Nutritional Needs for the Female Athlete

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1. Do the different types of oral contraceptives affect how the hormones affect/work?
   1. Oral contraceptives provide a synthetic source of hormones, so our natural hormones are down regulated. These are synthetic hormones which are at a different level or amount. These do not have the same impact, which could be positive or negative depending on how we look at it. 
      
2. What is the interplay of oral contraceptives and amenorrhea in athletes that are experiencing low energy availability?
   1. Oral contraceptive is not letting us see if that woman is having periods to begin with. The lower energy state is exacerbating some of the health and performance declines noted. The starting point here is to boost energy availability. Focus on that first. 
      
3. Follow-up question to #3: If it is masking, would calculating energy availability be the best way to ensure that adequate fueling is taking place? 
   1. Start by calculating this first. This should be your beginning point to work from. 
      
4. Would it be beneficial to supplement with caffeine during the early follicular phase when athletes are more likely to feel more fatigued?
   1. Caffeine would not hurt. There is a fine line though, as she believes we should look at energy intake, protein, and CHO intake is proper timing around training. Do not use caffeine as a fall back agent or a lazy way to avoid proper meal timing and adequate fueling of the body. 
5. What leucine-rich proteins do you like to recommend for your clients?
   1. Dairy Eaters: Greek and Icelandic Yogurts; Whey protein; There is leucine in animal foods.
   2. Plant-based people we can get leucine through nuts and seeds such as: pumpkin seeds, beans, hemp hearts, soy foods. 
      
      
6. Would you suggest taking iron supplements for women athletes. If so, would liquid iron or a pill better?
   1. Iron supplements- It is always best practice to test blood levels of iron first. Test these in the morning (ex: Ferritin, serum iron, iron binding capacity).
   2. She is not a fan of blindly supplementing before you have the blood biomarkers in place.
   3. Do a blood panel before supplementing!
   4. If you have the data to support the need for improvements first turn to optimizing iron from food sources.
   5. If supplementation is then required do so via liquid iron OR iron-bisglycinate is the form she recommends. Bisglycinates is the best form for absorption. 
8. Are there any special nutritional concerns for females with endometriosis and/or PCOS?
   1. Yes there is. PCOS for sure. We want to look at insulin resistance. Look at food and meal combinations to stabilize blood sugar well. 
   2. Endometriosis- optimize inflammation, get into a whole foods fueling set-up, learn about clients exercise stress and work with that. 
      
9. What is your opinion of period manipulation for competition?
   1. Approach to not have a period around competition. She believes we do not need to implement this approach. We have enough info to avoid this. We have foods, timing strategies, supplements if need be, and practices in place to not engage in this
      
10. How do you get sport physicians on board with referring to sports rd to assess athletes for LEA before prescribing birth control for athletes?
    1. It is establishing a relationship and open-communication. As RDs we know are stuff, so provide the evidence and clinical documentation or citation. If the sports MD is not on board, find a different professional to assist who is open to finding a collaborative approach to aiding the athlete. 
       
11. How do you feel about the book ROAR and do you recommend any other books or studies to brush up on for a dietitian to begin to specialize more with female athletes?
    1. Book recommendations for female athletes: ROAR is a great starting point to open our eyes to female athletes and our different needs. It is about 5 years old now, but stil relevant.
    2. Stacy Sims coming out with more resources soon. 
    3. Other resources: Nikki K out of New Zealand or Australia; Dr. Kirsty Elliot-Sale, Dr. Kathryn (Kate) Akerman. 
12. How might a male dietitian foster positive dialogue with female athletes on topics discussed today?
    1. Women will think it's the coolest if you talk about this stuff; It is great to have that platform!
    2. Asking those questions is awesome to build confidence as it shows you care about their medical and performance needs. 
    3. Open up with a question like “Can we talk about the female aspect of you and your training?” OR as the practitioner try to relate to the athlete with using the women in your life as an example to give context of how you can help. 
13. What's the reference for protein needs during perimenopause?
    1. 2-2.4 g/kg/day is the working range. 
       
14. For a female athlete who is on some type of oral contraceptive, how might she be able to track her menstrual phases if she may not even be releasing an egg when she has a "period"?
    1. For female athlete on OC: There aren't really any phases per say; May depend on type of OC. Pretty much as continuous stream of hormones so once we know which type we can make a couple of tweaks. Again though since body’s natural hormones are down regulated there is not much you can do to track and we do not get to do much nutritionally.
15. Do we know how the transition onto estrogen replacements affects nutritional needs? (For postmenopausal, medically necessitated, or medically transitioning athletes)
    1. Transition onto estrogen replacement therapy effects nutritional needs during hormone replacement therapy?
    2. Helps mitigate vasomotor symptoms when going through perimenopause; Will need to know type (patch,oral) since there are nuances with different types; There is some impact, but we have to dive deeper to get more information. 
       
       

       ***Check out Dina's website at www.nutritionmechanic.com