practical adolescent sports nutrition for … adolescent sports nutrition for pediatricians ......
TRANSCRIPT
Pediatrics
Practical
Adolescent
Sports Nutrition
for Pediatricians Elisabeth Hastings,MPH,RD,CSSD,LD
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Disclosure
I do not intend to
discuss an
unapproved/
investigative use of
a commercial
product/device in my
presentation
I have no relevant
financial relationships
with the
manufacturers of any
commercial products
and/or provider of
commercial services
discussed in this
CME activity
Pediatrics
Introduction
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Objectives
1. To discuss the increased requirements and
barriers to optimal nutrition in competitive
adolescent athletes
2. To describe key sports nutrition concepts and
sound resources for competitive adolescent
athletes
3. To provide appropriate baseline sports nutrition
education and referrals for individual nutritional
assessment for competitive adolescent athletes
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Stats on Teen Athletes
•Current estimates indicate that 55.5% of high
school students compete in sports1
•Texas has the greatest number of high school
athletes1
•Most coaches and athletes have inadequate
knowledge of sport specific nutrition2
•Parents want more positive messages about
nutrition from health care professionals that are
specific to youth3
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Who Plays What?
•Boys1
‐Football, track, basketball,
baseball, soccer, wrestling
•Girls1
‐Track, basketball, softball,
soccer, cross country
•6% of high school football players will play in college4
•Early specialization can cause burn out; overuse
injuries
© Lucky Dragon USA –Fotolia.com
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Sports Nutrition
•Sports nutrition can help promote optimal training,
body composition, performance, growth, healing
and immunity in teen athletes5
•Without proper nutrition, athletes are at risk for
suboptimal growth6
•A dietitian specialized and credentialed in sports
nutrition is a CSSD5
‐Certified Specialist in Sports Dietetics
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Barriers to Optimal Nutrition in Teen
Athletes
•Poor knowledge base
•Poor organization of
food and meal times
•Pubertal body changes
•Body dissatisfaction
•Lack of parental support
•Concrete thinkers
•Lack of financial
resources
•Obesogenic society
•Interest in supplements
& fad diets
•School challenges
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Calories - New School Lunch Program7
GRADES LUNCH (kcal) BREAKFAST (kcal)
K-5 550-650 350-500
6-8 600-700 400-550
9-12 750-850 450-600
© Michael Flippo – Fotolio.com
Is it enough?
Pediatrics
Sports Nutrition
Basics Subtitle
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What Type of Athlete?
Aerobic
•Distance
running
•Triathlons
•Cycling
Anaerobic
•Max effort-short duration
•Lineman
•Sprinters
•Stop and
go sports
© Shariff Che'Lah – Fotolia.com
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Hydration
•Never underestimate the value of hydration
•Differences in thermoregulation exist between
children and adult athletes
•Teen athletes are particularly poor at hydration
‐Thirst is not a good indicator of dehydration in sports
•AAP policy statement for children & adolescents8
‐Adolescents may consume up to 1-1.5 liters of fluids
every hour of exercise
‐Who is at highest risk?
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Hydration
•ACSM exercise and fluid replacement position stand9
‐Pre-pubescent children have lower sweat rates than adults
‐Performance is impaired with a >2% loss in body weight
•How to monitor hydration status ‐Urine color/Chart10
•http://www.csbsju.edu/Documents/CSB%20Campus%20Rec/Scan_Doc0011.pdf
‐Sweat rate9
‐Urine specific gravity9
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Fluid Intake
Recommendations
© Geoffrey Whiteway – freerangestock.com
•Before Exercise:
‐2-3 cups fluid 4 hours before
‐1½ -2 cups 15-30 minutes before
•During Exercise:
‐½ - 1 cup every 15-20 minutes
•After exercise:
‐2½ - 3 cups for every pound lost
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Comparison of Popular Fluids
Beverage 8oz
CHO % CHO (gm)
Calories Sodium (mg)
Potassium (mg)
Water 0 0 0 0 0
Propel Sport Water 1 3 10 35 0
Pedialyte 2.5 6 24 407 183
G2 3 7 20 110 30
Coconut Water 4 11 42 28 484
Vitamin Water 5.5 13 50 0 0
Gatorade 6 14 50 110 30
Powerade 8 19 72 53 33
Coke 11 27 100 30 1
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Food Is Fuel
•High school athletes tend to
‐Skip breakfast
‐Eat at least one meal at school
‐Come to practice 4+ hours after eating
•Consequences of under-fueling5
‐Loss of lean body mass
‐Earlier fatigue/suboptimal performance
‐Increase risk for injury & illness
‐Prolonged recovery & healing
‐Menstrual dysfunction © Ogerepus – Fotolia.com
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Daily Calorie Requirements11
AVE TEEN FEMALE
1700-1800 calories
AVE TEEN MALE
2200-2400 calories
MALE ATHLETE
3000-4000 calories
FEMALE ATHLETE
2200-3000 calories
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Calories - New School Lunch Program7
GRADES LUNCH (kcal) BREAKFAST (kcal)
K-5 550-650 350-500
6-8 600-700 400-550
9-12 750-850 450-600
© Michael Flippo – Fotolio.com
Is it enough?
Often not for competitive athletes
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Timing is Key – The Training Diet
2 TRAININGS/DAY
•Wake up
•Pre-training meal (breakfast)
•Training (fluids)
•Recovery meal/fluids
•Between training meal (lunch)
•Training (fluids)
•Recovery meal/fluids
•Post training meal (dinner)
•Bedtime (snack)
1 TRAINING/DAY
•Wake up
•Breakfast meal
•Lunch meal/fluids
•Pre-training snack
•Training (fluids)
•Recovery meal/fluids
•Post training meal (dinner)
•Bedtime (snack)
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Optimal Training Diet
•Abundant in Fluids
‐Drink all day
•Ample in nutrient dense
carbohydrates
‐50-70% of total calories
•Adequate in protein
‐15-20% of total calories
•Balance of fat
‐20-35% of total calories
Whole grains
breads/pasta/cereals, fruits,
vegetables, low fat milk/yogurt,
beans , energy bars
Lean meats and fish, low
fat dairy, nuts, beans
Dairy products, nuts, heart
healthy oils and butters ,
avocado
Water, milk, 100% juice,
sports drinks
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Carbs are King!
•Main source of energy for
working muscles & academic
brain
•Inadequate carbohydrate
consumption can lead to
glycogen depletion
•Younger athletes have smaller
gylcogen stores and more
limited glycolytic capacity than
adults12
© Katie Park – freerangestock.com
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Carbohydrates
•Low intensity, skill based athletes with large body mass
or energy restriction
‐3-5g/kg/d
•Moderate Exercise Program ~1 hour per day
‐5-7g/kg/d
•Endurance Program 1-3 hour moderate to high intensity
‐7-10g/kg/d
•Extreme Commitment >4-5h per day moderate to high
intensity
‐8-12g/kg/d
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Pre-workout Fuel
•Ideally 3-4 hours before
event/practice, maybe again 1
hour before
•High in carbohydrate, low or
moderate in protein, low in fat,
low in fiber
•High individual tolerance
•Race day NOT a good time to
try a new food!
© Chance Agrella – freerangestock.com
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During Exercise
•Prepubertal athletes may rely more on exogenous
carbohydrate intake during exercise than post12
•30 grams (120 calories) of carbohydrate per hour
during 1 to 2 hours of exercise
•60-90 gram (240-360 calories) of carbohydrate per
hour for exercise lasting more than 2.5 hours
•Easily absorbed carbohydrates
‐Sports drinks, banana, gummy candy, gels, dried fruit
‐Swish and spit?
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Protein5
•Post Pubertal Non exercising:
‐0.8 gm/kg/day
•Maintenance/Endurance athletes
‐1.2-1.4 gm/kg/day
•Strength/resistance athletes
‐1.4-1.8 gm/kg/day
•Teens
‐1.4-1.5 gm/kg/day (can be higher if actively growing)
•Most teens exceed this intake12
© Liddy Hansdottir - Fotolia.com
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Fat12
•Few studies have investigated fat intake for active
teens
•Recommendations are the same as general for age
‐20-35% daily calories
•Younger athletes rely more on fat as fuel than adults
•Especially important for endurance athletes
•Restriction of fat intake in non-obese children may
result in impaired growth and development
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Post-workout Fuel: Recovery5
•Muscles replenish energy stores most efficiently
within 30 minutes after exercise
•Type of carbohydrate
‐Fructose alone less affective that glucose and sucrose
•Addition of protein promotes maximal repair and
anabolism
‐Carbohydrate to protein ratio of 3:1 or 4:1
•Goal: 1.5 grams of carbohydrate per kg with 0.3-
0.5 grams/protein/kg per 2 hour interval
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Key Nutrients of Interest5
•Calcium & Vitamin D
•Iron, Zinc, Magnesium
•B Vitamins
•Vitamin C, E, Beta carotene, selenium
•Sodium, chloride, potassium
•Omega 3 Fatty Acids
Use of a multivitamin supplement does not improve performance in athletes consuming nutritionally adequate diets
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Vegetarian Athletes5
•Variety & monitoring body weight/body composition
is important to ensuring adequacy of diet
•Protein recs increase to 1.3-1.8gm/kg/day
•Protein quality may be of concern if athlete is a
vegan
•May be at risk for low intakes of energy, fat, vitamin
B12, riboflavin, vitamin D, calcium, iron, zinc
•Females may be at greater risk for developing iron
deficiency anemia
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Female Athlete Triad Spectrum13,14
Reduced or Low Energy Availability
Subclinical Menstrual
Disorders or Amenorrhea
Low Bone Mineral
Density or Osteoporosis
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Disordered Eating in Teen Athletes15
•Increased incidence at the onset of adulthood (18-
25 years) supports prevention strategies in
adolescence
•Female athletes and those with >16 hours/week of
activity have an increased tendency toward
disordered eating
•“Anorexia Athletica”
•“Lean-build sports”
‐cross country & track runners, swimming, gymnastics,
cheerleading, yoga, wrestling, dancing
•Can result in suboptimal bone mass in adulthood
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Alcohol and Teens21
•Drinking alcohol after exercise negates training
effect, hinders recovery, increases likelihood for
injury, decreases immunity
•Alcohol can increase appetite and promote weight
gain
•Males athletes are more likely than females to
drink heavily
•Team sports in adolescence increases likelihood of
alcohol intoxication
Pediatrics
Practical Tools
& Meal Ideas
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Athlete’s Meal Plate #1
Fruits and
Veggies
Lean Protein
Grains
Wt loss or low intensity/no workout day
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Athlete’s Meal Plate #2
Moderate/usual intensity workout day
Fruits and
Veggies
Lean Protein
Grains
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Athlete’s Meal Plate #3
High intensity or double workout day
Veggies
Grains
Fruit
Lean Protein
USOC ATHLETE PLATES: http://www.teamusa.org/About-the-USOC/Athlete-Development/Sport-Performance/Nutrition/Resources-and-Fact-Sheets
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Pre-Exercise Meals (2-4 hours)
Breakfast
Cold or hot cereal, fruit, and low-fat or nonfat milk
Pancakes or waffles with maple syrup, fruit
English muffin with peanut butter, banana, and fruit juice
2 eggs, potatoes or wheat toast, fruit, milk or yogurt
Bagel with low fat cream cheese, oatmeal, fruit
Granola bar, cereal with milk & almonds, fruit
Liquid meal replacement or smoothie
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Pre-Exercise Meals (2-4 hours)
Lunch or Dinner
Pasta with tomato sauce, grilled chicken, steamed vegetables, low-fat milk, canned fruit
Baked or grilled fish or lean beef; steamed rice, roll, green beans, yogurt, and fruit juice
Grilled chicken sandwich, baked potato with low-fat sour cream or salsa, and low-fat frozen yogurt
Turkey or tuna sandwich, baby carrots, trailmix with nuts, low fat milk
Tacos, rice, salad with dressing, fruit, milk
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Pre-Exercise Meals (<1hour)
•Simple/Refined:
‐Banana, gummy candy, dried fruit, pretzels, applesauce,
honey, fig bars, sports drinks, gels
•More complex:
‐oatmeal, bagel, banana, dried fruit, energy bar, yogurt, liquid
nutrition supplement
•Some choose to refrain from food and fluids just
before and during exercise
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The Athlete’s Pantry
•Trailmix
•Mini-wheats
•Dry cereal
•100% juice
•Sports drinks
•Sports bars
•Graham crackers
•Canned tuna
•Canned tuna
•Canned beans
•Canned
fruits/veggies
•Low fat sandwiches
•Granola bars
•Peanut butter
•Oatmeal
•Whole wheat
pasta/bread
•Instant brown rice
•Tomato sauce
•Nuts
•Dried fruits
•Pretzels
•Light popcorn
•Beef jerkey
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The Athlete’s Cooler
•Fresh fruit
•Cottage cheese
•Fresh vegetables
•Yogurt
•Hummus
•Turkey sandwich
•Food bar
•Low-fat choc milk
•Meal replacement drinks
•Peanut butter & crackers
© Adamophoto – freerangestock.com
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What Makes a Good Post
Exercise/Recovery Food?
Snack Food
Post Exercise
Food
Carbohydrate 15-30gm 30-100gm
Protein <6gm 6-25gm
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Recovery Snack Ideas
Fluids
•PowerBar
Recovery
•Clif bar
•Luna Sunrise Bar
•Gatorade Energy
Bar
•Kashi Go lean
•Balance Bar
Food Bars
•Low-fat choc milk
•Smoothie
•Carnation Instant
Breakfast
•Boost/Ensure
•Gatorade
Recovery
•Muscle Milk
•Lean meat or
PBJ sandwich
•Yogurt & granola
•Banana & PB
•Tuna w/ crackers
•Trailmix & juice
•Cheese & fruit
•Pita & hummus
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Recovery
•Fruit smoothie made with yogurt or milk
•Turkey sandwich with a piece of fruit
•Yogurt with berries and granola
•Bowl of minestrone soup with whole grain crackers
and low fat cheese
•Oatmeal with milk, raisins, and slivered almonds
•Peanut butter and banana sandwich
•Vegetable omelet with toast
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Travel & Eating Out (night before)
•2 cheese pizza slices with added grilled chicken,
green salad, 100% juice
•Turkey & cheese sub sandwich, baked chips, fruit,
low-fat milk
•Grilled chicken soft tacos, rice, beans, tomatoes, corn
•Spaghetti with meat sauce, bread, green salad with
dressing, low fat milk
•Baked potato with chili and broccoli
•2 burgers, extra veggies, no fries, water
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Grocery Store Tips for Athletes
•Perimeter of store = good
•Middle aisles = not as good
•Fruits & veggies = fluids & vitamins
•Round or Loin = leaner cuts
•Olive & canola oil = heart healthy
•100% whole wheat = Magnesium
•Blue/red/purple foods = helps delay muscle soreness
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To Gain Lean Body Mass
•Weight (muscle) gain is as hard to do for some as
weight loss
•Needs more than just protein but also, strength
training stimulus and extra calories
•Increasing calorie intake 300-500 calories per day
equates to ½-1 pound of body weight per week
•Late-maturing adolescents usually most concerned
about gaining muscle and size
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To Gain Lean Body Mass
•Always eat breakfast
•Eat every 3-4 hours
•Pack high calorie snacks
•Add fluids that contain calories to meals
•Increase portion sizes
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To Lose Body Fat
•A combination of proper training, calorie deficit,
plenty of protein, & enough, but not too many,
carbohydrates
•Cutting back on about 300-500 calories equates to
½ -1 pound of body weight per week
•Body composition assessment techniques
•Lowest reference body fat for adolescents16
‐7% males, 14% females – adolescents
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To Lose Body Fat
•Don’t skip or restrict meals
•Fill up on fruits and vegetables
•Avoid foods with added fats and sugars
•Decrease carbohydrates in meals that are not
before workouts
•Increase aerobic exercise as needed
© Geoffrey Whiteway – freerangestock.com
Pediatrics
Supplements Subtitle
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NOTHING BEATS REAL FOOD
THE KITCHEN SHOULD BE AS
CRUCIAL AS THE VITAMIN STORE
SUPPLEMENTS CAN HARM AN
ATHLETE AS MUCH OR MORE THAN
THEY CAN HELP
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Athletes & Supplements
•An athlete is fully responsible for all prohibited
substances found in his/her body
•Athletes generally don’t ask their doctors for advice
on taking supplements - you need to ask them!
•Scientifically testing products is becoming more
common, but the industry is still highly unregulated
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Teen Athletes and Supplements12,17
•Supplements for adolescents are generally not
recommended
‐Very few studies in children and adolescents
•Nonetheless, supplements are very popular among
adolescents
‐Most commonly used are sports drinks, multivitamins, vitamin
C, iron, whey protein, caffeine, & creatine
•Younger elite athletes tend to be more
performance focused and less health conscious
than adults with regards to supplements
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Look at Your Label
VS
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Whey Protein Powders
•Helps in conjunction with CHO
•Increases muscle mass more aggressively than
other proteins
•Enhances immune function
•Effective for those who don’t eat enough
•Isolate vs concentrate
•No more or less effective than food!
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Creatine
•Amino acid that provides energy to muscles,
usually as phosphocreatine
•Delays fatigue during explosive exercise
•May benefit those who are naturally deficient
•Dose: ‐20 gm total/day (divided) for five days, followed by 3-5 gm
per day to maintain.
•Sources: red meat, poultry, fish
•Water retention
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Creatine Guidelines for Teen Athletes18
•Only recommended when the athlete is a serious competitor
and is post-puberty.
•The athlete is eating a well-balanced sports diet that
optimizes performance.
•Both athlete and parents understand the effects of creatine
supplementation and approve of taking the supplement. No
one can guarantee safety.
•Qualified professionals supervise the supplementation of
only reputable brands of creatine supplements.
•The athlete does not take more than the recommended
dose.
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Caffeine
•Both a CNS and muscular stimulant
•Increases alertness and decreases perception of fatigue
•May increase fat utilization & decrease CHO
•Sources: Energy drinks, coffee, tea
•Optimal Dose: 3-6mg/kg taken ~1 hr prior
•Doping threshold in urine
•Symptoms of caffeinism
•Adolescents may be more sensitive to effects
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Common Caffeine Sources
Beverage/ Food
Caffeine (mg)
Coffee, brewed
110-150
Coffee, instant
40-108
Tea 20-58
Chocolate, 1 oz
6-13
Soda 30-5
Beverage/ Food
Caffeine (mg)
Red Bull 80
5-Hour Energy
208
NoDoz or Vivarin
200
Coffee Ice cream
10-50
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Branched Chain Amino Acids
•Leucine, isoleucine, valine – essential amino acids
known to fuel skeletal muscle
•Assists in synthesis of other amino acids
•Helps muscles absorb BG for energy
•Slows water absorption
•Food Sources: Dairy, eggs, red meat, fish,
legumes
•Dose: 1-5gm/day
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Beet Root Juice19
•Modulation of nitric acid
•Reduces oxygen demand
•Optimal for events lasting
5-30 minutes
•Poor taste
•Dose: 300-500mg
•Food sources:
‐beets, Chinese cabbage, leeks,
spinach, arugula, endive, fennel,
parsley, celery, kohlrabi
© Witold Krasowski – Fotolia.com
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Sodium Bicarbonate
•Base that buffers lactic acid in the blood
•Delays onset of intracellular acidosis
•Enhances anaerobic exercise performance
•Ideal for 400-800 meter runs
•Dose: 0.3+gm/kg 1-2 hrs prior
•Diarrhea side effect
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Beta-Alanine20
•An amino acid building block for carnosine, a
compound naturally found in muscle
‐Leads to a gradual increase in muscle carnosine. which
buffers muscle acids produced during high-intensity physical
activity
‐Reduces muscle burn and fatigue
•Dose: 3-6 g/day
•Relatively new, promising, but only a few well
designed studies have shown beneficial as well as
no improvements
Pediatrics
Resources
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Sports Nutrition Links & Resources
•www.scandpg.org
•www.eatright.org
•http://www.teamusa.org/About-the-USOC/Athlete-Development/Sport-
Performance/Nutrition/Resources-and-Fact-Sheets
•http://www.usada.org/files/active/athletes/NutritionBookletFinal.pdf
•http://acsm.org/access-public-information/acsm's-sports-performance-
center
•www.sportsnutritionresource.com
•www.healthydiningfinder.com
•http://www.teamusa.org/About-the-USOC/Athlete-Development/Sport-
Performance/Nutrition
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Sports Nutrition Links & Resources
•http://kidshealth.org/teen/food_fitness/sports/eatnrun.html#
•www.americanathleticinstitute.org
•http://vegetariannutrition.net/vegetarian-teens/vegan-teen-athlete/
•www.femaleathletetriad.org
•www.gssiweb.com
•http://www.powerbar.com/nutrition-in-training/eat-to-compete-high-
school
•www.supertracker.usda.gov
•www.nal.usda.gov/fnic
•www.ounceofprevention.org
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Be Supplement Savvy
•www.drugfreesport.com
•www.informed-choice.org
•www.nsfsport.com
•www.consumerlab.com
•www.supplement411.org
•www.ods.od.nih.gov
•www.usada.org
•www.supplementwatch.com
•www.supplementsafetynow.com
•www.naturaldatabase.com
•www.wada-ama.org
•FDA MedWatch Hotline
800-332-1088
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How to Find a Sports RD
•Commission on Dietetic Registration Specialist
Locator Directory
‐ www.cdrnet.org/applications/directory
•Find a SCAN RD
‐www.scandpg.org
© Geoffrey Whiteway – freerangestock.com
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RD’s Who See Teen Athletes in Texas
•Houston
‐Roberta Anding, RD, CSSD & Lisa Hastings, RD, CSSD
‐Texas Children’s Hospital Sports Medicine Clinic
‐832-822-4887
‐http://www.texaschildrens.org/sportsmed/
•Dallas-Fort Worth-Keller
‐Eve Pearson, RD, CSSD
‐214-793-2223
‐www.nutritionworkscnc.com
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RD’s Who See Teen Athletes in Texas
•San Antonio
‐Mandy Taylor, RD
‐Power at Play, LLC
‐210-286-7346
•El Paso
‐Marilyn Rotwein, RD
‐915-255-0487
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Summary
•Nutrition can play an essential role in the health
and performance of competitive adolescent
athletes
•Adolescent athletes require more fluid, calories,
carbohydrates, proteins, and many key vitamins
than their non-athletic peers
•Meal time constraints, poor nutrition knowledge,
and pubertal body changes are among the many
barriers to optimal sports nutrition for adolescents
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Summary
•Timing and composition of meals before, during, and
after exercise are crucial for optimal sports
performance and recovery
•Adolescent athletes at highest risk for suboptimal
nutrition are those who under-fuel, are vegetarian, have
disordered eating, or abuse alcohol
•Although supplements are popular and commonly used
among adolescents, they are not generally
recommended
•Individual assessment by a CSSD is recommended to
best meet an elite athlete’s nutritional needs
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Bibliography
1. National Federation of State High School Association 2011-2012
2. Torres-McGee et al, J of Athletic Training, 2012
3. Thomas et al, J of Nutr Edu & Behav, 2012
4. http://www.collegesportsscholarships.com/percentage-high-school-athletes-
ncaa-college.htm
5. American College of Sports Medicine Position Statement: Nutrition and
Athletic Performance, 2009
6. Stang & Story, Guidelines for Adolescent Nutrition Services, 2005
7. Nutrition Standards in the National School Lunch Program and Breakfast
Program; Final Rule. Federal Register, Dept of Agriculture, Vol. 77, No. 17,
January 26, 2012
8. American Academy of Pediatrics. Council on Sports Medicine and Fitness &
Council on School Health. Policy Statement-Climatic heat stress and
exercising children & adolescents. Pediatrics, Vol 128, No. 3, 2011
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xxx00.#####.ppt 9/10/2013 11:51:40 AM Pediatrics
Bibliography
9. American College of Sports Medicine Position Stand. Exercise and Fluid
Replacement. Med & Science in Sports & Exercise 2007
10. Urine Color Chart: Armstrong. L.E. (2000). Performing in Extreme
Environments.Human Kinetics. Champaign. IL.
11. Institute of Medicine Dietary Reference Intakes. Estimated Energy
Requirements, 2005
12. Jeukendrup A, Cronin L. The Elite Young Athlete; Med Sport Sci. Basel, Karger,
2011, vol 56, pp 47-58: Chapter 3: Nutrition and the Elite Young Athlete
13. American College of Sports Medicine Position Stand: The Female Athlete Triad.
Medicine & Science in Sports & Exercise, 2007.
14. Thein-Nissenbaum J, Carr, KE. Female athlete triad syndrome in the high school
athlete. Phys Therapy in Sport 12; 108-116. 2011
15. Anton, LG. Disordered Eating in Adolescent Athletes: Prevalence and Risk
Factors. SCAN’s Pulse Winter 2010, Vol 29, No. 1: 9-12
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Bibliography
15. Turocy, et al. National Athletic Trainer’s Association Position Statement:
Safe Weight Loss and Maintenance Practices in Sport and Exercise. J
Athletic Training. 2011;46(3): 322-366
16. Holway FE, Spriet LL. Sport Specific Nutrition: Practical strategies for team
sports. J Sports Sciences, 2011; 29(S1):S115-S125
17. http://www.menshealth.com/supplements/articles/The_Facts_About_Creatin
e.php
18. Coleman E. Reap the benefits of beetroot juice – evidence suggests it
improves heart health and athletic performance. Today’s Dietitian. 2012,
14(2): 48
19. http://www.humankinetics.com/excerpts/excerpts/beta-alanine-as-a-sport-
supplement
20. http://www.goeata.org/protected/EATACD10/downloads/pdf/presentation-
osullivan.pdf
