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Nutritional Considerations for the Female Athlete

Optimal nutrition is an important aspect of any athlete’s preparation to achieve optimal health and performance. Published literature often focuses on male athletes, leaving out specific advice for females. Women differ from men not only in size, but in body composition and hormonal balance. They also differ from one another – highlighting the individuality of any nutritional approaches.

 

Relative Energy Deficiency in Sport (RED-S)

 

Many female athletes will experience some form of deficiency in their life. Athletes that may be at risk usually compete in endurance sports, aesthetic sports, or weight class sports. This is due to inadequate nutrition for their training or competition, usually because of a perceived performance benefit, requirement of competition or lack of knowledge. It’s tough to quantify RED-S, but as a start we can look at energy availability. This quantifies the amount of caloric energy that can be used by the body for physiologic functioning and is a measure of nutritional energy status for athletes. It’s calculated as:

 

Energy intake minus exercise energy expenditure, normalized to fat free mass per day

 

An energy deficit occurs when energy availability < 30 kcal per kg of fat free mass per day. This can cause fatigue, poor performance and a range of health conditions. Athletes should look to hit energy availability of around 45 kcal per kg of fat free mass per day to promote maintenance of body mass, with >45 promoting weight gain and muscle hypertrophy.

 

Macronutrients

 

Protein recommendations are in line with ACSM guidelines suggesting intakes between 1.2 – 2g of protein per kg of body mass per day. Specific recommendations on female athletes have recommended protein intakes of 1.6 g/kg per day during the follicular phase of the menstrual cycle.

 

Carbohydrate recommendations follow a ‘fuel for the work required’ periodisation model – increasing carbohydrate intake on training days and reducing during rest periods. Both male and female athletes have been shown to under consume carbohydrate, which is the main fuel for high intensity exercise performance. This may result in RED-S, with carbohydrate often being the main macronutrient in the diet. Carbohydrate intakes range from 3-8g/kg per day, with 30-60g taken during endurance exercise lasting over 90 minutes or during high intensity team sports, often at the half-time period.

 

Fat should make up 20% of the diet for a female athlete, from a range of fatty acids. Athletes should promote unsaturated fats, particularly omega 3 e.g oily fish. Saturated fats should be limited e.g processed foods and fatty meats.

 

Micronutrients

 

Micronutrient deficiencies can occur due to overall inadequate nutritional intake. Deficiencies in iron, vitamin D, and calcium are common in female athletes and nutritional strategies should be adapted to prevent these deficiencies.

 

Iron is a common deficiency in female athletes. Some female athletes are at inherently higher risk than others for iron deficiency. These include athletes with restrictive diets e.g vegan, vegetarian, no red meat etc; team sport athletes that involve lots of running; endurance athletes and athletes those with heavy menstrual bleeding. The current recommended intake of iron is 18mg per day, however athletes with risk of deficiency should look to include more iron sources in their diet or consider supplementation.

 

Calcium deficiency can be hard determine, so dietary recall should be undertaken to determine risk. Athletes should consume around 1500mg of calcium per day, spread out to optimise absorption. 250ml of 1% fat milk contains around 300mg of calcium, key for bone health.

 

Vitamin D is important for bone health and is related to immune and muscle function. It is a fat-soluble compound primarily synthesised for sunlight exposure. Dietary vit D intakes are low, making vit D deficiencies common in winter months. Female athletes should aim to have 25-OH-vitamin D levels > 50 nM to protect their bones. This can be achieved with daily supplementation of 1000–2000 IU vit D3 in winter months, which depends on regular sun exposure.

 

References

 

Holtzman, B., & Ackerman, K. E. (2021). Recommendations and nutritional considerations for female athletes: health and performance. Sports Medicine, 1-15.

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