WEEK 13- Special Nutrition considerations

What four athlete groups require special nutrition considerations in this lecture?

1. Masters athletes: total energy, macronutrients, micronutrients and fluids

2. Female athletes during perimenopause

3. Vegetarian and vegan athletes

4. Athletes taking appetite-suppressing medication

Which sports illustrate the competitive range of masters athletes?

Olympics; Ironman World Championships; triathlon; marathons; swimming; athletics.

Examples discussed in the existing lecture notes include an older Olympic gymnast and a Perth athlete competing at Kona in the 60-64-year age category. Age alone does not indicate low sporting ability.

DIAGRAM ON SLIDE 5

How are masters athletes defined, how often are the World Masters Games held, and what health benefits of sport were cited?

Masters athletes: typically older than 35 years.

World Masters Games: every four years.

Participation in physical activity is associated with decreased chronic lifestyle-related disease risk, improved health and longevity.

Cited comparison of sport participants with non-participants: 20-40% lower all-cause mortality (Khan et al., 2012).

Do not assume all masters athletes have low training demands.

When assessing a masters athlete, what four personal circumstances should be discussed?

1. Lifestyle (employment, retirement, travel and training schedule)

2. Finances (ability to access nutrition support, equipment and events)

3. Beliefs (nutrition and sport-related beliefs)

4. Habits (longstanding routines and willingness to change)

These were open discussion prompts, without one model response on the slide.

What two masters-athlete case examples were presented?

- 66-year-old retired man competing in triathlon at world-championship level

- 55-year-old semi-retired woman competing in world-championship gravel cycling

Both illustrate substantial sporting demands despite age, with fuelling and recovery differing by discipline and event.

Which age-related changes in masters athletes may reduce energy requirements?

- Decreased muscle mass → decreased energy requirements

- Decreased aerobic capacity → decreased energy requirements

- Decreased muscle glycogen stores → decreased energy requirements

These are trends, not universal values; actual training load matters.

DIAGRAM ON SLIDE 9

Which age-related changes in masters athletes alter requirements for bone-related nutrients?

- Decreased bone density → increased calcium and vitamin D needs

- Decreased skin capacity for vitamin D synthesis → increased vitamin D needs

- Decreased calcium bioavailability → increased calcium and vitamin D needs

DIAGRAM ON SLIDE 9

How can age-related digestive and metabolic changes affect vitamin and mineral needs in masters athletes?

- Decreased gastric acid → higher need for vitamin B12, folic acid, calcium, iron and zinc

- Decreased hepatic uptake of retinol → lower need for vitamin A (as stated on slide)

- Less efficient metabolic use of vitamin B6 → higher vitamin B6 need

- Increased oxidative stress → higher need for carotenoids, vitamins C and E

- Elevated homocysteine → higher need for folate, vitamin B6 and B12

DIAGRAM ON SLIDE 9

Which age-related changes increase hydration concerns for masters athletes?

- Reduced thirst perception → fluid requirements/attention to fluid replacement increase

- Reduced kidney function → fluid requirements/attention to hydration increase

The lecture table labels both as increased fluid needs; individual prescription still depends on the athlete.

DIAGRAM ON SLIDE 9

Why may daily energy requirements decline with age, and how should masters-athlete needs be calculated?

Potential factors:

- Lower energy expenditure from physical activity (PA) and lower resting metabolic rate (RMR)

- Reduced fat-free mass (FFM)

- Reduced physical activity levels and training volume

However, estimate energy needs using the athlete's individual sport and training programme, rather than average older-population estimates.

How do carbohydrate requirements and glycaemic-index advice for masters athletes compare with younger athletes?

- Carbohydrate (CHO) absorption and utilisation are described as largely unaffected by ageing.

- CHO recommendations are therefore similar to those for younger athletes and should reflect training load.

- Low- to moderate-glycaemic-index (GI) choices are recommended for usual eating.

- The slide's GI graphic contrasts a sharper/higher blood-glucose response for high GI with a lower/flatter response for low GI.

DIAGRAM ON SLIDE 11

What fat recommendations and digestive capabilities apply to masters athletes?

- General guidance to limit total fat and especially saturated fatty acids (FA) applies.

- Ageing athletes retain the ability to digest, absorb and utilise dietary fats.

Why might total daily protein requirements be somewhat lower in some masters athletes than younger athletes?

Adult athletes need more protein than non-athlete adults. Possible reductions in some older athletes relate to:

- Lower lean muscle mass (LMM)

- Lower whole-body protein turnover and post-exercise protein synthesis

- Less protein oxidised as fuel with lower exercise intensity or volume

- Possible reduced intestinal absorption of amino acids (AA) and peptides at low doses

These do not imply that every masters athlete needs less protein: actual training and muscle goals matter.

What protein amount was reported to maintain nitrogen balance in resistance-training masters athletes?

1.0-1.3 g protein/kg body mass, reported in the cited Lucas & Heiss (2005) study.

This is the study finding on the slide, not a universal daily prescription.

What is anabolic resistance in older athletes?

A reduced muscle protein synthesis (MPS) response to exercise and/or a given protein dose with ageing.

Consequence: a greater amount per feeding may be needed for an equivalent MPS response.

How does post-exercise protein dosing differ between younger and older athletes according to the lecture?

Research cited (Drummond et al., 2008):

- Young athletes: post-exercise MPS response reportedly saturates at about 20 g protein.

- Older athletes: may need slightly higher per-meal/recovery doses because of anabolic resistance.

General recovery guidance is similar, but protein timing and dose become especially important.

Which nutrients deserve additional monitoring in masters athletes and what other health factors matter?

Micronutrient absorption may decline for:

- Vitamin B6

- Vitamin B12

- Vitamin D

- Calcium

Also consider prescription/over-the-counter medicine interactions and chronic disease.

What are vitamin B6 functions and ageing-related issues in masters athletes?

- Coenzyme in energy metabolism

- Increased turnover suggested by urinary 4-pyridoxic acid (4-PA) excretion

- Serum concentrations decrease with age

- Higher intakes may be needed to support immune function in studies cited

The slide illustrates vitamin B6 forms pyridoxine, pyridoxal and pyridoxamine.

Existing import notes caution against excessive supplementation because of toxicity.

DIAGRAM ON SLIDE 17

Why may vitamin B12 requirements or deficiency risk increase with age?

Vitamin B12 supports normal blood and neurological function, fatty-acid synthesis and DNA synthesis.

Age-related atrophic gastritis reportedly affects ~30% of adults older than 60 years.

Gastritis reduces gastric secretions and intrinsic factor (IF), both important for B12 absorption.

The existing import emphasises monitoring B12 using appropriate blood screening.

What roles does vitamin D play, and why can older athletes become deficient?

Functions:

- Promotes calcium absorption and reabsorption

- Regulates cell growth, immune function, inflammation and protein synthesis

- Slide estimates skin contributes 80-90% of the body's vitamin D needs

With ageing:

- Skin synthesises fewer vitamin D precursors

- Renal production of activated vitamin D is reduced (slide describes activated D3)

Possible deficiency signs: musculoskeletal pain, impaired muscle strength and weakness.

Existing import notes that vitamin D deficiency can also affect younger athletes.

What physiological functions of calcium are relevant to masters athletes?

- Bone health

- Nerve conduction

- Muscle excitation and contraction

- Cofactor in glycogenolysis

- Works with vitamin K in blood coagulation and wound healing

Why can bone stress injury and calcium deficiency be concerns in masters athletes?

- Repetitive-impact activity can increase stress-fracture concern.

- Low bone density, oestrogen insufficiency and suboptimal calcium intake may increase risk.

- Calcium absorption declines with age in both sexes, associated with lower vitamin D absorption and production.

Assess both dietary calcium and vitamin D/bone health.

What mechanisms make dehydration or heat stress more problematic in older athletes?

1. Total body water (TBW) and plasma volume decrease → higher heat-stress risk.

2. Reduced renal antidiuretic-hormone receptor efficiency → more urinary fluid loss → hypohydration risk.

3. Reduced thirst sensation → less voluntary drinking.

4. Reduced thermoregulatory efficiency → higher heat-stress risk.

5. Reduced sweat production → less evaporative skin cooling.

Individual sweat loss and exercise conditions still matter.

What medication-related issues should be checked in masters athletes?

- A cited study reported 34% taking medicines for cardiovascular (CV), respiratory or inflammatory conditions.

- Prescription and over-the-counter medicines can alter nutrient absorption, metabolism or excretion.

- They can mask or change the normal physiological response to exercise.

- Work with a sports physician; existing import also advises appropriate pharmacist review.

Which female-athlete nutrition position statement was recommended for further reading?

2023 International Society of Sports Nutrition (ISSN) position stand, "Nutritional concerns of the female athlete".

Journal of the International Society of Sports Nutrition, 20(1), article 2204066.

DOI: 10.1080/15502783.2023.2204066.

Authors include Stacy T. Sims, Chad M. Kerksick and Abbie E. Smith-Ryan.

The slide identifies it as open access.

DIAGRAM ON SLIDE 25

What is menopause, and when do the main perimenopausal body-composition changes occur?

Lecturer definition reflected in the existing import: menopause is marked by 12 months without menstruation.

The lecture states that most body-composition changes develop during the 4-5 years leading up to menopause; changes may begin in the 40s.

Which physiological and body-composition changes are associated with perimenopause in female athletes?

- Anabolic resistance of muscle protein synthesis (MPS)

- Insulin resistance

- Increased abdominal adiposity

- Decreased lean mass

- Reduced bone mineral density

- Reduced energy expenditure

What are the principal nutrition priorities for perimenopausal athletes?

Target:

- Insulin sensitivity

- Preservation of lean mass

- Bone density

- Recovery

Existing import adds appropriate carbohydrate, fibre/low-GI foods and calcium consideration.

These should be individualised to training and health status.

What protein intake and timing targets did the lecturer give for perimenopausal athletes?

Slide recommendations:

- About 1.6-1.8 g protein/kg body mass/day overall

- Spread protein across the day, approximately every 3 hours

- For recovery, slide states 10 g protein as soon as possible to manage anabolic resistance

Existing import clarifies that this prompt 10 g can be part of a larger, otherwise standard recovery protein serving.

What results for hormone therapy plus resistance training were reported at WHAM 2026?

The lecture attributes the following to Dr Tara Iyer, MD, at WHAM 2026:

- Hormone replacement therapy (HRT) plus resistance training: 7.9% muscle gain

- Resistance training alone: 3.9% muscle gain

Slide describes approximately double the gain.

Supporting citation shown: Dam et al. (2021), transdermal oestrogen and 12 weeks of resistance training in early postmenopausal women.

What other WHAM 2026 recommendations were presented for perimenopausal women?

- Higher-protein intake of 1.2-1.5 g/kg/day plus resistance training for preserving strength and muscle mass

- Weight loss: 300 minutes/week aerobic exercise

- Fibre: >25-30 g/day for weight management

- Important intervention window: 2 years before and 2 years after the final menstrual period

- Sleep under 6 hours affects metabolism

Note: this slide's 1.2-1.5 g/kg recommendation differs from the preceding lecture slide's 1.6-1.8 g/kg/day; both are preserved as presented.

What two public examples were used to introduce plant-based eating in elite sport?

- The documentary "The Game Changers"

- A cricket.com.au story: "Zampa's culinary challenge to keep his competitive wedge"

They illustrate interest in plant-based eating, but the lecture does not claim plant-based diets automatically improve performance.

DIAGRAM ON SLIDE 31

How does the lecture define vegetarian versus plant-based eating?

Vegetarian: dietary pattern containing no meat (including chicken), seafood or products containing these foods (Craig & Mangels, 2009).

Plant-based (PB): animal or animal-derived ingredients are consumed never or rarely, no more than 1-2 times/week.

The lecturer recommends asking exactly which foods an individual eats instead of assuming from their label.

What are the five major vegetarian or related diet categories listed?

1. Fruitarian

2. Macrobiotic

3. Vegan

4. Lacto vegetarian

5. Lacto-ovo vegetarian

These labels are starting points for diet history, not substitutes for asking about actual foods.

DIAGRAM ON SLIDE 33

How are fruitarian and macrobiotic diets characterised in the lecture?

Fruitarian:

- Raw or dried fruit, nuts, seeds, honey and vegetable oil

Macrobiotic:

- Eliminates animal foods, dairy and eggs

- Emphasises unprocessed, unrefined organic cereals and grains

DIAGRAM ON SLIDE 33

How do vegan, lacto vegetarian and lacto-ovo vegetarian diets differ?

Vegan:

- Excludes animal foods, dairy and eggs

- Excludes animal-derived products including honey, gelatine, silk, wool, leather and animal-derived additives

Lacto vegetarian:

- Excludes animal foods and eggs

- Includes milk and milk products

Lacto-ovo vegetarian:

- Excludes animal foods

- Includes milk, milk products and eggs

DIAGRAM ON SLIDE 33

What reasons for choosing vegetarian eating were listed?

- Health

- Religion

- Environment/sustainability

- Animal welfare

- Taste, smell or appearance

- Beliefs about nutritional quality

Lecturer notes recommend respecting the person's motivations while clarifying the actual diet.

Can vegetarian and vegan diets meet athletic needs, and which nutrients need attention?

Well-planned vegetarian/vegan diets can be nutritionally adequate.

Female vegetarians may be more at risk of suboptimal:

- Iron

- Zinc

- Calcium

- Total energy

The lecture reports greater requirements for zinc, iron and potentially calcium because of lower bioavailability.

Why might high-training-load plant-based athletes struggle to consume enough energy?

Common foods such as legumes, wholegrain cereals, fruit and vegetables contain substantial fibre and can be very filling.

An athlete may feel full before meeting high energy expenditure.

Recommendation: incorporate appropriate energy-dense foods and practical eating patterns.

DIAGRAM ON SLIDE 36

What protein considerations are important for vegetarian and especially vegan athletes?

- Vegetarians in general-population studies sometimes consume less protein, while still meeting usual requirements.

- Athletes must consider both total quantity and protein quality.

- Use varied plant sources across the same day and after exercise to ensure essential amino-acid (EAA) availability.

- Newly plant-based athletes may have particularly low protein intakes.

Examples in existing import: tofu, textured vegetable protein, legumes, soy milk, and vegan protein powder when useful.

Why is iron bioavailability central when assessing vegetarian athletes?

- Plant iron is predominantly non-haem.

- The issue may be absorption rather than intake alone.

- Lecture recommendation: vegetarian iron intake about 1.8× non-vegetarian intake (NHMRC, 2016); can exceed 3× the estimated average requirement (EAR) for female vegetarians.

- Inhibitors: phytates, calcium and polyphenols.

- Enhancer: vitamin C.

- Routine monitoring was recommended; existing notes mention ferritin testing.

DIAGRAM ON SLIDE 38

What are the main zinc concerns and food sources for vegetarian athletes?

- Female vegetarian athletes have been reported to consume less zinc than non-vegetarian athletes.

- Zinc has lower bioavailability in some plant-based diets.

- Sources: cereal grains, legumes, nuts and soy products.

Review intake and relevant clinical assessment where needed.

Why is vitamin B12 a special concern in vegan diets?

Active vitamin B12 is not naturally found in plant foods.

Sources to consider:

- Fortified plant milks

- Fortified cereals

- Supplements when needed

Existing import also mentions fortified soy products and B12 mouth spray as examples.

Which other three nutrients should be reviewed in vegetarian/vegan athletes?

1. Omega-3 fatty acids

2. Vitamin D

3. Calcium

Existing import notes that algae-derived omega-3, vitamin D screening and calcium assessment may be considered depending on intake.

What body-composition, glycogen and recovery hypotheses were discussed for plant-based athletes?

- Plant-based diets have been associated with lower body mass index (BMI) and body-fat levels in cited studies.

- Carbohydrate-rich plant-based diets may support glycogen storage.

- Fruits, nuts, seeds, legumes, vegetables and grains provide phytochemicals with antioxidant/anti-inflammatory properties, including carotenoids, flavonoids and phenolic acids, potentially affecting recovery.

The slide frames improved glycogen storage/recovery as questions, not established universal benefits.

What did the systematic review find when comparing plant-based with omnivorous diets for sporting performance?

Craddock et al. (2016): systematic review of 8 studies.

No meaningful differences reported in:

- Muscular power

- Muscular strength

- Anaerobic performance

- Aerobic performance

Conclusion: no significant performance advantage, but no performance detriment when diets are adequate.

What is the purpose of the three-day vegan team-sport athlete meal-plan illustration?

Guest (2021): three-day plan for an adult male vegan team-sport athlete (80 kg), training 12-15 hours/week, maintaining muscle mass.

Across three days: 613 g protein, 124 mg non-haem iron, 7000 mg calcium, 18 g alpha-linolenic acid (ALA), 75 mg zinc, 187 µg vitamin B12.

Sample day nutritional goals: protein 1.6 g/kg = 128 g; iron RDA 14 mg; calcium RDA 1000 mg; ALA AI 1.6 g; zinc RDA 17 mg.

Sample day actual: protein 186 g; iron 35 mg; calcium 2477 mg; ALA 3.0 g; zinc 25 mg. The plan includes 5.8 µg vitamin B12 from fortified foods.

The meal plan demonstrates the planning needed to meet demanding training needs.

DIAGRAM ON SLIDE 43

What sequence of meals, snacks and training sessions is shown in the vegan team-sport meal-plan figure?

7:00 am wake-up; 7:15 am breakfast (peanut butter, fruit and toast); 9:00-11:00 am sport practice; 10:00 am mid-practice snack (dates and iced-watermelon sports drink); 11:00 am post-workout shake (mixed berries, protein and chia); 1:00 pm lunch (vegan Mexican wrap); 3:00 pm pre-workout snack (baked sweet potato); 4:00-5:00 pm strength and conditioning; 5:00 pm post-workout shake (berry-coconut smoothie with creatine and roasted chickpeas); 7:00 pm dinner (sesame stir-fried tofu and vegetables over rice); 10:00 pm bedtime snack (recovery bites plus pea protein); 11:00 pm sleep.

Key foods in the figure include fortified plant milk, soy milk, plant protein powder, oats/bread, nuts, beans, avocado, tofu, seeds, fruit and vegetables.

DIAGRAM ON SLIDE 43

Why might creatine supplementation be particularly relevant to vegetarian athletes?

- Dietary creatine intake may be low because many dietary sources are animal foods.

- Studies cited report greater muscle creatine uptake in vegetarians, potentially reflecting lower baseline stores.

- Creatine may therefore merit individual consideration; no universal recommendation is made.

Which appetite-suppressing medicines were specifically named in the lecture?

Examples of medicines used for attention-deficit/hyperactivity disorder (ADHD):

- Vyvanse

- Ritalin

- Concerta

Their appetite-suppressing effects can contribute to inadequate energy intake in athletes.

How can meal timing help athletes taking appetite-suppressing medication meet nutrition requirements?

1. Eat a substantial early-morning meal before medication when feasible.

2. Have manageable snacks regularly throughout the day despite reduced appetite.

3. Shift a larger "lunch" to later in the day as medication wears off.

4. Consider an additional meal after dinner if needed to meet energy requirements.

Existing import suggests convenient liquid options such as Up & Go, Rokeby or Sustagen Sport.

Tailor timing with the prescribing clinician rather than changing medication independently.