Good Nutrition For Athletes

Beverly Bernal-Masuda, Cssd
Board-certified sports dietetics specialist at Kaiser Permanente

Where did you receive your schooling and training?

I graduated from McKinley High School, got my bachelor’s degree from the University of Hawaii and did an internship at Harper Hospital in Detroit.

How long have you been practicing?

I’ve been working with Kaiser Permanente for the past 32 years. I am the supervisor for the clinic outpatient dietitians.

What is a sports dietitian?

Board-certified specialists in sports dietetics are registered dietitians who have met the criteria of 1,500 hours of practicum experience and have successfully passed a national board exam. It’s a new certification program, created just two years ago. It recognizes that you have unique expertise and skills in this specialty area. Presently there are just two of us in Hawaii. Opportunities for sports dietitians are really opening up. Many are hired to work with professional teams, others are involved in collegiate or high school sports. Some also work with performance companies, helping them formulate engineered foods to enhance performance.

What’s the most common reason athletes come to you?

Most of the competitive athletes come because they want to improve their performance. They want to know what to eat, when to eat, what supplements to take and whether or not they need more protein for strength and power.

Do you mostly see student athletes?

I have been working mostly with endurance athletes - marathon runners, triathlon and Iron Man triathletes, and long-distance bicyclists. But our pediatric department has been referring a lot of teenage boys who want to build more muscle. They’re interested in protein supplements and tend to get information from the Internet. I work with them on their calorie and protein intake, and in improving their overall eating habits. I make them aware that they shouldn’t be taking more protein than what is recommended, and that supplements are not going to replace food intake.

Can you say something more about finding information on the Internet?

You can Google things and get bombarded by anecdotal information that may not be appropriate for you. That’s where my specialty can come in handy because it’s highly individualized. For example, I help athletes determine what supplements they should be taking and how much they need. I did marathons, triathlons and long-distance biking for more than 25 years. When I started out, we didn’t have engineered supplements like the energy gels and chews, electrolyte tablets and recovery drinks that are available today. These supplements can certainly help the athlete. What’s still important for athletes are the three critical phases of working out: before exercise, during exercise and after, recovery. It’s these three critical phases that I concentrate on when I see an athlete because endurance athletes are out there training for more than two hours, and nutrition and timing become critical.

Can you discuss the three phases?

Before exercise, the athlete needs to eat a carbohydrate-rich snack or meal to top off muscle and liver glycogen stores. A snack or light meal two hours before the event should consist of at least 100 to 200 grams of carbohydrate. If you have only one hour before a race, I recommend high-carbohydrate foods that are easy to digest such sports bars, fruit, jelly sandwich or my favorite, mochi. Studies show that an overnight fast of 12-15 hours without food significantly depletes liver glycogen stores. This could cause early fatigue. Your liver is your backup system, so you’ve got to fill it to maximum capacity. You also need to be well-hydrated. It takes at least 12-14 hours for fluid to fully saturate your muscles. You need to hydrate early. You are already dehydrated by the time you feel thirsty. Two hours before the event, the athlete needs to drink at least 16 to 20 ounces of fluids.

During the activity, timing and ensuring that you’re taking in the right mix of carbohydrates, sodium, electrolytes and fluid is important. You need to consume at least 30 to 60 grams of carbohydrate per hour of training, from liquid or semi-solid sources. You also need to drink at least 6-12 ounces of fluid for every 15-20 minutes that you’re exercising. Sports drinks need to have the right concentration of carbohydrates, no more than 6 to 8 percent. If it’s too concentrated, your system can’t absorb it.

Post exercise also is a critical period. The window of opportunity for you to replenish the carbohydrate that you’ve lost is 15-30 minutes. This is a crucial time for your body to take on new glycogen to replace what you’ve lost in training or a race. The best recovery foods are rich in carbohydrates such as fruits, fruit juices, breads, musubi or sports recovery drinks. As far as rehydrating, for every pound that you lose, you need to drink at least 16-20 ounces of fluid.

Are there nutritional concerns specific to female athletes?

Yes, Female Triad is a condition where women have three medical problems: amenorrhea (no menses), disordered eating patterns and osteoporosis. A lot of times these conditions are not apparent, but coaches and trainers are able to identify them when fellow athletes report when they notice that someone is not eating properly - an indication of disordered eating - or when family members can help identify whether or not a person is having a menstrual period. And chronic fractures can be an indication of osteoporosis. A female athlete can have all three of these conditions or just one or two of them. High-risk females are those who participate in activities where body size is important - ballet, figure skating and gymnastics, for instance.

Any advice for clients interested in maintaining an active lifestyle?

A lot of my referrals are patients with medical problems like diabetes, hypertension or coronary heart disease. Or, they have elevated cholesterol or some other medical problem. I’ve always felt that healthy diet and exercise should be the primary intervention first, rather than treatment with medication. When patients meet with me, I try to get them to exercise. I’ll have them start off slowly and try to get them up to the recommended 30 minutes of cardio exercise - walking, swimming, stationary cycling - five days a week. When patients see their blood sugar and blood pressure improve and they don’t need to add more medication, they feel better, they have more energy, they sleep better - they’re hooked, which is good. I try to give them a goal, maybe a 5K walk to start. I’ve had several clients who have gone from being a couch potato to exercising for 30 minutes, to getting involved with some of the races and then wanting to do the Honolulu Marathon - and most of them finish! That’s the most gratifying thing that I do - working with people with chronic medical problems and getting them to stay fit and healthy.

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