength training of course and again – for growth these kids need more protein than just the normal average person walking down the street. Usually we require about a gram of protein per kilogram of our body weight, but if you are in swimming especially and other types of sports like that – usually we recommend about 1 ½ to 2 ½ grams of protein per kilogram of their body weight. The thing is – if you OD on protein, your body has to have a lot of water to excrete it, so you risk some dehydration and other issues with that. And a lot of it then is excreted and you do not want to overload your kidneys.

I think this is important too, because this donut breakfast on the bottom here is really common in a lot of swimmers, but what happens is if you have a lot of sugar within an hour to two hours before an event or a workout or a race – what happens is you eat that sugar – your insulin goes whoop and goes way up. And then, that blood sugar gets sucked out of your blood stream and into the muscle. So, when you are exercising you have already kind of pre-decreased your circulating blood sugar level and it is not there for you to exercise so you will actually kind of end your rope more quickly – you will get earlier fatigue and won’t have an optimal performance. Now, that obviously changes when you start exercising hard because that insulin response is then kind of shut down so then you can eat all the donuts and the sugar that you would like, although I still don’t recommend that, but you are not going to get that same response, but that is why we certainly do not recommend the candy bars and the high sugary things right before kids are going to train or compete because it does have a true physiologic response that is not beneficial.

Fluids: again – absolutely critical. Part of that is because we cannot make water. You cannot store water. You have to ingest it and so it has to be replaced and just being of course in the pool, surrounded by water is not enough. If they weigh themselves before practice and then weigh themselves after practice – you just replace it ounce for ounce. If you lose a pound, then you put 16 ounces of water back in – or any kind of a carbohydrate drink. What is important for them to know and for you to know though is that 2-3% dehydration is a little bit. I do not personally know that I am 2-3% dehydrated. My body does not sit there and go – “my gosh, you are dying of thirst” – so I will sit there and still try to train hard on 2-3% deficit and yet, my body cannot optimally function with 2-3% dehydration. That is why we have to continue to train our athletes to drink frequently throughout a workout because it just has to give you that benefit that you cannot replace unless you just drink it frequently. Thirst is not reliable and this is worse the younger you go so if you are dealing with those little kids you have to stop – make them drink and drinking throughout the workout obviously – very helpful and beneficial.

Electrolyte drinks: clearly there has been years of controversy about – you know well, water really is the best thing and for the first hour and a half and that kind of issue. From a scientific standpoint – yes, that is right, but from a practical standpoint it just doesn’t work. They have looked at this over and over again and especially in younger kids – they just won’t drink water – you know – it is a taste issue that if it has color and if it has got flavor – they will drink it so much more than they will drink water so it is a battle not worth fighting. They need to have not only some carbohydrate in there, but they also – having the salt inside the sports drink – actually keeps the thirst drive stimulated because it kind of fools the body. So it does allow them to re-hydrate better than using just plain water, so we do have to again – realize what battles are worth fighting and which ones aren’t and in this case – if kids have sports drinks – it really is probably a good idea.

Clearly, soft drinks do not work – way too much sugar – certainly not necessary to have the caffeine, but any of the usual sports drinks across the market are good because their carbohydrate content is just right.

Q: What about the comeback of kids saying well this is diet – this is a diet soft drink?

A: Oh, a diet soft drink because it doesn’t have the sugar? You are right, it has no value then because there certainly are no calories either and the artificial sweeteners give them no benefit. In that case I don’t recommend it because there is no value in it. They may just do it out of a habit, but you are right – it is not going to be as harmful short-term for them. Now long-term yeah, if it causes cancer – I don’t know that issue.

So the power food for recovery? The power food for fuel again – some of that stuff you already know – some of it is common sense – some of it again is just helping the kid realize the value of the carbohydrates and how important that is and we are going to go in more detail about that in just a moment. The food for recovery though is also really critical. It is probably even more critical because it affects future performances.

You need at least 8 grams of carbohydrate per kg. of body weight to really replenish your stores after a really hard bout of exercise. This takes a really, really, really long time. That is why the timing of doing that is so important, because our body is set up a very specific way to help you out and part of that is because it is physiologically most receptive to restoring carbohydrate during the first 30-45 minutes after a hard workout. So, if you all have swum – you deal with swimmers – all that kind of stuff – you realize that after practice is over – what do they do? They hang out in the shower – you know – they probably text all day long. They get dressed – you know – driving around – they finally get somewhere – to school or maybe home – by then, that 30 minute window is long gone so you have to realize that that is that critical window.

If you just get a couple of grams of carbohydrate per kilogram of body weight during that first 30-45 minutes you have made a huge step in the right direction. Now, this isn’t very much. If you think of 70 kilograms – that is about 150 pounds – then that is 2 grams per kilogram so that would be 140 grams of carbohydrate – that is like two cups of orange juice. I mean – we are not talking about massive volume here, but it is so critical because those muscles are like sponges – just waiting to absorb that carbohydrate. This is monumental. What I was going to say about being monumental is that if you delay that process up to even just two hours – you have decreased that storage process by 65%.

That is massive because then, you have already set yourself up for a cycle of getting behind and further and further behind and leading to that awful dreaded over-training syndrome that all of us hate to hear about. What they are also finding is that if you don’t have any other way to get it than just carbohydrate that is fine, but if you have the ability to have a little protein with that as well – then it helps the muscle accommodate the carbohydrate into the muscle itself. We used to think that the protein was necessary to help restore the muscle breakdown, but unfortunately it hasn’t panned out, but it does help the carbohydrate replenishment in the muscle. Look at this – if you only have a 50% carbohydrate diet and you train two hours a day – which again is usually only one practice – most of our swimmers are doing 4-5 hours a day – you get this progressive decline in your storage carbohydrates. Clearly for a swimmer that can be a huge problem, because if you are just exercising two hours at only 70% of your VO2 MAX – you can completely wipe out your stores of carbohydrates. So we have to be able to really do a better job of supplying the body what it needs.

The good news is that if you just bump up your diet to about 70% of carbohydrates you will do a much better job at restoring those stores – keeping them on a more continuous level instead of beginning this precipitous decline over time. What happens if you do that, if you continually run a deficit? If you start out behind, then the next practice you use more, but if you don’t replace them then you have less to start with the next practice and then as you can see – it just goes down from there. So we all know that that can give us that slow burn – that progressive decline in performance – eventual over-training, muscle breakdown – true clinical depression can occur from carbohydrate depletion so it results in some of your groggy athletes that are just not interested in school any more or swimming – that kind of stuff. They really can be clinically depressed, because they have used up all their carbohydrates, and it also has a profound effect on your immune system function – hence why so many athletes that are starting to get over-trained start to get sick as well or they will be headed for the best and the biggest meet of their life and between the training and stress and the travel – then they end up getting sick and can’t perform.

What we are finding now is that this higher carbohydrate diet is not only optimizing your performance ability, but it is also really decreasing some of the suppressive affect of the immune system from the hormones that we generate from exercise stress. So that kind of leads us then into this whole aspect of exercise chemistry and what really happens when we exercise. I do not want to overlook the fact that there are so many tremendous benefits of exercise – all of us in here are big proponents of exercise and again I applaud you for doing what you do – to have such an impact on kids and adults – young adult’s lives. We know that you get better fitness and heart function and control cholesterol and blood sugar and body composition, etc., but I can’t stop there – there are actually some not benefits of exercise that we have to talk about and they happen at the cell level – at the chemical level. Sometimes they are those things that you just don’t see, but you have to know about in order to find out then how your nutrition can fight those things and still give you the best benefit of your exercise at the time.

So, what happens when we exercise? Sure – we break down muscles – we have microscopic cellular breakdown of our bones and tendons and our body does a great job of repairing that in most cases, but what happens if we exceed that body’s ability to repair is what brings people into my office – that causes that overuse injury – the tendonitis – that is so classic in swimming shoulders, as well as running – like stress fractures, etc. The other thing that happens when we exercise hard though is you get a major chemical flux basically. When you burn wood for example – you generate good positive fire, heat energy. What else do you generate? Nasty smoke, alright? That stuff is bad for you. The same thing in your body – you are generating all that heat and all that stuff when you exercise. You are producing a lot of good benefits of exercise, but you are also generating a lot of chemicals and those chemicals are called oxidative stress. They have a lot of fancy names – free radicals – lipid peroxide, blah, blah, blah, but those are – suffice it to say – things that are not good for you. They will attack healthy body tissue so if you have too much oxidative stress it can truly give you that muscle soreness that is really profound. It can give you contributions to tendonitis. It can break down your fat and cause it to be bad fat.

Cholesterol – the LDL that we have always heard of as bad cholesterol. It is not bad by itself. It is bad when it is attacked by oxidative stress chemicals, and then it can attach to your blood vessels and become nasty bad things. Oxidative stress chemicals are also able to influence our immune system function. Once again – if you are over-training or working super hard and you are emotionally stressed – those chemicals can attack your immune system and cause an untimely illness. They can also cause poor recovery from exercise, so you are not ready for that next bout and then you just generate more of those chemicals and of course, contribute to over-training which is the biggest thing we want to avoid. Now, what I have done here is just to show you that this is a really high area of exercise science right now and research, but you are going to see here that you can generate oxidative stress chemicals from just about anything. You know – anything as basic as breathing, so we have to learn how to control that.

The years in green up here are just the years that they were profound – very well done research studies that were published and when we look at that – okay – we see that with sprints you generate more oxidative stress – more with resistance training – great – so we do sprints and resistance training with swimming. What about squat training – of course – we do squats. What about long distance aerobic exercise? Well of course – that is what swimming is, but look at this one – this is great. In 2007 – how many of you all take Ibuprofen to kind of preload before you workout so you don’t get sore? Anybody here do that? Well, not many – I am surprised and that is good. You are doing the right thing because what they have found is that if you do that with a high endurance activity or an aerobic sport – not only do you generate oxidative stress just from the sport – you generate more just by taking Ibuprofen on top of it so if you preload before you workout – then what happens? You generate oxidative stress and you generate more than you should so you have all these negative effects, so then you take more Ibuprofen to counteract those negative effects and hence you see – the cycle continues. So, these are important aspects to really make sure that your kids are not doing this.

What else?? Eccentric training – if you are doing negatives – if you bring up a weight and you lower it real slowly – again – a very important strength training thing – a very important thing we use in physical therapy and rehabilitation as well, but it does cause more oxidative stress. We also get it with again – aerobic and endurance training and then this was a biggie for me – the past 23 years in a row – there has been at least one – if not more – significantly published research studies that show that oxidative stress has a profound effect on your immune system. I don’t know how many of you have had swimmers that have gotten sick at the wrong time, but I think all of us have experienced that to some degree and I know – every single trip that I ever went on – wherever it was in the world there was usually one athlete that had to have an IV or had to go to the hospital for something, so it really is something that plays a profound role and our nutrition can really help fight that.

Also, here they are finding out that increased training really increases our risk of infection and more moderate training lessens that risk, so if we are in a high-intensity training sport such as swimming – we know we are at a higher risk – then we have to use our nutrition to fight that oxidative stress – utilize the anti-oxidants in our food to give us a better protective effect and so that is clearly what we have to do. Now – in swimming you do not have the ability to spread out intense exercise, but you do have the ability to sometimes focus more on quality rather than quantity. Stay well hydrated – of course – incredibly important. The concept of active rest where they are in the pool and they are doing maybe a more moderate activity level, but not quite as intense and then again – increasing our whole food sources of the vitamins and antioxidants and all of those things that make plants and produce colorful.

We do think of nutrition as our best sports supplement, because it has such whole body value. We always want to increase our benefits from exercise, so the kids that you are dealing with can really get the best bang for the amount of time and effort that they are spending in the pool. What are some of the barriers that we have? One primary barrier is the four food groups that our kids know today: (1) buffet, (2) dine-in, (3) carry out and (4) delivery – that is what they know. That is their world and we have to try to get them away from that. I also am really surprised when I go on these trips because I think you all know – there are some athletes that eat very, very well, but there are some of these kids that just – it blows my mind what they are putting in their body. Part of it is because they are good and they go on good and what I am doing is fine, but I am thinking – well, but could you possibly think you might do better if you had better nutrition in your body? How can better nutrition ever be harmful for you? So, we want to make sure that they are not relying on talent alone and that they are optimizing every bit of their ability to perform.

Also, we spend a lot of time of course on finding the right pool and the right coach and the right equipment and all those things which are all critically important and personal training and strength training, etc., but the nutrition is an absolutely vital part of an overall athletes’ program. One concept that I think gets really so emphasized in kids and they don’t know it is this concept of metabolic programming. If they put that burger and fries and that soft drink in their mouth every day – multiple times a day – that is the nutrition their brain gets impacted by every single day. So it just gets programmed to expect that type of nutrition. Whereas, if they put really highly nutrient dense whole foods in their system with high fruits and vegetable intake, they have found studies that show that over time those kids get metabolically programmed basically to really request and desire more fruits and vegetables. So remember what you put in your body really does affect how your brain looks at that.

Some of the other barriers we have of course are the fact that our health status of the nation is so bad and that is why we have a new food pyramid, but just rearranging the pyramid isn’t going to solve our national health crisis. They have increased the recommendations and I applaud that – at the same time it’s like “okay great – wash your hands” – we have recommended more fruits and vegetables so now we have done our part to help the world’s health. Recommending that is great, but how many of us do that? I mean – I think that that is really difficult for us to do and all we can do is really say is do a better job, and then explain why. If you view your nutrition from a health standpoint of why it is going to help you perform better, it is so much easier to eat better produce and better foods.

Most of us don’t – can’t – won’t get the variety that we need and we are finding out across the board that unfortunately because of our American diet spreading across the world – whole food fruits and vegetable intake is becoming much more of a significant problem. When we look at some of the athletes that really have a barrier – where they hit the wall and they don’t improve – oftentimes it is not that they are training improperly – it is because they are not refueling their body properly and they do not have the stores to do it the right way. When we look at that and you say 13 servings you know – my gosh – that is really difficult – what can we do? This is an issue that really bombards all of us and even people like myself that really try to study nutrition as much as possible.

You probably know by now that in general – physicians aren’t ever trained in nutrition and spending time with the Olympic movement and the National team for years – I really had to educate myself and spend a lot of time with nutritionists and reading and things to understand why nutrition is so important, because it just was never part of my medial curriculum – which is a shame. It is totally a fault of the medical system, but what are some of the things that we can do?

Well, if we educate and if we know better why something works – I think we would all do a much better job of doing that and really acting on that knowledge. We need desperately to increase our daily intake of fruits and vegetables from multiple standpoints. You have got to have the carbohydrates, you have got to have the calories, you need the fiber – you need all of those plant nutrients that we have talked about. Some kids don’t get that and they don’t get enough to help counteract the bombardment of all that oxidative stress and that is why we consider a fruit and vegetable product.

Now again – this talk is primarily nutrition. I only have four slides coming up on Juice Plus, but I do mention it because as a physician, I value its medical research because it truly is – not a supplement, but it is a true whole food product that has nothing but fruits and vegetables and grains in a capsule – never ever meant to be a substitute – please hear me say that – we want kids to eat more fruits and vegetables because of the reasons we saw. They have to have the calories. They have to have the carbohydrates. They need that protective source, but Juice Plus provides a very condensed concentrated way to provide them that protective nutrition along the way. The other thing that is important is because it is pure fruit it is a drug test safe product. Many athletes, many Olympians are taking this because they realize the value of nutrition and it is not going to be harmful for them in a drug test because it is pure food.

The reason I bring it up is because I want you all to know that in general – this is something that is very valuable to me as a physician if I am dealing with an Olympic athlete or someone who is wanting to be an Olympic athlete – if I have them put something in their body that is beyond food and it is something like this – I want to make sure that it has been researched and it has been researched like crazy and when you look at that – I mean – these are obviously places that you all have heard about and know about so the research behind Juice Plus is massively substantial and is highly regarded. It has been published in over 90 journals. It has over 14 published studies – 10 more in progress, over multiple countries across the world and many medical institutions and as a gold standard researched where they employ the placebo control – double blind – randomized, etc.

Now when we are looking at this – why is it important? Well, it just proves to us what fruits and vegetables do and I think this is a clear distinction that I have to make is that the miracle isn’t Juice Plus – that is why I am saying that this is important, but you have got to know why. The miracle is that it really proves what fruits and vegetables do in our body and it just provides a very condensed, controlled, scientific way to look at it because we can vary the quantity. It is bio-available – it gets in your bloodstream and actually shows up in your blood stream. If it didn’t do that there is no reason to ever consider taking anything else. It raises the antioxidants and reduces those free radicals that are so potentially harmful. It also reduces the oxidative stress chemicals more than just free radicals. It reduces damage to DNA and I think that is important when you look at our long-term health.

How many cancers and bad things start from damaged DNA? It is profound and there has never been a prescription drug ever found to reduce damage to our DNA so again, look at the power of your food and your fruits and vegetables. It enhances immune system function and lowers a chemical marker in our blood stream that if it is elevated it will cause increased risk of death from anything so you want to keep your homocystine at a lower level. It maintains normal vascular function and specifically reduces oxidative stress chemicals generated by exercise. It also has been evaluated by – again, passed with flying colors because it has nothing but fruits and vegetables in it. The thing that is important for me is that it is a whole body benefit and again – echoes everything we have talked about how our food – our fruits and vegetables have whole body benefit – they are not isolated – it is really best for our body.

So, when we look at our nutrition we see that it is not only important for performance health, but for recovery health and preventive health. When we look at research that looks at food – this is a relatively new area in sports medicine, but thank goodness they are doing it because it is so vital. This was a study that was published and really kind of the bible of Sports Medicine Journal that we have, but it showed that yes, if you are a high intensity exerciser like a swimmer, you do generate more oxidative stress and you do require more antioxidants, but that you can get it in your fruits and vegetables in your food and there is no reason to recommend a synthetic vitamin supplement.

Cherries – for some reason – have a profound effect and of course, if you looked at every fruit and vegetable across the world – all those things, there are lots of things out there that have benefit and when we put them all together our body knows what to do with them. Again, they have shown it specifically reduced muscle damage after exercise and reduced inflammatory effects. Other things – now these two were the specific oxidative stress of exercise studies done with Juice Plus on – one was on elite military – one was on high-intensity exercisers like triathletes and again – reducing oxidative stress and reducing illnesses. These are other super important aspects of how food now is really making the headlines when we talk about Sports Medicine.

In 2006 there was a great study published on the fact that if you don’t have adequate nutrition it really, really affects your immune function and increases the risk of illnesses and we don’t want our athletes getting sick. They have got to be eating well. Just last year – same thing – if you restrict your nutrition – just for two days before an event it reduces the protective immune factors that you have circulating around in your saliva. The other thing that we found is that, for instance, some of the cells in your immune system get tremendously decreased with long distance activity which again – swimming really falls into that category, but if you give an adequate amount of carbohydrates with your exercise it does not decrease that immune system function. It keeps it healthy.

Just this year, in 2008, already some great results coming out of a study overseas where they saw that again – your neutrophils, which is again a very protective part of your immune system do not decrease after exercise if you have carbohydrates and a little bit of protein. So, what did we talk about earlier? That critical window of 30-45 minutes – carbohydrates with a little protein. It wasn’t just to restore carbohydrates – it is also to help protect your immune system function. This protective effect did not happen if you delayed that one hour – same kind of process. If you don’t put it in there within an hour – two hours, you get a double whammy there so it just really reminds us how we have to do this.

So overall nutrition and health – we have got lots of great benefits from exercise – especially swimming – it is just such a lifelong sport that is so incredible, but we know that we have a lot of athletes that are just kind of always on that verge of going over this cliff, because they just are riding that fine line of working too hard and not quite getting enough nutrition. They are overloading. They are emotionally stressed because of school and family and girlfriend or whatever and it becomes a real issue. Sometimes they are becoming nutritionally depleted so we have to have the tools on how to prevent that kind of a scenario so that your kid can perform to their specific optimal best – so remember – proper nutrition – major component – not only just to exercise. We all know that, but it is a huge player for recovery and then to protect you from the chemical negative effects of exercise – not only to help with best performance, but then your long-term health – even beyond the pool and that is the point that I hope that I made today.

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