TrueSport: August 2021 - Preparation & Recovery

Have you evaluated your diet, met with a physician and fine-tuned your training program only to find that you really do need to use a supplement? Now it’s time to decide which supplements might actually work and learn how to pick the lowest-risk product possible. Keep reading!

Through this five-part series on supplements, you will find an overview of the dietary supplement industry so that you can decide if the potential benefits of dietary supplements outweigh the risks. And, if you find you do need to use supplements, how you can better choose a low-risk product.

Decision-making process

1. Make sure you need a supplement. (Make sure the benefits outweigh the risks.)
2. Use products certified by a USADA-recommended third party. (See supplement411.org for current recommendations.)
3. If you choose to use an uncertified product in spite of the risks, eliminate products with red flags. (See Supplement Red Flags section.)
4. Make a decision knowing that in spite of your due diligence and care in selecting a lower-risk supplement, there are no guarantees. You can never be 100 percent sure that what is listed on the label is what's in the bottle.

If a dietary supplement is the most realistic way for an athlete to obtain necessary dietary ingredients, how do you pick the safest one?

There is no risk-free way to choose a supplement, as the only way to have zero risk is to not use supplements. But you can reduce the risk significantly by following USADA’s Decision-Making Flow Chart.

If using a dietary supplement is needed, the best way to reduce the risk of using a low-quality or contaminated product is to choose one that is certified by a USADA-recommended third party.

How do I find supplements that actually work?

Alicia Kendig Glass, sports dietitian at the United States Olympic & Paralympic Committee, gives her opinion on some trending supplements and what works in the Q&A below.

What are your thoughts on the use of supplements for athletes?

When it comes to supplements, I critically evaluate an athlete’s training program, their goals and their diet. I will not even allow the utterance of the word “supplement” until all those aspects are optimized.

What vitamins and minerals do you recommend?

Most athletes do fine without taking any multivitamins.

I don’t usually recommend any kind of multivitamin, even to elite Olympians and Paralympians. My approach is always food first. On the other hand, if an athlete has a clinically diagnosed deficiency, then we will treat it. For example, there are always a handful of athletes diagnosed with sport anemias, and we treat those with an oral iron supplement.

Our approach to supplements is very clinical. We don’t ever dose an athlete with something unless there is a very good rationale for doing so, which means a blood test to confirm their current nutrients status. There are some athletes who we find have hemochromatosis, a genetic condition that makes iron levels too high. We would never suggest iron for those athletes.

I will sometimes recommend vitamin D to an athlete who has a low blood test value. Depending on the time of the year and if they’re training inside or outside, I may recommend a low dose to get them through the winter months when sunlight exposure is limited. But, I warn them that more is not better.

Recently, I had a bobsled athlete that I was treating for low vitamin D. The next time I saw her she complained of tingling in her fingertips. I sent her for a blood test and she had toxic levels of vitamin D. She admitted that she had tripled her dose because her coach told her she should take more. Her symptoms resolved once we got her back on the correct dose. Things like this can happen to anyone.

In another case, the father of one of our athletic trainers ended up in the ER because of vitamin D toxicity. He didn’t realize it at the time, but all the supplements he was taking for his eyes and skin were adding up to a mega dose of vitamin D, which then exacerbated his symptoms of diabetes. Not only did he not realize vitamin D could be toxic, but he didn’t realize how much he was taking. This is common when people take more than one supplement. Things end up “stacking.”

Too much vitamin D can also block the absorption of other fat-soluble vitamins.

What about creatine and protein powder?

So many athletes ask me if they should take creatine. For some reason, people just think this is a magic ingredient. I always ask myself, “Are the demands of the sport going to be supported by what this active ingredient does?”

I did have a vegan athlete who was a sprinter and she wasn’t eating the food sources for creatine (meat). She responded well to creatine. But, if I’m working with vegan or vegetarian athletes, I will often start with making sure they are getting enough quality protein in their diet first.

Another situation where protein powders can be helpful is for older athletes who have an increased need for quick recovery and may have a more difficult time maintaining lean muscle mass. In some cases where an athlete must train smarter instead of harder, and they are having a hard time sustaining lean mass, a simple whey protein can help.

What is a nitric oxide booster? Would you recommend it to athletes?

Nitric oxide boosters advertise to increase blood flow to your muscles, therefore increasing your ability to perform and recover faster. I completely avoid any supplement that advertises to be a nitric oxide (NO) booster. Those supplements are just too risky for me to even navigate. The ingredients claim to deliver the same results as substances prohibited in sport, so I just don’t trust them. On the other hand, there are great functional foods that can offer slight improvements in oxygen uptake and muscle efficiency. Beet juice is my favorite!

Caffeine and energy drinks are everywhere these days. What should an athlete do if they’re fighting sluggishness and fatigue?

Caffeine can be a great help for those athletes who can handle it. Some athletes are distracted or jittery on caffeine. It's not for everyone.

I do not recommend that athletes obtain caffeine through supplements or energy drinks though, because oftentimes, the caffeine dose is listed as part of a ‘proprietary blend,’ which doesn’t list the individual doses. This makes it difficult to be certain about how much caffeine is actually consumed.

Energy drinks are particularly bad because they can also contain hidden sources of caffeine or other stimulants like yohmbine. The cumulative effect of multiple stimulants can harm performance and health.

We know that supplement labels can be inaccurate, so if an athlete doesn’t like coffee (which can also be hard to dose), we will recommend a No Doz or other over-the-counter product with a known amount of caffeine.

What is carnitine? Can it help an athlete?

I have had athletes ask me about carnitine, but I don’t recommend it. Some athletes want to take carnitine because they think it will make the body burn more fat.

The research that I’ve reviewed is not convincing and more evidence is needed to suggest that carnitine does indeed work for an elite athlete population -- that principle applies for any dietary supplement ingredient. The evidence needs to be specific and beneficial to an elite athlete population, specific to an athlete’s sport or discipline.

Can you tell us more about beta-alanine?

When dosed properly, beta-alanine increases carnosine in the muscle, which then acts as a lactate buffer. For athletes whose efforts last 40 seconds to about four minutes, it can help delay anabolic metabolism, which is when your muscle has too much lactic acid built up to function optimally.

Beta-alanine is no magic pill -- it just delays this threshold slightly. But, it can be beneficial in training. Beta-alanine is found in meats, but at very low levels, so you’d have to eat a lot of it. For it to work, it requires a loading phase of 3-4 weeks at high dose and then you back off. If you get a high-quality product, it’s very expensive.

I had a high jumper once who just wanted to take anything and everything, and he thought “more is better.” I asked him, “How is this going to help you? You are not even doing a lactate-accumulating sport!” For the high jumper, I recommended that he not waste his time or money on beta-alanine.

Do you think athletes can benefit from taking probiotics?

I’m a big fan of probiotics. There are many good food sources like yogurt, kefir, ceviche and other fermented foods. I will sometimes recommend a probiotic supplement for athletes traveling internationally because finding trusted food sources overseas can be difficult.

There is still a lot of research to be done. We are not in a place where we can pull out a menu of recommendations for probiotics. We still have a lot to learn about all the different strains, how high of a dose is required, and how long dosing of probiotics is necessary for various benefits. Research is suggesting that improved gut health has very wide health effects on the whole body, both mentally and physically.

What is tart cherry? What can it do for athletes?

I’ve been asked a lot recently about vitamin C mega-dosing and the use of functional foods like tart cherry to reduce the stress on the body from heavy training. Although there is evidence that tart cherry juice has benefits to fight inflammation for elite athletes, I often need to remind athletes who choose to consume tart cherry juice after workouts, that tart cherry juice should not take the place of other recovery snacks that contain both carbohydrates and protein. There is no protein in tart cherry juice.

One thing athletes need to realize is that if they do want high doses of vitamin C, it’s better to get it through foods. The water-soluble vitamins are highly unstable, and more importantly, mega-doses of antioxidants in dietary supplement form can actually stunt training responses. If they take it in a capsule or tablet, much of it could already be degraded.

Alicia Kendig Glass, MS, RD, CSSD
Certified Specialist in Sports Dietics, United States Olympic & Paralympic Committee

Alicia Kendig Glass is a U.S. Olympic & Paralympic Committee sport dietitian. Since 2011, she has provided performance nutrition consulting to the summer strength and power sports athletes, as well as the winter sport athletes. Throughout her career, Kendig Glass has worked with many National Governing Bodies and USADA to educate athletes on performance nutrition and dietary supplements. She continues to help athletes achieve performance goals through well-planned nutrition strategies. Kendig Glass holds a bachelor's in nutrition and a Master's in public health nutrition from Case Western Reserve University in Cleveland.

Resource: https://truesport.org/dietary-supplements/supplements-series-supplements-safe/

Choosing the right footwear for your athlete can be frustrating and confusing given the constant foot growth, the different shoes for different sports and the huge variety of styles and price points.

According to Dr. Michele LaBotz, TrueSport Expert and sports medicine physician, choosing the right footwear should come down to performance and protection. "We want to have the foot working hard enough that it has to stay strong and flexible. But we also want to protect the foot and the athlete," says LaBotz. Here, she is looking at some of the nuanced decisions to consider as you shoe shop.

Training on turf? Get proper shoes

If you're new to sport, you might think that turf shoes or soccer cleats for your 8 year old feels like a bit much. But depending upon the sport and the playing surface, the appropriate shoes for the situation really do matter, and many leagues have specific rules regarding required footwear. "If you have a young athlete who's running pretty fast on grass or turf, then they should be in the right type of shoe to minimize injury risk,” says LaBotz.

No problems? No problem.

"If your athlete isn't having discomfort or foot problems, you probably don't need to spend too much time fixing their stride. If a child has good running mechanics, is a healthy weight and is not having any issues, I don't think you have to worry about buying pricey shoes," LaBotz says. Instead, look for shoes that feel comfortable and simply get new pairs as they outgrow the old ones.

"However, if there is a pattern of injury, an evolution of injury, or some regular discomfort seems to be coming up, that's when families should really pay attention to what they're putting on a kid’s feet,” she notes.

There's no perfect shoe

Unfortunately, there's no singular shoe or shoe brand that stands out as "the best." At one time, coaches would recommend a specific shoe that all the athletes on the team should get. But now, LaBotz says, the evolution is toward a much more individualized approach to shoes. "It sounds simplistic but really the main thing to look for is comfort," she says. "After that, you want a shoe that protects potentially vulnerable areas. But comfort is top priority."

Watch for heel pain

"We need to be sensitive about heal pain in young athletes," says LaBotz. Too much impact over that area, particularly during times of rapid growth, can cause a stress injury through the growth plate in the heel known as Sever's Disease. LaBotz has seen a lot of these cases recently, and notes that taking care of it early is important. "If an athlete is starting to get some pain in the heel, you should get some silicone heel cups or cushions to take some of the strain off of that heel." This is especially important in shoes without cushioning, like soccer cleats. There are also braces with built-in heel pads that athletes in barefoot activities, such as gymnastics and dance, can use.

Heading to the shoe store? Get a video first.

Most parents aren't able to assess whether an athlete is an overpronator, but a running store typically has staff on hand to help make that assessment. An overpronator is more at risk of shin splints, Achilles' issues and knee pain, but the right shoes can help provide support. Before you head to the nearest running store, grab a video of your athlete running for their sport, which will be the most accurate representation.

Price is no object

There are plenty of decent shoe options at budget stores, so don't worry if you can't spend $200 for new shoes for your athlete. Instead of continuing to drop money on expensive shoes, LaBotz says it's better to talk to a physical therapist or sports medicine doctor.

Laces can change shoe fit and address issues

Remember that shoelaces can be used to alleviate pressure in certain parts of the foot depending on how loose or tight they're laced. You can also change the lace configurations to help an athlete avoid a hotspot. That's why actual shoelaces are preferable over Velcro options, even if Velcro is speedier. "If I see a child who's having a lot of pain through the arch or the top of the foot, they can experiment with different lacing patterns before changing shoes entirely," she says. (You can find different lacing options for different foot issues here.)

Go as minimal as possible

It’s true that some athletes will need shoes with more cushioning and more heel lift. But if your athlete is comfortable in a shoe that's very minimal, then don't add unnecessary support. And don't worry if it seems like your athlete's foot is getting wider. "A broad foot is really good at shock absorption," says LaBotz. "And regardless of the shoe they wear during sport, I'm a huge fan of letting kids go barefoot whenever it's safe and comfortable. Building up that foot strength is important."

Socks matter too

When considering your athlete's shoes, make sure they're wearing the socks that they'll wear with the shoes as they try new pairs on. It may not make much of a difference, but if your athlete goes to school in thin low-rise socks but will be wearing thicker sport-specific socks for practice, that can change the comfort (and even size) of the shoe you'll need. LaBotz also warns against using cotton socks with synthetic shoes, unless your athlete wants a soggy, potentially bacteria-laden sock after a sweaty practice.

Know when to replace shoes

Do not buy shoes that are too big in anticipation that the athlete will “grow into them,” and similarly, replace shoes as your athlete outgrows them and they become uncomfortable. If their toenails are turning black, they need new shoes. Another sign is if your athlete is suddenly getting blisters. "Breaking in new shoes may cause blisters for a few wears, but if your athlete is getting blisters in old shoes, it's time to change," says LaBotz.

"In the past, we'd always look at the at the tread of the shoe. But with new technology, treads are lasting for much longer," LaBotz adds. "Look at the midsole instead. Look for cracks and folds and see if the midsole material is collapsing down. Midsoles break down faster than any other part of the shoe now."

Takeaway

Choosing shoes for sport is never easy, but it is critical to an athlete’s performance and physical wellness. These tips from Dr. Michele LaBotz will help you and your athlete find the right footwear.

Resource: https://truesport.org/preparation-recovery/choose-footwear-youth-athletes/

As a coach, you may have suggested icing a sore ankle or taking a hot bath after a grueling practice to alleviate aches and pains. But some of the age-old recommendations around ice and heat have been debunked. Ice and heat still have a place in an athlete’s recovery, though, and can be incredibly useful tools when applied appropriately.

Dr. Michele LaBotz, TrueSport Expert and sports medicine physician, will explain some of the best practices around using heat and ice for recovery, but notes that both are rapidly evolving fields of research. She expects to see a lot more research on how heat, in particular, works for athletes. In the meantime, here's what we know.

Recovery is a nuanced process

Unfortunately, the entire topic of recovery -- especially in terms of temperature -- is very nuanced. What works well for one athlete may not work for another, and best practices are rarely clear-cut. For instance, using ice to help with inflammation right after an ankle sprain is going to be helpful, but using too much of it a few days later may actually slow the healing process, LaBotz says. So, try to avoid giving athletes any "one-size-fits-all" recommendations.

For acute injury, use ice

"If you sprain an ankle during a game and you're on the sidelines with an ankle that is swelling up, that's an inflammatory process that is out of control,” says LaBotz. “Putting ice and some compression on the ankle to keep inflammation under control in that acute setting is a reasonable thing to do, and your best first step."

But stop icing it eventually

While ice is a good idea in the first stages of an injury, it shouldn't be something you use non-stop. "One of the concerns about the use of ice is that it slows down blood flow. That means that it slows down the inflammation, and it slows down all the enzyme reactions that are part of the inflammatory process," LaBotz explains. "While inflammation sounds like a negative, it is actually necessary and part of the healing process that needs to occur at some point."

"There have been some studies showing that athletes don't replenish glycogen as quickly if they have a muscle that's been iced down," she says. "Old recommendations were to continue to ice a spot a few times a day until the soreness went away. But because we want injuries to begin to heal, we want blood flow to come in and we want cells to have access to glycogen and glucose so they can do the healing work. With that in mind, you need to strike a balance between icing to alleviate pain and inflammation and allowing inflammation to do its job."

Heat helps... eventually

Heat application won't help much on the sidelines of a game, but post-practice heat application is a good idea. "You would use heat in the short term to help with pain or muscle soreness," says LaBotz. "But some of the newer data on the role of heat in recovery and repair suggests that over the longer term, using heat can stimulate the growth of capillaries and turn on the enzymes to start the repair and muscle building process. This effect may ultimately help support optimal performance and recovery, which reinforces the consistent use of heat, but these changes take time and aren’t expected to result in any immediate impact for the athlete,” she explains.

Be smart about cold application

There's a fine line between too cold and not cold enough. Occasionally, there are issues with frostbite from chemical packs, LaBotz says. But more frequently, athletes have such a thick towel between their body and the icepack that the ice can't actually cool the muscles. "You want the cold penetrating into the injury," LaBotz says. "You get the best conveyance of cold using something like a dampened thin kitchen towel over the ice pack." And don't leave it on past the point of discomfort. If you're noticing more discomfort because of the ice, or if the area starts going numb or tingling, take the ice pack off.

Skip the ice vests

You may be tempted to recommend ice vests or other icy cooling solutions to your athletes on hot days. But LaBotz recommends that instead of ice vests, your athletes focus on minimizing time in the direct sun and sipping icy water or sports drink before their practice or game. "Athletes need to be aware of the environmental risk, and with ice vests on, they may not realize how hot it is until they're playing," explains LaBotz.

Hot and cold gels and lotions aren’t the same as ice and heat

You might be tempted to grab a balm or gel that offers "heating and cooling" action. But while these topically applied rubs might feel icy or hot and may relieve discomfort, they aren't doing anything for the healing process. "These balms just give the sensation of cooling," LaBotz says. “They don’t change the temperature of the muscles. When we're discussing the effects of heat and cold, we're talking about enough heat or enough cold to change the temperature of the muscles beneath. The cooling from a gel is mental. It distracts the nerves from the pain, which can be helpful. But it's not going to give you the same effects as actually heating or cooling the area."

Takeaway

While using heat and ice for injuries is a nuanced topic with rapidly emerging research, there are some best practices to keep in mind when helping your team recover safely and effectively.

Resource: <a href="https://truesport.org/preparation-recovery/when-to-apply-heat-cold-recovery/" target="_blank" >https://truesport.org/preparation-recovery/when-to-apply-heat-cold-recovery/

Meal prepping is a common recommendation for busy parents who want to provide healthy meals and make weeknights smoother, especially when there’s a young athlete with a packed schedule and a big appetite in the house. But meal prepping can also be overwhelming, and most people simply don't have six hours to spend in the kitchen on a weekend.

Thankfully, meal prep doesn't have to be a drawn-out process. Here, TrueSport Expert Kristen Ziesmer, a registered dietitian and board-certified specialist in sports dietetics, shares her tips for successful, simple meal prepping.

Planning is part of meal prep

Carve out time once a week to plan out meals for the coming week, including breakfast, lunch, dinner and snacks -- the busier your schedule is, the more important this step becomes! "Every weekend, I sit down and look at the week coming up," says Ziesmer. "For instance, I know that on Tuesdays, my son has soccer until 6:15 p.m., which means there's not a lot of time to make dinner. We know that meal should be leftovers from the night before, which means the night before, I need to make a bigger meal so that we have those leftovers."

Build a regular grocery list

Meal prep also means having all your ingredients on hand. Once you decide on meals for the week, you can build a comprehensive grocery list. "Blindly going to the grocery store and shopping at random usually means you'll be back at the grocery store within a day or two," Ziesmer notes. And once you've created this master grocery list once -- ideally in a digital format so it doesn't get thrown out -- it becomes easier to quickly look in the fridge and pantry each week and add or subtract items from the list as needed.

Redefine what meal prep means

The concept of meal prepping calls to mind stacks of perfectly organized containers in the fridge, labeled with which night they'll be eaten. That's not realistic for most families. "Before I had kids, I used to spend Sundays meal-prepping, making all of my food for the entire week, but now there's no way I have half a day to devote to that," says Ziesmer. Now, she meal preps by always cooking extra when she is in the kitchen. "Cook extra when you do cook! Rather than make everything on Sunday, I double recipes for dinner every time I cook it, and then we have that for lunches, or use the extra ingredients to have a dinner made with leftovers," she explains.

Apply meal prep to breakfast too

Most people think of meal prep as a lunch or dinner solution, but Ziesmer also loves simplifying a healthy breakfast. "I make overnight oats to save cooking time in the morning, or I'll make a big egg and vegetable frittata with whatever vegetables are starting to wilt in the fridge and we'll eat that for a few days," she says.

You can find a great hot oatmeal recipe here, but instead of cooking it on the stove, simply put the ingredients together in a container and refrigerate overnight, then warm up in the microwave in the morning or enjoy cold!

The right equipment helps

"Getting an Instant Pot is easily my No. 1 tip," Ziesmer says. A pressure cooker like the Instant Pot can cook an entire chicken in under an hour, slow cook a chili or stew all day or make rice in minutes. "It's great for quickly cooking frozen meat and vegetables -- with so much going on, I often forget to take things out of the freezer for dinner, but with the Instant Pot, I can still cook quickly," she says. An Instant Pot or slow cooker also helps avoid massive cleanups, since most meals can be made using just that pot. And since you don't need to stir or sauté when using an Instant Pot, you can dump your ingredients in, walk away and come back to a perfectly prepared meal.

Look for whole food-friendly shortcuts

Think past the traditional Sunday meal prep and keep your kitchen stocked with foods that don't require much forethought or meal prep at all. Frozen vegetables are just as healthy as fresh ones, and if you're the kind of person who often ends up with wilted, moldy vegetables in your crisper, you may want to swap at least some of your veggies to frozen options that can be sautéed or tossed in a stew or chili. And stock favorite easy meal staples: Things like canned wild-caught salmon, 5-minute brown rice, canned black beans and a jar of salsa in the pantry can be used to make a healthy burrito bowl in minutes.

Use spices and condiments to keep it interesting

Rather than making completely different meals for every day of the week, consider how basic ingredients can be seasoned in different ways in order to make each meal taste completely different despite the same base. For instance, chicken and brown rice cooked in the Instant Pot can be made into a Thai-inspired dish by adding some peanut sauce and frozen peppers and onions in a stir-fry; or a curry with the addition of some curry powder, a bit of coconut milk and frozen cauliflower; or a burrito bowl with some shredded lettuce, guacamole and pico de gallo. This simplifies your meal prep and prevents tastebud fatigue.

Takeaway

Meal prep should work for you and your family, which may mean reimagining the process to save time, accommodate picky tastebuds, and work around your athlete’s busy schedule.

Resource: https://truesport.org/nutrition/7-meal-prep-tips-young-athletes/