Considerations for Vegan & Vegetarian Athletes

Alicia Kendig, MS, RD, CSSD

USOC Sport Dietitian

Types of Vegetarianism

• 4 Major Groups – None of which eat meat, fish or fowl:

– Lacto-ovo vegetarian

– Ovo vegetarian

– Lacto Vegetarian

– Vegan

Larson-Meyer, PhD, RD. Vegetarian Sports Nutrition, 2007

Types of Vegetarianism Other categories of Vegetarianism to consider

– Macrobiotic vegetarianism – Avoids animal products with focus on unprocessed organic foods

– Pesco vegetarian – Avoids all meet, with the exception of fish

– Pollo vegetarian – No red meat or fish, consumes dairy and egg products

– Semivegetarian – Tries to limit meat intake

Courtesy of the Vegetarian Resource Group , 2014

Another way to look at Vegetarianism

• Vegetarian

• Vegan

• Flexitarian – Regularly follows a vegan diet, but occasionally

consumes dairy, meat, fowl or fish

• Nutritarian – Follows an eating style high in micronutrients,

based on unrefined plants foos; may or may not be vegan

Fuhrman, J, et al. Current Sports Medicine Reports, 2010.

Reasons for choosing Vegetarianism

• Ethical

• Financial

• Social

• Heath Conscious

• Food Preference

• Dieting Behavior

• Form of Control

• Perceived Performance Benefit

Support for Vegetarianism • Adventist Health Studies are long-term studies

exploring the links between lifestyle, diet, and disease among Seventh-day Adventists.

• 96,000+ church members from the U.S. and Canada participating in the current study

• Seventh Day Adventists tend to be homogeneous in many lifestyle choices and more heterogeneous in nutritional habits than the general population.

http://www.llu.edu/public-health/health/index.page

Support for Vegetarianism

Cancer VD ↓ risk of prostate and colon cancers Red meat consumption ↑ bladder cancer

Dementia Meat consumption 2-3x more likely to develop dementia

Diabetes VD ↓ risk for Type 2 diabetes

Heart Disease VD or Vegan diet↓ reduces risk of HD Beef consumption ↑ risk of HD in men, but not women VD creates protective effect against fatal and non-fatal DH

Hypertension VD ↓ risk of hypertension

Arthritis VD ↓ risk of arthritis

http://www.llu.edu/public-health/health/index.page

Vegetarianism may ↑ REE

• REE = Resting Energy Expenditure

• Energy needs at rest were approx 11% higher in a group of 17 young men consuming VD, compared to 40 young men consuming non-VD diets

• Result of habitual high CHO diet

– Which can stimulate Sympathetic Nervous System

Toth, Metabolism, 1994

When restricting any food group

Relative Energy Deficiency in Sport (RED-S) – Previously “Female Athlete Triad”

• Common in endurance sports due to heavy training

• Beyond just a “Triad” – metabolic rate – menstrual function – Bone Health – Immunity – Protein synthesis – Cardiovascular health

Mountjoy, Br J Sports Med, 2014

Psychological Implications to RED-S Precedes or Caused by RED-S

• Dieting to enhance performance • Personality factors • Pressure to lose weight • Frequent weight cycling • Early start of sport-specific training • Overtraining • Recurrent and non-healing injuries • Inappropriate coaching behavior • Regulations in some sports • Long-term implications of this syndrome

Mountjoy, Br J Sports Med, 2014

Male athletes at low risk for ED/DE

• However, prevalence of RED-S in elite male athletes is high:

• Cycling (50%)

• Gravitational (24%)

• Weight class sports (18%)

Mountjoy, Br J Sports Med, 2014

Mountjoy, Br J Sports Med, 2014

Consuming Adequate Calories

• Resting energy Expenditure – Cunningham

– Katch/McArdle

– Mifflin-St.Joer

– Harris Benedict

• Lifestyle Energy Expenditure – Elite athletes: Eat, Train, Eat, Sleep

• Training Energy Expenditure – Technique/Efficiency Dependent

Is it possible for elite athletes to be vegan and still perform to their highest ability?

• Tony Gonzalez – Kansas City Chiefs

• Brendan Brazier – Ironman triathlete

• Carl Lewis – Track and Field Olympian

• Kenneth Williams – Body Builder

• And many more…

Takes: TIME, PLANNING, PREPARATION and

ATTENTION TO DETAIL!

Special Considerations for Vegan Athletes

• Adequate Energy Intake (EA)

• Protein

• Calcium

• Vitamin D

• Iron

• Zinc

• Iodine

• Vitamin B12

• Docosahexaenoic Acid (Omega-3 Fatty Acids)

• Creatine

Fuhrman, J. Current Sport Medicine Reports, 2010 J Am Diet Assoc. 2009

How much protein do you really need?

130 kg

Calculating Protein Needs based on Body Weight

Weight in Kilograms Lean Body Mass (FYI, lbs /2.2 = kgs) (A)_____ kgs

Select Protein needs based on current level of training:

Sedentary - 0.8 g PRO/kg body mass

Endurance – 1.2-1.4 g PRO /kg body mass

Strength, Power, Anaerobic/aerobic – 1.4-1.6 g PRO/kg

body mass

Weightlifting, Increase muscle mass – 1.6-1.8 g PRO/kg

body mass

(B)____ g/kg

(C)____g/kg

Multiply your weight (A) in kgs by the lower Range (B) _____ g Pro/Day

Multiple your weight (A) in kgs by the upper Range (C) _____ g Pro/Day

Protein Content in Common Foods Food Serving Protein (g) Food Serving Protein (g)

Chicken Breast 4 oz 27 Tofu, soft 1 cup 10

Fish 4 oz 23 Tofu, soft 1 cup 10

Beef 4 oz 19 Tofu, firm 1 cup 20

Egg (whole) 1 large 7 Yogurt, Greek non-

fat

1 cup 15

Legumes, most

beans/peas (cooked)

½ cup 7 Yogurt, Light 1 cup 8

Soybeans, cooked ½ cup 11 Yogurt, Soy 1 cup 8

Soy Milk 1 cup 7 1% fat Cottage

Cheese

½ cup 14

Skim Milk 1 cup 8 Vegetarian Burger 1 patty 6-16

Quinoa (cooked) 1 cup 11 Sunflower Seeds 3 Tbsp 5

Brown Rice (cooked) 1 cup 5 Almond/Peanut

Butter, natural

2 Tbsp 6

Oatmeal, regular

(cooked)

1 cup 6 Fresh Vegetables

(cooked), most

½ cup 2-3

Nuts, most 2 Tbsp 7

Plant Based vs Milk Based Proteins • No difference in protein needs due to source

• Protein digestibility (bioavailability) indicates quality of protein

– Soy Protein Isolate as effective as animal proteins

– Wheat proteins less bioavailable

• Speed of absorption can be a factor for strength and power athletes

– Or heavy phases of training for endurance athletes

Position of the American Dietetic Association: Vegetarian Diets, 2009.

Calcium (& Vitamin D) • Vitamin D involved in metabolism of calcium

– Not readily found in food sources

• Lacto-ovo often have higher calcium intakes than nonvegetarians

• 30% higher chance of bone fracture in vegans due to lower calcium intake – Euro Prospective Investigation into Cancer and Nutrition, 2007

• Dietary calcium to Protein ratio – ↑ratio favors bone health

• Oxalates/phytates block absorption: Spinach, chard

• Sources: Low-oxalate greens (bok choy, broccoli, chinese cabbage, kale), Fortified Fruit Juice, calcium set Tofu, cow’s milk, seeds, nuts, fortified foods

Iron

• Sensitive non-heme iron found in plants • Inhibitors: Phytates, calcium, polyphenolics, coffee,

herb teas • Sprouting seeds/grains/beans can decrease phytates • Fermenting miso and tempeh can increase

bioavailability • Supplementation vs. dietary sources

– When iron stores are low, non-heme absorption more responsive

• Sources: Leafy greens, beans, nuts/seeds, fortified foods

Zinc

• Essential for immune system function

• Readily found in plant sources, but low bioavailability

• Sources: Beans, whole grains, nuts, and seeds – Phytates inhibit absorption

– Dietary protein enhance absorption

– Supplemental iron inhibit absorption, and other metals

Do your best…

Iodine

• Plant sources of iodine can be low due to low levels in soil

• Vegan diets often low in iodized salt

• 80% of vegans, 25% vegetarians, 9% of nonvegetarians are iodine deficient

Sources: Kelp or other seaweeds, dietary supplement

Krajcovicova-Kudlackova, Ann Nutr. Metab 2003

Vitamin B12

• Essential for CNS functioning, homocysteine metabolism, DNA metabolism, and erythrocyte production (RBC production)

• B12 is more abundant in animal foods

• Dietary supplementation for vegans is essential for vegans

• Inverse relationship btw absorption and current status

Omega-3 Fatty Acids (EPA & DHA)

• EPA and DHA contribute to brain and heart health • For athletes, supplementation may:

– ↓ exercise induced inflammation and oxidative stress – ↑ pulmonary function

• Alpha-linolenic acid (ALA) can be metabolized into EPA/DHA – May not be possible to metabolize enough EPA/DHA

from ALA, making supplementation necessary for vegans

• Source: Flax, chia, hemp seeds, and nuts and leafy greens

Creatine

• Average dietary intake of creatine in nonvegetarians is 2g/day

– Negligable in vegans

• Vegetarian athletes have lower muscle creatine concentrations due to lower dietary intakes of creatine

• Creatine beneficial for high explosive activity, with a side effect of increased body mass.

J Am Diet Assoc. 2009

Vegetarian/Vegan for Triathletes

In Summary:

• What is the ultimate goal?

• Is it doable?

• What will it take? Planning/Preparation…

• Is it worth it?? I can be…

References • Larson-Meyer, PhD, RD. Vegetarian Sports Nutrition, 2007. • Vegetarian Resource Group. www.vrg.org, 2014. • Fuhrman, J. and D. Ferreri. “Fueling the Vegetarian (Vegan) Athlete”. Curr.

Sports Med. Rep. Vol. 9, No. 4, pp.233-241, 2010. • Loma Linda University, School of Public Health. Adventist Health Studies.

http://www.llu.edu/public-health/health/index.page. 2014 • Toth, M and E. Poehlman. Sympathetic nervous sytem activity and resting

metabolic rate in vegetarians. Metabolism, 43:621-625, 1994. • Mountjoy, M., et al. The IOC consensus statement: beyond the Female

Athlete Triad—Relative Energy Deficiency in Sport (RED-S). Br J Sports Med, 48:491–497, 2014.

• “Position of the American Dietetic Association: Vegetarian Diets”. J Am Diet Assoc. 2009; 109: 1266-1282.

• Euro Prospective Investigation into Cancer and Nutrition, 2007 • Krajcovicova-Kudlackova, Iodine deficiency in vegetarians and vegans. Ann

Nutr. Metab. 47 (5) 183-5, 2003.