Setting Your Training Table Menu

John Horton:

Hello, and welcome to another episode of Sports Essentials, the fit friend of our popular Health Essentials Podcast. I'm John Horton, your co-host with Dr. Lauren Wichman. How you doing today, doc?

Lauren Wichman, MD:

John, I'm doing great, and I think we have such a special treat for our listeners today.

John Horton:

Oh, we definitely do. And we're going to talk about the way you should eat if you're an athlete. And if you are somebody in competition, we know you're devoted to your workout routine, to keep your body in tip-top shape. But the truth is, the lifting we do with our forks might be as important as any weights we're throwing around at the gym. Right, Dr. Wichman?

Lauren Wichman, MD:

No doubt about it. And I think we have such a special guest here today. Carly, she is our Cleveland Clinic sports registered dietitian and a truly incredible resource for all of our athletes. And the fact that our listeners get to hear the specific recommendations that she gives to athletes without technically maybe being one of her athletes is such an awesome opportunity.

John Horton:

Well, I feel like this conversation, we are all going to be athletes with Carly Sedlacek. And she is top-notch at what she does and just works with a couple colleges that we have here in Northeast Ohio and helps the athletes in those programs just really maximize their performance.

Lauren Wichman, MD:

She helped us out a ton at Cleveland State University, Kent State University and John Carroll University. But she also sees a lot of other athletes in the community — high schoolers, athletes that are maybe finished with college but still looking to take on a new hobby, like a half-marathon, a marathon — so I think a lot of the advice today that she will give is applicable to athletes at a lot of different levels.

John Horton:

Totally agree, Dr. Wichman. There is going to be a ton of food for thought coming up here, so let's get to it.

Lauren Wichman, MD:

Let's jump in.

John Horton:

Carly, welcome to the podcast. I'm glad we could get a little bit of your time. I know you are always running everywhere with your work here at the clinic.

Carly Sedlacek, RD:

Figuratively and literally sometimes. Thanks for having me.

John Horton:

Well, let's get into it a little bit because you have such a fascinating job here. So if you could just tell us a little bit about what you do here at Cleveland Clinic and, specifically, how your job takes you to campuses to work directly with college athletes.

Carly Sedlacek, RD:

I'd love to. So yes, I'm Carly. I'm our sports dietitian. I'm our sports medicine dietitian at the clinic. I've been at Cleveland Clinic for four years in total, but in the sports medicine program for three years now. And I absolutely love our sports medicine program.

So I get to see our athletes from Kent State, Cleveland State, John Carroll, for either one-on-one appointments — and we'll talk specifically about their fueling needs, what they want their performance to look like for the season. And a lot of times, I'm also seeing athletes in group visits at the beginning of the season. So we talk about nutrition basics — what should they be choosing, what types of things do they have access to, how do we make sure that we're fueling them appropriately?

So that's a little bit of what I'm doing with our athletes at the clinic.

John Horton:

Well, and that explains why we have you here because we want to pick your brain and get all that great information that you're sharing with these athletes. We want to get it to everybody so that we can all benefit from that sort of wisdom.

I want to throw in, too, go Kent State. I'm a Golden Flash, so I love that you're there helping them out. So hopefully, get them a few more Ws this year.

But I know when we were talking about how you start with all of your athletes, and you start with the very basics, and we thought that would be the best place to start here. And I guess, it's a little nutrition 101, and everything revolves around, I guess, those three big macronutrients.

Carly Sedlacek, RD:

Yeah, absolutely. So anytime I see an athlete, my first questions are, "Do you have any sort of nutrition education behind you? Have you seen a dietitian before?" And many of them haven't. Sometimes, they have, whether there is some sort of past medical history with something nutrition related or chronic condition for some reason, but I think having that base of our macronutrient education creates, again, that base of the pyramid. How do we take our basic information of carbs, fats, protein, what do they do and how do we apply them into performance?

Lauren Wichman, MD:

I think a lot of athletes may or may not say, or a lot of people in general may or may not say, that they have some nutrition background from looking on social media and looking online and doing a little bit of their own research. And I think that — plug for Carly — I send many athletes her way because of that, and being able to have her as a reliable resource for our athletes where they know that they're getting the actual accurate information to truly help their performance has been huge.

John Horton:

Well, and it's funny because you mentioned those three: carbs, fats, protein. We've heard them and we all relatively know what they are, but how well do we know it? And I know I had to laugh when you said when you talk to your athletes and you're like, "Well, do you know what carbs are?" And they're like, "Well, it's bread." And you're like, "It's a little more involved than that." So why don't we start there?

Carly Sedlacek, RD:

Yeah, absolutely. That's how I go about every presentation, is I explain each macronutrient. I say, "You've heard of carbohydrates, give me a source of food." First answer is always bread, rice or pasta. Any one of the three starches, that's usually the first answer. And it's great that they recognize those starches contain carbohydrates because carbohydrates are your body's main source of energy. A lot of times, I'll explain carbohydrates to my athletes as, because it's your main source of energy, almost think of your carbohydrates like the gas that you're putting into a car. A car needs gasoline to get anywhere. If you're not consuming carbohydrates, you're not going to get to where you need to go. But it's not just in the starches. We can find carbohydrates in fruits and veggies, which are wonderful if I can get some of the athletes to consume some of those things or even looking at some of our dairy products. So it's not just in the starches. I mean, again, great source that we're identifying, but carbohydrates can be lots of foods and they're very beneficial from a performance standpoint.

Lauren Wichman, MD:

The main energy source … when you hear people that need a carbo-load before exercise, and we'll dive into some of that, too, there's a difference between eating a variety of carbs versus just a pizza or something like that, too.

Carly Sedlacek, RD:

Absolutely. I mean, generally, I break it up into: Here's carbohydrates. We're breaking it into two sections. One section are those simple, easy-to-digest carbohydrates, which can look like lots of different foods. I mean, that can include some of your fruits, for example, but might contain some of the other carbohydrates, like your candies, your fruit snacks, your fruit juices even, all those things the body can break down really, really easy. Versus maybe your complex carbohydrates, which could be in the form of your whole grains, things like oatmeal, whole-grain bread, maybe even things like chickpea pasta. Those items contain a little bit more fiber, so they break down a little bit slower. So when you're thinking about carbohydrates as an energy source before exercise, and we do want to try to focus on things to digest a little bit easy so you're not having any sorts of belly issues going into exercise.

John Horton:

How you broke that down, I mean, there are clearly two carb camps, I guess. It sounds like athletes should lean into both of those at different times. And I guess when should you do the one, when should you do the other?

Carly Sedlacek, RD:

It's a really good question, and I think it does depend a little bit on the athlete, maybe the sport that they're participating in. Lots of times, if we're thinking about that pre-exercise piece, I think it depends on when is exercise because when I talk to my college athletes, maybe they wake up 20 minutes before they have to be in the gym.

Lauren Wichman, MD:

No doubt.

Carly Sedlacek, RD:

So if we're thinking about carbohydrates in that sense, it's going to have to be something quick and easy to digest. They don't really have a ton of time to put something together anyway. So usually, if there's an hour or less before exercise, I'm saying let's focus on those easy-to-digest things. And like I said, that can include so many different items. Really, I think that the biggest thing I try to get is for my athletes to have something before exercise.

John Horton:

What are some of those? If you could just lay out the quick hit things right before practice.

Carly Sedlacek, RD:

I recommend … fruit snacks are the big one. Applesauce is a big one that a lot of my athletes will use. Graham crackers. Sometimes, we'll use the chewy granola bars, for example. Again, you want to think about that energy source. Again, right before exercise, you're topping off your fuel tank. It shouldn't be the main source that we already have created there because, realistically, the night before we had dinner, probably had some carbohydrates in there, so we should already have a storage. So day of, we really just want to top off that tank with something easy.

John Horton:

And I take it, the storage are the complex carbs that you were mentioning?

Carly Sedlacek, RD:

Yes, correct. So that storage form, and that can, again, I'm sure we'll get into that, it can look very different athlete to athlete as well. But typically, that storage form — we refer to it as glycogen, which is just a storage form of all your carbohydrates — so it can be still a combination of both of those things, but maybe it's more of those complex carbs, especially thinking about dinner or maybe the meals the day beforehand.

Lauren Wichman, MD:

So as far as how far out from exercise to have athletes make sure they're taking in some of those complex carbs, what do you recommend usually for that?

Carly Sedlacek, RD:

So let's say that maybe one of my athletes, they have a game and it's later on in the day, for example. If we're thinking about those complex carbohydrates, maybe that is breakfast and lunchtime. We're trying to focus on more of those fiber sources. Maybe that means breakfast contains oatmeal, for example, and maybe lunchtime contains brown rice or quinoa, or again, maybe it's that chickpea pasta, whole-grain pasta. Generally, when there is more of that time, two hours or more for most athletes, that's plenty of time to digest something prior to a workout.

John Horton:

Now, I noticed you didn't say pizza in there, which is a favorite carb for a lot of folks. I take it matters what kind of fuel you're putting in the tank. And since we're talking here about optimizing your performance, is this where you have to start looking at the quality of the carbs that you're getting in and how it's going to, I guess, affect what you're doing later?

Carly Sedlacek, RD:

Yeah. A lot of times, I refer back to this concept of the car. Sometimes, there are higher-quality cars that need different types of gasoline, so we have to match up that exercise with the preferred type of carbohydrate. And don't get me wrong, pizza is my favorite food by far, so we can absolutely still include that, but maybe pizza is not our best option if we're working out in the next hour or so. It might not feel the best for you.

John Horton:

And how big of a difference can it make in your performance? If you're carb-loading right or just carbing right, I guess, what are you going to see? I mean, is it just your workouts are going to feel a little more fluid, you're going to come out of them, recover a little more quickly, just going to feel more powerful during them? What are the benefits we get?

Carly Sedlacek, RD:

The big one is definitely going to be more of we're seeing those benefits in terms of performance. So maybe that is quick. Maybe that means, for some of my longer endurance athletes, maybe that means they can perform better for longer. There's been so many times where I have met with an athlete that maybe in the past has been told to or looked at social media that said to not include those carbohydrates, and we start to implement those a little bit more into their diet and they come back to me and they're like, "Wow, this made a huge difference in terms of my performance. I don't feel as tired afterward. I don't feel like I have to crawl up the steps after I'm done for the day to get into bed and to start that other recovery process." So a lot of times, we are seeing those bigger performance benefits, whether that is performing longer for better, faster, building that strength, all the performance benefits.

Lauren Wichman, MD:

Do you have or do you see athletes that, depending on if they're in a particularly long preseason workout or a game is going into overtime or something like that, whether we need to replenish some of those simple carbs throughout the workout?

Carly Sedlacek, RD:

That's a really great question. So yes, especially when we are looking at really all of your sports. I think a big one, especially right now, we're in baseball season still, some of these sports that don't necessarily have a timeline of when they're going to be finished versus soccer, we've got a countdown or football, we've got a countdown. Usually, during exercise that's going to be lasting over 60 minutes, we do want to try to include some carbohydrate sources. So maybe that means at halftime, for example — and maybe for either of you, when you played sports younger, maybe you remember having orange slices on the sideline at games, or again, fruit snacks or whatever that is. But a lot of times, for my athletes, we're creating a schedule for them, again, because the fueling just does look so different even depending on maybe the position that they're on at the field.

Maybe they're coming out at a certain time and we've got some snacks available for them on the sideline, whether that is a granola bar or again, graham crackers, fruits, fruit snacks, whatever their preferred fueling source is. Even if we were looking at some of your sports beverages, things like your Gatorade®, your Powerade®, some of those can absolutely be options because they are more of those liquid carbohydrates. They digest pretty fast. So in that same realm as far as some simple carbohydrates to replenish a little bit of the energy.

John Horton:

It sounds like the key there is you're always, you're topping off the tank when you're doing this mid-game or mid-practice. So you just want to get a little bit in to get that fuel level up so that way, you can keep going during whatever event you're in.

Lauren Wichman, MD:

Absolutely.

John Horton:

Well, I know we're going to talk more about carbs and how you break that down in meals a little bit later, but we want to make sure we tackle these three macronutrients we want to focus on. And I suppose the next one, going in alphabetical order here, would be fats, which I feel like just has a bad connotation to it because nobody goes like, "I need more fats." But it sounds like they are pretty important to getting your body ready to go through all you're going to put it through.

Carly Sedlacek, RD:

So fats are one I would agree with you. I think there's ... and we could argue, well, all of macronutrients besides protein, there's probably negative connotation out there for some of our athletes or just some of our population out there. But fats are really important, I think, especially when we're looking at specific vitamins and minerals that we're consuming. So we have fat-soluble vitamins — that's going to be vitamin A, D, E and K. And those fat-soluble vitamins are required to have some fat sources within our diet to actually help activate those things. So vitamin D, again, we can get it from the sun. Great, wonderful. But we do need to consume some fat sources to help activate that. Fats are also going to play a huge role in terms of hormone regulation. So many times, again, depending on the population I'm working with, but I'm working with a group of female athletes and maybe there are some medical things going on. We do want to make sure that they're getting adequate fat sources to help with that hormone regulation so that their body can perform that it needs to.

Lauren Wichman, MD:

And what kinds of performance deficits or things may you see if you aren't getting enough fats compared to what we talked about with the carbohydrates?

Carly Sedlacek, RD:

So there's lots of different things that we can see, especially when we get into the micronutrient side of things. There's some different signs, symptoms we can look for for fats. Especially for females, we might see that the menstrual cycle is not regular for them. For some of our male athletes, or I guess, both sides of that population, if we don't have enough body fat, it is going to be very hard for our body to activate those specific vitamins, minerals for it to actually process the way it needs to. Fat also provides a barrier for our organs, so it is really important that the body has enough of that body fat to perform the way it needs to.

John Horton:

So if carbs are the fuel, which I love the way you described that, it sounds like fats are what? They're just more to help everything work a little better, provide those connections?

Carly Sedlacek, RD:

Yeah. So when we look at macronutrients, and this is where it does get a little bit confusing from the biochemistry standpoint, because we really want to strive to get those carbohydrates, but when we look at carbs, fats and proteins, they do all work at the same time. They're all energy-providing. However, many times, carbohydrates takes precedence there. It tends to provide the most energy. So fats are still going to be a nice energy source for us, but they do that behind the scenes work a little bit, especially with those micronutrients.

John Horton:

And what is the key then to make sure you're getting good fats? Because we know that there are bad ones, and I think we're all familiar with those because the donuts and pastry, all that sort of stuff. Where do you recommend people go to get good, healthy fats that are going to help your performance as you hit the field?

Carly Sedlacek, RD:

This is another funny one because, again, when I talk to a group of athletes, I'll say, "Give me a fat source." First source that is always out of the mouth is avocado, which is great because avocados are wonderful.

John Horton:

That's a good food.

Carly Sedlacek, RD:

It's a very healthy fat. So I'm always happy to hear that instead of butter being the first thing that comes out of their mouth, which is good. A lot of times, when I talk about fats, again, fats are great — we need them as an energy source. And I'm also a dietitian that is very realistic. I know that some of my athletes are probably going to have some of those fats that might not align as well with performance goals, things like your donuts or pastries and some of those items. And that's OK because they're delicious foods. However, many times when we talk about fats, if we can include more of your omega-3 sources of fat, or again, more of your balanced fat sources, so your olive oil, your avocados, your nuts, your seeds, your nut butters, chia seeds, flax seeds, some of those other foods that might even have some fiber to them. So other properties that can be really beneficial for overall health, those are the ones we want to try to focus on.

Lauren Wichman, MD:

Is timing as important for fats as it is with the different types of carbs, or is it more just making sure that you have some fats on board?

Carly Sedlacek, RD:

So fats play a really big role in terms of timing as well. So if we were thinking about, again, coming back to this concept of maybe there's only an hour before exercise, and again, it does come down to portion size, how much are we consuming of these things as well. There's so many different things that come into it, but fats do tend to digest slower than our carbohydrates, our protein. So if those things digest slowly, it might not be the best move for an athlete maybe beforehand to have something a lot higher in fat versus something a little bit more moderate or even lower in fat. That digestion can change athlete to athlete. Of course, I do have some boys that can go out and get a breakfast sandwich from McDonald's and go into practice and be completely fine. But for most of us, that is something that's not going to feel very good if we go into exercise an hour after eating that because it digests so slowly.

John Horton:

We've all had that. When you hit a workout after you've eaten a little too close to it, and you do feel it and it is not a good feeling.

Carly Sedlacek, RD:

Not fun.

John Horton:

So as you're walking through, then, getting the right fats in, is it something you focus on, I mean, try to stay away from saturated fats. Or I guess everything you brought up, the ones that are good, I seem to notice there's a lot of nutritional value aside from the fats to it. Is that where you want to put your focus then, where if you're going to have a food with fat in it, you want to make sure you're getting a lot of other stuff with it, too?

Carly Sedlacek, RD:

Yeah. I mean, I think that's a really good way to look at it because you're right, a lot of those fats that I had mentioned, not only again that source of fat, but maybe there's fiber there, maybe we have other sorts of micronutrients underlying there. Those, again, coming back to this concept of putting the right fuel into the right car, I think that can be a really good and better way to think about it, choosing something that has a lot of nutritional benefits being a lot more beneficial than something that might be missing or lacking in some of those specific nutrients.

John Horton:

All right. Well then moving on to our last one, which is protein, which everybody loves now. I mean, protein is the thing. I take it everyone is excited when you started talking about how they can put more protein in?

Carly Sedlacek, RD:

Yes, yes, 100%. I mean, even with the general population, because I do still work a little bit with the general population as well, I mean, I'll use my dad as an example. My dad thinks it's so wonderful that there's protein Pop-Tarts® out there right now, and I have to sit down with my dad and say, "Yeah, Dad, there is protein here, but let's look at the product itself, too. I mean, we do have some extra added sugars there, some things that we don't necessarily need because of what your goals look like." So yes, navigating the conversation around protein can be very interesting, I think, especially for our college athletes. Again, coming back to this social media standpoint, or with my college athletes, they are also working with strength and conditioning coaches, athletic trainers. I mean, there are other people in their ear all the time, too, trying to provide some recommendations there, but not everyone is on the same page, especially with some of these goals, maybe it is protein-related, how much we actually need, that can be very, very challenging to navigate at times.

Lauren Wichman, MD:

And when you probably have many athletes that come in and say, "Oh, well, I know that I need to eat high protein," I'm really curious to hear what your recommendations are for them in trying to particularly talk about some of the other nutrients as well, and so on, and so forth.

Carly Sedlacek, RD:

This is probably where I thrive as a dietitian because, not that I love telling my athletes that they're wrong per se, but it is a really good learning opportunity for them, especially when I can show them raw data or raw numbers of some of these things. Because I do sit down sometimes with my athletes and we do look at numbers. It's not always beneficial for all my athletes to look at numbers because it can become overwhelming, but especially with some of those that might already have a little bit of education related to nutrition, looking at those numbers can be beneficial in terms of just piecing the puzzle together.

So, many times, when I'm calculating somebody's protein goals, I'm looking at, obviously, what are the overall goals? Are there goals related to maybe a position on the field? Maybe there are some athletes, maybe football, for example, that I'm working with that have maybe specific weight goals, for example. So it's where we start our conversation, what do we want this to look like?

Then, we take a look at, what does their weight look like now? Typically, I will take their weight in kilograms and multiply it by a certain factor, and that's how most dietitians will do it. That is based on our academy as far as some of those guidelines there. Sometimes, those numbers can be very similar. For some of my athletes, they'll say, "Well, I've been told if I take my weight in pounds and multiply it by this, this is how much I need to aim for." And sometimes, those numbers are relatively similar to what I calculate for them. But many times, when athletes are calculating that number themselves, not using the strategies that I'm talking through, it's a lot of protein, and sometimes that can be very overwhelming for that athlete.

I think in both cases, sometimes that is something that an athlete will look at and they're like, "Wow, I need to eat a lot more than I think I do." But sometimes they'll take it as, "Oh my gosh, this is too much. This is so stressful, so overwhelming for me." So I'll look at that number in kilograms. I'll multiply it by a certain factor. For most of my athletes, if I'm looking at an endurance athlete, of course, they need some protein, but they might not need as much as someone who is in the weight room a lot more often than some of those endurance athletes. So their protein needs might be a little bit lower versus maybe some of those strength training athletes.

John Horton:

Well, and let's get into a little bit about why athletes do need protein. And I think we all associate it with muscle-building, but how specifically can you break it down for us as to what you're going to get out of it, how it's going to help us, I guess, get bigger, faster, stronger, all the things that we're looking for?

Carly Sedlacek, RD:

So the primary use there, obviously, it's going to be helpful for muscle mass, muscle-building or even muscle maintenance. I think I can even take this into the realm of maybe I have an athlete going through injury recovery and really we're trying to maintain that muscle mass the best they can, especially if they can't exercise as much as they were previously or not able to move as well as they were previously. So that primary use is typically that muscle-building capacity.

John Horton:

All right. So to use your car analogy, we're souping up the engine a little bit more with protein.

Carly Sedlacek, RD:

Exactly. It's a great way to look at it.

Lauren Wichman, MD:

Now, do you have specific recommendations? Because I know there are probably a lot of different sources of protein. Commonly, you'll see it in not only whole foods, but then also powders and supplements, as well as certain enhanced foods like protein [inaudible 00:28:57]. Where do you stand on some of those different sources of that protein?

Carly Sedlacek, RD:

So, similar to fat, and we talked about if some of these fat sources actually have some of these other micronutrients or beneficial nutrients to them. Obviously, food is going to be the best source for us to get if we're looking at protein, protein in particular. Again, because we're not just getting protein.

If we're looking at our animal products, for example, we're finding protein, but we're also getting iron, which can be extremely beneficial for athletes. Iron is a micronutrient that can help provide oxygen to the body, so we absolutely need that if we want to try to improve performance.

If we're looking at maybe some of our plant-based sources of protein, not only are we finding protein, but we might be finding, again, fiber, some of those micronutrients there.

If we're looking at dairy products, we're finding calcium, vitamin D, especially for bone health or bone growth.

So there's lots of different sources out there, so we do want to try to focus on the ones that are more balanced.

When we think about the supplement route, things get really dicey really quickly. Usually, what I'll say is protein powders can be an option to help or protein drinks can be an option to help get the amount of protein that we need throughout the day. But again, coming back to this concept, lots of times, I will calculate that energy need or that protein need. Let's take a look at how close we are to that. Let's look at the protein sources you're actually consuming. Are you getting an animal product here? Animal products tend to have the most protein versus plant-based options. If we know that 3 ounces of an animal product is anywhere from 20 to 30 grams of protein, you might be in a better spot than you think you are. You might not need that extra supplement. You might not need that extra protein drink.

So I think it comes down to, yes, obviously trying to choose that, again, the best services for the car, but also looking at what does this base look like? How do we need to adjust to help or how do we need to adjust to create the best base possible for nutrition for you?

John Horton:

Do you give different protein recommendations depending upon where you're at in the season? Is this something that you do a little bit heavier early and then as the season goes on, maybe you cut it back a little bit or what is the pattern?

Carly Sedlacek, RD:

It's a really good question. I think, again, it's dependent on the athlete. I think definitely if I have an athlete that is trying to build muscle mass per se, yes, protein needs might be a little bit higher preseason. During the season, we might work our way down.

The biggest concept with protein that I feel I touch on most with athletes is we need protein throughout the entirety of the day. So we don't want protein just after exercise or just at dinner time. We need it throughout the entirety of the day to help regulate metabolism. And that's really how the body likes to utilize protein as a recovery tool. We have done some research showing that you could have someone who consumes a mass amount of protein at one meal, but lots of times that just leads to upset stomach, don't feel very well. So I think in terms of looking at that amount and how we actually set that up, it might change a little bit. It might be fairly similar. Again, I think it does depend on where we're at in the season or maybe even what goals look like at that point.

Lauren Wichman, MD:

Similar to what we just talked about with fats, is timing for protein important considering how soon you're about to compete?

Carly Sedlacek, RD:

Yeah. So protein timing, especially after exercises is where we try to focus a little bit more on. There used to be these really rigid guidelines as far as protein after exercise. Within a certain window, this is where we see the most recovery, and we've debunked that.

With my athletes, I do try to say as soon after exercise as possible, we should be trying to have something because that is really what starts that muscle recovery and muscle growth period. So for example, let's say that I have an athlete that's going in, finishing up their session, maybe their practice session, and then maybe afterward, they're going into a lift session and then after that they're going to another, and there's just so many things going on. We have to plan ahead for those things. So typically, after exercise, I will say, "We want to try to aim for anywhere from 20 to maybe 40 grams of protein."

So if we were thinking about different sources that would fit in there, that could be 3 to 6 ounces of an animal product, so chicken or some sort of meat, for example. Obviously, pairing this with the carbs, the fats, having the whole balance there. If we were looking at some of those quick sources, again, maybe this is a spot where protein shakes or some of those supplements are actually beneficial, especially if we have an athlete that isn't able to make it to a dining hall to get a meal or isn't able to make it home to have something prepared. Some of those protein shakes fit right in that recommendation, too, that 20 to 40 grams of protein. So yes, timing does play a huge role. It's not as intense as we used to set it up to be, but for my athletes, for their sake of that recovery, we're trying to get a plan as far as getting it in as quick as possible if we can.

John Horton:

If athletes are shortchanging their protein intake, what do you see? Are they a little more sluggish? Are they more apt to get injured? What are the concerns you might have there?

Carly Sedlacek, RD:

So definitely the big concern I always have is injury because no one wants to get injured during the season. That's no fun. So that's one of my biggest concerns that I have. When I see an athlete isn't getting enough protein, maybe the muscles aren't able to recover as well as they need to. Sometimes, I actually see this in the case where an athlete is actually overdoing protein and not consuming enough of carbohydrates, for example, the same concept of recovery might not be very well for us. We might end up having to use protein as an energy source at that point if we don't have enough of those carbohydrates. So lack of recovery is a big one. With protein, sometimes we see that can lead to athletes getting sick a lot easier. I think a lot of those immune types of things and definitely the recovery and injury piece would be big focuses.

Lauren Wichman, MD:

Animal products being such robust protein sources, do you have any specific recommendations for athletes that may have dietary preferences or restrictions, vegetarian, something like that?

Carly Sedlacek, RD:

So this is one I talk about pretty often, especially because I do have athletes that don't consume dairy for one reason or the other, whether it's lactose or maybe they just don't feel like they digest it very well. We are looking at some of these different sources of protein. If we're still in that supplement route, we do have plant-based options of powders and beverages. Sometimes, this is a really good opportunity for athletes to try something new within their diet from a food standpoint, which again, sometimes a hit or miss depending on the athlete that I'm talking to, and might also come down to, are they visiting a dining hall or are they able to go to the grocery store? What do they have access to?

But one that I've been talking to some of my athletes a little bit more frequently, we're talking about edamame, for example. "Let's go get a bag of frozen edamame from Aldi. It's $2. Let's roast that. We can use it as a high-fiber, high-protein snack for you after exercise." So I think there's lots of opportunities to push the scope in lots of different directions, again, from a performance standpoint. But let's try new food too. Let's open up your taste buds a little bit.

John Horton:

Well, Carly, I feel like we just got the whole nutrition 101 thing that you give athletes, and we don't have to go through two a day, so that's a pretty good setup. Now, I know we all think of college athletes as these finely tuned machines with everything they're doing, but you said a lot of times that those engines, they're knocking and pinging and things like that because you're dealing with some nutritional deficiencies. Where do you see these deficits the most, and what are the most common ones?

Carly Sedlacek, RD:

The ones that I tend to look for a lot … one of my questions I always have in one-on-one sessions with my athletes is, "How are your energy levels?" Because that tends to tell me a lot of information right off the bat. That can tell me a little bit about how their dietary information is matching up with performance, but it can also give me a little bit of intel. Well, if energy is not right, is this something related to maybe an iron deficiency or maybe it's related to a vitamin D deficiency, especially if I have someone who might have a history of stress fractures or some sort of bone-related injury? I love being a dietitian because this is where I start to become a little FBI agent. I start to ask some of these specific questions about that energy level.

Someone notices that they have a low energy halfway through exercise. All right, well let's explore what does the beginning of your dietary intake look like? Or are you taking any vitamin supplements? Have we got any blood work on you since you started taking X, Y or Z? Occasionally, I will have an athlete that I see that they actually started an iron supplement because their iron was so low, maybe it's not enough iron, maybe we need to reevaluate that dose. So energy is the first one that I look for.

I had mentioned this previously, but sometimes we'll see it in terms of some different signs, symptoms. If we are noticing iron deficiency, maybe it's related to we're seeing hair breaks a little bit easier or nails break a little bit easier, maybe someone feels cold all the time. There are some signs and symptoms we can look for as well.

Lauren Wichman, MD:

And this is something that Carly and I collaborate on really closely when it comes to some of the medical side of sports medicine and what can be affecting performance in a negative way. We collaborate when we are ordering that blood work to figure out, there are multiple different things, whether it's iron, whether it's thyroid, whether it's a couple of different things that can contribute to fatigue, so investigating and figuring out what path we need to go on, but many times it can be a mismatch of that energy. And if our athletes aren't taking in enough energy compared to what they are putting out, there's actually even a medical concept called “relative energy deficiency in sport,” which is something we may do a whole episode on in the future, but it can have multi-organ and multi-system effect with performance in sport being a huge piece of that.

John Horton:

Carly and Dr. Wichman, both of you, I know you work so closely with so many different athletes. Do you have any examples you can give of where you've had an athlete who's just really been struggling and you make a little fine-tuning to their diet to maybe address one of these deficits, and it's like boom, all of a sudden they're back at it? They're totally overachieving.

Lauren Wichman, MD:

I think iron is probably one of the most common ones. I could name multiple different cases of athletes that are low iron, and it can be due to a multitude of factors, whether they are like, "I don't like meat," and that's where I can get them over to Carly to say, "OK, what else can we give you?" There are other sources of iron besides meat or other things that may not be necessarily entirely in their control. One of the most common things I speak to a lot of my female athletes is you can lose a lot of your iron through your period. And if you have particularly heavy periods, that's not always in your control, something that we can work on from the medical side of things. But if you are losing a lot of iron in that setting, that's where it is so helpful to meet with somebody like Carly to say, "Your iron needs are going to be higher." And when we can make that small change, they feel vastly better.

Carly Sedlacek, RD:

I would 100% agree with that. I've seen lots of individuals this year training for half marathons, full marathons, and along those same lines, maybe we don't notice something at first, maybe the first few weeks we don't necessarily notice these huge changes, but maybe throughout that training cycle, we're coming up on our eight-mile run on Saturday, we talk about this concept of carb-loading, getting more of those things in, and they come back to me on Monday and they're, "Wow, I felt great. I felt like I could..." Sometimes, they're a little too excited and they'll say, "I could have ran so much more than that." Let's stick to your training cycle. We'll be all right.

But yes, those are my favorite visits is when an athlete will come back and say, "I implemented X, Y and Z, and I just feel so much better."

John Horton:

It's one of those things where we all eat throughout the day. I mean, three meals, snacks, whatever else, and I don't know if we often just totally connect what we're putting in with what we're doing and how it affects that performance. And it sounds like you can really see some drastic changes if you tinker with it a little bit and make sure you're getting those carbs, the fats, the protein, all at the levels that you need.

Carly Sedlacek, RD:

And sometimes, it can be really tough talking about those things. Again, depending on the person that I'm talking to, maybe they have different experiences, that maybe this is their first time moving away from home, and now they're in a school where they're introduced to all different kinds of foods, they're cooking on their own. It can be a little bit tough to have athletes buy into this concept. Whereas, maybe in high school, they didn't need to do X, Y and Z. Their bodies are consistently changing, they're consistently growing, and we can't just utilize that same amount of fuel forever. We need to be increasing if we have some of these specific goals. So the buy-in sometimes can be the most challenging, and there are some days I wish that I could just pull another patient or another athlete that I've seen before that did all the things and, "Look, this is what we could be doing right now if we could just start to work a little bit toward that direction."

Lauren Wichman, MD:

Well, and for our college athletes, especially the ones that are transitioning from high school to college, the workload is just at a whole other level. I remember that transition from high school to college, and for a lot of our athletes, their parents are making their food, and then now, they're in charge. And like you said, not only are they balancing a challenging sports and academic schedule, but they're trying to navigate, "OK, when do I have time to go find those foods in the cafeteria? Oh, well, I guess I don't have time. Maybe I'll just skip it." And that can really be detrimental for them more than they realize.

Carly Sedlacek, RD:

And my comment is always, "Come see me. We'll talk about it. We'll figure it out. I promise."

John Horton:

Do you find, is it tough to get them to buy in? Because I know when you're young, I mean, you feel like you can eat anything and you burn it, you don't feel bad. A lot of times, you just keep going. As you get older, you realize you can't do that, but when you're young, sometimes you just feel like you can do whatever. How do you really impress on them that, "Hey, it will make a difference, and it might just be that little edge that you need to make the play or do everything that you want to do on the field"?

Carly Sedlacek, RD:

I really try to get a good connection with every athlete, especially if I'm seeing them one-on-one in that setting. I really try to get to know them well and what will actually help promote more of that motivation. And as a dietitian, I'm using a lot of motivational interviewing skills. "Well, why are there some barriers here?" Or "In the past, what types of things have worked for you?" Or again, maybe I'm pulling data at that point, pulling research if I have some of those more analytical students that want to actually see those results. Sometimes, to create that connection, sometimes I'm talking about my own experience. I do run half marathons. I am not a D1 athlete by any means, but I do find it sometimes helpful for them to hear it from somebody else. Me talking about, "Well, when I was in college and I would run, these are things that were really helpful for me."

Sometimes, I think being able to relate to the athlete in some way can be really beneficial because I think, as an athlete, especially in that D1 setting, they're almost always in a performance state. Whether it is out on the field or maybe just at school, eyes are constantly on them. Sometimes, they just need someone to be able to relate to them as a human being, and sometimes that's how I can push the motivation.

John Horton:

Well, let's bring everything we've talked about together now and start putting our plates together. It's time to chow down, man. We want to get the food in, and we want to do it in the best way possible. So Carly, when you start working with athletes and telling them, "Hey, this is how your plate should look or how your meal should look," what advice do you give?

Carly Sedlacek, RD:

So our number-one first stop is looking at some sort of guide or thinking about this concept of accountability. “How do I know I will be meeting my needs if I do X, Y and Z?” And the first step that I always take is, I'm a very visual person, so maybe it's my own willing or doing, but I do find it's beneficial for athletes to visually see something and say, "Oh, this is what my plate is supposed to look like." So the International Olympic Committee has created what we call our athlete plates, and they're a spinoff of MyPlate®, which gives you a general big picture, how should we be setting up our meals. MyPlate shows us half our plate is fruits and veggies, a fourth of our plate is proteins, and a fourth of our plate is starch. When we look at it from an athlete standpoint, we need to maybe alter those things. Again, the exercise is a lot more intense. To Lauren's point, they're not only putting hours in on the field, but also in a classroom setting. They're burning a lot of energy on a day-to-day basis. So typically, I'm looking at these athlete plates — and there are three of them. I tend to not use the easy plate as often. The easy plate is basically what my plate is. Half that plate fruits veggies, fourth plate protein, fourth plate starch. Sometimes, I'll tell my athletes, maybe very, very end of season, maybe season just ended, maybe we're focused on that if there's not a ton of exercise going on. But most of my athletes are going to be in more of this moderate to hard training periods. So that moderate training is going to look like a third of our plate carbohydrates versus a fourth of our plate. It's going to be a third of our plate veggies and a fourth of our plate protein versus maybe our hard training, now we're half plate carbohydrates, fourth plate protein, fourth plate veggies.

So it can change depending on what that intensity looks like. So that's where I start those visits as far as, "Let's put this all together, what should this look like?" We take a look at those two plates, and honestly, sometimes I'll have an athlete tell me, "Based on these two plates, do any of your meals look like this?" And again, that can give me an inside view, are we missing things or where do we need to add?

John Horton:

I was surprised when you brought that up, that all the changes were pretty much carb-based. I was expecting the protein to go up, maybe I've just heard too much of the protein, protein, protein pitch that you hear all the time, but it does seem like, if you're going to be a high-functioning athlete, it's all about the fuel. I mean, you got to get those carbs.

Carly Sedlacek, RD:

Absolutely. And when I talk about the protein with those plates, it can look a little bit different for that fourth plate. Maybe that fourth plate is technically 3 to 6 ounces, so maybe it's not as small as they think it is. But again, with that carbohydrate source being the body's main source of energy, we want to make sure that's the one that we're prioritizing the most.

Lauren Wichman, MD:

Are there specific patterns or things that you see from most of your athletes that are more common that need to be fixed?

Carly Sedlacek, RD:

Yeah. I think I could go lots of different directions with this question. I would say, again, when I phrase the question of “How do these two plates look like versus maybe dinner time,” let's say exercise was before dinner, a lot of times they'll tell me, well — maybe again, depending on who is cooking the meal, we can go from that concept, mom and dad are cooking the meal and maybe carbohydrates are low. And again, that's because they're following mom and dad's plate or mom and dad don't know maybe how much energy that athlete needs.

Or maybe it's one of my athletes that don't like our fruits and veggies as much. “I would love to see you at least get one veggie in through the day, get some of those antioxidants that can really promote recovery.” So it can look a little bit different.

I have some athletes, I guess, looking from the protein, and maybe they don't like animal products. That can be really challenging when they're in a setting such as a dining hall that might not have the options that they're used to at home.

So it can really depend athlete to athlete, which is why we say nutrition is so individualized. It's really hard for an athlete to come to me and say, "I want you to make me a meal plan," when I know it's going to be so individualized for them.

John Horton:

What advice do you give them to navigate the cafeteria? And I feel like this is something that our high school athletes could really benefit from also.

Carly Sedlacek, RD:

So I think lots of times, what I'll say to start with is, "Let's get our visual right. Should we be aiming for an easy, a moderate, a hard training plate? What should that visual look like? And let's break this down into sections if we're in the dining hall. Is there an option for starch for you? Is there a pasta? Is there a rice? Is there a potato? Is there a protein option? Can we add a fruit or veggie to that?" Maybe for example, those components might not look as balanced as we might want it to. So for example, let's say someone's going to the dining hall and they hate absolutely all the options besides the pizza. All right, well, let's use pizza as our base here. We do get carbohydrates there, great, but can we add some sort of protein source? Can we add a veggie source? Can we still create balance here even if it doesn't look exactly like that plate does?

So I think it's all about looking at what's available, but being realistic with the athlete. Again, I think that's where you get that buy-in from athletes as well as you've got to work with what you have and sometimes it doesn't look exactly how we want it to, but how can we make it in a way that it's still going to be beneficial for performance for you?

John Horton:

What about fast food? Because as we all know, I mean, you're younger, you're hitting those joints a little bit more. What advice do you give them as to where they can still go and maybe get the most out of it? Yeah,

Carly Sedlacek, RD:

So a lot of times, with my athletes, again, it's such a learning experience sometimes when I go, and especially with our group sessions, and maybe we'll pull up the menu of a fast food place together and I'll tell them, "You could actually look at this information before you go, so you don't have to make a stress decision or a rash decision of if you don't know what they even have available. Let's look at the options before you go so you feel more confident in terms of ordering what's going to be best from a performance standpoint for you." So lots of the options at many of your places can still fit into balance here. So a big one that I'm talking about with athletes, Chick-fil-A, because it's, well, it's my favorite, it's most people's favorites. You can get a lot of things at Chick-fil-A, right? I mean, as far as that protein source, it's probably going to be chicken, which we have the option.

John Horton:

Odds are, yeah.

Carly Sedlacek, RD:

We have got the option for fried or grilled. If we were trying to choose a better option there, grilled is going to be a little bit better. It's going to have less of that saturated fat, which is going to provide a lot more benefit in terms of overall health. Let's say that we are doing the grilled nuggets, but maybe I have someone that really loves the Chick-fil-A fries. OK, well then here's our starch. Can we also get a fruit cup with that? How do we add to this to make it more nutrient dense? I think a lot of times, that's how I'm phrasing it to athletes, especially if we're in a situation where we're not typically eating out, but this is what the plan is, how do we add more to that without taking away maybe some of that opportunity to enjoy foods?

Because again, when we think about nutrition, food should be enjoyed. It should not feel like a chore. It should not feel like a task, something we have to do. It's something that we do want to try to enjoy. But again, how do we get the most bang for your buck? How do we get the most nutrition in here so it's still beneficial for us?

Lauren Wichman, MD:

And I know you just mentioned some of the most rewarding and helpful sessions are group sessions, and I know that you have actually taken some of our teams to the grocery store to walk them through what may be good options on the shelves for them. Can you tell us a little bit about that experience?

Carly Sedlacek, RD:

Yeah, absolutely. I will never forget that entire experience. It was the most fun I've ever had and probably the most perfect group to do it with. So we took the Cleveland State boys’ golf team to ALDI, which is my favorite grocery store for several different reasons. But again, if we're thinking about this college setting, it is a lot more affordable than some of your other grocery stores. And really, you can get a lot of nutrient-dense, beneficial foods, things that might not take a ton of time to put together. So before going to the grocery store, we did have a general session — what types of things should we include? We even took it a step further as far as let's start to look at nutrition labels. Obviously, looking at the carbs, fats, protein, very important, but let's get a little bit more specific with fats. How much saturated fat is in this product? How much added sugar is in this product? If we were thinking about using this product before exercise, is this a good option based on the nutrition label that we're looking at?

Again, going with all boys, running through each section, of course, we had to step in the candy aisle as well and look at all the things, which again, so much fun, but I think it was a really helpful way for them to actually think about, "OK, I can do this. Now that I've been in a grocery store..." Because some of them just have never been in a grocery store or just never take the time to actually look at things. "Now that I have this knowledge, now that I'm looking at these things, now that I know what would be the most beneficial for me, I can do this on my own." It's not as scary as it seems like it is because sometimes … I mean, I don't know about you guys, sometimes you walk in a grocery store, it is overwhelming depending on when you go and who's all with you.

John Horton:

Given that, do you advise them to go in with a plan like, "Hey, I want to make sure I get this many proteins and certain ones in mind, this many carbs," all that?

Carly Sedlacek, RD:

Absolutely, yes. That was one of our main things before going in is, "Let's create a grocery list. What do we need? What are we going to..." A lot of times, when I'm putting together my own grocery list, I'm thinking about the fact that I'm probably going to need at least two meals that I'm going to make this week. Maybe I'm going to use those leftovers into the lunch or dinner or switch it around for myself. So we took that approach going into the grocery store. "What all do you guys need for the week? How many meals do you actually need to plan for?"

Realistically, maybe some of them are traveling to a tournament, so they're not going to be home for a certain period of time. If we know that, then maybe that means that we are planning to make one big meal and we're portioning it out for certain days, and then on those other days where maybe we'll have enough to make that last portion, or maybe that means that we need to focus on something, maybe it's some sort of frozen option that, again, coming back to this concept of adding nutrition to that, maybe that's something that we're utilizing so that we're not over under-purchasing things, that coming into this concept of budget, what does that look like, too?

If we know, for example, we need X amount of proteins, does it make more sense for us to get into the frozen section? Maybe we're going to get frozen chicken breasts versus our fresh options. Maybe that means that fruits veggie-wise, again, do we need frozen options because you're not going to be here this amount of days? So those bananas that were once yellow and beautiful are going to be very, very brown when you come back.

John Horton:

They go in a hurry.

Carly Sedlacek, RD:

Absolutely. So yes, I think going in with a plan is huge and especially it was in that case, but again, obviously, can't plan for every situation.

So the ALDI aisle, the fun aisle, is always one that can maybe throw your list for a little bit of a loop by the time you get to that one.

John Horton:

So we've covered so much here today, and we're going to wrap everything up as to the key points that we want athletes to take away from this, as to how they can, I guess, rethink how they're eating and their nutrition to really optimize their performance. So I guess, Dr. Wichman, if you want to start, what would be the main things you would want people to take away from this discussion?

Lauren Wichman, MD:

I think one of the biggest things that I see really commonly in athletes is we're really, really good at focusing on training in our sport. It's the nitty-gritty of putting in the hours for practice, watching film, doing all of those things. And I think that nutrition probably isn't a huge consideration for a lot of people. And I hope by the end of this episode, our athletes realize how big of a piece to the puzzle that it can be and how truly influential it can be on performance and injury prevention. Because if we're not getting those quality nutrients and enough of those quality nutrients, we can be in a bad spot.

John Horton:

I mean, there's a reason why pro athletes have their own personal chefs, right? It's because nutrition does make a huge difference.

Lauren Wichman, MD:

It can be that extra level up.

John Horton:

And Carly, we're all on your roster here. So what do you want us to take away from here as you say goodbye and send us off to the store to do our shopping?

Carly Sedlacek, RD:

Well, I would say first of all, obviously, always getting your nutrition information from a trusted source. So preferably, a registered dietitian that has some sort of credentialing or background there. But again, thinking about these concepts of being realistic, thinking about what your goals are, how can you get nutrition in the most efficient way possible for yourself? And putting everything into practice. Like Dr. Wichman said, I mean, nutrition is such a big piece of the puzzle and you can do all the things. You can put in all the hours for practice, you can put in all the hours for PT, but if this big puzzle piece is missing, it's not going to allow you to get to the performance or the top that you want to get to. So I'm hopeful that that'll be an influential part of this episode for individuals.

John Horton:

Well, it sounds like it can really be the key to take your performance to that next level. And I mean, if you're competing, that's what you're shooting for. I mean, you want to be the best you can be, and it sounds like adjusting your diet in a healthy manner and really thinking through what you're eating is a great way to accomplish that.

Lauren Wichman, MD:

Absolutely.

John Horton:

All right. Well, Carly, thank you so much for coming in here. I'm glad we could break you away from all the teams that you work with. I know, especially this time of year, you said it's really crazy, but thank you for giving us a little glimpse behind the curtain as to what these college athletes are hearing and how they're going about getting all their meals together.

Carly Sedlacek, RD:

Thank you so much. I appreciate you guys having me.

Lauren Wichman, MD:

Thanks for coming, Carly.

John Horton:

So Dr. Wichman, I have to say, after talking with Carly, 1) I feel like I'm about ready to suit up and go out and compete. But 2) I'm just really amazed at how simple she makes it sound. I mean, this nutrition to fuel your best performance is really pretty basic when you get down to it.

Lauren Wichman, MD:

I feel like nutrition can be such an intimidating topic, and like we touched on in our conversation, there are a lot of different sources and people and things that may be coming at you that this or that are your best nutrition recommendations. And the fact that we got to hear from such a reliable and incredible source like Carly and hear what she gives those college athletes at the beginning of the year, those basics, breaking it down in that way, that was just such an incredible overview.

John Horton:

Well, and I love how she gets it broken down as simply as looking at your plate and figuring out what type of food is covering what portion of it. And it can be as easy as that to make sure you're fueling your body in the right way.

Lauren Wichman, MD:

And that can apply to so many different athletes. Like she said, you can look at it from a moderate to a hard training level, but that applies to the football lineman and the cross country athlete and everybody in between.

John Horton:

And it sounds like if you're not hitting your marks on this, you're going to see it in your performance. You're going to be a little sluggish, you're not going to have the energy that you need, and that's how you end up falling behind.

Lauren Wichman, MD:

No doubt. And that's where I think, hopefully, the education that we take away from today with those basics helps to prevent those dips in performance and prevent nutritional deficiencies and potential injuries that we see on a regular basis.

John Horton:

Well, I think people definitely learned a lot if they listened through this whole thing. So I think they're in a good spot now.

Lauren Wichman, MD:

Absolutely.

John Horton:

All right. Well, if you liked what you heard today, please hit the subscribe button and leave a comment to share your thoughts. Until next time, play hard and be well.