Considerations for Vegan & Vegetarian Athletes. Alicia Kendig, MS, RD, CSSD USOC Sport Dietitian

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2 Considerations for Vegan & Vegetarian Athletes Alicia Kendig, MS, RD, CSSD USOC Sport Dietitian

3 Types of Vegetarianism 4 Major Groups None of which eat meat, fish or fowl: Lacto-ovo vegetarian Ovo vegetarian Lacto Vegetarian Vegan Larson-Meyer, PhD, RD. Vegetarian Sports Nutrition, 2007

4 Types of Vegetarianism Other categories of Vegetarianism to consider Macrobiotic vegetarianism Avoids animal products with focus on unprocessed organic foods Pesco vegetarian Avoids all meet, with the exception of fish Pollo vegetarian No red meat or fish, consumes dairy and egg products Semivegetarian Tries to limit meat intake Courtesy of the Vegetarian Resource Group, 2014

5 Another way to look at Vegetarianism Vegetarian Vegan Flexitarian Regularly follows a vegan diet, but occasionally consumes dairy, meat, fowl or fish Nutritarian Follows an eating style high in micronutrients, based on unrefined plants foos; may or may not be vegan Fuhrman, J, et al. Current Sports Medicine Reports, 2010.

6 Reasons for choosing Vegetarianism Ethical Financial Social Heath Conscious Food Preference Dieting Behavior Form of Control Perceived Performance Benefit

7 Support for Vegetarianism Adventist Health Studies are long-term studies exploring the links between lifestyle, diet, and disease among Seventh-day Adventists. 96,000+ church members from the U.S. and Canada participating in the current study Seventh Day Adventists tend to be homogeneous in many lifestyle choices and more heterogeneous in nutritional habits than the general population.

8 Support for Vegetarianism Cancer Dementia Diabetes Heart Disease Hypertension Arthritis VD risk of prostate and colon cancers Red meat consumption bladder cancer Meat consumption 2-3x more likely to develop dementia VD risk for Type 2 diabetes VD or Vegan diet reduces risk of HD Beef consumption risk of HD in men, but not women VD creates protective effect against fatal and non-fatal DH VD risk of hypertension VD risk of arthritis

9 Vegetarianism may REE REE = Resting Energy Expenditure Energy needs at rest were approx 11% higher in a group of 17 young men consuming VD, compared to 40 young men consuming non- VD diets Result of habitual high CHO diet Which can stimulate Sympathetic Nervous System Toth, Metabolism, 1994

10 When restricting any food group Relative Energy Deficiency in Sport (RED-S) Previously Female Athlete Triad Common in endurance sports due to heavy training Beyond just a Triad metabolic rate menstrual function Bone Health Immunity Protein synthesis Cardiovascular health Mountjoy, Br J Sports Med, 2014

11 Psychological Implications to RED-S Precedes or Caused by RED-S Dieting to enhance performance Personality factors Pressure to lose weight Frequent weight cycling Early start of sport-specific training Overtraining Recurrent and non-healing injuries Inappropriate coaching behavior Regulations in some sports Long-term implications of this syndrome Mountjoy, Br J Sports Med, 2014

12 Male athletes at low risk for ED/DE However, prevalence of RED-S in elite male athletes is high: Cycling (50%) Gravitational (24%) Weight class sports (18%) Mountjoy, Br J Sports Med, 2014

13 Mountjoy, Br J Sports Med, 2014

14 Consuming Adequate Calories Resting energy Expenditure Cunningham Katch/McArdle Mifflin-St.Joer Harris Benedict Lifestyle Energy Expenditure Elite athletes: Eat, Train, Eat, Sleep Training Energy Expenditure Technique/Efficiency Dependent

15 Is it possible for elite athletes to be vegan and still perform to their highest ability? Tony Gonzalez Kansas City Chiefs Brendan Brazier Ironman triathlete Carl Lewis Track and Field Olympian Kenneth Williams Body Builder And many more Takes: TIME, PLANNING, PREPARATION and ATTENTION TO DETAIL!

16 Special Considerations for Vegan Athletes Adequate Energy Intake (EA) Protein Calcium Vitamin D Iron Zinc Iodine Vitamin B12 Docosahexaenoic Acid (Omega-3 Fatty Acids) Creatine Fuhrman, J. Current Sport Medicine Reports, 2010 J Am Diet Assoc. 2009

17 How much protein do you really need? 130 kg

18 Calculating Protein Needs based on Body Weight Weight in Kilograms Lean Body Mass (FYI, lbs /2.2 = kgs) Select Protein needs based on current level of training: Sedentary g PRO/kg body mass Endurance g PRO /kg body mass Strength, Power, Anaerobic/aerobic g PRO/kg body mass Weightlifting, Increase muscle mass g PRO/kg body mass Multiply your weight (A) in kgs by the lower Range (B) Multiple your weight (A) in kgs by the upper Range (C) (A) kgs (B) g/kg (C) g/kg g Pro/Day g Pro/Day

19 Protein Content in Common Foods Food Serving Protein (g) Food Serving Protein (g) Chicken Breast 4 oz 27 Tofu, soft 1 cup 10 Fish 4 oz 23 Tofu, soft 1 cup 10 Beef 4 oz 19 Tofu, firm 1 cup 20 Egg (whole) 1 large 7 Yogurt, Greek nonfat 1 cup 15 Legumes, most ½ cup 7 Yogurt, Light 1 cup 8 beans/peas (cooked) Soybeans, cooked ½ cup 11 Yogurt, Soy 1 cup 8 Soy Milk 1 cup 7 1% fat Cottage ½ cup 14 Cheese Skim Milk 1 cup 8 Vegetarian Burger 1 patty 6-16 Quinoa (cooked) 1 cup 11 Sunflower Seeds 3 Tbsp 5 Brown Rice (cooked) 1 cup 5 Almond/Peanut 2 Tbsp 6 Butter, natural Oatmeal, regular 1 cup 6 Fresh Vegetables ½ cup 2-3 (cooked) (cooked), most Nuts, most 2 Tbsp 7

20 Plant Based vs Milk Based Proteins No difference in protein needs due to source Protein digestibility (bioavailability) indicates quality of protein Soy Protein Isolate as effective as animal proteins Wheat proteins less bioavailable Speed of absorption can be a factor for strength and power athletes Or heavy phases of training for endurance athletes Position of the American Dietetic Association: Vegetarian Diets, 2009.

21 Calcium (& Vitamin D) Vitamin D involved in metabolism of calcium Not readily found in food sources Lacto-ovo often have higher calcium intakes than nonvegetarians 30% higher chance of bone fracture in vegans due to lower calcium intake Euro Prospective Investigation into Cancer and Nutrition, 2007 Dietary calcium to Protein ratio ratio favors bone health Oxalates/phytates block absorption: Spinach, chard Sources: Low-oxalate greens (bok choy, broccoli, chinese cabbage, kale), Fortified Fruit Juice, calcium set Tofu, cow s milk, seeds, nuts, fortified foods

22 Iron Sensitive non-heme iron found in plants Inhibitors: Phytates, calcium, polyphenolics, coffee, herb teas Sprouting seeds/grains/beans can decrease phytates Fermenting miso and tempeh can increase bioavailability Supplementation vs. dietary sources When iron stores are low, non-heme absorption more responsive Sources: Leafy greens, beans, nuts/seeds, fortified foods

23 Zinc Essential for immune system function Readily found in plant sources, but low bioavailability Sources: Beans, whole grains, nuts, and seeds Phytates inhibit absorption Dietary protein enhance absorption Supplemental iron inhibit absorption, and other metals Do your best

24 Iodine Plant sources of iodine can be low due to low levels in soil Vegan diets often low in iodized salt 80% of vegans, 25% vegetarians, 9% of nonvegetarians are iodine deficient Krajcovicova-Kudlackova, Ann Nutr. Metab 2003 Sources: Kelp or other seaweeds, dietary supplement

25 Vitamin B12 Essential for CNS functioning, homocysteine metabolism, DNA metabolism, and erythrocyte production (RBC production) B12 is more abundant in animal foods Dietary supplementation for vegans is essential for vegans Inverse relationship btw absorption and current status

26 Omega-3 Fatty Acids (EPA & DHA) EPA and DHA contribute to brain and heart health For athletes, supplementation may: exercise induced inflammation and oxidative stress pulmonary function Alpha-linolenic acid (ALA) can be metabolized into EPA/DHA May not be possible to metabolize enough EPA/DHA from ALA, making supplementation necessary for vegans Source: Flax, chia, hemp seeds, and nuts and leafy greens

27 Creatine Average dietary intake of creatine in nonvegetarians is 2g/day Negligable in vegans Vegetarian athletes have lower muscle creatine concentrations due to lower dietary intakes of creatine Creatine beneficial for high explosive activity, with a side effect of increased body mass. J Am Diet Assoc. 2009

28 Vegetarian/Vegan for Triathletes In Summary: What is the ultimate goal? Is it doable? What will it take? Planning/Preparation Is it worth it?? I can be

29 References Larson-Meyer, PhD, RD. Vegetarian Sports Nutrition, Vegetarian Resource Group Fuhrman, J. and D. Ferreri. Fueling the Vegetarian (Vegan) Athlete. Curr. Sports Med. Rep. Vol. 9, No. 4, pp , Loma Linda University, School of Public Health. Adventist Health Studies Toth, M and E. Poehlman. Sympathetic nervous sytem activity and resting metabolic rate in vegetarians. Metabolism, 43: , Mountjoy, M., et al. The IOC consensus statement: beyond the Female Athlete Triad Relative Energy Deficiency in Sport (RED-S). Br J Sports Med, 48: , Position of the American Dietetic Association: Vegetarian Diets. J Am Diet Assoc. 2009; 109: Euro Prospective Investigation into Cancer and Nutrition, 2007 Krajcovicova-Kudlackova, Iodine deficiency in vegetarians and vegans. Ann Nutr. Metab. 47 (5) 183-5, 2003.