Bariatric Athlete Nutrition Lea Crosetti, RD, CSSD www.BariAthletes.com September 22nd 2012 © BariAthletes Objectives • Review bariatric and sports nutrition guidelines • Identifying the variables when combining bariatric and sports nutrition guidelines • Learn how to address and motivate the athlete through their transformational barriers © BariAthletes Bariatric Surgery © BariAthletes Nutritional Changes Post Bariatric • Minimal caloric intake – Restrictive and malabsorption • Minimal carbohydrate intake – Dumping syndrome – Expansion – Reduces protein intake EVERYTHING IS REDUCED! VERY CATABOLIC! • Minimal fluid intake – 1-3oz fluid at a time – Hold fluids 30 minutes pre and post meals • Vitamin and mineral deficiencies – Malabsorption and reduced intake – Noncompliance with supplements Allis, Blankenship, Buffington, Furtado, Parrott. Surgery for Obesity and Related Diseases. ASMBS Allied Health Nutritional Guidelines for the Surgical Weight Loss Patient. 4 (2008) S73-S108 © BariAthletes Athletes © BariAthletes © BariAthletes Sports Nutrition Guidelines • Maintain neutral or positive calorie balance – +500-1000kcal for muscle building • Increase carbohydrates to meet the energy demands of workouts – 5-13g CHO / kg • Increase fluids to meet sweat losses – ~1L/hr • Adequate vitamin and minerals – Fe, Ca, Zn, K, Vitamin D, E, C, B12, Folic acid Rosenbloom CA, Coleman, E. Sports Nutrition: A Practice Manual for Professionals, 5th ed. SCAN dietetic practice group, American Dietetic Association (in press). © BariAthletes Disconnect Between Bariatrics and Sports Nutrition Goals • Bariatric Nutrition Goals – Low carb, high protein – Low calorie diet – Small volume meals • Sport Nutrition Goals – High carbohydrate diet – High calorie diet – Large volume meals There are NO set guidelines for bariatric athletes! © BariAthletes Common Complaints When Trying To Follow One Or The Other • Follow Bariatric Guidelines – No energy! – ‘Hit the wall’ or ‘bonk’ • Follow Sports Nutrition Guidelines – GI distress or dumping syndrome – Vomiting or stomach pain © BariAthletes What Are Their Goals? • To finish? • To PR? • Achieve healthy weight? • Develop new lifestyle to avoid weight regain? © BariAthletes Things to consider when working with this population • Sports Nutrition: – What type of event do they plan on doing? – Individual preferences • Bariatric Nutrition: – No 2 patients are the same • Different surgeries • Different surgeons • Different time post op © BariAthletes Considering the Spectrum 1 month post op Bariatric Nutrition 5k 3 years post op Sports Nutrition Ironman © BariAthletes Leave the Numbers Out • There are no standards! • Everyone’s anatomy is different • Great opportunity to reconnect with hunger / fullness levels © BariAthletes Tapping Into the Right Energy Source • Training the body to rely more on its own energy stores (fat tissue), which reduces calorie intake during training • Goal is to reduce calorie consumed per hour during training and race • This is ideal for bariatric athletes who can’t consume large amounts of simple sugars during events Seebohar. Metabolic Efficiency Training.; Teaching the Body to Burn More Fat. 2009 © BariAthletes Periodized Workouts • Training philosophy that is done in cycles, with each cycle having its own goal. • Cycles vary in volume and intensity, allowing you to build and prevent injury. • Each cycle is broken up into weekly cycles that will have gradual builds and then a recovery week. • Periodized training allow for an aerobic base to be built early in the season while more sport specific and higher intensity workouts the closer the event becomes. © BariAthletes Periodized Nutrition • If volume and intensity changes so should nutritional intake • The composition of meals change because of the different energy systems being used • Fat can be a primary fuel source for lower intensity workouts • Carbohydrates are primary fuel source for higher intensity workouts Seebohar. Nutrition Periodization for Endurance Athletes: Taking Traditional Sports Nutrition to the Next Level. 2005 © BariAthletes Basic Everyday Guidelines • • • • Eat balanced meals throughout the day Plan to have a meal, snack or shake every 2-4 hours Should be a mix of carbohydrates and protein Volume of meals and snacks depend on type of surgery, how far out from surgery, and type of activity © BariAthletes Pre Workout Nutrition • Something easy to digest and best tolerated • Make sure there is both protein and carbohydrates in it, preferably low in fat © BariAthletes During Workouts • May not be needed – depends on workout intensity and duration as well as the conditioning of the athlete – 1 hr or more will likely need carbohydrate and electrolyte repletion • Smaller more frequent dosing to prevent high sugar load • Usually whey protein – Protein mixed with carbohydrate tends to have better results during and helps with recovery – Try to avoid fructose as it is less tolerable among most athletes © BariAthletes Sports Nutrition Products • Drinks, Bars, Gels, GUs, Shot Blocks – Infinite drinks, Cliff bars, Shot Blocks • Hydration and Electrolytes – NUUN, Salt Sticks • Find one the one that is best tolerated © BariAthletes Post Workout Nutrition • 45 minute to 2 hour window for best repletion • Post workout nutrition is key for recovery, strength building, and improved performance during next workout • Carbohydrates and protein mix – Typical sports nutrition: 4:1 ratio – Bariathlete appropriate: 2:1 ratio © BariAthletes Who are you working with? © BariAthletes © BariAthletes New perceptions • Weight loss driven – Vs performance driven • Food is now fuel – Breaking emotional ties to food – No “good”/”bad” • Exercise is no longer punishment • Establish rapport – Not the food police! © BariAthletes How they see themselves • They still see themselves as overweight – Body dysmorphia and poor body image • Really hard for them to acknowledge themselves as athletes – Athlete as an image vs trait/behavior – Definition: a person trained or gifted in exercises; a participant in a sport, exercise, or game requiring physical skill. © BariAthletes © BariAthletes Triggers and Barriers • Taking injuries personally and motivating them to stay on track • Mentality to do it all right now • Knowing past triggers and saboteurs • Identifying new coping strategies • Remember their journey – Remind them how far they have come © BariAthletes © BariAthletes Key Points To Remember • You are working with people with very individualized needs – Assess surgical and athletic status • • • • Focus on balancing daily meals and snacks Help them find what products may be right for them Adjust for individualized tolerances Always be a major contributor to their support system © BariAthletes CONTACT INFORMATION LEACROSETTI@BARIATHLETES.COM 877-66-FUEL4YOU TWITTER.COM/BARIATHLETERD FACEBOOK.COM/BARIATHLETES © BariAthletes