Implications of a Vegan Diet for Athletic

Performance

Andrea Gorman PhD, RD, LPC Rocky Mountain University of Health Professions

Nutrition Beginnings LLC

Outline

What is vegetarianism?

Health benefits vegetarian diet

Vegetarian diet for athletes

Nutrients needed adequate intake

Strategies for nutritional needs

Academy of Nutrition & Dietetics Position Statement

“It is the position of the American Dietetic Association that appropriately planned vegetarian diets, including total vegetarian or vegan diets, are healthful, nutritionally adequate, and may provide health benefits in the prevention and treatment of certain diseases. Well-planned vegetarian diets are appropriate for individuals during all stages of the lifecycle, including pregnancy, lactation, infancy, childhood, and adolescence, and for athletes.”

Craig WJ, Mangels AR. (2009). American Dietetic Association: Position of the American Dietetic Association: vegetarian diets. J. Am. Diet. Assoc. 109(7):1266Y82

Definitions

Vegetarian- no flesh - maybe dairy & eggs

Lacto Vegetarian- no flesh, but dairy

Ovo Vegetarian- no flesh, but eggs

Vegan- no animal products whatsoever

Craig WJ, Mangels AR. (2009). American Dietetic Association: Position of the American Dietetic Association: vegetarian diets. J. Am. Diet. Assoc. 109(7):1266Y82

Why Vegetarianism?

Ethical concerns

Religion

Health benefits

Vegetarian Diet

Emphasizes whole plant foods:

– Vegetables

– Fruits

– Nuts

– Seeds

– Legumes

– Whole grains

Typical American Diet

90% of calories- processed foods & animal products

Lack antioxidants and phytochemicals USDA Economic Research Service: loss-adjusted food availability (2012)

Health Effects of Vegetarianism

Decreased risk heart dz

Lower LDL

Lower BP

Decreased dx DMII

Lower BMI

Decreased cancers

Decreased body fat

Increased insulin sensitivity

*Craig WJ, Mangels AR. (2009). American Dietetic Association: Position of the American Dietetic Association: vegetarian diets. J. Am. Diet. Assoc. 109(7):1266Y82

*Pilis, et. Al. (2013). Health benefits and risks associated with adopting a vegetarian diet. National Institute of Public Health. 65(1):9-14.

Vegetarian health benefits

Vegetarian or vegan diet beneficial for athletic performance?????

Key Nutrients Possible Deficiency

Protein

Iron

Zinc

B12

Calcium

Vitamin D

DHA

Protein Needs in Athletes

IOM (.8g/kg resistance/endurance)

Studies pro required for vegetarian athletes?

2009 joint position paper recommend higher protein (details next slide)

– ACSM

– Academy of Nutrition and Dietetics (ADA)

– Dietitians of Canada

Joint Paper Recs…

Endurance athletes – 1.2-1.4 g/kg/day-

pro. nec to support nitrogen balance

Intense, prolonged exercise (muscle tears)

Strength athletes - 1.2-1.7 g/kg/day

– Maintain muscle mass

Vegetarians – 1.3-1.8 g/kg/day

– Plant pro= decreased digestibility

– An increase ~10% protein

– 165# (75kg) athlete need 90-135g/day

Position of the American Dietetic Association, Dietitians of Canada, and the American College of Sports Medicine: Nutrition and Athletic Performance. J Am Diet Assoc. 2009;109:509-527

Larson, E. (2010). RD Resources: Sports nutrition for vegetarians. Academy of Nutrition and Dietetics Vegetarian Nutrition Dietetic Practice Group

Protein Quality

Complete protein

– Contains all EAAs

– Animal, Dairy, Soy protein

Incomplete protein

– Lacking 1+ EAAs (LAA)

– Most plant proteins

– Food combining

McDonald L, et al. The Protein Book A Complete Guide for the Coach and Athlete. 1st ed. Salt Lake City, UT: Lyle McDonald Publishing; 2007.

Vegetarian Protein Sources

Type of Protein Matters

Casein -protein synthesis prolonged duration

Whey -initial benefit protein synthesis

– Recovery isometric force

– Postprandial muscle protein growth

Likely a combo beneficial or

Smaller but more frequent ingestion of whey

Martin et al. (2013) Whey Proteins Are More Efficient than Casein in the Recovery of Muscle Functional Properties following a Casting Induced Muscle Atrophy. PLOS One 8 :vol. 9

Hoffman, J; Falvo, M. (2004) Protein- Which is best? Journal of Sports Science and Medicine 3, 118-130

Leucine

3-4 g needed

MFP, eggs Dairy

Soy, Beans, lentils, peanuts

+ Carbohydrate

– Maltodextrin or glucose

Stark et al (2012). Protein timing and its effects on muscular hypertrophy and strength in individuals engaged in weight-training . J Inter Soc of Sports Nutrition 9:54

Protein Timing

Strength analysis 20 studies

Hypertrophy analysis 23 studies

No claim <1 hour consumption protein

– pre/post workout

Schoenfeld, et al. (2013). The effect of protein timing on muscle strength and hypertrophy: a meta-analysis. J. Inter Soc Sports Nutrition. 10:53

Vegan Protein

<2g/kg

Excess- kidneys?, bone, CV health

Whole foods best

– Soy, nuts, seeds, hemp seed meal

Isolated pro powders micronutrient poor

Cancers & Upregulation of IGF

Frank H, Graf J, Amann-Gassner U, et al. (2009) Effect of short-term highprotein compared with normal-protein diets on renal hemodynamics and associated variables in healthy young men. Am. J.Clin. Nutr. 90(6):1509Y16.

Halbesma N, Bakker SJ, Jansen DF, et al. (2009) High protein intake associates with cardiovascular events but not with loss of renal function. J. Am. Soc. Nephrol. 20(8):1797Y804

Bonjour JP. Protein intake and bone health. Int J Vitam Nutr Res. 2011;81(2-3):134-142.

Protein Distribution

2014 Journal of Nutrition

Muscle protein synthesis 25% higher when pro. evenly distributed across breakfast, lunch, & dinner

– Compared to most protein consumed at dinner (total daily protein intake same)

Mamerow MM, Mettler JA, English KL, et al. Dietary protein distribution positively influences 24-h muscle protein synthesis in healthy adults [published online January 29, 2014]. J Nutr. doi: 10.3945/jn.113.185280.

Iron in Vegetarians

Nonheme

– Reduced bioavailability

– Vit C & Carotenes

Reduced athletic performance

Greater in young females

Low Ferritin- Suppressed immune fx

Beard, J. & Tobin, B. (2000). Iron Status and Exercise. Am J Clin Nutr 72(suppl):594S–7S.

Iron and Vegetarians

Intense endurance exercise (running)

– Needs ~30%-70% higher

– loss GI tract & RBC destruction

Low iron status supplements Norris, J. (2013). RD Resources: Iron in vegetarian diets. Academy of Nutrition and Dietetics Vegetarian Nutrition Dietetic Practice Group

Test, esp teens and pregnant Rodriguez, etc. al (2009) American College of Sports Medicine position stand. Nutrition and athletic performance.Med Sci Sports Exerc.Mar;41(3):709-31.

RDIs

Age Male Female Pregnancy Lactation

9-13 8 mg 8 mg

14-18 11 mg 15 mg 27 mg 10 mg

19-50 8 mg 18 mg 27 mg 9 mg

51+ 8 mg 8 mg

Institute of Medicine. Food and Nutrition Board. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc : a Report of the Panel on Micronutrientsexternal link icon. Washington, DC: National Academy Press; 2001.

Difference in Iron Supple

Ferrous and ferric iron salts

Ferrous solubility & bioavailable

>45 mg/day -GI side effects

Fewer GI effects-

– Heme iron polypeptides, carbonyl iron, iron amino-acid chelates, polysaccharide-iron complexes

NIH (Feb 19, 2015) Iron Supplement fact sheet. Retrieved from http://ods.od.nih.gov/factsheets/Iron-HealthProfessional/ on Feb 2015

Zinc

Zinc NOT absorbed readily from plants

– Beans, whole grains, nuts, seeds contain much zinc but also Phytates

Bioavailability enhanced by protein

50% higher in vegetarians Frassinetti S, et al.(2006). The role of zine in life: a review. J. Environ Pathol Toxicol Oncol 25(3):597-610

Vegetarian Zinc

RDA 11mg men; 8mg women

Zinc supplement recommended

– multivitamin/mineral

½ c pumpkin or hemp seeds (5mg) Norris, J. (2014). RD Resources: Zinc in vegetarian diets. Academy of Nutrition and Dietetics Vegetarian Nutrition Dietetic Practice Group

28

B12 & Vegetarians

Plant no significant vitamin B12

Lacto-ovo obtain sufficient B12; vegans at high risk

Low in B12 heart disease

Supplements, fortified foods, dairy, eggs

Small amounts & frequent intervals

– chewable or dissolvable under tongue

Elmadfa I, Singer I. (2009). Vitamin B12 and homocysteine status amoung vegetarians: A global perspective, Am. J. Clinical Nutrition 89(5) 1693s-1698s

Vitamin B12 DRI (non-vegans)

Age Male Female Preg Lact

9–13 yrs 1.8 mcg 1.8 mcg

14+ yrs 2.4 mcg 2.4 mcg 2.6mcg 2.8mcg

B12 Supplement

50+yrs decreased digestion protein anemia

– Gastric Acid

– IF

B12 injections

High doses may also be effective

Butler CC, Vidal-Alaball J, Cannings-John R, McCaddon A, Hood K, Papaioannou A, et al. (2006) Oral vitamin B12 versus intramuscular vitamin B12 for vitamin B12 deficiency: a systematic review of randomized controlled trials. Fam Pract 23:279-85.

Calcium

Increased risk of stress fractures

– 15% of all running injuries

– Decreased BM content & density Exercise Sport Science Review, 2006

Girls 12-19 ~790mg/day

50% adult women < 700mg Exercise Sport Science Review, 2006

*Need 1000mg 19-50yrs, 1200mg 50+ Messina, V. (2014). RD Resources: Meeting calcium recommendations on a vegan diet. Academy of Nutrition and Dietetics Vegetarian Nutrition Dietetic Practice Group

A Review of Calcium & Dairy Intake with Bone Health

58 studies: Relationship b/t milk, dairy, or calcium intake and bone mineralization or fracture

Findings:

– Very low calcium harmful to bone dev.

– Calcium >400-500mg/d not correlated BMD/fracture

No evidence for rec. to increase dairy

Lanou AJ, Berkow SE, Barnard ND. (2005). Calcium, dairy products, and bone health in children and young adults: a reevaluation of the evidence. Pediatrics. 115(3):736-743.

Calcium Sources

300mg 200mg 100mg 75mg 50mg

8oz calcium fortified OJ/veg juice

½c collard greens-ckd

½c turnip greens, kale, broccoli -ckd

½c bok choy mustard grns -ckd

½c vegetar. baked beans

Calcium fortified energy bar

½c calcium fortified tofu

½c soy nuts

2T almond butter, tahini

1 orange

8 oz plant milk (soy, rice, almond, cashew,etc)

1 T blackstrap molasses

½c soybeans

½c textured vegetable protein

½c black, navy, northern beans, chickpeas

1 oz ca fortified breakfast cereal

1 pkg instant oatmeal

½c tempeh 1 pkg instant cream of wheat

5 dried figs 2 T almonds

Sample Menu 1000mg Ca

Breakfast

½ sesame seed bagel with 2 tbsp almond butter

1 cup melon cubes

8 oz calcium-fortified orange juice

Lunch

1 6” pita pocket

½ cup hummus

Sliced tomato and cucumber

Apple

Vanilla wafers

Snack

Smoothie: ½ cup fortified plant milk with ½ cup frozen strawberries

Dinner

Stir fried vegetables with ½ cup calcium fortified

firm tofu, ½ cup bok choy, ½ cup

broccoli, onions, and carrots

1 cup brown rice

½ cup frozen non-dairy dessert with sliced peaches

Calcium Supplements Citrate vs. Carbonate

Citrate superior bioavailability (2.5x calcium carb)

Protection bone loss

Better absorption

Fasting Heller,H, et. al. (2000) Pharmacokinetics of calcium absorption from two commercial calcium supplements. J Clin Pharmacol. 40:1237-12

**Can only absorb ~500mg at one time

Vitamin D Status in Athletes

Requirements

Vitamin D (mcg / IU)

– 15 / 600 (men)

– 15 / 600 (women)

– 100 / 4000 IU (UL)

Two forms:

– D2 (plants, fish)

– D3 (sunlight)

Factors

Outdoor training time

– peak hrs 10-2 pm

Skin color

Geographic location

Dietary Intake

Sunscreen use

Area of skin exposed

Latitude & Vit D Production

Vitamin D & Stress Fractures

Prospective cohort study

6,712 girls 9-15 y/o

Dairy, calcium, vit D intakes FFQ

3.9% dev. stress fracture

Dairy, calcium unrelated risk stress fracture

Vit. D lower stress fracture risk

Sonneville, K., et. Al. (2012) Vitamin D, Calcium, and Dairy Intakes and Stress Fractures Among Female Adolescents. Arch Pediatr Adolesc Med. 166(7):595-600.

Vitamin D

Emerging Research: Vitamin D status during musculoskeletal rehab (injury or surgery)

Barker et al. (2011)

– Vit D influenced strength & recovery in young, following ACL repair

Barker, T., Martins, T. B., Hill, H. R., Kjeldsberg, C. R., Trawick, R. H., Weaver, L. K., & Traber, M. G. (2011). Low Vitamin D Impairs Strength Recovery After Anterior Cruciate Ligament Surgery. J Evid Based Complementary Altern Med, 16(3), 201-209.

Sports Health Benefits of Vitamin D A Review

Vitamin D and skeletal muscle, athletic performance, review articles

Results

– Vitamin D sufficiency & muscle fx

– Reduce inflammation, pain, and myopathy

– Increase muscle protein synthesis, ATP conc., strength, jump height, jump velocity, jump power, exercise capacity, and physical performance

……..Cont’d next slide

Shuler, F. et al. (2012) Sports Health Benefits of Vitamin D Sports Health Nov;4(6):496-501

Findings contd…

– 25(OH)D levels >40 ng/mL fx prevention

– Optimal musculoskeletal benefits > 30 ng/mL

No benefits >50 ng/mL

– Vitamin D deficiency common in athletes

– Athletes with stress fx, musculoskeletal pain, illness

– Supplementation protocols Shuler, F. et al. (2012) Sports Health Benefits of Vitamin D Sports Health Nov;4(6):496-501

Prevalence Vit. D insufficiency in Collegiate Athletes

Purpose: Determine 25(OH)D conc. related to vit D intake, sun exposure, body comp, risk illness/ injury

41 athletes (18 men, 23 women, 12 in, 29 outdoor)

Diet & lifestyle – questionnaire

Bone density-DEXA

Injury/illness documented

Halliday, T. M., Peterson , N. J., Thomas , J. J., Kleppinger , K., Hollis , B. W., & Larson-Meyer , D. E. (2011). Vitamin D status relative to diet, lifestyle, injury, and illness in college athletes. Med Sci Sports Exerc, 335-343.

Findings…

Vit. D conc. changed across time (P = 0.001)

– 49.0 ± 16.6 fall, 30.5 ± 9.4 winter, and 41.9 ± 14.6 spring ng•mL (mean ± SD)

Higher in outdoor versus indoor in fall (P < 0.05)

Sufficient status fall & spring

Supple in winter

Suggest insufficient vit D may increase illness

Halliday, T. M., Peterson , N. J., Thomas , J. J., Kleppinger , K., Hollis , B. W., & Larson-Meyer , D. E. (2011). Vitamin D status relative to diet, lifestyle, injury, and illness in college athletes. Med Sci Sports Exerc, 335-343.

Vit. D Recs if Deficient

Vit D 3 1000-5000 IU/day

– Largest meal

Arms and/or legs to sunlight 20 min/day

Vit D supple + fish, eggs, and dairy

Prescription vit D2 at 50,000 IU/ 1x-2x/mo Holick MF. Vitamin D deficiency: what a pain it is. Mayo Clin Proc. 2003;78(12):1457-1459

National Academy of Science Recommendations

4000 IU of vitamin D3 for adolescents and adults

With sufficient 25(OH)D levels

– Not >4000 to 5000 IU vitamin D3 per day

News from the National Academies. IOM report sets new dietary intake levels for calcium and vitamin D to maintain health and avoid risks associated with excess. http://www8.nationalacademies.org/onpinews/ newsitem.aspx?RecordID=13050. Accessed January 22, 2012.

Vitamin D Toxicity

Vitamin D toxicity extremely rare

– Case reports of unintentional ingestion of extreme doses

i.e. above 50,000 IU for several months

Bone loss

Kidney stones

Calcification of organs

DHA

EPA and DHA-brain and heart health

ALA- flaxseeds, chia seeds, hempseeds, walnuts, leafy greens

Algae-based DHA supplement

Supple + ALA= adequate omega 3s

DHA Athletes

Bloomer et al 2009

Omega 3 supple

– 2224mg EPA + 2208 mg DHA or placebo

– 6 wks, dbl blind, crossover (8 wk washout)

– Blood drawn pre/post treadmill (wtd pack)

– Oxidative Stress & Inflam markers (CRP, TNF)

Attenuates exercised-induced inflam & oxidative stress

Bloomer et al (2009). Effect of eicosapentanoic and docosahexaenoic acid on resting and exercise- induced inflammatory and oxidative stress biomarkers: a randomized, placebo controlled, cross-over study. Lipids Health Dis. 8:36.

Summary

Vegetarian diets takes planning

May be Healthful

Nutritionally adequate

– Track

Supplements

Thank you

Andrea Gorman PhD RD LPC Rocky Mountain University of Health Professions

www.nutritionbeginnings.com

agorman@rmuohp.edu

Extra Slides

Vitamin D Synthesis & Intake

Ceglia, L. (2009)

Protein Digestibility Corrected AA Score

PDCAAS Standard by FAO/WHO

– Complete pro≥ 1.00

Protein Source PDCAAS

Egg 1.0

Milk 1.0

Beef 0.92

Soy protein 1.0

Wheat 0.42

Whey protein 1.0

Casein 1.0

Peanuts 0.52

Black beans 0.75

Hoffman JR and Falvo MJ. J Sports Sci Med. 2004;3:118–130. Schaafsma G. J Nutr. 2000;130(7):1865S-1867S.

Protein Efficiency Ratio

Food PER

Almonds 0.4

Barley 1.7

Beans, black 1.61

Beef muscle 2.7

Bread, white 1

Bulgur wheat, Rice 1.4

Casein, Cheese 2.5

Soy 2.0

Chick peas, ckd 2.32

Corn, whole 1.4

Food PER

Egg white 3

Fish 2.7

Kidney beans 1.55

Lentils, ckd 0.3

Milk 2.5

Oats, rolled 1.8

Peas, split yellow 1.42

Peanuts 1.7

Pinto beans 1.64

Pork, Poultry 2.7

BV = ( Nr / Na ) * 100

Hoffman, J; Falvo, M. (2004) Protein- Which is best? Journal of Sports Science and Medicine 3, 118-130