Online Health Chat with Kylene Guerra, MS, RD, CSSD LD
May 14, 2014
Whether you are the weekend warrior, the parent of a student athlete or just starting to engage in a physical fitness program, keeping a strong and healthy athletic routine requires more than just training and keeping in shape. Maintaining proper nutrition, hydration and eating habits are essential for your body to keep performing at high intensity.
Working with a certified specialist in sports dietetics (CSSD) who has special knowledge and skills in sports nutrition may help improve exercise or sports performance. A CSSD can calculate how many total calories and fluids is needed, including how many calories and servings should come from carbohydrates, protein and fat to adequately fuel their sport. Safe, evidence-based nutrition therapy is essential to anyone—young or old—interested in optimizing health, fitness or athletic abilities.
Nutrition—both pre-performance and recovery, proper hydration, supplementation, meal and snack timing are vital to sports training. Knowing how to properly hydrate, optimal timing of meals, and what you should eat and when will ensure peak performance with sports training.
About the Speaker
Kylene Guerra, MS, RD, CSSD LD is a certified specialist in sports nutrition and works in Cleveland Clinic’s Department of Nutrition Therapy. Her special interests include weight management, sport and fitness nutrition, weight loss/weight gain, fueling for performance, and wellness/prevention. Guerra completed her dietetic internship at Tulane University School of Public Health & Tropical Medicine in New Orleans, La. She earned her master’s degree in exercise physiology and adult fitness from the University of Akron after receiving her undergraduate degree in nutrition and dietetics from the University of Dayton, Dayton, Oh.
Areas of involvement include education and counseling. She is a member of the College and Professional Sports Dietitians Association, Sports, Cardiovascular and Wellness Nutrition Practice Group, Academy of Nutrition and Dietetics, Ohio Dietetic Association; and public education committee co-chair for the Cleveland Dietetic Association.
Let’s Chat About Fueling for Performance: Sports Nutrition
Proper Food Selection for Sports
SuzyD: My favorite meal time foods before a game are usually “heavy” foods, such as fried chicken, macaroni and cheese, and burgers. I figure this isn’t a big deal because I exercise six days a week. Is this true?
Kylene_Guerra,_MS,RD,CSSD,_LD_: Unfortunately, this is not true because the theory of “calories in = calories out” is not completely true. High-fat foods are more difficult for our bodies to digest. When we eat high-fat foods, all the blood rushes to our intestines to help get the job done. In order for blood to reach the stomach, less is available to circulate in our arms and legs. This is where we need it most in order to perform your sport to the best of your ability. For this reason, it is always best to save high-fat foods for after the event.
jills: For someone who is just getting started in an exercise program, does it matter what and when to eat as opposed to a more serious athlete?
Kylene_Guerra,_MS,RD,CSSD,_LD_: This would depend on duration and intensity of course, but let's say you recently began walking for exercise, or maybe you are jogging a mile or using the elliptical once or twice a week, there would be no need to change your nutrition at this time. On the other hand, if you began training for a half marathon or something of that nature, you would want to consider changing your nutrition habits (recovery nutrition, calorie intake, etc.) after a month or so of training.
ironwoman: Do different sports need different fuels—for instance, long-course vs. short-course sports?
Kylene_Guerra,_MS,RD,CSSD,_LD_: Definitely. To make a long story short, the endurance athlete needs a greater percentage of carbohydrates and less protein than a strength athlete. Hydration needs also greatly increase for this population. They are at greater risk for electrolyte disturbance. The same can be said for recovery nutrition among these sports. For example, cross country and soccer athletes would fuel differently than sprinters and throwers.
jills: Would you recommend different foods based on the type of activity—aerobic vs. anaerobic vs. resistance exercises?
Kylene_Guerra,_MS,RD,CSSD,_LD_: It depends what you are referring to. A high-intensity endurance athlete would benefit greatly from a higher percentage of carbohydrates in their diet (around 60 percent). This athlete would perform better with an increase in foods such as whole grain pasta or brown rice. An athlete that mostly trains anaerobically would benefit from a greater percentage of protein (around 20 to 30 percent) and a slight decrease in carbohydrates (around 45 to 55 percent) depending on the sport, intensity and weight goals. If you are an athlete that changes your activity from day to day, diet will not vary significantly.
Davis: I know pre-game fueling is important, but I am way too nervous before a game to eat anything. What would you suggest?
Kylene_Guerra,_MS,RD,CSSD,_LD_: Try to focus more on liquid carbohydrates vs. a solid meal. It would be best to drink a sports drink 30 to 60 min prior to exercise if you are unable to eat. Fluid is always more readily absorbed than a solid. You could also consider eating something that is easy to digest three to four hours prior to the event such as apple sauce or mashed potatoes. These foods are rich in carbohydrates and low in fat, fiber and protein.
Marathon Nutrition and Hydration
Baldedemiel: I would like to know about fueling for a marathon. Is there a certain amount of calories you recommend per hour? In the past I think I have not been getting enough when I run over three and one half to four hours, because when I am done I have felt nauseated and like my sugar was low (not diabetic). Post-run, what do you recommend to eat and drink? I've heard chocolate milk for the protein, fat and sugar mixture, but I don't think I can stomach that. It's hard to eat after running, the stomach just doesn't feel ready for it.
Kylene_Guerra,_MS,RD,CSSD,_LD_: It’s important to focus more on amount of carbohydrates consumed per hour, not necessarily calories per hour. If you are running for three and one half to four hours, you should focus on 60 to 90 g of easily digestible carbohydrates per hour. This will help prevent that uncomfortable feeling that accompanies a drop in blood sugar.
You are correct, chocolate milk provides an ideal ratio for recovery, but if you feel that you cannot stomach milk or eat regular food at this time, the key is to find an electrolyte-rich fluid that you are able to tolerate. Examples include vegetable juice (full sodium) and tart cherry juice that contains whey protein. You can also try the “enhanced” or “ultra endurance” version of your favorite sports drink. These formulas contain additional electrolytes needed for recovery.
Erickson: Everyone talks about chocolate milk as a great recovery source after exercise. Why is it superior to the majority of other recovery options?
Kylene_Guerra,_MS,RD,CSSD,_LD_: Chocolate milk is an excellent option for recovery nutrition because it naturally contains healthy nutrients, such as the protein, calcium and potassium, needed for replenishing lost stores. Plus, chocolate milk contains a 3:1 carbohydrate to protein ratio, ideal for optimal recovery. Not to mention it is affordable. For lactose-free athletes, Chocolate Lactaid® milk is a great option.
Baldedemiel: How long before an endurance event do you recommend upping the overall percentage of carbohydrate intake? Should they be simple carbohydrates, like white rice instead of brown, to avoid too much fiber before a race?
Kylene_Guerra,_MS,RD,CSSD,_LD_: It depends on the event. For example, a marathon or Ironman could increase carbohydrate intake five to seven days beforehand, vs. half marathon, which would only require a boost a day or two before. For a 5k marathon no changes are necessary. Whole grains can be consumed during the week leading up to the race. Focus more on the low-fiber, white products the day before and especially the morning of the race. Also keep in mind that every athlete's gastrointestinal tract is very different in terms of tolerance, so you will have to experiment with what works best for you.
Nutrition for Senior Athletes
tlg43: I am a 70-year-old male who goes to the gym about three days a week. I especially do leg, shoulder and arm exercises because I'm a bike rider who sometimes ride for two or three days straight, up to 35 to 40 miles a day. What is the best nutrition and fluids to build and help prevent sore muscles?
Kylene_Guerra,_MS,RD,CSSD,_LD_: Proper nutrition 30 to 60 minutes post-exercise is critical for helping to maintain lean muscle mass while preventing muscle soreness. It varies between each athlete, but in general, you should aim for a 3:1 carbohydrate to protein ratio in the recovery drink that you consumed immediately after the workout. For example, you may flip over a label and see that the beverage contains 45 g of carbohydrate and 15 g of protein. This would be an example of a 3:1 ratio. Chocolate milk is a great example of a pre-made beverage that contains this ratio, but you can always create your own or shop the shelves at your local grocery store now that you know what to look for.
Babs: I swim early in the morning with a group of masters in senior swimming—really early, like 5:30 a.m. What should I eat or drink prior to the work out. It is one hour and a half of drills with a swim coach.
Kylene_Guerra,_MS,RD,CSSD,_LD_: Good for you! It depends how early you rise, but assuming that you do not wake up at 3:00 a.m. to eat breakfast, I would recommend you consume a very easily digestible carbohydrate right when you wake up (or at least by 5 a.m.). Remember, liquid will always digest more readily than a solid, so try to focus on a liquid carbohydrate such as a sports drink. Fruit is also very easy to digest prior to a workout. If you have more than 30 minutes before practice, try a bagel or an English muffin with honey. Be sure to avoid anything high in fat such as peanut butter or whole milk. Lastly, make sure that your recovery shake or recovery meal is consumed within 30 to 60 minutes of exercise since you may be a bit limited with pre-practice fuel.
Student Athlete Nutrition and Hydration
almost retired mom: My third grader students —both boys and girls—play organized soccer, baseball, softball, and football. They would like to know if there are any special sports nutrition tips you could give them to stay healthy for sports and perform their best. These children are all nine years old.
Kylene_Guerra,_MS,RD,CSSD,_LD_: I am glad to hear your students already have an interest in nutrition! It is important to make sure a young athlete is staying hydrated with water throughout the day. Sugar sweetened sports drinks such as a Gatorade® or Powerade® should only be consumed after physical activity of more than 60 minutes. It is also helpful to pack an afternoon snack as sometimes there is a large gap between lunch and dinner. You will have more energy to practice if you fuel properly. Great examples include an apple with peanut butter, whole grain pita chips with hummus, low-fat yogurt, or half of a turkey sandwich. And— of course—never skip breakfast!
GigiRocks: After school is a very busy time for our family. What are a few portable snacks that we can have on hand prior to the sporting event?
Kylene_Guerra,_MS,RD,CSSD,_LD_: The key is to focus on foods that are rich in carbohydrates with a low protein, fiber and fat content. Great examples include fruit, animal or graham crackers, low-fat yogurt, half of a turkey sandwich, raisins and dry cereal, or a peanut butter and jelly sandwich (light on the peanut butter) in a pita pocket.
schaeferlady: Is there any advice you can give competitive cheerleaders and gymnasts on proper nutrition?
Kylene_Guerra,_MS,RD,CSSD,_LD_: Never skip meals and avoid training on an empty stomach. Always balance your plate. Make sure to consume adequate amounts of lean protein after practice—especially if continuous tumbling or weight training is a part of your routine. Lean protein such as chicken, fish, tuna or black beans can be extremely helpful for muscle repair post-workout.
Herrin: I see that my child is drinking sports drinks throughout the entire day with very minimal water intake. He is very physically active though. Is this OK?
Kylene_Guerra,_MS,RD,CSSD,_LD_: Water is always the best source of hydration for anyone—especially a child. If he is very physically active (meaning over 60 minutes of exercise per day) a sports drink or electrolyte replacement beverage would be a great way to replenish lost stores after physical activity. Sipping a sports drink throughout the day can lead to excess intake of added sugars.
Joanie: I noticed my daughter is choosing lower calorie ”diet” sports drinks after her long runs? Is this a good idea?
Kylene_Guerra,_MS,RD,CSSD,_LD_: A lower calorie sports drink also contains a lower amount of carbohydrate and electrolytes such as potassium and sodium. Therefore, it is not always the best replacement after high intensity physical activity lasting longer than 45 minutes, especially in the heat. A low-calorie sports drink would be acceptable to consume after lower intensity exercise lasting less than 30 minutes, perhaps on a cross-training day. Something else to keep in mind: diet sports drinks often contain sugar alcohol and/or artificial sweeteners. At times, this may cause gastrointestinal upset for athletes upon digestion.
Hydration vs. Exertion
JoyD: What is the ratio of hydration to exertion? I usually drink 16 oz water during kickboxing class. Would this be enough? How much liquid do I need for the day?
Kylene_Guerra,_MS,RD,CSSD,_LD_: It actually differs for every single athlete. We would need to calculate your sweat rate for exact numbers. For now, the best way to make sure you re-hydrated properly is to weigh yourself before and after kick-boxing class. Do you weigh the same? If so, you did a nice job hydrating. Do you weigh less? This is a sign of dehydration. Replenish with 16 oz fluid for every pound lost. For example, if you find that you weigh two lbs less after your workout, you will want to re-hydrate with 32 oz fluid.
Female Athletes and Protein
JoyD: I recently read that it is erroneous that women need more protein. The RDA (recommended daily allowance) for protein is 46 g for women and most adults far exceed this. I do not eat red meat, but I am able to meet the RDA with other food sources. I have been told that animal protein is the most nutritious way to get protein. Is there any truth to this claim?
Kylene_Guerra,_MS,RD,CSSD,_LD_: This completely depends on the size and the activity level of the female—46 g may be o.k. for some women and for others it would serve as complete protein-malnutrition. There is nothing wrong with avoiding red meat as long as you are reaching protein goals from other sources. I would not say that animal protein is the most nutritious form, but is it absorbed more readily by our bodies by plant protein? Yes. In summary, a very athletic female, especially one that incorporates strength training into her routine, would need significantly more protein than the average female who is completely sedentary.
Nutrition for Joint Health
almost retired mom: I am a 57-year-old female of normal weight who has had a knee replacement. I do moderate low-impact exercise, such as light weights, biking, walking, swimming and yoga. What types of supplements or drinks should I be using for good joint health? Also, are the lower calorie sports drinks better than the regular ones for someone like me, or should I just be drinking lots of water?
Kylene_Guerra,_MS,RD,CSSD,_LD_: For joint health, it’s always best to focus on foods that decrease inflammation. Examples include heart healthy fats that can be found in olive oil, avocado, nuts, salmon and tuna. Foods high in sugar and saturated fat such as dessert or red meat can actually increase your joint pain! It's also important to try and cook with a variety of anti-inflammatory spices as herbs such as cinnamon, turmeric, ginger and nutmeg.
Lower calorie sports drinks can be a great idea for those trying to watch their weight. However, this would not be a good alternative if you begin participating in endurance events (lasting more than 60 minutes). The carbohydrate and electrolyte content is not enough to meet your needs. You will also want to be careful as these drinks contain artificial sweeteners that may result in gastrointestinal upset for some athletes.
Nutrition and Motherhood
FOTB: I saw your television report where you assisted a young mother in losing over 50 pounds and helped her gain back her self-esteem. That was a remarkable story! How is she doing five months later? Please continue sharing success stories like that!
Kylene_Guerra,_MS,RD,CSSD,_LD_: Thank you for tuning in. Terri is a great example of how a few simple lifestyle modifications such as diet and exercise can completely change your life for the better. She is keeping the weight off and still feeling great!
Randyosu: My son is 18 years old, and is a workout nut with weights. He uses supplements NDS™ PMD® Pump Fuel® and GNC Pro Performance® AMP Amplified Mass XXX™ (creatine). I have concerns with the products, but I cannot seem to find much literature addressing any potential health risks with their usage. Can you provide any guidance regarding potential health issues?
Kylene_Guerra,_MS,RD,CSSD,_LD_: First, it’s important for your son to evaluate his goals. Is he hoping to gain weight? This can actually be done properly through food intake alone. Is he hoping to gain strength? This can be done safely and effectively by supplementing with pure creatine monohydrate. This form of creatine has been studied extensively—therefore, making it the safest choice to date.
There are so many supplements on the market now and each typically contains a ton of “foreign” ingredients, making it a very confusing decision for the consumer. Please note that no dietary supplement is regulated by the U.S. Food and Drug Administration (FDA). This means that the product may not actually contain what is stated on the product label. It is also important to realize that a company might safely and accurately produce its product thousands of times, but that does not guarantee safety and efficacy for the next batch of product that is produced. And lastly, many ingredients found in these products might be safe to consume when taken alone (for example, ginseng), but safety and efficacy when combined with all the other ingredients in the product (such as “proprietary blends”, excessive amounts of caffeine, DMAA [methylhexanamine or “geranium extract/oil”], etc.) is unknown. So, how do you know if your product is safe? Do not waste your time looking for literature because the chances are you will not find it unless the company created their own small study. Instead, check the front of the label for the NSF (National Science Foundation) stamp of approval. This means that the product was third party tested. If you do not see the NSF logo, there are various sites you can visit in order to research different supplements or specific ingredients in those products. These include the following:
You can also go straight to the websites for the FDA or FTC (Federal Trade Commission) to check for any warning letters, enforcement actions, etc. regarding your product.
Robb: I am considering taking a sports supplement, but I am wondering if they are really necessary?
Kylene_Guerra,_MS,RD,CSSD,_LD_: The answer is likely “no.” Sports supplements are not necessary for people who train smart and eat balanced diets. Proper training will ensure your body is adapting to training and a balanced diet should provide you with 100 percent of the nutrients you need to support proper training. But, a daily multivitamin and mineral supplement is not a bad idea if you are looking for an insurance plan to guarantee you meet all of your daily micronutrient needs.
Sports supplements are attractive because they are marketed to athletes with lofty claims, such as being able to increase strength, power, or endurance, decrease fatigue, improve recovery, and promote weight loss. While the Food and Drug Administration holds manufacturers accountable for the identity, purity and strength of product ingredients, the law doesn’t require companies to prove their supplements’ safety or effectiveness.
To help you sort through the myriad of sports supplements on the market, let’s break down sports supplements into three categories: “effective as claimed,” “may be effective, but research is inconclusive,” and “avoid due to adverse effects.” “Effective as claimed” means that according to the American Dietetic Association, the American Society of Sports Medicine, and Dietitians of Canada, only creatine, caffeine and sodium bicarbonate are effective as claimed.
Research shows creatine is effective at increasing lean body mass in athletes who perform repeated bouts of high-intensity exercise for less than 30 seconds (such as sprinters, jumpers, throwers, hurdlers, sprint swimmers, cyclists and weight lifters). Caffeine is effective as a central nervous system stimulant, increasing alertness and decreasing perception of effort. Sodium bicarbonate is touted for its ability to prevent fatigue by neutralizing lactic acid, although a common side effect is nausea and diarrhea. “May be effective, but research is inconclusive” means the jury is still out on many popular sports supplements that may be effective, but more research is needed to prove their benefits. These include beta-hydroxy-beta-methylbutyrate (HMB), glutamine and ribose. “Don’t purchase” means avoid using the following sports supplements because they have yet to prove either the ability to improve performance and may have adverse health effects. These include products with branched chain amino acids, carnitine, chromium, coenzyme Q10, medium chain triglycerides and pyruvate.
Sports supplements are not necessary for those who train and eat smart. But, it is up to you as an athlete and consumer to choose whether or not sports supplements are right for you. Here are some resources to help you in making that choice:
unclemarkie: My diet is very well balanced. Is supplementation necessary for me?
Kylene_Guerra,_MS,RD,CSSD,_LD_: No, supplementation is not necessary or recommended when you are able to eat a balanced diet. If you feel that you may have a vitamin or mineral deficiency, your doctor can place an order for lab work to be drawn in order to determine if supplementation would be beneficial to your health.
WellTrained: I know that sport gels are often recommended for endurance athletes, but I tend to experience gastrointestinal upset after I take a few. Am I doing something wrong?
Kylene_Guerra,_MS,RD,CSSD,_LD_: No, you’re not. Energy gels contain a 5-1/2 to six percent carbohydrate concentration vs. the typical four to eight percent concentration commonly found in sports drinks. The higher concentration of carbohydrate makes digestion a bit more difficult during training and competition. Be sure to take a few sips of water before and after using the gel to ease the process of digestion.
janiceasad: Can 5-HTP (5-hydroxytryptophan) really help your metabolism speed up to help you lose weight?
Kylene_Guerra,_MS,RD,CSSD,_LD_: At this point in time, the answer is to avoid this product until it has been proven safe and effective. According to the Natural Medicines Comprehensive data base, this product might be unsafe and it is considered to be “possibly effective.” Some people who have taken it have come down with eosinophilia-myalgia syndrome (EMS), a serious condition involving extreme muscle tenderness (myalgia) and blood abnormalities (eosinophilia). Some people think the EMS might be caused by an accidental ingredient (contaminant) in some 5-HTP products. But there is not enough scientific evidence to know if EMS is caused by 5-HTP, a contaminant or some other factor.
Sports Dietetics Certification
Shelby: What is a certified specialist in sports dietetics (CSSD) and what can one do for me?
Kylene_Guerra,_MS,RD,CSSD,_LD_: First and foremost, a CSSD is a registered dietitian who is also a board-certified specialist in sports dietetics. That means a CSSD has special knowledge and skills in sports nutrition. A CSSD will offer safe, evidence-based nutrition therapy to anyone interested in optimizing their health, fitness or athletic abilities.
The most common reason athletes go to see a CSSD is to improve their exercise or sports performance. A CSSD will calculate how many total calories and fluids they need, including how many calories and servings should come from carbohydrates, protein and fat to adequately fuel their sport.
Depending on each athlete’s particular goals, a CSSD will work with them to achieve them. Common goals include:
- Gaining muscle strength and power
- Building muscle mass or losing body fat
- Increasing energy during endurance events
A CSSD also educates athletes on what type and how much food and fluids to eat and drink before, during and after exercise, including practices, races or games. For those with food allergies, gastrointestinal issues, or even diabetes, heart disease, osteoporosis and anemia, a CSSD will assess their unique needs and develop a specific meal plan just for them. In fact, a CSSD can create a customized meal plan for anyone.
Or maybe you just need some pointers. Do you have questions about sports drinks, energy-enhancing products or dietary supplements? A CSSD can help! Whether you are interested in changing your body composition, can’t seem to finish an endurance training session without zonking out, or just need guidance with what to eat and when to eat it, an appointment with a CSSD will help you achieve even the smallest goals.
Moderator: I am sorry to say that our time with Kylene Guerra is now over. Thank you for sharing your expertise and time to answer questions today.
Kylene_Guerra,_MS,RD,CSSD,_LD_: Thanks to everyone who participated in the chat today. I enjoyed answering all your questions. Keep up the interest in nutrition and sports!
To make an appointment with Kylene Guerra, MS, RD, CSSD, LD, or any of the other specialists in our Digestive Disease Institute, Department of Nutrition at Cleveland Clinic, please call 216.444.3046 or toll-free at 800.223.2273, ext. 43046, or visit us online at www.clevelandclinic.org/nutrition.
For More Information
On Cleveland Clinic
All of the dietitians in the Department of Nutrition Therapy are registered and licensed in the state of Ohio. Several also have advanced degrees and/or specialty certifications, and each dietitian practices the science of medical nutrition therapy. To learn more about our dietitians and their specialties, please visit our website at www.clevelandclinic.org/nutrition.
Cleveland Clinic’s Sports Health Program, which is part of the Orthopaedic& Rheumatologic Institute and associated with Cleveland Clinic Children’s, enables pediatric specialists to provide consultation, diagnosis and management for children and adolescents with problems or injuries related to athletics.
Cleveland Clinic Sports health brings together top orthopaedic surgeons, primary care sports medicine physicians, physician assistants, nurses, physical therapists, athletic trainers and exercise physiologists all under the same roof through our multidisciplinary approach.
Cleveland Clinic Sports Health Team focuses on several areas from developing performance improvement, injury prevention and proper nutrition to rehabilitation and surgical correction.
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