The North Face Ultra-Endurance Challenge

Marin Headlands 12-6-14


On Friday December 5th I flew out to San Francisco to observe and provide crew support for a former student who recently joined the ultra-running world and quickly achieved elite status. He would be running the next day in the North Face Ultra-Endurance Challenge, a 50 mile race through the trails of the Marin Headlands. My first task was to make sure that he was fueling and hydrating himself well the day before the race. We went to Fisherman’s Wharf where he happily ate most of a loaf of sourdough bread, which he had never tasted before. He needed protein too, of course, so he included chicken breast. He had flown in the day before and was drinking plenty of water to make sure he was well hydrated. This meal was followed by a hefty portion of trail mix before an early bedtime.

We carefully planned his fueling and hydration strategy based on an estimate of his energy expenditure, which we had determined during exercise testing the week prior, and his fluid needs based on an assessment of his sweat rate. Our goal was to provide 75 grams of carbohydrate and 24 ounces of fluid every hour from a combination of gels, bars, bananas, fig newtons, and sports drinks. We placed foods in baggies which I would carry and give him at those aid stations that I was able to get to.

Race day morning started at 2:30 am, when he woke to have several bowls of cereal with milk for his pre-race meal. I weighed him and checked his hydration level before the race. He was off with the elite crowd at 5 am with 3 packets of carbohydrate gel in his vest and sports drink in his water bottle. In the dark all I could see was a sea of headlights. After the start I was off to the first aid station. Luckily I was able to get close with my car because I didn’t have much time. He arrived there having run 6.3 miles in about 40 minutes at a pace of 6:50 minutes per mile. He maintained this pace through the second aid station. And I was off to my next stop, the Cardiac aid station at the 23 mile mark, way up in Mt. Tamalpais State Park.

This took me longer to navigate and I was worried that I’d miss him. I arrived just as the lead runners came through, but he wasn’t with them. He had slowed down to a 7:12 minute per mile pace due to pain in his hip flexor. I handed him the packet with fig newtons, but he just wasn’t in the mood. He grabbed 3 gels and left.   His path continued through Mt. Tam and down to Stinson Beach, then looped back to Cardiac. He had now completed 35.8 miles. His time had slowed with continued hip flexor pain and calf cramping. He had no interest in the foods we had prepared, opting instead for the Coke, potatoes, and salt available at the aid station. He grabbed another 22 ounces of sports drink and continued on his way. We met up again at Mile 45.1. I had a banana ready, but he passed it up for more Coke, potatoes, and a handful of skittles. We both headed for the finish line, him down the path and me jumping back in the car. He crossed the finish line in 7 hours 58 minutes, 57th in a field of 537 and 17th of 71 in his age group. After a big hug I whipped out the scale. He had lost only 2.6 pounds. When we tested his urine, he was only slightly above the normal range indicating mild dehydration, not bad for a race of this duration. A loss of 2% of body weight from fluid loss has minimal impact on performance, and he had lost less than this. He also tested negative for ketones, indicating that he had ample carbohydrate to fuel his race.

What a thrill this was for me – as well as a great learning experience! I can’t wait for the next race!

Want the runner’s perspective?  Follow the link:


“I qualified as an elite!”

When my former student proudly told me this, and gleefully said that he had been asked to compete in The North Face Endurance Challenge Championship Race in the Marin Headlands, the sports nutritionist in me saw a unique opportunity.  I’d study him while he prepares for and runs his race, and see how well he keeps up with the extreme nutrition challenges this requires.

Endurance sports are taking off as those who want to push themselves harder and harder jump to the challenge.  These athletes have nutrition challenges that make a mere marathon seem like a walk in the park.  The lead runners in a marathon often streak to the finish line with no more than sips of water, finishing in a little over 2 hours.  The winning time in a 50 mile race, though, may be about 7-8 hours depending on terrain.  Attempting this without nutrition is simply not an option.

While all nutrients are essential, the key nutrients here are carbohydrates and fluids.  Science-based nutrition guidelines recommend 60 to 90 grams of carbohydrate each hour.  Carbohydrates fuel working muscles and also help keep fatigue at bay by fueling the brain.  Fluids are essential so that blood can continue to provide nutrients and oxygen to working muscles and remove carbon dioxide and heat.  Dehydration impairs this ability, causing the body to heat up and ultimately slow down.  If not reversed, this can result in heat stroke.  Finally, runners need calories.  Depending on gender, size, speed and terrain, this could amount to 600-1000 calories an hour.  Assuming an 8 hour race, the energy demands of this event run from 4800 to 8000 calories!  While impossible to keep up with this demand, maximizing energy intake is the third key component in a successful nutrition plan.

During the preparation stage, an athlete needs to evaluate his or her tolerance to specific foods and fluids and to determine fluid needs.  Measuring weight before and after a run provides an estimate of sweat loss and the amount of fluid that must be ingested to avoid dehydration.  Just as important in ultra-endurance races is prevention of over-hydration which can lead to hyponatremia, a condition where the blood becomes diluted from too much fluid.  Hyponatremia is potentially fatal.

The North Face Endurance Challenge Championship Race takes place on December 6.  This week my runner will be fine tuning his nutrition and hydration plan.  Stay tuned – I’ll keep you posted!


Caffeinated Energy Drinks: An Asset to Training?

First there was the sports drink. Modeled after rehydration fluids used for medical purposes, sports drinks provide fluid, electrolytes (sodium and potassium) and an energy source (sugar). These drinks can be more effective than water in aiding performance as they facilitate the absorption of fluids into the bloodstream and replace sugars which are rapidly used by exercising muscle for fuel. Sports drinks are recommended for high intensity sports, long duration activities, and/or physical activity performed in a hot, humid climate.

Sports drinks should not be confused with energy drinks. Energy drinks contain caffeine, a stimulant, along with other substances, and are generally marketed as providing mental and physical stimulation. Energy drinks appear to have originated with Pepsi and Coca-Cola, caffeine-containing brands that initially promoted the energy boosting powers of their products. Dosing up with a caffeinated energy drink before workouts and competitions has now become commonplace.

Researchers examining the performance-enhancing capabilities of caffeine have determined that 3 mg per kilogram (kg) of body weight is optimal, with greater doses providing more side effects without additional benefit. This is equivalent to 150 mg for someone weighing 110 pounds or 300 mg for a 200 pounder. To put this in perspective, an 8 oz. cup of coffee will provide 80-180 mg. Red Bull supplies 80 mg in the same 8 oz., while 12 oz. of Coke supplies 34 mg and a 1.9 oz. package of 5 Hour Energy packs 208 mg.

As with all ergogenic aids, the effectiveness of caffeinated energy drinks will vary with sport, position and individual tolerance. A new study sought to determine whether the potential benefits of an energy drink would outweigh possible side effects in male and female athletes engaged in a variety of sports. A total of 98 men and women from rugby, tennis, volleyball, badminton, swimming, hockey and soccer teams were given one of 2 drinks in a randomized, double-blind trial (neither the researchers nor the subjects knew which drink was being consumed). The placebo drink contained taurine, sodium bicarbonate, L-carnitine and maltodextrin (sugar), while the caffeine drink contained these ingredients plus the recommended 3 mg/kg body weight dose of caffeine. One hour after consuming the respective drinks, the athletes participated in a simulated competition appropriate to their respective sport. They then filled out questionnaires describing their perceptions of benefits and side effects. After 1 week, each group was given the other drink and the experiment was repeated. Each gender was evaluated separately.

Interestingly, both men and women felt they had more muscular power with caffeine, but they did not perceive a difference in endurance and exertion between the 2 drinks. Women who drank the caffeinated beverage felt less fatigued after the event, but men did not notice a difference. All felt an increase in nervousness and insomnia when consuming the caffeinated beverage. The study did not measure actual performance, but instead focused solely on the subjects’ perceptions.

Anyone who uses or is considering using caffeinated energy drinks should be cautioned to consider the side effects as well as benefits of these products. They should also be aware that perception of benefits may not correspond with actual changes in performance. In these days, when it is common to ingest multiple cups of coffee or caffeinated product, users should be advised that greater dosages are more likely to increase side effects than performance.


Salinero JJ Lara B Abian-Vicen et al The use of energy drinks in sport: perceived ergogenicity and side effects in male and female athletes. The British Journal of Nutrition epublished 9/2014; DOI: 10.1017/S0007114514002189


Answering the Low Fat vs. Low Carb Question – Again

The media was all over it. “A Call for a Low-Carb Diet That Embraces Fat” announced Anahad O’Connor in the New York Times (9-1-14) . Even Medscape Medical News responded to a study published in the Archives of Internal Medicine on September 2 with the headline ” Heart Disease Risk: Low-Carb Diet Trumps Low-Fat Option.”

Do the headlines tell the whole story? Should we swap our brown rice for steak?

Not so fast. The devil, as usual, is in the details. In the study in question, researchers Lydia Bazzano and colleagues followed 148 men and women for 1 year after placing them in groups and instructing them to eat either a low carbohydrate or low fat diet. In both groups, all of the individuals were obese but none had cardiovascular disease or diabetes. The low fat group received nutrition guidance aimed at keeping fat to less than 30% of total calories. The low carbohydrate group also received nutrition guidance, and was advised to keep total carbohydrate under 40 grams per day.

The results were interesting in several ways. After 12 months, those in the low carb group had lost on average about 7 1/2 pounds less than those in the low fat group. BUT, an analysis of the diets based on food logs found that compliance in the low carb group was poor. Rather than limiting carbohydrates to 40 grams or less, this group averaged 97 grams of carbohydrate each day after 3 months and by 12 months they were eating 127 grams daily. The low fat group did a good job at keeping total fat to under 30% of calories, but this didn’t represent a big change as their normal diets at the beginning of the study averaged about 35% of calories of total calories from fat. Another interesting observation was that the amount of fiber consumed by each group was similar. All subjects had less fiber in their diets during the study than before, well below recommended amounts.

What does this tell us?

First, calories count. The group consuming the fewest calories (low carb) lost the most weight. This occurred even though they were eating 3x the amount of carbohydrate prescribed.

Second, quality counts. The similar amounts of fiber consumed by each group suggest that rather than getting their carbs from minimally processed grains, fruits, vegetables and beans as is generally recommended, they were likely getting them from highly processed sources, possibly white breads and pastas, chips and pretzels, and perhaps even sweets. The portion of carbohydrates obtained from sugar was not specified.

This study does not shed any new light on the question of whether it is healthier to eat more or less carbohydrate. The best advice remains to eat plenty of fruits and vegetables, include mostly whole grains, and reach for healthier sources of fats including olive oil, avocado and nuts. Above all, calories must be reduced to promote weight loss in obese people.



Nuts are often avoided by those following low-fat or low-calorie diets. After all, 1 cup of shelled pistachios have 702 calories, 67% of which are from fat. Recent research has suggested, though, that the type of fat as well as other substances found in nuts may actually improve heart health, insulin sensitivity, and help with weight loss.

Saturated fat is known to contribute to increases in blood cholesterol levels and inflammation, which can lead to heart disease. The American Heart Association recommends that saturated fats, found mostly in full fat dairy products and fatty meats but also in coconut and palm oils, be limited to 5-6% of total daily calories for those at risk for heart disease.  All nuts also contain some saturated fat, but most of the fat in nuts is the healthier monounsaturated or polyunsaturated fats.

A newly published experimental study tested the effect of pistachio nuts on markers of heart health. Twenty-eight healthy men and women who had elevated levels of low density lipoprotein (LDL, associated with an increased risk of heart disease), were assigned to 1 of 3 diets: a low fat diet (25% of calories from fat), a moderate fat pistachio diet (30% of calories from fat with 10% of calories coming from pistachios), and a moderate fat high pistachio diet (34% of calories from fat with 20% of calories from pistachios). All food was provided to ensure compliance, and neither researchers nor subjects knew who was on which diet. All diets provided the appropriate number of calories for each subject to maintain their weight, and 8% of calories came from saturated fat. Diets were followed in a randomized order for 4 weeks, with a 2 week break between each diet.

As compared with the low fat diet, the pistachio diets showed a significant reduction in small and dense LDLs and triglycerides, both of which are markers for heart disease. The ratio of triglycerides to HDL (high density lipoprotein) was improved, suggesting an improvement in insulin resistance. The greatest reduction was observed in those consuming 20% of calories from pistachio nuts.

So should you break out the nuts? Yes, as long as you are mindful of reducing calories elsewhere. According to this study, a person eating 2000 calories a day to maintain their weight would need to eat over 1/2 cup of pistachios a day to achieve these benefits, which would provide 400 calories. These calories would need to be eliminated elsewhere in the diet to avoid weight gain.


Holligan, Simone, et al. “A Moderate-Fat Diet with Pistachios Lowers Small-Dense LDL and Improves Markers of Insulin Sensitivity in Subjects with Moderately-Elevated Cholesterol Levels.” FASEB JOURNAL. Vol. 27. 9650 ROCKVILLE PIKE, BETHESDA, MD 20814-3998 USA: FEDERATION AMER SOC EXP BIOL, 2013.

Coconut Oil Craze

By Natalie Rizzo


Coconut oil has grown in popularity tremendously lately.  It’s said to be a “miraculous” oil with many health benefits as well as being helpful for hair, skin, and lips.  Vegans are using it as a substitute for butter when baking.  To find out where all the support for these benefits are coming from, I did a simple google search using the terms “coconut oil”.  A promotional site popped up first with an article titled “10 Proven Health Benefits of Coconut Oil.”  Here I found claims that coconut oil has strong medicinal qualities, can help burn fat, and stave off hunger(1). Another piece, titled “Health Benefits of Coconut Oil”, stated that it benefits “hair care, skin care, stress relief, cholesterol level maintenance, weight loss, immune function, proper digestion and regulates metabolism” (2).  No wonder people think of coconut oil as a wonder food!  However, scouring the scientific research lead me to a very different conclusion.  Here’s what I found:

Cholesterol: One of the most consistent claims that Internet sites make about coconut oil is that it lowers cholesterol.  Despite this, I found only a handful of studies that even consider the association between coconut oil and cholesterol, and the methods used as well as the findings do not paint a clear picture..  One study measured cholesterol levels after 45 days of coconut oil consumption, and found a decrease in total cholesterol and LDL (the ‘bad’ cholesterol) and an increase in HDL (the ‘good’ cholesterol) (3).  Sounds good, but the subjects in this study were rats, making the results a very far stretch for humans.  A human study tested the effect of adding coconut flakes to cereal in 21 adult with moderately raised .  After 14 weeks, the researchers found a decrease in total cholesterol and LDL (4).  These results seem promising, but the inclusion of only 21 subjects, use of coconut flakes (rather than oil), the absence of diet control, and the absence of similar studies finding the same results makes it premature to make a cholesterol lowering claim.  Another notable study showed a decrease in total cholesterol when coconut oil was added to the diet. But, all the subjects already had high cholesterol and were on a cholesterol lowering medication and a low-fat diet in tangent with adding coconut oil to the diet.  There is no way to know if the coconut oil, the medication, or the low-fat diet caused the cholesterol decrease (5).  Lastly, one study showed that healthy men actually had an increase in total cholesterol when consuming a diet of 30% fat from coconut oil as compared to soya-bean fat (6).  Clearly, these studies were all very different from each other and the results were mixed.  So  in answer to my original question: Will coconut oil help lower cholesterol?  I conclude that with all the conflicting studies and results, there’s very little evidence to suggest that coconut oil can help lower cholesterol.

Weight Loss: The research on coconut oil and weight loss is also confusing. Many leaps have been made in order to state that “coconut oil will aid in weight loss.”  Let’s start with the basic facts.  The main fat in coconut oil is lauric acid, a saturated fat and a medium chain fatty acid (MCFA).  It is believed that these MCFA increase energy expenditure and fat oxidation (otherwise known as fat breakdown) (7). However, these increases are likely to be very small, and studies have concluded that the rise in energy expenditure associated with MCFA does not translate into lower body fat (8).  Furthermore, these studies did not all use coconut oil as their source of medium chain fatty acids.  I could only find one study that measured the effect of coconut oil on weight in obese women.  After a 12-week period of coconut oil consumption, both BMI and waist circumference decreased in these women, although minimally (9).  And once again, there is a caveat.  The women were also following a reduced calorie diet and walking 50 minutes per day, so it’s impossible to tell what caused the weight loss.

Healthier than other oils:  With all the conflicting evidence on coconut oil, the potential health benefits are unclear, to say the least.   Meanwhile, there is a great deal of evidence that olive oil, as part of a Mediterranean diet, is one of the most beneficial oils to health.  The Mediterranean diet has been proven to reduce cardiac death, heart attacks, and stroke (10, 11). One component of the Mediterranean diet is the use of moderate servings of olive oil in cooking.  So when in doubt, reach for the olive oil rather than coconut oil, and don’t expect miracles.


1) Accessed 8/20/14


2) Accessed 8/20/14


3) Nevin, K.G., Rajamohan, T. (2004). Beneficial effects of virgin coconut oil on lipid parameters and in vitro LDL oxidation.  Clinical Biochemistry. 37 (9), 830-5.


4) Trinidad, T.P., Loyola, A.S., Mallillin, A.C., Valdez, D.H., Askali, F.C….Masa, D.B. (2004).  The cholesterol-lowering effect of coconut flakes in humans with moderately raised serum cholesterol.  Journal of Medicinal Food. 7 (2), 136-40.


5) McKenney, J.M., Proctor, J.D., Wright, J.T., Kolinski, R.J., Eiswick, R.K., Coaker, J.S., (1995).  The effect of supplemental dietary fat on plasma cholesterol levels in lovastatin-treated hypercholesterolemic patients.  Pharmacotherapy. 15 (5), 565-72.


6) Mendis, S., Kumarasunderam, R. (1990). The effect of daily consumption of coconut fat and soya-bean fat on plasma lipids and lipoproteins of young normolipidaemic men.  British Journal of Nutrition. 63 (3). 547-52.


7) St-Onge, M.P., Ross, R., Parsons, W.D., Jones, P.J. (2003). Medium-chain triglycerides increase energy expenditure and decrease adiposity in overweight men.  Obesity Research & Clinical Practice. 11 (3). 395-402.


8) Roynette, C.F., Rudkowska, I., Nakhasi, D.K., Jones, P.J. (2008). Structured medium and long chain triglycerides show short-term increases in fat oxidation, but no changes in adiposity in men. Nutrition, Metabolism and Cardiovascular Diseases. 18 (4). 298-305.


9) Assuncao, M.L., Ferreira, H.S., dos Santos, A.F., Cabral, C.R., Florencio, T.M. (2009). Effects of dietary coconut oil on the biochemical and anthropometric profiles of women presenting abdominal obesity.  Lipids. 44 (7). 593-601. doi: 10.1007/s11745-009-3306-6


10) Estruch, R., Ros, E., Salas-Salvado, J., Covas, M.I., Corella, D., Aros, F…Martinez-Gonzalez, M.A. (2013). Primary prevention of cardiovascular disease with a Mediterranean diet. New England Journal of Medicine. 368 (14). 1279-90. 10.1056/NEJMoa1200303


11) Chiuve, S.E., Fung, T.T., Rexrode, K.M., Spiegelman, D., Manson, J.E., Stampfer, M.J. Albert, C.M. (2011). Adherence to a low-risk, healthy lifestyle and risk of sudden cardiac death among women.  Journal of the American Medical Association. 306 (1). 62-9. doi: 10.1001/jama.2011.907




Fortified Cereals and Snack Bars: Too Much Of A Good Thing For Kids?

Earlier this year the Environmental Working Group (EWG) issued a report that examined the levels of vitamin A, zinc, and niacin in fortified foods. They found that fortified cereals and snack bars could lead to an excessive intake of these nutrients for kids because the daily values used to calculate the amount added are designed to meet the needs of adults.

Vitamins and minerals play a critical role in normal growth and development for children. While fortified foods can help reduce the risk of many diseases and also “fill in the gaps” if your child does not eat well, it can be dangerous to consume too many of them. Eating too little of a nutrient can cause deficiencies, but over consuming vitamins and minerals can cause health problems as well.

The amount of vitamins and minerals in a fortified food vary. Adding 20% of the adult daily value can provide 100% of a child’s requirement. Some products contain 100% of the adult daily value.

Children’s Requirements Compared to 20% of the Adult Daily Value 

Vitamin A: 20% of the adult DV is 300 mg RAE

  • Total daily requirement for 1-3 year old:
  •      300 mg /day RAE
  • Total daily requirement for 4-8 year old:
  •      400 mg /day RAE

   Zinc: 20% of the adult DV is 3 mg

  •  Total daily requirement for 1-3 year old:
  •      3 mg/day
  • Total daily requirement for 4-8 year old:  
  •     5 mg/day

   Niacin: 20% of the adult DV is 4 mg

  • Total daily requirement for 1-3 year old:
  •      6 mg/day
  • Total daily requirement for 4-8 year old:
  •      8 mg/day


  • Monitor the portion sizes of the fortified foods your children eat.
  • Limit the number of fortified foods your children are eating, especially if they are taking a multivitamin.
  • When shopping, check the nutrition label to see if foods are fortified.
  • Create a balanced diet by offering unfortified foods like fruit and vegetables with any fortified products.
  • Reference: Environmental Working Group. How much is too much? Excess vitamins and minerals in food can harm kids’ health. _of_a_good_thing.pdf. Published June 2014. Accessed July 1, 2014.

Sports Nutrition Graduate Student Places 1st in 50 Mile Event

One of the great things about teaching sports nutrition is that most of my students are physically active, and some are even competitive athletes.  This enables them to put their education to practice – almost as though their activities are learning laboratories where they can implement the theories and recommendations they’ve heard in the classroom.

One student, Anthony Wind, recently competed and came in first in the North Face Endurance Challenge, a 50 mile race in Washington DC.  I invite you to share our conversation.

When did you first compete in an ultra-endurance event?

Anthony:  I first competed in an ultra endurance event back in the Fall of 2011 at the NYC Knickerbocker 60K in Central Park. It was all roads, and I wasn’t properly prepared, but wanted to test my endurance. I had run since I was 8 years old and had just started to realize that I enjoyed the longer bouts of sustained pace, but wasn’t knowledgeable enough to realize what it took to train for these.   .

Was this before or after you started your education in nutrition?

Anthony:  This was before the nutrition education. I realized the importance of nutrition for athletic performance after the 60K because I had not planned a fueling strategy for myself and remember feeling completely shot at the marathon point. I did finish 10th, but I honestly felt sick for a day afterwards and remembering telling myself that I wasn’t sure I’d ever attempt that again.

Did your fueling and hydration strategies change as you learned more?  If so, how?

Anthony:  Obviously yes, it has changed dramatically. After that first ultra, I started to read up on the strategies of fueling, as well as the science behind it to learn why I had felt so terribly, and what I could do better in the future. In the 60K, I raced thinking that healthy eating for performance meant consuming whole grain whole oat bars packed with nuts and almonds, along with only 150 calories worth of sports drink in one bottle! I was on a mission to kill myself, and didn’t know it.

After learning more from my own experiences, from my own reading, and from going to school for it, I have drastically changed my eating. I now focus on before, during and after stages of fueling, as well as train with numbers and guidelines in mind. I also focus on only simple carbohydrates when I am in the middle of a competition. During sport, eating for performance demands a different strategy than the typical healthy eating pattern.

Do you feel that your knowledge of sports nutrition has given you a competitive edge?

Anthony:  I do feel that it has provided an edge over much of the competition, and I say that even amongst athletes who are fairly knowledgeable, or at least very interested about nutrition. This is the case because many of the athletes have a basic understanding, or even a false understanding because of all the contradicting articles put out to the general public. In my case, I am able to study the primary research and compare different articles, as well as be fortunate to have an in depth understanding of how metabolism works at a very micro level. With all this being said, I have the resources to start with the guidelines as to how much of each macronutrient to consume, and then adjust depending on the day, the race, or even the individual if I am working with someone else.

So yes, I believe I do have an edge and hope to use it for my own performance, and then share the knowledge with other athletes who are passionate about their sport.

 What key advice would you give to others attempting ultra-endurance events?

Anthony:  Be consistent with training and fueling strategies, and understand that each training run is not only physical but is also setting you up for mental success. In order to succeed in racing and in life, it’s important to be mentally strong to endure through the hard times. In an ultra endurance race, there are points in the race when you physically just don’t feel like going on, especially when the other racers are feeling good and are breathing down your neck. So in order to get through those points, you need to trust yourself and know that you have built yourself not only a strong body, but a strong mind that can endure anything that gets in the path to the finish line.

Be prepared for a physical low point, and adjust accordingly by maintaining mental toughness.

 How do you plan to use your degree in Nutrition and Exercise Physiology?

 Anthony:  As of now, I am trying to figure out the right path in nutrition to take. Currently I am working on something completely different. I am using my knowledge of nutrition to work with an international nutrition policy organization started by the United Nations called Global Alliance for Improved Nutrition (GAIN) to improve the health of malnourished nomadic people in Northern Kenya. Ideally, I would love to use my international work as a stepping stone and eventually work with professional or semi professional endurance athletes domestically and internationally, and maybe even pursue sports diplomacy. I would like to be a part of the research team that works with ultra runners and their nutrition, and possibly work towards my doctorate in this topic.

Additionally, I would like to compete as an athlete ambassador for a US or European based sports nutrition company and use my knowledge and experience to help possibly develop a new fueling product that is more easily utilized during the race in terms of ease of access and ease of digestion, with the perfect amount of each macro and micronutrient based on the latest science.

One thing is for certain, I intend to continue training and racing with my knowledge of sports nutrition as leverage to help me succeed.

Protecting an Athlete’s Health: IOC Focuses on Energy Deficiency

The primary goal of the International Olympic Committee’s (IOC) sports medicine team is to protect the health of the athlete. The Committee addressed the widespread incidence of eating disorders and it’s effect on the menstrual cycle and bone health in a 2005 Consensus Statement on The Female Athlete Triad.1 They have recently followed this up with a new paper, “Beyond the Female Athlete Triad: Relative Energy Deficiency in Sport (RED-S),” in recognition of the widespread consequences of failing to meet the energy needs of training with adequate food intake.2 The new designation RED-S broadens our focus to both males and females who fail to make up for the energy cost of their sport with an adequate increase in calories.

This new consensus statement acknowledges the widespread consequences of under-eating even without loss of the menstrual cycle, and recognizes that male under-eating has consequences as well. While major athletic groups including the National Collegiate Athletic Association (NCAA), American College of Sports Medicine (ACSM) and the IOC have stepped up efforts to increase awareness of the Female Athlete Triad among athletes, coaches, and trainers, under-eating female athletes who do not present with the entire Triad and male athletes who don’t eat enough have historically received far less attention.

Eating too little affects the bone health of both males and females. This is disturbing as weak bones can result in stress fractures and bones which will remain under-mineralized throughout the lifespan, but that is not all. Protein synthesis, metabolic rate, immune function, and cardiovascular function will all be compromised as well. The result? Decreased muscle strength and performance, decreased endurance performance, and an increased risk of injury and illness.

Failure to meet energy needs may be deliberate as an athlete tries to lose weight, or unconscious as athletes struggle to ingest enough food to compensate for calories used each day in the hours spent training for their sport.

The expert work group who developed the consensus statement recommends that a multi-disciplinary support system including sports physician, sports nutritionist, psychologist, physiotherapist and physiologist be identified, and that athletes and all who work with them be educated as to how to prevent, recognize and treat this syndrome.

1IOC Consensus Statement

2Mountjoy M et al The IOC consensus statement: beyond the Female Athlete Triad-Relative Energy Deficiency in Sport (RED-S). British Journal of Sports Medicine 2014;48:491-497.