There are a few different paths to becoming a sports nutritionist. The CSSD certification from the Commission on Dietetic Registration mentioned above is the gold standard for registered dietitians who work with athletes.

According to the Academy of Nutrition and Dietetics , the CSSD is the first and only sports nutrition certification program to be accredited by the National Commission for Certifying Agencies NCCA.

The NESTA certified sports nutrition specialist is offered by the National Exercise and Sports Trainers Association. However, there is a wide range of eligibility requirements for different credentials and many are geared toward the general public without higher level nutrition science training.

Whether you're an athlete seeking performance optimization, an individual with dietary restrictions on a fitness journey, or someone aiming for weight management, Nutrisense can offer an advantage with its team of nutritionists , each specializing in distinct areas that cater to your specific needs.

With a comprehensive array of specialties, including sports nutrition, the Nutrisense nutrition team can ensure that your nutritional journey is personalized, effective, and tailored to your individual goals. See how Nutrisense can help you take the first step toward better health today!

Your blood sugar levels can significantly impact how your body feels and functions. When you join the Nutrisense CGM program , our team of credentialed dietitians and nutritionists are available for additional support and guidance to help you reach your goals.

Ready to take the first step? Start with our quiz to see how Nutrisense can support your health. Heather is a Registered and Licensed Dietitian Nutritionist RDN, LDN , subject matter expert, and technical writer, with a master's degree in nutrition science from Bastyr University.

She has a specialty in neuroendocrinology and has been working in the field of nutrition—including nutrition research, education, medical writing, and clinical integrative and functional nutrition—for over 15 years.

How It Works Nutritionists Journal. What Is A CGM? Get Started. Promo code SPRING will be automatically applied at checkout! Achieving Peak Performance: Why Working with a Sports Nutritionist Matters. Team Nutrisense. Share on Twitter. Share on Facebook. Share via Email. Reviewed by.

Heather Davis, MS, RDN, LDN. The Role of a Sports Nutritionist in Athletic Performance. Related Article. Read More. Engage with Your Blood Glucose Levels with Nutrisense Your blood sugar levels can significantly impact how your body feels and functions.

Take Our Quiz. Reviewed by: Heather Davis, MS, RDN, LDN. Plan a nutritious meal by choosing at least one food from each category. Healthy fat. Adequate hydration is a key element in sports performance. Most athletes benefit from developing a personal hydration plan.

A general rule for training is to consume a minimum:. Four to six ounces of fluid every 15 minutes of exercise. To properly assess, weigh yourself immediately prior to and after a workout. For every pound of weight lost, replace with 16 ounces of fluid.

Best hydration choices include water, low-fat milk or percent juice. Sports beverages are best reserved for competition, where quick hydration and electrolyte replacement are necessary.

There are a few golden rules when it comes to eating on game day:. It happens the days, weeks, and months leading up to the competition. Peak performance during competition means eating nutritious food while traveling.

Relying on the concession stand for food during competition is an almost certain failure. Players and parents should prepare by packing a variety of food and beverages.

Choose energy-packed foods such as whole grain crackers with low-fat cheese, tortilla wraps with veggies and lean meat, hard-boiled eggs, vegetable or bean soups, small boxes of non-sugary cereal, fresh fruit, mini-whole wheat bagels with peanut butter, pita bread with hummus or pasta with grilled chicken.

Fibrous carbohydrates can be beneficial as these tend to cause GI disturbances. UW School of Medicine and Public Health. Refer a Patient. Clinical Trials. Find a Doctor. Increased respiratory water loss and the diuresis often seen in the early response to altitude exposure can create a significant increase in water requirements at the same time that reduced thirst and changes in fluid availability in a new environment may alter usual drinking practices [ 2 , 24 , 25 ].

Therefore, athletes should consider altitude training a time of increased risk for dehydration and both monitor and address their hydration status appropriately [e. Adequate EA is an important consideration for both sea-level and altitude training. EA reflects the amount of energy that remains after exercise for use by other body systems, including the endocrine, immune and reproductive systems, and is calculated as energy intake EI minus exercise energy expenditure EEE relative to fat-free mass FFM [ 26 ].

This concept of low EA has recently been termed relative energy deficiency in sport RED-S and has multiple implications in both male and female athletes for iron metabolism, injury and illness, training adaptation and performance [ 27 ]. However, while it is not clear whether low—moderate hypoxic exposure has additive effects on EA requirements, there are several emerging, and compelling, concepts to suggest that EA will play an important role in optimizing hypoxic adaptation.

For example, low EA and iron metabolism are linked [ 28 ], which may have direct effects on hematological adaptations at altitude see Sect.

Low EA has also been shown to drastically increase the risk of injury and illness [ 26 , 27 ], which at altitude, has consistently demonstrated deleterious effects on hypoxia-induced increases in HBmass. Meanwhile, estrogen is important for iron homeostasis through its suppression of the peptide hormone hepcidin, which results in an increase in iron bioavailability [ 35 ].

Further, testosterone treatment in older males can reverse anemia [ 36 ]. While the effects of high-altitude exposure on endocrine systems, EI, resting metabolic rate RMR and ultimately BM are consistent and severe, the handful of research findings at low—moderate altitudes are much less consistent and appear to be far less pronounced.

Indeed, emerging case-study data include loss of appetite reported by four rowers who reported increased fatigue during a day intense training block at m [ 38 ]. Conversely, data from five elite runners reported an increased appetite, with no change in EI, after 4 weeks of living and training at m [ 39 ].

Furthermore, both negative [ 40 , 41 ] as well as optimal energy balance EB [ 42 ] have been reported in both elite Kenyan and Ethiopian runners at moderate altitudes. However, it should be noted that dietary records [ 43 ] are poor estimates of EA when used in isolation Table 1 , and the variability of these BM and EA outcomes demonstrate that more research is required.

With respect to RMR, to our knowledge, only two studies have investigated the effects of moderate altitude on this variable in elite athletes. In comparison, the second study followed four elite rowers, who reported no change in RMR after 12 days at m [ 38 ]. Collectively, this work presents the notion that when EA is adequate as indicated via no change in BM in the study by Woods et al.

However, given the small participant populations used here, more research is required to confirm these findings that RMR is increased at low—moderate altitudes Table 1.

The decreases in BM may reflect low EA and have been associated with negative EB [ 41 ] and stable RMR [ 38 ]. Meanwhile, when BM was maintained suggesting optimal EA , stable hormone concentrations [ 32 ] and increased RMR [ 39 ] were noted across an altitude camp.

The importance of maintaining BM via optimal EA is highlighted by studies showing that a failure to do so may negatively influence hematological adaptations to altitude.

For example, McLean et al. It is also important to note that upon arrival to altitude there is a contraction of plasma volume PV [ 47 , 48 ] and typical altitude associated dehydration. Accordingly, acute small weight loss i.

Indeed, loss of body water due to increased ventilation and diuresis is an essential short-term adaptation to altitude which serves to increase arterial oxygen content via increased hemoglobin concentration prior to longer-term erythropoietic adaptation [ 49 ].

Residual BM loss associated with PV contraction is typically reversed upon return to sea level [ 31 ]. Overall, the impact that training at moderate altitudes has on BM, EA, and subsequent endocrine and metabolic e. Athletes highlighted as a red dot had illness throughout the camp.

BM body mass, HBmass hemoglobin mass. However, hypoxia provides a distinct environment where several micronutrients may need to be considered. This section will focus on the impact of iron status and dietary supplements, deliberating on whether anti-oxidant supplementation is warranted to minimize the production of reactive oxygen and nitrogen species RONS and oxidative damage at low—moderate altitudes.

Beyond this, the nutrition intervention receiving the most scientific attention with regards to optimizing adaptations to moderate altitudes is the mineral iron.

Indeed, several studies have shown no relationship between pre-altitude ferritin stores and the magnitude of the HBmass response [ 44 , 54 , 55 ]. Current recommendations are to assess iron status 8—10 weeks prior to altitude training [ 11 ] and to commence oral supplementation 2—3 weeks prior to altitude exposure, and to continue this supplementation throughout Fig.

In this study, athletes who did not supplement with iron had HBmass increases of only 1. Accordingly, a blunted erythropoietic response was also observed in non—iron-supplemented athletes during simulated live-high train-low LHTL despite being iron replete [ 55 ].

Nevertheless, these ferritin cut-offs require further scientific validation, as no definitive iron dose—response study at low—moderate altitudes in athletes currently exists. Contemporary blood health screening and supplemental iron recommendations before, during and after altitude.

Final recommendations should always be sought from a sports medicine physician. CO carbon monoxide, CRP C-reactive protein, GI gastro-intestinal, Hb hemoglobin, HBmass hemoglobin mass, h hours, IV intravenous, MCHC mean corpuscular hemoglobin concentration, MCV mean corpuscular volume, PV plasma volume, Vit vitamin.

Recent advances in intravenous IV iron formulations have radically changed the accessibility and safety associated with IV iron delivery [ 61 ], raising questions surrounding its suitability and efficacy as a supplementation option during altitude exposure.

The regulation of the peptide hormone hepcidin needs to be considered when looking to maximize iron bioavailability in hypoxia. Hepcidin is suppressed in hypoxic conditions [ 57 , 63 ], but is upregulated when high amounts of iron are present in the circulation and subsequent to exercise training [ 64 ], which, in turn, reduces iron availability since both dietary iron uptake from the gut and expression of iron on macrophages are impaired [ 65 ].

Accordingly, a number of iron dosing protocols are possible, such as single or split daily doses, or dosing every other day [ 66 , 67 ]. Interestingly, at sea level, multiple daily doses of iron caused an increase in hepcidin, and a decrease in the percent of iron absorbed from subsequent iron doses in iron deficient females [ 66 ], suggesting single dosing protocols may be superior.

Further support for a single daily iron dosing protocol comes from a recent applied study in elite runners over a training camp at m [ 57 ]. While both supplemented groups experienced a significant increase in HBmass post altitude, the single-dose group had a significantly greater increase 6.

However, this difference was not apparent by week 3, suggesting gut adaptation can occur to the greater single dose [ 57 ]. Also, there may be different GI tolerance to different types of oral iron supplements [ 68 ], which also may be individually trialed. Of note, the efficacy of an alternate-day iron supplementation protocol is yet to be explored in athletes at altitude, but offers a promising possible avenue for further research Table 1.

Nevertheless, optimizing iron bioavailability, via optimal iron dose timing, requires an appreciation of the temporal effects of hepcidin that are influenced by baseline ferritin [ 64 ], timing of multiple daily iron doses [ 66 , 67 ], timing, duration and intensity of training [ 64 ], and diurnal effects [ 69 ].

Figure 3 highlights our current knowledge and recommendations regarding blood health screening and supplemental iron recommendations before, during and after altitude, including highlighting factors that will increase or decrease oral iron bioavailability.

We recommend the involvement of a sports medicine physician in this process, as excess iron supplementation and clinically elevated endogenous iron stores can have negative health consequences [ 70 , 71 ].

Exercise at moderate altitudes is associated with increased production of RONS with reduced antioxidant capacity, leading to oxidative stress [ 72 , 73 ]. The excessive overproduction of RONS, in excess of the endogenous antioxidant defense systems, can cause damage to lipids, proteins and DNA which may impair cell and immune function, resulting in delayed post-exercise recovery [ 74 ].

Both acute [ 75 , 76 ] and chronic exposure to hypoxia [ 72 , 77 , 78 ] augments oxidative stress in well-trained athletes, while reduced antioxidant capacity may persist for up to 2 weeks following altitude training [ 79 ]. Interestingly, normobaric hypoxia appears to produce a larger increase in oxidative stress than hypobaric hypoxia [ 80 ], while a recent study in a team sport setting showed no impact of intermittent hypoxia on biomarkers of oxidative stress [ 81 ].

Although several factors can modulate the oxidative stress response to altitude e. The clinical implications of altitude-induced oxidative stress are not entirely clear [ 85 , 86 ], beyond being linked to acute mountain sickness AMS at high altitudes [ 87 , 88 ].

At moderate altitudes, some studies have shown increased inflammation and illness in association with higher levels of oxidative stress [ 89 , 90 ], but others have not [ 81 ]. It is important to note that, although there is some evidence of immunological biomarker disturbances at low—moderate altitudes in elite athletes [ 91 , 92 ] and anecdotally there is an assumption of increased rate of illness at altitude, there is actually limited evidence of an increased rate of illness at low—moderate altitudes.

In fact, a recent athlete and immune function review by Walsh et al. Given that exogenous antioxidants neutralize free radicals, it is logical to hypothesize that antioxidant supplementation would be a worthy intervention to combat altitude-induced oxidative stress and its potentially associated perils.

Although early investigations have shown that antioxidant supplements had modulating effects on oxidative stress and AMS symptoms at high altitudes [ 94 , 95 ], more recent studies indicate no effect [ 96 , 97 , 98 ] or mixed results [ 99 ].

Furthermore, none of these studies have assessed the impact of antioxidant supplementation on training adaptation. With the current understanding of the essential role of RONS in initiating the positive adaptive response to endurance training [ ], hypoxia [ ] and upregulation of the endogenous antioxidant defenses [ ], dampening RONS with antioxidants might actually be counterproductive and reduce the adaptive responses to altitude training Table 1 , which has been shown at sea level [ , , ].

Two recent studies have examined the effect of antioxidants from food sources on the adaptive response to altitude training [ 44 ], and oxidative stress and inflammation [ ]. The first study [ 44 ] revealed that more than doubling the daily intake of antioxidant-rich foods during a 3-week altitude camp m did not interfere with the training responses in elite endurance athletes [measured as HBmass and maximum rate of oxygen consumption V O 2max ].

While the follow-up study showed that the food-based antioxidant intervention elevated plasma antioxidant capacity and attenuated some of the altitude-induced increases in systemic inflammatory biomarkers, it had no impact on altitude-induced oxidative stress in the elite athlete population [ ].

Collectively, there is not sufficient evidence to recommend high-dose single antioxidant supplementation to attenuate altitude-induced oxidative stress, especially at low—moderate altitudes. Furthermore, the impact of antioxidant supplements on the adaptive training response to altitude requires further research Table 1.

Despite a growing body of evidence for a handful of specific ergogenic aids for performance enhancement at sea level [ ], there are very few acute or chronic supplementation studies completed in hypoxic conditions.

Given that hypoxia changes oxygen extraction, delivery and uptake, as well as altering lactate kinetics and buffering, we would caution against the indiscriminate use of sea-level ergogenic aids until more hypoxia-based data are generated.

Nevertheless, there are some preliminary data on nitrate supplementation and some theoretical use of buffers at altitude, along with several other emerging supplements that will be covered in this section.

Nitric oxide NO is a pleiotropic signaling molecule and a regulator of many physiological and adaptive processes that are endogenously stimulated by hypoxia. Therefore, dietary nitrate NO 3 ; an NO precursor supplementation, usually in the form of concentrated beetroot consumption, during hypoxia has garnered much recent attention [ , ].

Accordingly, humans have evolved to have many varying endogenous mechanisms contributing to total buffering capacity, which are innately enhanced upon ascent to altitude [ 6 ] and potentially increased by several nutrition-based ergogenic aids.

It is beyond the scope of this review to unravel the complexities of anaerobic performance determinants and associated potential ergogenic aids for recent reviews, see Peeling et al.

Instead, this section will briefly overview the buffering changes upon ascent to altitude and then examine the scant data on whether exogenous buffering supplements should be considered at altitude Fig.

Subsequent to this immediate response, chronic altitude days to weeks actually increases intra- and extra-cellular buffering capacity [ , , ]. Indeed, hypoxia-induced changes in blood pH can occur in elite m runners in just several days [ ].

Obviously, much more research is required to better understand the limiting effects of performance in hypoxia, the time course and impact of these extracellular buffering changes in elite athletes at low—moderate altitudes, as well as the mechanism s responsible for the subsequent enhanced muscle buffering capacity Table 1.

The chronic utilization of nutritional buffers to potentially enhance training adaptations is not well understood. For example, there are only a few studies examining the chronic effect of NaHCO 3 supplementation 5—7 days in normoxia, all of which have initially demonstrated promising outcomes [ , , , ].

Additionally, two studies have examined whether augmented carnosine via BA supplementation may lead to an enhanced training effect, with one study showing a trend for greater resistance-training volume [ ] and another finding no influence of BA to further enhance high-intensity interval training [ ].

Conversely, we are only aware of a single study examining the acute effects of NaHCO 3 supplementation both prior to and after 5 weeks of BA supplementation. All of these trials were conducted in simulated hypoxia Obviously, our global understanding of the adaptive effects of buffers is not well understood at either sea level or altitude Table 1.

Taken together, current evidence would not support the use of exogenous NaHCO 3 or citrate supplementation to augment acute hypoxic performance.

Limited evidence exists for alternative nutritional supplements that have extensive data as potential ergogenic aids for enhancing adaptation to altitude. For example, we are unaware of any intervention studies investigating the impact of vitamins B 6 , B 12 and D or glutamine or branched chain amino acids in athletes at low—moderate altitudes.

Therefore, whether a higher intake of these vitamins and proteins in the form of supplements would have additional benefits has not been investigated and again highlights areas for future research. However, when looking beyond the aforementioned prospects of nitrate and buffers, the thiol-containing compound N -acetylcysteine NAC seems to show mechanistic promise.

Previous work has shown that NAC increases circulating free cysteine levels, which, in the presence of increased glutathione demand, can support glutathione synthesis and prevent its depletion [ ]. Interactions between NAC, cysteine and glutathione are suggested to act in potentially numerous mechanistic ways that may be beneficial for athlete performance, recovery and adaptation.

For instance, NAC ingestion is proposed to result in an anti-oxidant effect that minimizes the oxidative stress and inflammatory response imposed from physical activity [ ] see Sect. Furthermore, NAC is proposed to enhance fatigue resistance [ ] and improve athletic performance [ ]; to enhance immune system function [ ], hemodynamics and muscle blood flow [ ]; and to modulate EPO production and the hypoxic ventilatory response [ ].

Intuitively, each of these mechanisms appears likely to support a positive adaptation to hypoxic environments such as altitude exposure. However, scant literature exists to explore such a prospect in applied athlete settings where an altitude sojourn has occurred.

However, it should be noted that not all literature supports the positive modulation of NAC on EPO production [ ], and when consumed in high doses for prolonged periods of time i. With this in mind, there appears to be potential for the use of the herb extract G.

biloba GBE , with proposed mechanisms such as reducing tissue hypoxia, increasing vasodilation and, via its anti-oxidant properties, possibly reducing the incidence of a mild AMS [ ], characterized by headache, lightheadedness, fatigue, nausea, and insomnia [ ].

Within this narrative review, we have focused on six key altitude-related nutrition themes Fig. Accordingly, many research questions have been raised Table 1 , with a definitive iron dose—response study at natural altitudes in athletes probably being one of the key current gaps in the literature.

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Chapman RF, Laymon Stickford AS, Lundby C, et al. Timing of return from altitude training for optimal sea level performance. Bartsch P, Saltin B. General introduction to altitude adaptation and mountain sickness. Scand J Med Sci Sports. Stellingwerff T, Pyne DB, Burke LM. Nutrition considerations in special environments for aquatic sports.

Int J Sport Nutr Exerc Metab. Meyer NL, Manore MM, Helle C. Nutrition for winter sports. J Sports Sci. Bergeron MF, Bahr R, Bartsch P, et al.

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Innovations in athletic preparation: role of substrate availability to modify training adaptation and performance. Michalczyk M, Czuba M, Zydek G, et al. Dietary recommendations for cyclists during altitude training. Wing-Gaia SL. Nutritional strategies for the preservation of fat free mass at high altitude.

PubMed PubMed Central Google Scholar. Hamad N, Travis SP. Weight loss at high altitude: pathophysiology and practical implications. Eur J Gastroenterol Hepatol. Millet GP, Roels B, Schmitt L, et al.

Combining hypoxic methods for peak performance. Sharma AP, Saunders PU, Garvican-Lewis LA, et al. Training quantification and periodization during live high train high at M in elite runners: an observational cohort case study.

J Sports Sci Med. Normobaric hypoxia reduces V O 2 at different intensities in highly trained runners. Pasiakos SM, Berryman CE, Carrigan CT, et al.

Muscle protein turnover and the molecular regulation of muscle mass during hypoxia. Butterfield GE. Nutrient requirements at high altitude.

Clin Sports Med, viii. Brooks GA, Butterfield GE, Wolfe RR, et al. Increased dependence on blood glucose after acclimatization to 4, m. Braun B, Mawson JT, Muza SR, et al. Women at altitude: carbohydrate utilization during exercise at 4, m.

Burke LM, Hawley JA, Jeukendrup A, et al. Toward a common understanding of diet-exercise strategies to manipulate fuel availability for training and competition preparation in endurance sport. Butterfield GE, Gates J, Fleming S, et al.

Increased energy intake minimizes weight loss in men at high altitude. Mawson JT, Braun B, Rock PB, et al. Women at altitude: energy requirement at 4, m. Loucks AB, Kiens B, Wright HH. Energy availability in athletes. Mountjoy M, Sundgot-Borgen J, Burke L, et al.

International Olympic Committee IOC consensus statement on relative energy deficiency in sport RED-S : update. Petkus DL, Murray-Kolb LE, De Souza MJ.

The unexplored crossroads of the female athlete triad and iron deficiency: a narrative review. Jelkmann W, Kurtz A, Bauer C. Effects of fasting on the hypoxia-induced erythropoietin production in rats. Pflugers Arch. Gough CE, Sharpe K, Garvican LA, et al.

The effects of injury and illness on haemoglobin mass. Int J Sports Med. Wachsmuth NB, Volzke C, Prommer N, et al. The effects of classic altitude training on hemoglobin mass in swimmers. Eur J Appl Physiol. Heikura IA, Burke LM, Bergland D, et al.

Impact of energy availability, health, and sex on hemoglobin-mass responses following live-high-train-high altitude training in elite female and male distance athletes. Int J Sports Physiol Perform. McLean BD, Buttifant D, Gore CJ, et al. Year-to-year variability in haemoglobin mass response to two altitude training camps.

Garvican-Lewis LA, Sharpe K, Gore CJ. Time for a new metric for hypoxic dose? Hou Y, Zhang S, Wang L, et al. Estrogen regulates iron homeostasis through governing hepatic hepcidin expression via an estrogen response element.

Roy CN, Snyder PJ, Stephens-Shields AJ, et al. Association of testosterone levels with anemia in older men: a controlled clinical trial. JAMA Intern Med. Heikura IA, Uusitalo ALT, Stellingwerff T, et al. Low energy availability is difficult to assess but outcomes have large impact on bone injury rates in elite distance athletes.

Woods AL, Garvican-Lewis LA, Rice A, et al. Appl Physiol Nutr Metab. Woods AL, Sharma AP, Garvican-Lewis LA, et al. Four weeks of classical altitude training increases resting metabolic rate in highly trained middle-distance runners.

Fudge BW, Westerterp KR, Kiplamai FK, et al. Evidence of negative energy balance using doubly labelled water in elite Kenyan endurance runners prior to competition.

Br J Nutr. Onywera VO, Kiplamai FK, Boit MK, et al. Food and macronutrient intake of elite kenyan distance runners. Beis LY, Willkomm L, Ross R, et al. Food and macronutrient intake of elite Ethiopian distance runners. J Int Soc Sports Nutr. CAS PubMed PubMed Central Google Scholar.

Burke LM, Lundy B, Fahrenholtz IL, et al. Pitfalls of conducting and interpreting estimates of energy availability in free-living athletes. Koivisto AE, Paulsen G, Paur I, et al. Antioxidant-rich foods and response to altitude training: a randomized controlled trial in elite endurance athletes.

Gore CJ, Hahn A, Rice A, et al. Altitude training at m does not increase total haemoglobin mass or sea level V O 2max in world champion track cyclists. J Sci Med Sport.

Trexler ET, Smith-Ryan AE, Norton LE. Metabolic adaptation to weight loss: implications for the athlete. Siebenmann C, Cathomen A, Hug M, et al. Hemoglobin mass and intravascular volume kinetics during and after exposure to 3,m altitude. Siebenmann C, Robach P, Lundby C.

Regulation of blood volume in lowlanders exposed to high altitude. Heinicke K, Prommer N, Cajigal J, et al. Long-term exposure to intermittent hypoxia results in increased hemoglobin mass, reduced plasma volume, and elevated erythropoietin plasma levels in man.

Larson-Meyer DE, Woolf K, Burke L. Assessment of nutrient status in athletes and the need for supplementation. Gore CJ, Sharpe K, Garvican-Lewis LA, et al. Altitude training and haemoglobin mass from the optimised carbon monoxide rebreathing method determined by a meta-analysis. Robach P, Siebenmann C, Jacobs RA, et al.

Stray-Gundersen J, Alexander AC, Hochstein A, et al. Failure of red cell volume to increase to altitude exposure in iron deficient runners.

Ryan BJ, Wachsmuth NB, Schmidt WF, et al. AltitudeOmics: rapid hemoglobin mass alterations with early acclimatization to and de-acclimatization from m in healthy humans. PLoS One. Garvican-Lewis LA, Vuong VL, Govus AD, et al. Intravenous iron does not augment the hemoglobin mass response to simulated hypoxia.

Garvican-Lewis LA, Govus AD, Peeling P, et al. Iron supplementation and altitude: decision making using a regression tree. Hall R, Peeling P, Nemeth E, et al. Single versus split dose of iron optimizes hemoglobin mass gains at m altitude.

Pedlar CR, Brugnara C, Bruinvels G, et al. Iron balance and iron supplementation for the female athlete: a practical approach. Eur J Sport Sci. Pedlar CR, Whyte GP, Burden R, et al. A case study of an iron-deficient female Olympic m runner.

Normobaric hypoxia reduces V O 2 at different intensities in highly trained runners. Pasiakos SM, Berryman CE, Carrigan CT, et al. Muscle protein turnover and the molecular regulation of muscle mass during hypoxia.

Butterfield GE. Nutrient requirements at high altitude. Clin Sports Med, viii. Brooks GA, Butterfield GE, Wolfe RR, et al.

Increased dependence on blood glucose after acclimatization to 4, m. Braun B, Mawson JT, Muza SR, et al. Women at altitude: carbohydrate utilization during exercise at 4, m. Burke LM, Hawley JA, Jeukendrup A, et al. Toward a common understanding of diet-exercise strategies to manipulate fuel availability for training and competition preparation in endurance sport.

Butterfield GE, Gates J, Fleming S, et al. Increased energy intake minimizes weight loss in men at high altitude. Mawson JT, Braun B, Rock PB, et al. Women at altitude: energy requirement at 4, m. Loucks AB, Kiens B, Wright HH. Energy availability in athletes.

Mountjoy M, Sundgot-Borgen J, Burke L, et al. International Olympic Committee IOC consensus statement on relative energy deficiency in sport RED-S : update. Petkus DL, Murray-Kolb LE, De Souza MJ. The unexplored crossroads of the female athlete triad and iron deficiency: a narrative review.

Jelkmann W, Kurtz A, Bauer C. Effects of fasting on the hypoxia-induced erythropoietin production in rats. Pflugers Arch. Gough CE, Sharpe K, Garvican LA, et al. The effects of injury and illness on haemoglobin mass. Int J Sports Med. Wachsmuth NB, Volzke C, Prommer N, et al.

The effects of classic altitude training on hemoglobin mass in swimmers. Eur J Appl Physiol. Heikura IA, Burke LM, Bergland D, et al. Impact of energy availability, health, and sex on hemoglobin-mass responses following live-high-train-high altitude training in elite female and male distance athletes.

Int J Sports Physiol Perform. McLean BD, Buttifant D, Gore CJ, et al. Year-to-year variability in haemoglobin mass response to two altitude training camps. Garvican-Lewis LA, Sharpe K, Gore CJ. Time for a new metric for hypoxic dose? Hou Y, Zhang S, Wang L, et al.

Estrogen regulates iron homeostasis through governing hepatic hepcidin expression via an estrogen response element. Roy CN, Snyder PJ, Stephens-Shields AJ, et al.

Association of testosterone levels with anemia in older men: a controlled clinical trial. JAMA Intern Med. Heikura IA, Uusitalo ALT, Stellingwerff T, et al.

Low energy availability is difficult to assess but outcomes have large impact on bone injury rates in elite distance athletes. Woods AL, Garvican-Lewis LA, Rice A, et al.

Appl Physiol Nutr Metab. Woods AL, Sharma AP, Garvican-Lewis LA, et al. Four weeks of classical altitude training increases resting metabolic rate in highly trained middle-distance runners.

Fudge BW, Westerterp KR, Kiplamai FK, et al. Evidence of negative energy balance using doubly labelled water in elite Kenyan endurance runners prior to competition. Br J Nutr. Onywera VO, Kiplamai FK, Boit MK, et al. Food and macronutrient intake of elite kenyan distance runners.

Beis LY, Willkomm L, Ross R, et al. Food and macronutrient intake of elite Ethiopian distance runners. J Int Soc Sports Nutr. CAS PubMed PubMed Central Google Scholar.

Burke LM, Lundy B, Fahrenholtz IL, et al. Pitfalls of conducting and interpreting estimates of energy availability in free-living athletes. Koivisto AE, Paulsen G, Paur I, et al. Antioxidant-rich foods and response to altitude training: a randomized controlled trial in elite endurance athletes.

Gore CJ, Hahn A, Rice A, et al. Altitude training at m does not increase total haemoglobin mass or sea level V O 2max in world champion track cyclists. J Sci Med Sport. Trexler ET, Smith-Ryan AE, Norton LE.

Metabolic adaptation to weight loss: implications for the athlete. Siebenmann C, Cathomen A, Hug M, et al. Hemoglobin mass and intravascular volume kinetics during and after exposure to 3,m altitude.

Siebenmann C, Robach P, Lundby C. Regulation of blood volume in lowlanders exposed to high altitude. Heinicke K, Prommer N, Cajigal J, et al.

Long-term exposure to intermittent hypoxia results in increased hemoglobin mass, reduced plasma volume, and elevated erythropoietin plasma levels in man. Larson-Meyer DE, Woolf K, Burke L. Assessment of nutrient status in athletes and the need for supplementation. Gore CJ, Sharpe K, Garvican-Lewis LA, et al.

Altitude training and haemoglobin mass from the optimised carbon monoxide rebreathing method determined by a meta-analysis. Robach P, Siebenmann C, Jacobs RA, et al. Stray-Gundersen J, Alexander AC, Hochstein A, et al.

Failure of red cell volume to increase to altitude exposure in iron deficient runners. Ryan BJ, Wachsmuth NB, Schmidt WF, et al. AltitudeOmics: rapid hemoglobin mass alterations with early acclimatization to and de-acclimatization from m in healthy humans.

PLoS One. Garvican-Lewis LA, Vuong VL, Govus AD, et al. Intravenous iron does not augment the hemoglobin mass response to simulated hypoxia. Garvican-Lewis LA, Govus AD, Peeling P, et al. Iron supplementation and altitude: decision making using a regression tree.

Hall R, Peeling P, Nemeth E, et al. Single versus split dose of iron optimizes hemoglobin mass gains at m altitude. Pedlar CR, Brugnara C, Bruinvels G, et al. Iron balance and iron supplementation for the female athlete: a practical approach.

Eur J Sport Sci. Pedlar CR, Whyte GP, Burden R, et al. A case study of an iron-deficient female Olympic m runner. Govus AD, Garvican-Lewis LA, Abbiss CR, et al.

Pre-altitude serum ferritin levels and daily oral iron supplement dose mediate iron parameter and hemoglobin mass responses to altitude exposure. Macdougall IC. Evolution of iv iron compounds over the last century. J Ren Care. Rishi G, Wallace DF, Subramaniam VN.

Hepcidin: regulation of the master iron regulator. Biosci Rep. Govus AD, Peeling P, Abbiss CR, et al. Live high, train low—influence on resting and post-exercise hepcidin levels.

Peeling P, Sim M, Badenhorst CE, et al. Iron status and the acute post-exercise hepcidin response in athletes. Nemeth E, Tuttle MS, Powelson J, et al. Hepcidin regulates cellular iron efflux by binding to ferroportin and inducing its internalization.

Moretti D, Goede JS, Zeder C, et al. Oral iron supplements increase hepcidin and decrease iron absorption from daily or twice-daily doses in iron-depleted young women. Stoffel NU, Cercamondi CI, Brittenham G, et al.

Iron absorption from oral iron supplements given on consecutive versus alternate days and as single morning doses versus twice-daily split dosing in iron-depleted women: two open-label, randomised controlled trials. Lancet Haematol. Cancelo-Hidalgo MJ, Castelo-Branco C, Palacios S, et al.

Tolerability of different oral iron supplements: a systematic review. Curr Med Res Opin. Schaap CC, Hendriks JC, Kortman GA, et al. Diurnal rhythm rather than dietary iron mediates daily hepcidin variations. Clin Chem. Fisher AE, Naughton DP. Iron supplements: the quick fix with long-term consequences.

Nutr J. Munoz M, Gomez-Ramirez S, Bhandari S. The safety of available treatment options for iron-deficiency anemia. Expert Opin Drug Saf. Pialoux V, Mounier R, Rock E, et al.

Eur J Clin Nutr. Dosek A, Ohno H, Acs Z, et al. High altitude and oxidative stress. Respir Physiol Neurobiol. Sies H, Berndt C, Jones DP. Oxidative Stress.

Annu Rev Biochem. Wadley AJ, Svendsen IS, Gleeson M. Heightened exercise-induced oxidative stress at simulated moderate level altitude vs. sea level in trained cyclists. CAS Google Scholar. Vasankari TJ, Kujala UM, Rusko H, et al.

The effect of endurance exercise at moderate altitude on serum lipid peroxidation and antioxidative functions in humans. Eur J Appl Physiol Occup Physiol. Subudhi AW, Davis SL, Kipp RW, et al. Antioxidant status and oxidative stress in elite alpine ski racers.

Pialoux V, Brugniaux JV, Rock E, et al. Antioxidant status of elite athletes remains impaired 2 weeks after a simulated altitude training camp.

Eur J Nutr. Debevec T, Pialoux V, Saugy J, et al. Goods PS, Dawson B, Landers GJ, et al. Effect of repeat-sprint training in hypoxia on post-exercise interleukin-6 and F2-isoprostanes. Debevec T, Millet GP, Pialoux V.

Hypoxia-induced oxidative stress modulation with physical activity. Front Physiol. Pialoux V, Mounier R, Brugniaux JV, et al.

Lewis NA, Howatson G, Morton K, et al. Alterations in redox homeostasis in the elite endurance athlete. Quindry J, Dumke C, Slivka D, et al. Impact of extreme exercise at high altitude on oxidative stress in humans.

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Exercise, immune function and respiratory infection: an update on the influence of training and environmental stress. Immunol Cell Biol. Simon-Schnass I, Pabst H. Influence of vitamin E on physical performance.

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Stellingwerff T, Maughan RJ, Burke LM. The focus on sports nutrition is frequently thought to be reserved only for the elite competitor; however, my practice includes helping individuals who range from the fitness enthusiast through the competitive amateur or professional.

Tournament plans that span several days can also be developed. One of my specialty areas is helping triathletes to meet their race goals, from sprint through Ironman-distance events.

Read the testimonials here. I will help to develop sports nutrition policies and procedures for your athletic department or team. I will manage and execute sports nutrition programs tailored to the needs of your athletes, coaches, parents, athletic trainers, and strength and conditioning coaches.

I will also work closely as a team with physicians, sports psychologists and therapists. My team approach will help to effectively enhance athletic performance as well as manage athletes with medical concerns or disordered eating.

I am currently the sports dietitian for all the IUPUI Athletic Teams as well as Community Health Network Sports Medicine. Vitamin E is an antioxidant which stops reactive oxygen species ROS production which naturally occurs especially following exercise. Vitamin E is a key player in immune system functioning.

Food sources of Vitamin E include plant oils, seeds, and nuts such as almonds, sunflower seeds and peanut butter. Vitamin B12 absorption of food sources decreases with age and therefore supplementation may be needed. B12 foods are only found in animal products such as fish, meat, poultry, eggs, and dairy products or fortified cereals and nutritional yeast.

If supplementation is needed, a B12 lozenge in the form of methylcobalamin could be useful. B2, Riboflavin plays key roles in energy production and metabolism of fats, drugs, and steroids.

Food sources include eggs, organ meats kidneys and liver , lean meats, milk and fortified cereals and grains. B6, Pyridoxine is involved in more than enzyme reactions within protein, carbohydrate, and fat metabolism with an emphasis on protein metabolism. B6 daily needs increase after age 50 to 1. Food sources of B6 are fish, beef, poultry, starchy vegetables, fortified cereals, and some non-citrus fruits.

B9, Folate is involved in making DNA, RNA and protein metabolism. Food sources include spinach, brussels sprouts and other dark leafy greens, fruits and fruit juices, nuts, beans, peas, seafood, meat, eggs, dairy and fortified grains, and cereals.

Calcium requirements increase to mg for women over the age of 51 and men over 71 years old. For those years old, calcium recommendations are mg per day for the non-pregnant or lactating person. It is best to get calcium via food sources such as milk, yogurt and cheese or non-dairy sources like canned sardines and salmon with bones, kale, broccoli and bok choy or fortified foods like orange juice, dairy free milks, cereals, tofu.

Magnesium is involved in more than enzymatic reactions in the body including protein synthesis, muscle and nerve function, blood glucose control, and blood pressure regulation. Magnesium is required for energy production. It is involved in bone development and creates DNA, RNA, and the antioxidant glutathione.

Magnesium transports calcium and potassium ions across cell membranes which is important for nerve impulse conduction, muscle contraction, and normal heart rhythm. The highest food source of magnesium is roasted pumpkin seeds.

Other food sources include: spinach, legumes, nuts, seeds, and whole grains. Be careful with supplementation as some supplements can cause a laxative effect.

I tend to recommend magnesium glycinate as a supplement mg at bedtime. Zinc catalyzes hundreds of enzymes. Zinc is involved in immune function, protein and DNA synthesis, wound healing and cell signaling.

The recommended dietary allowances for zinc are 11 mg for male and 8 mg for females aged 19 years or older. The richest food sources of zinc are meat, fish, and seafood such as oysters and beef.

Plant based sources such as beans, nuts and whole grains contain some zinc, but are not highly bioavailable meaning the absorption of zinc in these foods is low.

Those aging past 30 years should start to pay attention to protein, fluid and nutrient intakes. Not only do aging athletes need more protein and need to pay attention to fluid intake and certain nutrients, but they need to consume enough fuel to support metabolic needs AND physical activity.

Older adults, especially some older women who are frustrated with body changes tend to eat less and exercise more. This effect will have your body hold onto more fat for fear that it is in a state of starvation mode.

If you are frustrated with your body and sport performance, see a Sports Dietitian to nail down nutrition and fitness tailored to your age, gender, and lifestyle.

Hamrick MW, McGee-Lawrence ME, Frechette DM.