CALCIUM

A variety of foods contain calcium. Foods with the highest amounts of calcium per serving include milk and milk products, calcium-fortified milk substitutes (e.g., soy, almond, rice, oat, etc.), calcium-fortified orange juice, tofu packed in calcium brine, canned sardines with bones and coffee lattes, mochas, cappuccinos, etc. Foods with lower amounts of calcium per serving include shrimp, canned tuna, broccoli, dark green leafy vegetables, almonds, dried figs, beans, chickpeas, kiwi, oranges, and fortified cereals (check labels).

Recommendations for daily calcium intake:

Individuals aged 9 to 18, need 1300 mg of calcium per day, which is equal to approximately 4 servings of dairy products or the equivalent of calcium-containing nondairy foods and beverages (see below for suggestions and quantities). After the age of 19, calcium requirements drop to around 1000 mg/day (~ 3 servings of dairy products or the equivalent of nondairy alternatives). During periods of pregnancy and breastfeeding, and after menopause, needs rise to around 1500 mg. Athletes who previously menstruated and have been diagnosed with amenorrhea (3 or more missed periods in a row) may be encouraged to consume 1500 mg/day until their menses are restored. Significantly underweight and/or undernourished individuals may are encouraged to consume 1500 mg of calcium per day until they are weight restored.

Up to 90% of "peak bone mass" Is acquired between the ages of 18 to 20, but bone mass can continue to increase until around age 30. You have this last window of opportunity to get as much calcium into your skeletal frame as you can. Three servings of dairy products per day would only get you to about 900 mg, and for many individuals, even getting that much is a challenge. If you can get your intake up to 4 servings of dairy (or the equivalent of nondairy alternatives), you're doing just fine! If you are in the range of 3 or less and are consuming an adequate amount of calcium-fortified foods and/or calcium-containing nondairy alternatives, your bones are thanking you. Anything lower than that means you should start thinking about increasing your calcium intake in order to prevent problems of stress fractures and osteopenia (loss of bone tissue, which can eventually lead to osteoporosis, a more serious condition, and often irreversible).

If you’re unable to consume adequate calcium from food and beverages, a calcium supplement may be warranted. Always consult a health care professional (primary care doctor or registered dietitian nutritionist) before deciding to take a supplement since supplements are not regulated by the FDA. Your health care professional can work with you to determine the appropriate amount to take, the best time(s) to take it and the best brand. Calcium supplements are available in the Brown Health Services pharmacy on the 2nd floor.

There are a variety of dairy  products to choose from. Try different ones to see which ones you like best. If you find you don’t care for them try other nondairy calcium-rich alternatives and enjoy the ones you like in order to meet your calcium needs. If you have lactose intolerance you can easily find lactose-free versions of milk in Brown's Dining Services. You can also purchase low lactose or lactose free milk and other dairy products in local markets. Try taking a lactase enzyme tablet or two (available in local pharmacies) right before eating a regular dairy product, to ease digestion. No need to miss out on late night pizza parties!

What is a serving of dairy?

A serving of dairy is equal to approximately 300 mg of calcium. Below is a list of foods and beverages that supply this amount of calcium.

• 1 cup milk or nondairy calcium-fortified milk (soy, rice, almond, oat, hemp, coconut, etc.)

• 1 cup calcium-fortified orange juice

• 1 cup yogurt or nondairy calcium-fortified yogurt (i.e. soy or coconut)

• 1 ½ ounces hard cheese including cheddar, mozzarella, Swiss, Parmesan

• 1/3 cup shredded cheese

• 2 ounces processed cheese such as, American cheese

• ½ cup ricotta cheese

• 2 cups cottage cheese

If you choose a non-dairy milk alternative, it’s important to note that other than soymilk, they do not contain notable amounts of protein.

There are also nondairy sources of calcium; however, they contain less calcium per serving.

Weight bearing activity and bone health

"Weight bearing exercise" (e.g., walking, running, tennis, soccer, basketball and especially strength training with weights) also contributes to a strong skeletal structure, but cannot make up for an inadequate calcium intake, which only you can provide.

Milk and athletic performance: Debunking the myths

There are several myths that seem to keep circulating about milk's effects on athletic performance. Nancy Clark, Boston area sports dietitian nutritionist and consultant for pro and amateur athletes, writes about some of these "Milk Myths" in her book Nancy Clark's Sports Nutrition Handbook.

• Drinking too much milk leads to calcium deposits - For most healthy people, this is not true. If you take in more calcium than your body needs, you will simply excrete it.

• Milk causes "cotton mouth" - Again, this has not been shown. This feeling in the mouth or throat is usually caused by not getting enough fluid before exercising, or by being nervous or anxious before a competitive event.

• Milk is hard to digest and will cause cramping and bloating - Milk and yogurt are actually very soothing and easy to digest, unless you are lactose intolerant. If you are, there are many lower lactose and non-lactose alternatives available.

• Drinking more milk than normal will speed healing of fractures - Unfortunately, this is not true. Continue with your healthy, balanced diet, have patience, and set up a good plan of rehabilitation from your physician and/or trainer. Six to 8 weeks is usually the time frame for most fractures to heal. 

Weight bearing activity and bone health

"Weight bearing exercise" (e.g., walking, running, tennis, soccer, basketball and especially strength training with weights) also contributes to a strong skeletal structure, but cannot make up for an inadequate calcium intake, which only you can provide.

Milk and athletic performance: Debunking the myths

There are several myths that seem to keep circulating about milk's effects on athletic performance. Nancy Clark, Boston area sports dietitian nutritionist and consultant for pro and amateur athletes, writes about some of these "Milk Myths" in her book Nancy Clark's Sports Nutrition Handbook.

• Drinking too much milk leads to calcium deposits - For most healthy people, this is not true. If you take in more calcium than your body needs, you will simply excrete it.

• Milk causes "cotton mouth" - Again, this has not been shown. This feeling in the mouth or throat is usually caused by not getting enough fluid before exercising, or by being nervous or anxious before a competitive event.

• Milk is hard to digest and will cause cramping and bloating - Milk and yogurt are actually very soothing and easy to digest, unless you are lactose intolerant. If you are, there are many lower lactose and non-lactose alternatives available.

• Drinking more milk than normal will speed healing of fractures - Unfortunately, this is not true. Continue with your healthy, balanced diet, have patience, and set up a good plan of rehabilitation from your physician and/or trainer. Six to 8 weeks is usually the time frame for most fractures to heal. 

VITAMIN D

What Is Vitamin D?

Vitamin D is a unique fat-soluble vitamin and is known as “the sunshine vitamin” because it is produced when skin is exposed to UVB light. Therefore, vitamin D levels are likely to be lower in athletes who live in areas with less sunlight, those who train in the early morning, evening, or inside, those with a dark complexion, and those who wear protective clothing or sunblock. In addition, the older you are, the less vitamin D your body is able to produce from exposure to UVB.

The Benefits of Vitamin D

The benefits of optimal vitamin D levels are staggering. A review of the latest research on vitamin D3 has shown that it may enhance athletic performance and lead to multiple physiological enhancements. Sufficient vitamin D levels:  

• reduce exercise-induced inflammation

• optimize energy and bone health

• influences skeletal muscle repair and remodeling

• positively effect muscle strength

• reduce risk of cancer

• boost immunity

• impact neurological function, cardiovascular health, and glucose metabolism

• may increase aerobic capacity, muscle growth, force and power production

• could decrease recovery time from exercise

Vitamin D Deficiency

Surprisingly, approximately 88% of the world’s population has inadequate vitamin D levels. Deficiency has been shown to be associated with a variety of adverse psychological and health consequences, such as suicidal thoughts, depression, cognitive decline and neurological impairment, increased risk of cancer, and increased risk of bone fractures. Deficiency also breaks down muscle tissue, resulting in weakness. Because of the increase in enzymatic activity of exercise, athletes may be as susceptible, if not more susceptible to becoming vitamin D deficient when compared to the general population.

How Can I Get Sufficient Vitamin D?

Vitamin D is naturally present in only a few foods. The best sources are fatty fish such as salmon, tuna, and mackerel. Small amounts of vitamin D are found in beef liver, cheese, egg yolks, and mushrooms exposed to sunlight. Some foods may be supplemented with vitamin D such as, milk, yogurt, cereal, and orange juice. Athletes typically consume only small amounts of vitamin D. Therefore, vitamin D supplements may be warranted; as always, discuss the use of supplements with a qualified health professional.

In the Northeast United States, your body can produce vitamin D from April through October.  To obtain adequate vitamin D during these months you can receive sensible sun exposure (at least 3 times a week with arms, back and legs exposed between the hours of 10 am and 3 pm).  While it is advantageous to get vitamin D from sunlight, we have to keep sun safety and skin cancer prevention in mind as well. It takes about 15 minutes after application for sunscreen to become effective. So if you apply sunscreen immediately before going outside, you can soak up some vitamin D safely in the first 15 minutes of sun exposure.

How Much Supplemental Vitamin D Do I Need?

If you you typically receive little sun exposure and do not consume vitamin D-containing foods on a daily basis, you may want to consider a daily supplement of 1000-2000 I.U. vitamin D3 (should be taken with food for best absorption).  Please note: It is advisable that you have your plasma vitamin D level tested before taking more than 2,000 IU daily in supplemental form. To learn more about vitamin D and how much you should take in supplemental form based on your current plasma levels, visit the Vitamin D Council’s website.

Supplement Recommendations

Look for a supplement that has one of the following certifications: CL, USP, NSF or Informed-Choice.  These certifications verify that the product has been tested by a third party for quality, purity and disintegration.  Also, look for a supplement that does not contain any artificial colors. Read the ingredient list carefully for any allergies you may have such as, tree nuts, peanuts, soy, shellfish, wheat, or gluten as some supplements can contain these ingredients.

Nature Made and Kirkland Signature are two brands that offer USP verified vitamin D supplements that can be purchased at most grocery stores, CVS and Walgreens. Look for a supplement with a third-party verification symbol such as USP, Informed-Choice or NSF. Just because it’s Nature Made or Kirkland Signature supplement does not mean that it is USP verified.  

For a quick overview of Vitamin D, view this pdf:  SunnySideVitaminD_2016.pdf.

IRON

Iron transports oxygen and manufactures hemoglobin, which are both vital in maintaining energy and good health.

Food sources of iron include meat (especially red meats such as, beef, venison, lamb), poultry, fish, egg yolks, iron-fortified cereals, breads and other grains, legumes, nuts and seeds, dark green leafy vegetables, dried fruits and blackstrap molasses.

Recommendations for daily iron intake:

• 8-18 mg/day

• Upper end of range recommended for those who typically menstruate

The most frequent cause of insufficient iron in the diet is the elimination of red meat from the diet and for some, the monthly loss of iron in the menstrual period. Even though iron can be found in other food sources, the "heme" form found in the muscle of red meats in particular (and to a lesser extent poultry and some fish) contains the highest concentration of the form best absorbed by your body. Nonheme iron found in plants is not absorbed as well as it is from animal sources. However, there are several factors that enhance nonheme iron including:

• MFP factor found in meat, fish and poultry

• Vitamin C – Excellent food sources of vitamin C are tomatoes, oranges and other citrus fruits, strawberries, kiwi fruit, brussel sprouts, cauliflower, broccoli, cabbage

• Vitamin A found in the greatest amounts in carrots, kale, spinach, cantaloupe

• Higher intakes of vitamin C and of fruits and vegetables

• Hydrochloric acid in the stomach

Strategies to enhance iron intake and bioavailability

Below are suggestions for enhancing iron intake and bioavailability.

• Eat lean red meat 3 to 4 times per week

• Enjoy lean red meat, poultry or seafood at meals daily

• Combine the following iron-rich vegetarian foods with vitamin C- or vitamin A-rich foods that are listed above

  • Whole grain, enriched breads

  • Fortified breakfast cereals

  • Potatoes

  • Beans, lentils

  • Peanuts, cashews  

  • Soybeans

  • Eggs

  • Tofu

  • Dark leafy greens such as spinach and chard  

• Cook with cast iron skillets

• If diagnosed with depleted iron stores or with iron deficiency:

  • Avoid or limit added bran or wheat germ to meals and include vitamin C-rich food to help decrease inhibitory effect of phytate, an antioxidant compound that interferes with iron absorption.

• Avoid the following at meal or snack containing iron:

  • Tea, coffee, cocoa, red wine (rich in polyphenols & tannins)

  • Black tea & coffee have 2x as much polyphenols as herb & green teas (similar amount of tannins as red wine)

  • High fiber

  • Chocolate

  • Dairy

• Avoid calcium supplements or antacids within 2 hours of iron supplement or meal containing iron

Iron deficiency

When your blood is too low in iron, this is called iron deficiency anemia. As an athlete, when you become anemic, you usually have a lot less energy as you participate in your sport or activity. The reason for this is because an important function of iron in the body is to form substances in the muscle that help bind oxygen, necessary for the muscle to perform for you. In addition, iron helps to manufacture enzymes that help with the energy-making process.

Dietary causes of iron deficiency

• Inadequate energy intake: most common for athletes

• Vegetarian diets

• Avoidance of iron-fortified commercial foods

• Low intake of vitamin C- or A-rich foods with meals

• Regular consumption of strong tea or coffee with most meals

• Poor food knowledge, limited cooking skills, and reliance on takeaway foods

• Irregular or erratic eating patterns

• Unbalanced diets, fad diets, limited variety of food choices

Athletes are sometimes more likely to develop anemia than less active students. This is because iron is lost in sweat, urine, and feces, as well as in small breakdowns in tissue that occur in the pounding of feet in long distance running and other surface contact. If your eating patterns don't replace these iron losses (e.g., if you are restricting calories or you’re vegetarian/vegan and unable to eat sufficient iron-rich alternatives), you could be at risk for developing iron deficiency anemia. Periodic testing of iron status is often recommended for athletes. You may want to ask your coach or medical provider about this if you have been experiencing fatigue and/or think your iron intakes have been low. A long-term deficiency in iron can markedly affect your performance as an athlete, and if you have developed anemia, the earlier you start treatment the faster you can be back at your peak level of performance. Although iron deficiency anemia is usually not considered a serious illness, full recovery can take from 3 to 6 months. Prevention is certainly preferable to treatment! 

Signs and symptoms of iron deficiency anemia

At first, iron depletion can be so mild that it goes unnoticed. Yet, as the body becomes more deficient in iron and anemia worsens, the signs and symptoms intensify.

The signs and symptoms of iron deficiency anemia may include:

• Extreme fatigue

• Weakness

• Pale skin

• Shortness of breath, fast heartbeat or chest pain

• Headache, dizziness or lightheadedness

• Cold hands and feet

• Inflammation or soreness of your tongue

• Brittle nails

• Unusual cravings for non-nutritive substances, such as ice, dirt or starch

• Poor appetite, especially in infants and children with iron deficiency anemia

If you experience any of the above signs and symptoms that correlate with iron deficiency anemia and/or you lack adequate intake of iron-rich foods (e.g. avoid red meat or are a vegetarian or vegan) it is recommended that you make an appointment with Health Services. Iron deficiency anemia should not be self-diagnosed or treated.

Bottom Line

• Iron deficiency anemia can require 3 to 6 months to reverse – prevention is key.

• Food first – enjoy iron-rich foods combined with vitamin C or vitamin A-rich foods.

• Routine, unmonitored supplementation is not recommended since it may result in deficiencies in both copper and zinc.

  • Note: Hemochromatosis is a genetic disorder that predisposes individuals to a toxic build-up of iron. Because iron supplementation may accelerate the effects of this condition, individuals with this condition should avoid taking supplements that include iron. Check with your primary doctor or registered dietitian nutritionist before taking a supplement.

  • Supplementation is warranted if you have tested low for iron – work with your doctor and/or a registered dietitian nutritionist.  For information on what to look for in a supplement, click here.

Source: Burke, L., & Deakin, V. (2010). Clinical Sports Nutrition. (4th ed.). Sydney, Australia: McGaw-Hill

Many athletes, from high school sports through the pro level, have come to believe that taking some type of supplement, varying from protein shakes touted to build muscle mass to the more controversial steroid-related products, will give them an edge in their athletic endeavors. You may have been encouraged to try some of these supplements by friends, magazine or web site ads, or coaches and trainers. Many of these products are advertised as "natural" and therefore appear to be safe. Unfortunately, there is little guarantee of the safety or even the efficacy of what you are getting. Under heavy lobbying from the supplement industry, a federal law was passed in 1994 that pulled dietary supplements from under the Food and Drug Administration's regulatory authority. This included all vitamins, minerals, amino acids, herbs, and other botanicals. It is therefore practically impossible for you to know, as a consumer, whether what you purchase as a supplement is safe, will do what it says it does, or even contains in the bottle what it claims to have.

When you look on web sites or read articles to do your own research, always beware of studies done by companies or individuals selling products. Look for scientific studies published in reputable journals, not just anecdotal stories. Also be sure the studies were done on humans and not animals - results are not always the same on different species.

If you are a competitive athlete, know that many substances contained in supplements have been banned by the NCAA (National Collegiate Athletic Association) and/or the IOC (International Olympic Committee). You can be eliminated from competition if you are found to have taken these substances, even if you were not aware that the supplement you consumed contained that substance. Banned substances can also exist in foods and beverages that athletes might not even consider supplements. In 2009, for example, the NCAA banned 6 flavors of the Coca-Cola Company's VitaminWater. (Power-C, Energy, B-Relaxed, Rescue, Vital-T, and Balance were determined to containe the impermissible or banned substances taurine, caffeine, guarana seed extract, L-theanine, green-tea extract, ecgc, Rooibus tea extract, or glucosamine.) You can go to the web site of the NCAA to look for lists of banned substances. 

Staying hydrated during your workouts and competition can make an enormous difference on both how you feel as well as how well you actually execute your sport. Yet ignoring hydration needs is one of the most common errors athletes often make in their training regimens. Water is important for many functions in your body, including cushioning your joints and muscles, regulating your body temperature (extremely important for you as an athlete!), bringing all the nutrients to your cells, and removing waste products from the body.

To stay well-hydrated before, during and after exercise or competition, the American Dietetic Association recommends the following:

• Drink plenty of fluids with meals.
• Drink 16 oz. 2 hours before activity.
• Drink another 8 to 16 oz. 15 minutes before activity.
• Drink 6 to 12 oz. every 15 minutes during exercise.
• Drink 24 oz. for every pound of body weight lost after exercise.

In events lasting longer than one hour, performance will likely be enhanced with the use of a sports drink containing carbohydrates and a small amount of sodium.

It is recommended that you occasionally weigh yourself before and after a workout to see how much weight you have lost. This will be fluid loss, and you can figure that for every pound lost, you will need to replace that with 3 cups, or 24 ounces, of water.

You cannot depend on feeling thirsty to know when your body needs water. By the time you notice that you are thirsty, you have lost about 1% of your body weight. A 2% loss of body weight in fluid can actually decrease your performance by 10 to 15%! It is important to get in the habit of increasing your fluid intake routinely if you are active, not just on competition days. During extreme conditions (either hot OR cold weather and at high altitudes), your intake should increase even more, because your body is working harder. Water is usually the best fluid to use for fluid replacement, but if you are involved in an "all day" activity, you should consider a commercial sports drink that has carbohydrate added. A less expensive alternative is to dilute any fruit juice by about half with water. Try drinking your fluid when it is cool, but not too cold - it will leave the stomach more quickly and get into your system at this temperature.

Keep in mind that some juices, high water content fruits (e.g., watermelon, berries, and peaches), and non-caffeinated drinks can substitute for some of your water. Generally it is recommended that at least half of your water needs be met by plain water to spare your kidneys from having to filter out too many extra substances. You can increase your water intake by getting in the habit of always having a glass of water with meals, in addition to low-fat milk and/or juice. You can also carry a bottle of water in your backpack, take water breaks instead of coffee breaks, alternate sparkling waters with other beverages at parties, and drink before, during, and after any physical activity. Also remember than caffeine and alcohol dehydrate you and increase your fluid needs. 

If you are working out in the exercise rooms in the OMAC or the Bear's Lair, you may have noticed from time to time certain students who always seem to be there, no matter what time or day of night you show up. Perhaps you have even made lighthearted comments to them about the amount of time they seemed to be devoting to their fitness regimens. They probably do not view their workout schedules as anything excessive, even though they may have been coming to the gym over an hour at a time, two times a day, every day. Their rationale may have been that they just wanted to "stay fit/healthy," or that they were "in training." Even athletes who are training for the Olympics know the importance of giving themselves a day off every week for muscles and ligaments to rest.

Warning signs that someone is exercising excessively include:

• Rigid rules about exercising
• Anxiousness or restlessness if s/he doesn't follow a usual activity schedule
• Reluctance to change the exercise routine, even when ill, injured, or in need of rest
• Working out more than a coach or athletic trainer recommends
• Eating patterns that are rigid or calculated to exactly match the calories expended on exercise
• Decreased time and energy for relationships, academics, and other activities

All of these behaviors are strong indicators that good intentions for a healthy lifestyle may have gone too far. This person may well be at risk for a sports injury, an eating disorder, or other serious health problems.

You may be questioning how to best approach someone you are worried about. Usually it is not recommended that you focus directly on how much this person is exercising or how little they are eating. This usually puts the person on the defensive and may drive a wedge between the two of you. Keep your comments as statements from your own perspective ("I" statements, vs. "you" statements). An example could be, "I've noticed that you look pretty wiped out after some of these long workouts. I'm concerned. Are you OK? Want to go for a cup of tea when we leave the OMAC?" You may not get a direct or positive response after your first effort, but your words will be heard, and they will know that someone cares and has reached out. Sometimes your voice will be the one that will make the difference, and enable a person who has felt completely alone to begin to feel that there is someone who is there for them. You can also be ready to offer information about some of the resources Brown has to offer students who might want to talk about patterns of compulsive exercise and/or eating concerns. Click on Help at Brown, and Worried About a Friend to learn more.