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Dan Benardot

Athletes are influenced by coaches, other athletes, media, parents, the national sport governing body, members of the sports medicine team, and the athlete's own desire for success. It is impossible, therefore, for one member of the sports medicine team to unilaterally determine workable solutions that enhance performance and diminish health problems in an athlete. A focus on ensuring that the athlete can perform to the best of her ability is a key to encouraging discussion between the nutritionist, athlete, and coach. Using the assumption that health and top athletic performance are compatible, this focus on performance provides a discussion point that all parties can agree to and, if approached properly, also fulfills the nutritionist's goal of achieving optimal nutritional status. Membership on the sports medicine team mandates that the nutritionist know the paradigms and health risks associated with the sport and develop assessment and feedback procedures specific to the athlete's needs.

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Sherry Robertson, Dan Benardot and Margo Mountjoy

The sport of synchronized swimming is unique, because it combines speed, power, and endurance with precise synchronized movements and high-risk acrobatic maneuvers. Athletes must train and compete while spending a great amount of time underwater, upside down, and without the luxury of easily available oxygen. This review assesses the scientific evidence with respect to the physiological demands, energy expenditure, and body composition in these athletes. The role of appropriate energy requirements and guidelines for carbohydrate, protein, fat, and micronutrients for elite synchronized swimmers are reviewed. Because of the aesthetic nature of the sport, which prioritizes leanness, the risks of energy and macronutrient deficiencies are of significant concern. Relative Energy Deficiency in Sport and disordered eating/eating disorders are also of concern for these female athletes. An approach to the healthy management of body composition in synchronized swimming is outlined. Synchronized swimmers should be encouraged to consume a well-balanced diet with sufficient energy to meet demands and to time the intake of carbohydrate, protein, and fat to optimize performance and body composition. Micronutrients of concern for this female athlete population include iron, calcium, and vitamin D. This article reviews the physiological demands of synchronized swimming and makes nutritional recommendations for recovery, training, and competition to help optimize athletic performance and to reduce risks for weight-related medical issues that are of particular concern for elite synchronized swimmers.

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Satya S. Jonnalagadda, Dan Benardot and Marian Nelson

The nutrient intakes and dietary practices of elite, U.S. national team, artistic female gymnasts (n = 33) were evaluated using 3-day food records. The gymnasts' reported energy intake was 34.4 kcal/kg (total 1,678 kcal/day), which was 20% below the estimated energy requirement. The contributions of protein, fat, and carbohydrate to total energy intake were 17%, 18%, and 66%, respectively. All reported vitamin intakes, except vitamin E, were above the RDA. The reported mineral intakes, especially calcium, zinc, and magnesium, were less than 100% of the RDA. The overall nutrient densities of the subjects' diets were higher than expected. Eighty-two percent of the gymnasts reported taking nonprescription vitamin and mineral supplements, and 10% reported taking prescription vitamin and mineral supplements. Forty-eight percent of the gymnasts reported being on a self-prescribed diet. Compared to NHANES III, the reported nutrient intake of these gymnasts was different from that of the average U.S. adolescent female. In summary, certain key nutrients such as calcium, iron, and zinc should be given more attention to prevent nutrient deficiencies and subsequent health consequences.

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Darren Triplett, J. Andrew Doyle, Jeffrey C. Rupp and Dan Benardot

A number of recent research studies have demonstrated that providing glucose and fructose together in a beverage consumed during exercise results in significantly higher oxidation rates of exogenous carbohydrate (CHO) than consuming glucose alone. However, there is insufficient evidence to determine whether the increased exogenous CHO oxidation improves endurance performance. The purpose of this study was to determine whether consuming a beverage containing glucose and fructose (GF) would result in improved cycling performance compared with an isocaloric glucose-only beverage (G). Nine male competitive cyclists (32.6 ± 5.8 years, peak oxygen uptake 61.5 ± 7.9 ml · kg-1 · min-1) completed a familiarization trial and then 2 simulated 100-km cycling time trials on an electronically braked Lode cycle ergometer separated by 5–7 d. During the randomly ordered experimental trials, participants received 36 g of CHO of either G or GF in 250 ml of water every 15 min. All 9 participants completed the 100-km time trial significantly faster when they received the GF beverage than with G (204.0 ± 23.7 vs. 220.6 ± 36.6 min; p = .023). There was no difference at any time point between trials for blood glucose or for blood lactate. Total CHO oxidation increased significantly from rest during exercise but was not statistically significant between the GF and G trials, although there was a trend for CHO oxidation to be higher with GF in the latter stages of the time trial. Consumption of a CHO beverage containing glucose and fructose results in improved 100-km cycling performance compared with an isocaloric glucose-only beverage.

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Dan Benardot, Wes Zimmermann, Gregory R. Cox and Saul Marks

Competitive diving involves grace, power, balance, and flexibility, which all require satisfying daily energy and nutrient needs. Divers are short, well-muscled, and lean, giving them a distinct biomechanical advantage. Although little diving-specific nutrition research on performance and health outcomes exists, there is concern that divers are excessively focused on body weight and composition, which may result in reduced dietary intake to achieve desired physique goals. This will result in low energy availability, which may have a negative impact on their power-to-weight ratio and health risks. Evidence is increasing that restrictive dietary practices leading to low energy availability also result in micronutrient deficiencies, premature fatigue, frequent injuries, and poor athletic performance. On the basis of daily training demands, estimated energy requirements for male and female divers are 3,500 kcal and 2,650 kcal, respectively. Divers should consume a diet that provides 3–8 g/kg/day of carbohydrate, with the higher values accommodating growth and development. Total daily protein intake (1.2–1.7 g/kg) should be spread evenly throughout the day in 20 to 30 g amounts and timed appropriately after training sessions. Divers should consume nutrient-dense foods and fluids and, with medical supervision, certain dietary supplements (i.e., calcium and iron) may be advisable. Although sweat loss during indoor training is relatively low, divers should follow appropriate fluid-intake strategies to accommodate anticipated sweat losses in hot and humid outdoor settings. A multidisciplinary sports medicine team should be integral to the daily training environment, and suitable foods and fluids should be made available during prolonged practices and competitions.

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Satya S. Jonnalagadda, Dan Benardot and Marian N. Dill

This study examines the degree of under-reporting of energy intake by elite, female gymnasts, and the impact this predicted under-reporting has on associated macro and micro nutrient intake. Twenty-eight female U.S. national team artistic gymnasts participated in the study. Dietary intake was assessed using 3-day food records, and the degree of under-reporting was predicted from the ratio of reported energy intake (EI) to predicted basal metabolic rate (BMRestd), using the standards described by Goldberg et al. (10). Sixty-one percent of the subjects had an EI/BMRestd ratio of < 1.44, and were classified as under-reporters. The under-reporters had higher BMIs and percent body fat, and lower reported total energy intakes than the adequate energy reporters. Additionally, under-reporting of energy intake had a significant impact on reported micro nutrient intake. The under-reporting of energy intake seen in these subjects has an impact on the reported intake of macro and micro nutrients that can influence the interpretation of the nutritional status of these athletes and the strategy for nutrition intervention. Therefore, when assessing dietary intakes of elite gymnasts, some means of determining the accuracy of the reported energy and nutrient intake should be employed to more accurately identify the true nutritional problems experienced by these elite athletes.

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Michael S. Green, J. Andrew Doyle, Christopher P. Ingalls, Dan Benardot, Jeffrey C. Rupp and Benjamin T. Corona

This study determined whether disrupted glucose and insulin responses to an oral glucose-tolerance test (OGTT) induced by eccentric exercise were attenuated after a repeated bout. Female participants (n = 10, age 24.7 ± 3.0 yr, body mass 64.9 ± 7.4 kg, height 1.67 ± 0.02 m, body fat 29% ± 2%) performed 2 bouts of downhill running (DTR 1 and DTR 2) separated by 14 d. OGTTs were administered at baseline and 48 hr after DTR 1 and DTR 2. Maximum voluntary isometric quadriceps torque (MVC), subjective soreness (100-mm visual analog scale), and serum creatine kinase (CK) were assessed pre-, post-, and 48 hr post-DTR 1 and DTR 2. Insulin and glucose area under the curve (38% ± 8% and 21% ± 5% increase, respectively) and peak insulin (44.1 ± 5.1 vs. 31.6 ± 4.0 μU/ml) and glucose (6.5 ± 0.4 vs. 5.5 ± 0.4 mmol/L) were elevated after DTR 1, with no increase above baseline 48 hr after DTR 2. MVC remained reduced by 9% ± 3% 48 hr after DTR 1, recovering back to baseline 48 hr after DTR 2. Soreness was elevated to a greater degree 48 hr after DTR 1 (48 ± 6 vs. 13 ± 3 mm), with a tendency for greater CK responses 48 hr after DTR 1 (813 ± 365 vs. 163 ± 43 U/L, p = .08). A novel bout of eccentric exercise confers protective effects, with subsequent bouts failing to elicit disruptions in glucose and insulin homeostasis.