Clinical features of autism

Clinically, autism is characterized by restricted interests, impaired communication and impaired social interaction among a multitude of other things. For some autistic people, speech does not develop fully, if it does at all. In other cases, speech is restricted to a few topics of expertise, which do not require conversational interplay. The impairment in communication also encompasses non-verbal behavior.

The role of neural connectivity in autism

Autism has also been characterized by deficiency in executive functioning, empathy and complex information processing. Recent research has been focused on establishing abnormal neural connectivity as a cause of autism. The brain of an autistic person features high local connectivity in tandem along with low, long-range connectivity. Such development fails to make a distinction between a noise and a signal.

Problems in long range connectivity are linked to the cerebellum, as are impaired coordination of cognitive functions. Recent MRI-behavior and genetic correlation studies suggest that abnormalities in cerebellum play a key role in autism. Studies in neurobehavioral fields have also shown a direct relationship between abnormalities in cerebellum and social, motor and cognitive deficits.

As far as functionality is concerned, autistic people exhibit very low cerebellar activation when involved in tasks that require selective attention, while cerebellar activation is very high when performing simple motor tasks. These abnormalities in function are linked to the small size of cerebellar sub-regions.

Studies of the cerebral cortex in autistic people show abnormalities of columnar and synaptic structure. Autistic children display a large volume of cerebral white matter. Viral infection in the mother during pregnancy is considered the central non-genetic cause of autism.

Children diagnosed with autism have an excess of cells in the areas of brain associated with emotional development and communication. This explains why children with autism have larger than normal brains. The condition most likely begins when the child is still in the womb. Findings of researchers from the University of California San Diego Autism Centre of Excellence show a 67 % increase in cells in the prefrontal cortex.

The researchers counted and compared brain cells in boys who had and did not have autism at the time of death. The prefrontal cortex was focussed upon. According to the lead researcher, the significant increase in the number of cell not only relates to neurons, but also to potential connections, which could eventually develop into a wrong wiring. This in turn causes abnormal brain function. Neural connections are said to be a major cause of autism. Other causes for autism are genetic and environmental factors.

Practical tip: Rather than treating symptoms, treat the root cause of autism. It should be approached like a neurological problem rather than a psychological one.

Conventional therapies

Movement and exercise is one of many aspects of conventional chronic spinal pain treatment.

Common methods often include guidance for performing physical activities and exercises at home. Patients are encouraged to learn about the management of symptoms through particular exercises, right body mechanics, postural alignment and physical techniques. Self- Calibration or learning to interpret symptom response to activity and exercise is also an important facot. Active management of symptoms is often facilitated using therapies like heat, electrical stimulation, cryotherapy and ultrasound.

Alternative therapies

In a number of cases, conventional therapies on their own are insufficient. These patients often resort to CAM(complementary and alternative medicines). Although these therapies and practices are not included under conventional medicine, many chronic spinal pain patients claim their effectiveness. As the results of these therapies are not same for everyone, you may have to try out several options before you hit a combination of practices that are best suited for your individual needs. You can either use CAM as a complimentary or an alternative to conventional therapies.

PTSD shows through reliving of the traumatic event, avoidance of it and arousal. These three are the main ways in which the symptoms show. No specific tests can be done to diagnose a person with PTSD, but the symptoms are used to identify its presence. Depending on the diagnosis, doctors administer different types of treatments. A report published by the Institute of Medicine (IOM) indicates that cognitive behavioural therapy is most effective for people suffering from PTSD.

Popular PTSD treatments

Several studies have been conducted on exposure-based treatment, where the patient is exposed to the traumatic event that is the cause for anxiety. This exposure can be through imagination of the event or vivo exposure in controlled safe circumstances.

In a controlled random trial of prolonged exposure treatment in female veterans, the treatment showed good results in the reduction of the diagnostic criteria for PTSD. Prolonged exposure combined with cognitive restructuring brought the depression and PTSD levels down in the patients.

Cognitive processing therapy or CPT is a highly researched approach that targets modifying and challenging maladaptive beliefs that are linked to trauma. Written exposure is also a part of this approach.

Veterans with PTSD that was chronic and related to the military showed great improvement after receiving CPT. A study was carried out to compare the effectiveness of the entire CPT protocol with each of its components, which include written exposure and cognitive therapy. Cognitive therapy when isolated showed much better results than written exposure alone.

Ehlers and Clark developed a cognition based therapy for PTSD that has three goals, fixing autobiographical memory troubles, changing extremely negative judgments and eliminating problematic cognitive and behavioural strategies. This therapy has seen positive results in random trials. It features certain unique elements, for instance performing acts disconnected to the traumatic memory.

Additional components have been added to already existing treatments to optimize the results further. Enhanced treatment includes things like multiple channel exposure therapy that combines CPT and prolonged exposure, sequenced skill training that introduces interpersonal regulation before prolonged exposure and brief eclectic therapy that combines cognitive therapy with psychodynamic therapy. According to studies done with these therapies, they are effective and the results are better with these added components.

EMDR and other approaches

EMDR or eye movement desensitization and reprocessing is a type of psychotherapy that aims at making the patient develop better cognitive adaptive coping mechanisms by exposing him/her to events that are particularly distressing. This therapy forms a part of several manuals of PTSD treatment.

Patients receiving this treatment participate in imaginative exposure to trauma, while they perform saccadic eye movements at the same time. A growing body of evidence suggests that this treatment may not be necessary as the mechanism that makes it effective is exposure, which is also used in prolonged exposure.

Other approaches used in addition to EMDR and cognitive therapy may be effective. Some such treatments may include group therapy, trauma desensitization and hypnotherapy. Acceptance and commitment therapy (ACT) concentrates on reducing avoidance and the persons’ engagement in maladaptive thought. It encourages the person to indulge in activities that are in line with the personal ideals.  A number of case studies have favoured ACT as a useful treatment of PTSD. The interest in alternative therapy and medicine to treat PTSD is on a steady rise. For instance, acupuncture was equally effective as compared to cognitive behavioural treatment.

PTSD therapies that deal with cognitive behaviour like cognitive processing therapy, EMDR and prolonged exposure have been proven most effective in treating this disorder. The research and evidence to back their success is also quite large. However, when certain components of these treatments have be isolated and used in combination with other approaches there hasn’t been much success.

Group therapy and alternative medicine show some promise. But it is too early to comment conclusively on their efficacy. These therapies require more research before any final conclusions can be drawn on their effectiveness.

Practical tip: For those suffering from PTSD, prompt treatment and strong social support are highly recommended as this can considerably increase the chances of a positive outcome from therapy.

According to research, psychological intervention can hasten the recovery process for athletes. It helps increase positive energy, self-esteem and confidence. A study by Cupal and Brewer examines how relaxation and imagery affects anxiety levels, knee strength and the perception of pain during rehabilitation. The results indicate that imagery and relaxed intervention reduce re-injury anxiety and the perception of pain among participants.

Case study  

The methods suggested by Cupal and Brewer in their research were used in the persent case study. The athlete considered in this case study was a striker in his early 20′s. The player had represented his country at the high school level. While competing at college, the footballer began working with a psychologist due to performance related anxiety, low self-confidence and fear of failure. Self-talk intervention and imagery helped the patient. But, he was setback by a knee injury, which kept him off the field for almost a month.

The main goal during the injury period was to maintain the developed self-confidence. A reduction in confidence is often seen as a negative impact of injury. It is important to stay confident during recovery as it is closely linked to the performance on return.

The main method used in this study was imagery. In this approach the participant is encouraged to create scenarios in his mind, without any actual environmental stimuli. Auditory, visual, kinaesthetic and mood aspects are used. The footballer displayed superior imagery ability and like using it as the primary mode of treatment. It is vital to match the individual’s needs while using this technique. The patient was encouraged to imagine himself in a positive light. The imagery comprised of scenarios where he overcome challenging and difficult situations. Imagining a positive outcome is critical to this method.

The next step was three-stage intervention. The first stage entailed making the patient discuss the injury in detail in terms of his feelings towards it and what it meant to him. Any specific concerns were noted and used during the imagery sessions. The second stage involved the patient and physiotherapist accepting conclusions about the injury and consequential recommendations.

The patient and the psychologist then decided on their course of action, aims and expected outcomes. The intervention involved the patient recalling positive instances in performance and reliving them. This was a key step to ensure the maintenance of confidence levels. The imagery session was guided by the psychologist, who helped the patient focus on the sounds, movements and feelings associated with successful situations during the game. The patient reported feeling optimistic, energized and eager to return to the game.

The third stage began when the patient was preparing to begin physical training and eventually return to competition. The concerns raised by the player during the initial sessions were focused upon and used to strengthen the mental outlook of the player. The patient was worried about losing out on speed, which was his biggest asset. This was tackled by encouraging the player to create potential scenarios (not real experiences) that featured the concern. He was encouraged to find a solution to overcome the scenario successfully.

Results of the therapy

The player was successful on his return to playing football. He did mention some initial stress while being introduced as a substitute, but this was soon overcome when he began making positive contributions. Questionnaires and interviews conducted during the recovery period showed consistency in confidence levels, which resembled those before the injury.

The imagery and intervention continued for the next six months and a significant positive shift in the footballers’ attitude was noted. The initial issue with self-confidence and cognitive anxiety was completely eliminated. The goal-scoring targets that were set before the season were achieved proving the effectiveness of the imagery.

The psychological therapy aided motivation and helped maintain healthy self-confidence levels during recovery. This is a clear example that shows that channelling energy into the right places can actually improve performance after recovery. It is important to remember that every individual is unique and the course of treatment needs to be tailored to their specific requirements.

 Useful Tip:  Introduce psychological training as a part of an athlete’s regular training. This will not only help him/her cope with recovery in case of accidents and injuries, but also improve performance.

Proper diet and a good conditioning program play a vital role in athletic performance. Athletes who are not at their ideal playing weight will not perform as well as they might.

What about fad diets and crash diets?

Fad diets are popular because they promise rapid weight loss. However, fad diets and crash diets actually result in a loss of lean muscle mass, water, and stored energy, not a loss of excess body fat. As a result, most athletes on such diets become tired early in the day or game and have a hard time finding the energy they need.

How does weight loss occur?

How many calories you need depends on your age, sex, weight, and activity level. To maintain your weight, you have to take in the same number of calories you burn. It takes about 3,000 calories a day for the average 165-pound man who is 19 to 24 years old to maintain his weight. From ages 25 through 49, the daily calorie requirement for maintenance drops to 2,700. An average 127-pound woman, 19 through 24 years old, will have to consume 2,100 calories daily for weight maintenance. From ages 25 through 49, it takes 1,900 calories per day. Your body weight will change when there is a difference between calories in and calories out.

How can I lose weight?

To lose weight you must eat less, exercise more, or both. Combining diet with exercise is a healthier, more balanced, and more successful way of losing weight than by dieting alone.

One pound of body weight is equal to 3,500 calories. Eating 500 fewer calories per day will result in a weight loss of 1 pound per week. Eating 250 fewer calories per day combined with a 250-calorie deficit from exercise will also result in a weight loss of 1 pound per week. Athletes should lose no more than 2 to 3 pounds per week.

Exercise

You should exercise 3 to 6 times per week for 30 to 60 minutes at 60% to 80% maximum heart rate. The goal is to expend at least 300 calories per exercise session. This would be about a 3-mile jog, 12-mile bicycle ride, or a 1-mile swim. See the chart below for more examples of calories burned during different types of exercise.

You may also burn off calories simply by being more active during the day:

• Take the stairs instead of the elevator.
• Park farther away from the store and walk briskly through the parking lot.
• Do your errands on foot or on a bicycle instead of driving.

Diet

To lose weight safely, it is important to eat a wide variety of foods. You should eat enough carbohydrates to fuel your body for exercise. You should reduce your fat intake to reduce calories, rather than follow a very low calorie diet.

Because everyone is different, there are no general guidelines as to how much or how little you should eat or exercise. Use the charts below to help guide you in your food choices.

 Calories Burned per Minute of Activity

---------------------------------------------------------

120-lb 160-lb 200-lb

person person person Activity 

---------------------------------------------------------

2.5        3.4       4.6      Walking 2 miles an hour

                              Bicycling 5 miles an hour



3.3        4.4       5.9      Walking 3 miles an hour

                              Bicycling 6 miles an hour

                              Badminton



5.1        6.8       9.0      Walking 4 miles an hour

                              Dancing

                              Calisthenics

                              Bicycling 10 miles an hour

                              Roller skating



6          8         10.6     Tennis (singles)

                              Water skiing

                              Basketball (recreational)

                              Swimming (35 yards/minute)



6.5        8.7       11.6     Walking briskly 5 miles an hour



7.3        9.7       12.9     Jogging 5 miles an hour

                              Bicycling 12 miles an hour



7.8        10.5      14.1     Downhill skiing

                              Basketball (vigorous competition)

                              Mountain climbing



9.2        12.3      16.4     Jogging 7 miles an hour

                              Cross-country skiing

                              Squash and handball



12.9       17.3      23.2     Running 9 miles per hour

------------------------------------------------------------

From "The Ultimate Sports Nutrition Handbook" by Ellen Coleman

and Suzanne Nelson Steen, Bull Publishing, 1996, Palo Alto, CA.







 Good High-Carbohydrate Foods to Eat 

------------------------------------------------------------

Food Calories Carbohydrates (grams) 

------------------------------------------------------------

Potato                   220             50

Bagel                    165             31

Biscuit                  103             13

White bread, 1 slice      61             12

Cereal, 1 cup            110             24

Oatmeal, 1/2 cup          66             12

Graham crackers, 2        60             11

Rice, 1 cup              223             50

Noodles, 1 cup           159             34

Pizza, cheese, 1 slice   290             39

Pretzels, 1 oz           106             21

------------------------------------------------------------





 Making Proper Food Choices 



Food Type Choose Decrease 

--------------------------------------------------------------------

Meats       Fish, poultry without skin,      Fatty cuts of beef,

            lean cuts of beef, lamb,         lamb, pork; spare ribs,

            pork, shellfish                  organ meats, regular

                                             cold cuts, sausage,

                                             hot dogs, bacon



Dairy       Skim or 1% milk, buttermilk      Whole or 2% milk,

                                             whipped toppings,

                                             cream



            Nonfat or low-fat yogurt         Whole-milk yogurt or

            or cottage cheese                cottage cheese



            Low-fat cheeses, farmer          All natural cheeses

            or pot cheeses (no more          (blue, cheddar,

            than 2 to 6 grams of fat         Swiss, Roquefort)

            per ounce)



            Sherbet, sorbet                  Ice cream





Eggs        Egg whites (2 whites =           Egg yolks

            1 whole egg in recipes)





Fruits      Fresh, frozen, canned, dried     Vegetables prepared

Vegetables                                   in butter, cream, or

                                             other sauces



Breads      Homemade baked goods using       Commercial baked

Cereals     unsaturated oils sparingly,      goods: pies, cakes,

            angel food cake, low-fat         doughnuts, croissants,

            crackers, low-fat cookies        muffins, biscuits,

                                             high-fat crackers,

                                             high-fat cookies

-----------------------------------------------------------------

From "The Ultimate Sports Nutrition Handbook" by Ellen Coleman

and Suzanne Nelson Steen, Bull Publishing, 1996, Palo Alto, CA.

Written by Jackie Berning, PhD, R.D., for RelayHealth.
Published by RelayHealth.
© 2009 RelayHealth and/or its affiliates. All Rights Reserved.

Proper diet and a good conditioning program play a vital role in athletic performance. Athletes who are under their ideal playing weight will not perform as well as they might.

What about weight gain?

How many calories you need depends on your age, sex, weight, and activity level. To maintain your weight, you have to take in the same number of calories you burn. It takes about 3,000 calories a day for the average 165-pound man who is 19 to 24 years old to maintain his weight. From ages 25 through 49, the daily calorie requirement for maintenance drops to 2,700. An average 127-pound woman, 19 through 24 years old, will have to consume 2,100 calories daily for weight maintenance. From ages 25 through 49, it takes 1,900 calories per day. Your body weight will change when there is a difference between calories in and calories out.

To gain weight, athletes need to consume more calories than they expend. This sounds simple but may not be easy. Most research shows that it takes longer to gain weight than to lose it.

Since the goal is to increase muscle mass, be sure to increase your exercise level. Consuming more calories without exercise will increase body fat stores.

How many calories do I burn during exercise?

In planning your calorie needs, consult the following table. It gives the average calories burned for different activities. Multiply the number of calories burned per minute by the number of minutes that you exercise to get the number of calories you need to replace after exercise.

 Calories Burned per Minute of Activity

---------------------------------------------------------

120-lb 160-lb 200-lb

person person person Activity 

---------------------------------------------------------

2.5        3.4       4.6      Walking 2 miles an hour

                              Bicycling 5 miles an hour



3.3        4.4       5.9      Walking 3 miles an hour

                              Bicycling 6 miles an hour

                              Badminton



5.1        6.8       9.0      Walking 4 miles an hour

                              Dancing

                              Calisthenics

                              Bicycling 10 miles an hour

                              Roller skating



6          8         10.6     Tennis (singles)

                              Water skiing

                              Basketball (recreational)

                              Swimming (35 yards/minute)



6.5        8.7       11.6     Walking briskly 5 miles an hour



7.3        9.7       12.9     Jogging 5 miles an hour

                              Bicycling 12 miles an hour



7.8        10.5      14.1     Downhill skiing

                              Basketball (vigorous competition)

                              Mountain climbing



9.2        12.3      16.4     Jogging 7 miles an hour

                              Cross-country skiing

                              Squash and handball



12.9       17.3      23.2     Running 9 miles per hour

------------------------------------------------------------

From "The Ultimate Sports Nutrition Handbook" by Ellen Coleman

and Suzanne Nelson Steen, Bull Publishing, 1996, Palo Alto, CA.

Family history plays a major role in an athlete’s build. Athletes from naturally thin families are less likely to be able to transform their bodies from slight, slender figures to bulky, muscular ones. With improved diet and suitable weight training, however, they can increase their chances of gaining weight. Many people naturally gain weight as they age because their metabolism slows down.

What are the keys to gaining muscle mass?

Muscle mass can be gained through moderate to intense strength training several times each week, coupled with taking in extra calories.

For each pound gained as muscle in a week, you will need to consume about 500 extra calories each day. The extra calories should come from a variety of foods: milk, meat, fruits, vegetables, and grains.

The key is to be consistent. Eating three meals a day with snacks in between is an essential part of gaining lean body mass. If you sleep in and skip breakfast, you miss a chance to add extra calories to your diet.

Eat enough to satisfy your appetite and then try to eat a little more. This can be done by:

• eating larger than normal portions
• eating an extra snack or meal
• drinking commercial liquid meals or milkshakes with regular meals or as snacks

Some good snacks if you are trying to gain weight are:

• peanut butter sandwich
• low-fat milkshake (with skim milk and low-fat ice cream)
• dried fruit
• cottage cheese
• pasta with sauce

Commercial protein supplements will not help you gain weight and will probably add too much protein to your diet. If you need a liquid supplement, make sure it provides the extra calories you need as carbohydrates, not protein.

Written by Jackie Berning, PhD, R.D., for RelayHealth.
Published by RelayHealth.
© 2009 RelayHealth and/or its affiliates. All Rights Reserved.

Americans say they are very concerned about nutrition. Most people understand that too much fat in their food can be a serious health problem. However, many admit that their diets are not balanced and are too high in fat and sugar. When you are rushed and hungry between meals, it is often easiest to grab a candy bar or chips and a soda. Sometimes you may even eat these types of foods for meals because they are fast and give a boost in energy without requiring the time it takes to sit down and eat a healthy meal.

The concept of eating healthier is starting to take hold, however, as we begin to see the consequences of our poor eating habits. Obesity, even among our children, is skyrocketing. We can see that we need to choose our foods more wisely, eat less, and take time to plan our meals and snacks. Snacking can be healthy and often more desirable then eating just 3 meals a day if it is done the right way.

Do some people need to snack more than others?

If meals are not oversized and snacks are usually healthy, anyone should be able to enjoy snacking. In fact, some people need to snack in order to get enough calories.

• Infants and toddlers need to snack because they have such high energy demands and small stomachs.
• Teenagers who are rapidly growing and developing also need to snack because they require more calories and nutrients to sustain their growth spurts.
• Athletes involved in sports or endurance training need to snack to meet their increased energy demands. Carbohydrates (stored as a substance called glycogen in the liver and muscles) are used up during exercise and must be replenished.
• People with very strenuous professions may perform better if they eat more often throughout the day to maintain a high energy level.
• People who may not have time to sit down for a meal should snack so they don’t have an energy letdown in the late afternoon.
• People who don’t eat breakfast should carry a snack with them so they will have the energy to focus on their work.

If you do not fit into one of the above categories, it is still OK to snack on healthy foods and an occasional treat. Just be careful to limit high-calorie, high-fat foods such as candy bars and ice cream to avoid unwanted weight gain and increased health risks.

What kinds of snacks are healthy?

Well-planned snacks can help most people reach their dietary goals. Picking snacks to complement your meals or your diet is the key to snacking. You can use snacks to reach the goal of eating foods from all food groups every day.

The 6 food groups are:

• meat, poultry, fish, dried beans, eggs
• grains
• fruits
• vegetables
• milk, cheese, yogurt
• fats (avoid saturated and trans fats).

Remember that fats, even healthy ones such as canola oil, are high in calories. You should try to keep added fat servings between 3 and 6 teaspoons a day.

Carbohydrates (grains, fruits, and vegetables) should make up at least half of your daily calories.

For example, if all you had for breakfast was a bowl of cereal with low-fat milk and you became hungry at 10 AM, pick a snack from the food groups that you missed. Because you had only 2 of the 6 food groups for breakfast, you should pick a snack from 1 or more of the other 4, like fruits, fruit juice, vegetables, peanut butter on celery, almonds, or hard-boiled eggs.

Listed below are healthy snacks that are low in saturated fat and contain about 100 to 120 calories:

• 1 medium apple or any round fresh fruit
• 18 small pretzel twists
• 10 multigrain honey graham mini rice cakes
• 18 white cheddar soy crisps
• 2 whole-grain white cheddar or butter popcorn rice cakes (natural flavor, light salt)
• 1/2 small (2 ounces) whole-wheat bagel with fat-free cream cheese
• 3 cups of air-popped or low-fat microwave popcorn
• baby carrots or broccoli and cauliflower tops with low-fat or nonfat dressings for dipping (2 cups raw vegetables and 1/2 cup nonfat creamy dressing)
• celery with nonfat cream cheese and 2 tablespoons of raisins or dried cranberries
• 1 cup (8 ounces) of 1% or nonfat (skim) milk
• 1/2 cup low-fat cottage cheese with 1/2 cup pineapple chunks
• 6 to 8 oz carton of light yogurt (sweetened with NutraSweet or Splenda)
• 4 to 5 vanilla wafers
• 5 to 6 saltine crackers (also available with low sodium)
• 1 and 1/2 graham crackers
• 1/2 cup of low-fat ice cream
• 2 tablespoons of raisins
• 1/2 cup of unsweetened applesauce
• 1 fruit roll-up
• 1 fruit juice bar.

Below are healthy snacks also low in saturated fat and containing about 160 and 220 calories:

• 1 large banana or 2 medium servings of fresh fruit
• 1 cup of multigrain Cheerios with 1/2 cup nonfat milk
• 1 small whole-wheat bagel (4 ounces) with fat-free cream cheese
• 1 mozzarella cheese stick (part-skim) with 1 cup of fruit chunks and 6 to 8 low-fat, whole-wheat crackers
• 1/2 turkey and low-fat Swiss cheese sandwich with mustard
• about 6 homemade breaded and baked chicken breast nuggets
• 1 low-fat granola bar
• 4-oz fruit cup and 1 cup of nonfat milk
• 1 cup of sugar-free pudding
• 1/4 cup dried fruit
• 2 caramel corn rice cakes
• 1 cereal bar
• 1 oz of baked tortilla chips with 1/4 cup salsa
• 15 baked potato chips
• 14 animal crackers and 1/2 cup nonfat milk
• 2 fig cookies and 1/2 cup nonfat milk
• 1 cup (8 ounces) of low-fat or nonfat chocolate milk (regular sugar sweetened).

Can I eat high-fat, high-calorie foods occasionally?

Indulging once in a while is normal and healthy. People who swear off all sweets and high-fat foods can begin to crave sweets and fatty foods, which can lead to overeating. Instead, sit down and enjoy the taste and pleasant feelings you get from having the occasional high-fat, high-calorie snack. If guilt overcomes you or you want to enjoy this kind of snack more often, prepare for the extra calories and fat by skipping an extra serving of food at dinner or by exercising a little longer. The fear of having to give up a favorite snack is one of the main reasons most Americans exercise. You can have your cake and eat it, too, as long as you maintain a regular and consistent exercise program.

Developed by RelayHealth.
Published by RelayHealth.
© 2009 RelayHealth and/or its affiliates. All Rights Reserved.

The precompetition meal serves 3 purposes:

• to keep you from feeling hungry before and during the event
• to maintain the levels of sugar in your blood for your muscles to use during training and competition
• to provide proper electrolytes and nutrients
• to supply high quality protein that is easy to digest to help prevent muscle breakdown

Many athletes often skip meals before they train or workout, especially if the workout is in the early morning. Skipping meals or not eating before an early morning workout lowers the stored energy in your body and can impair your performance. This is particularly true if your workout involves endurance training that lasts for 30 minutes or longer.

When should I eat my precompetition meal?

Your stomach should not be full during your event. In general, it takes 1 to 4 hours for your stomach to digest a meal and empty it into your intestines. If you are nervous, that process may take even longer. Food that remains in your stomach during an event may cause nausea and vomiting.

Every athlete is different in terms of when to eat the precompetition meal. A simple guideline is to eat your meal 1 to 3 hours before the start of your competition, so your stomach will be almost empty during the event. Experiment with the timing of your precompetition meal to see what works for you.

What is a good precompetition meal?

Your pre-event meal should include 2 main calorie sources:

• Foods that are high in carbohydrates, such as breads, pasta, fruits, or vegetables. Your stomach and intestines digest these foods quickly. Carbohydrates also help build up stored energy in your body for use later during your event.
• Foods that are a good source of protein.

To avoid stomach upset or nausea, the closer you are to the time of your event the less you should eat. You can have a liquid meal closer to your event than a solid meal because your stomach digests liquids faster. This is especially useful if you are nervous and tense.

If you compete at all-day events such as track meets, swimming meets, or tournaments, you may be tempted by whatever is available at concession stands. Consider the amount of time you have between your events, bring healthy foods, and plan accordingly.

Suggested pre-event menus include the following:

1 hour or less before competition

• fruit or vegetable juice such as orange, tomato, or V-8, and/or
• fresh fruit such as apples, watermelon, peaches, grapes, or oranges and/or
• up to 1 and a half cups of a sports drink and/or
• protein that is easy to digest, such as whey protein in liquid form (like a protein shake)

2 to 3 hours before competition

• fresh fruit, fruit or vegetable juices, and/or
• bread; bagels; English muffins with limited amounts of butter, margarine, or cream cheese; or low-fat yogurt; and/or
• up to 4 cups of a sports drink
• protein that is easy to digest, such as whey protein in liquid form (like a protein shake)

3 to 4 hours before competition

• fresh fruit, fruit or vegetable juices, and
• bread; bagels; baked potatoes; cereal with low-fat milk; low-fat yogurt; sandwiches with a small amount of peanut butter, lean meat, or low-fat cheese; and/or
• up to 7 and one-half cups of a sports drink
• lean protein foods (avoid fatty or fried foods)

Does eating sugary foods before exercise improve performance?

Athletes sometimes consume simple carbohydrates such as honey, candy, or soft drinks right before exercise in hopes of getting quick energy. Unfortunately, eating sugary foods won’t provide it. Most of the energy for exercise comes from foods eaten several hours or even days before the start of the race or event.

If you are an endurance athlete, recent evidence suggests that eating some sugary foods (like energy bars, some types of candy bars, or sports drinks) 35 to 40 minutes before an event may benefit you by providing energy (glucose) to your exercising muscles when your other energy stores have dropped to low levels. However, some athletes are sensitive to having their blood sugar levels go up and down quickly. Eating sugary foods right before an event could harm their performance. Also, there is overwhelming evidence that athletes also benefit from eating highly digestible protein, such as whey protein, before and during exercise. The whey protein helps athletes recover faster and decreases muscle breakdown. Also, drinks containing easily digestible protein as well as carbohydrates have been shown to be more effective than carbohydrate-only drinks. Try different things and find out what works best for you. Never try new precompetition foods and strategies without trying them in practice first.

Does caffeine improve performance?

Yes, caffeine can help improve athletic performance. Like other drugs, caffeine can provide some benefits but too much can lead to problems. There are many studies of caffeine’s effect on athletic performance going back to the 1800s. It has been shown to improve coordination, endurance, and speed, even in moderate doses of 3 to 5 milligrams per kilogram of body weight. The effect is dose related: the higher the dose, the larger the effect. However, higher doses also cause more side effects. Some people are very sensitive and have side effects from caffeine that include nausea, muscle tremors, and headaches.

A common myth is that caffeine can cause an athlete to produce more urine and lose more water. Studies have shown caffeine does not have much of an effect on fluid status or electrolyte balances.

Caffeine binds to receptors in the brain, heart, skeletal muscle, and fat cells. It works mainly by stimulating your central nervous system. It increases heart rate, decreases feelings of pain and fatigue, and increases the burning of fat.

What should I avoid for my precompetition meal?

The hot dogs, doughnuts, nachos, potato chips, and candy bars found at most concession stands are very high in fat and not digested quickly. If you eat these foods as pre-event meals, they will likely be in your stomach much of the morning or afternoon. Avoid or limit eating these foods for your pre-event meal.

Written by Jackie Berning, PhD, RD, for RelayHealth.
Published by RelayHealth.
© 2009 RelayHealth and/or its affiliates. All Rights Reserved.

Iron is a mineral that is important to all body cells. It is particularly important for blood cells because iron is needed to make hemoglobin. Hemoglobin is the protein in blood cells that carries oxygen to body tissues.

If you don’t have enough iron you may develop iron deficiency anemia, which means that your blood has less hemoglobin than normal. People who have iron deficiency anemia are often tired and lack energy.

Iron deficiency anemia may result from:

• a diet that lacks enough iron
• blood loss
• body changes during pregnancy.

How much iron do I need?

How much iron you need depends on your age and whether you are male or female. The recommendations are:

GROUP MG IRON PER DAY



Children 7 to 12 months old                      11

Children 1 to 3 years old                         7

Children 4 to 8 years old                        10

Children 9 to 13 years old                        8

Females 14 to 18 years old                       15

Males 14 to 18 years old                         11

Males over 18 years old                           8

Females 19 to 50 years old                       18

Females over 50 years old                         8

Pregnant females                                 27

Breast-feeding females 14 to 18 years old        10

Breast-feeding females 19 to 50 years old         9

What foods are good sources of iron?

The best way to get enough iron is to eat a healthy, well-balanced diet. Iron is found in a variety of foods. Heme iron is found in meat, poultry, and fish. Nonheme iron is found in fruits, vegetables, grains, nuts, legumes, and iron-enriched foods. The body absorbs heme iron better than nonheme iron.

FOOD SERVING SIZE MG IRON (APPROXIMATE) 

------------------------------------------------------------

Heme Sources

liver, chicken         3 oz                7.2

liver, beef            3 oz                5.8

beef                   3 oz                3.0

shrimp                 3 oz                2.8

turkey, dark           3 oz                2.0

ground beef            3 oz                1.8

lamb                   3 oz                1.5

chicken, dark          3 oz                1.3

chicken, white         3 oz                1.1

turkey, white          3 oz                1.1

fish                   3 oz                1.1

pork, shoulder         3 oz                1.0

pork, loin             3 oz                0.8

tuna, white,

  water packed         3 oz                0.8



Nonheme Sources

fortified breakfast

  cereals*             1 cup               4.5 to 18

soy beans, cooked      1/2 cup             4.7

pumpkin seeds          1 oz                4.2

molasses,

  blackstrap           1 tablespoon        3.5

lentils                1/2 cup             3.3

spinach, cooked        1/2 cup             3.2

bagel                  1 bagel             3.2

tofu, extra firm       3 oz                2.7

prune juice            8 oz                2.7

potato, baked

  with skin            1 potato            2.7

red kidney beans       1/2 cup             2.6

green peas             1 cup               2.5

navy beans             1/2 cup             2.3

garbanzo beans         1/2 cup             2.3

black-eyed peas        1/2 cup             2.2

asparagus, cooked      1 cup               2.2

avocado                1 avocado           2.0

macaroni, enriched,

  cooked               1 cup               2.0

green beans, cooked    1 cup               1.6

enriched rice,

  cooked               1/2 cup             1.4

apricots, dried        6 apricots          1.2

dates                  10 dates            1.0

wheat germ, toasted    2 tablespoons       1.0

whole wheat bread      1 slice             0.9

raisins                1/4 cup             0.8

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* Many cereals and breads are fortified with extra iron.

Check the labels.

Heme foods that are very high in iron such as beef and chicken livers are also very high in cholesterol. Eat these foods in limited amounts.

Do I need an iron supplement?

If you get enough iron in your diet you don’t need a supplement. Taking unnecessary supplements may be harmful. You can accumulate too much iron in your body, which can damage various organs.

If you have iron deficiency anemia, your healthcare provider may recommend a supplement. Iron pills can have side effects such as abdominal cramps; nausea; constipation; and dark stools. To lessen side effects, your healthcare provider may start you on a low dose of iron and slowly increase your dose to the necessary amount. He or she may suggest that you take vitamin C with the iron pills to help your body absorb the iron. Taking the iron at mealtimes can help prevent stomach and intestinal upset. To help prevent constipation, make sure you drink enough fluid and have enough fiber in your diet. Do not take antacids or eat or drink any dairy products at the same time you take iron pills. Antacids and dairy products keep the body from absorbing the supplement fully.

Extra iron may increase nausea during the first 3 months of pregnancy. If your blood count is normal, you may not need the extra iron during this time. If you are taking supplements and feel nauseated after taking the pills in the morning, try taking the pills at night before bedtime.

What foods affect the way the body absorbs iron?

Vitamin C (high in citrus fruits and tomatoes) helps the body absorb nonheme iron. To help your body absorb nonheme iron, try combinations like spinach salad with mandarin oranges slices or a glass of grapefruit juice with your cereal. Also, eating heme-iron-rich foods with nonheme-iron-rich foods helps increase absorption. It is especially important to include foods that improve nonheme iron absorption if you have a condition that causes you to lose more iron losses (such as may occur with heavy menstruation) or when you need more iron (as during pregnancy) It’s also important if you have a condition that causes poor absorption, such as Crohn’s and celiac disease, or if you have a vegetarian diet that includes only vegetarian nonheme sources of iron.

Drinking coffee and tea (even decaffeinated), eating a lot of dietary fiber, or taking a calcium supplement within 2 hours of eating iron-rich foods can decrease iron absorption.

Written by Pierre Rouzier, MD, for RelayHealth.
Published by RelayHealth.
© 2009 RelayHealth and/or its affiliates. All Rights Reserved.

Your daily diet and physical activity are very important to your health. They are important for how you feel today and how you will feel in the future. The three keys to a healthy diet are:

• Make smart choices from every food group: fruits, vegetables, grains, milk products, meat (or other protein-rich foods), and fats.
• Find a balance between how much food you eat and how much physical activity you have.
• Get the most nutrition out of your calories.

What foods do I need?

The best way to give your body the balanced nutrition it needs is by eating a variety of nutrient-packed foods every day. Just be sure to stay within your daily calorie needs. A healthy eating plan is one that:

• Emphasizes fruits, vegetables, whole grains, and fat-free or low-fat milk and milk products.
• Includes poultry, fish, soy protein, beans, eggs, nuts, and lean meats if you choose to include meat in your diet.
• Is low in saturated fats, trans fats, cholesterol, salt (sodium), and added sugars.

Fruits

Eat a variety of fruits–whether fresh, frozen, canned, or dried–rather than fruit juice for most of your fruit choices. (Fruit juice is higher in calories and sugar and does not have as much fiber as whole fruits.) A good goal is to have at least 3 servings of fruit each day (for example, 1 small banana, 1 large orange, and 1/4 cup of dried apricots).

Vegetables

Choose from a variety of vegetables. Try to eat at least 2 and 1/2 cups a day. Eat:

• more green vegetables, such as broccoli, cabbage, and dark leafy greens
• more yellow, orange, and red vegetables, such as peppers, tomatoes, carrots, sweet potatoes, pumpkin, and squash.

Whole Grains

Make sure that half of the grains you eat are whole grains. Eat at least 3 ounces of whole-grain cereals, breads, crackers, rice, or pasta every day. One ounce is about 1 slice of bread, 1 cup of cereal, or a half cup of cooked rice or pasta. Look for products that list whole grains or whole wheat as one of the first ingredients.

Whole grains are good sources of fiber and other important nutrients. As well as helping to prevent constipation, fiber can slow sugar absorption and help lower cholesterol levels. You should try to have 14 grams of fiber for every 1000 calories in your diet. Whole-grain sources of fiber are whole wheat, bran, whole rye, oats and oatmeal, whole-grain corn, and brown or wild rice. Other good sources of fiber are flax seeds, nuts, vegetables, fruits, and beans.

Milk products

Get 3 cups of low-fat or fat-free milk–or an equivalent amount of low-fat yogurt or low-fat cheese (1 and 1/2 ounces of cheese equals 1 cup of milk)–every day. If you don’t or cannot drink milk, choose lactose-free milk products or calcium-fortified foods and beverages.

Protein

Choose lean meats and poultry. Bake, broil, or grill the meats instead of frying them. Get some of your protein from other foods, such as fish, beans, peas, nuts, and seeds. Try to use meat as a side dish rather than a main course. You can decrease the amount of meat you eat by including it in a casserole or stew, using the meat as a flavoring for the main dish.

It is possible to have a healthy diet without eating meat. Vegetarians do need to make sure to eat a variety of nonmeat proteins every day and to get enough iron and zinc. Beans and peas, such as kidney, garbanzo, navy, and pinto beans; lentils; and split peas, are an excellent source of nonmeat protein and iron. They add variety, flavor, and fiber to your diet.

Healthy Fats

Very low fat diets are no longer recommended. Fats should make up 25 to 35% of daily calories. Most of the fats you eat should be healthy, polyunsaturated and monounsaturated fats, such as canola, olive, peanut, soybean, corn, and flaxseed oil. When you buy foods such as margarine, mayonnaise, and salad dressings to add to foods, look for products made with these healthy oils and no trans fats. Three to 6 daily servings of added fat are recommended. One serving equals 1 teaspoon of oil or 1 tablespoon of a reduced-fat product. You don’t have to use added fats to include healthy fat in your diet. Eating avocado and small portions of nuts (1/4 cup) and seeds (2 tablespoons) and having fatty fish a few times a week is a good way to get these fats without adding too many extra calories.

The foods to limit

Some foods contain very little nutritional value or have ingredients that can cause disease. Eating healthy doesn’t mean giving up all sweets, salt, and snacks. It means viewing such foods as a treat, eating them in small portions and less often. You should limit saturated fats, trans fats, cholesterol, sodium, and added sugars in your diet. Reading the Nutrition Facts label on foods can help you do this.

Unhealthy Fats

Avoid foods high in saturated fats, trans fats, and cholesterol to help reduce the risk of heart disease. Examples of foods that contain saturated fat include butter, cheese, and other whole-milk products; the fats in meat and poultry skin; and tropical oils such as coconut and palm oil. Some margarines, shortening, and many packaged convenience, snack, and fast foods contain trans, or hydrogenated, fats. Saturated fats should make up no more than 7% of your daily calories and you should have as little trans fat as possible. Cholesterol is a substance found in animal products such as meat, eggs, dairy products, and baked goods made with eggs and milk. You should have no more than 300 mg (milligrams) of cholesterol per day.

Salt

Choose and prepare foods and beverages with little salt (sodium). An average healthy person should have at least 500 mg (milligrams) of sodium a day but no more than 2300 mg a day. Research shows that eating less than 2300 milligrams of sodium (about 1 tsp of salt) per day may reduce the risk of high blood pressure. Most of the sodium people eat comes from processed and fast foods, not from the salt shaker. Taste food before you add salt to it at the table. Try adding other spices or herbs to the foods you cook and eat instead of salt. Also look for foods high in potassium, which counteracts some of sodium’s effects on blood pressure.

Sugars

Choose foods and beverages low in added sugars. Sugars supply a lot of calories with few, if any, nutrients. Read the ingredient list for packaged foods and make sure that added sugars are not one of the first few ingredients. Some names for added sugars are high fructose corn syrup, sucrose, glucose, corn syrup, corn sweetener, maple syrup, and fructose.

Alcohol

If you choose to drink alcohol, do so in moderation. Moderate drinking means up to 1 drink a day for women and up to 2 drinks for men. A drink equals 12 ounces of regular beer, 5 ounces of wine, or 1 and 1/2 ounces of 80-proof distilled spirits. Remember that alcoholic beverages have calories but are low in nutritional value. Generally, anything more than moderate drinking can be harmful to your health. Some people, or people in certain situations, should not drink at all.

Read the Nutrition Facts Label

Most packaged foods have a Nutrition Facts label, which includes a % Daily Value (DV) section. Use this tool to make healthy food choices quickly and easily. If a serving of a food provides 5% DV or less of a nutrient, it is considered low in that nutrient and 20% DV or more is considered high. Try these tips:

• Keep these low: saturated fats, trans fats, cholesterol, and sodium.
• Get enough of these: potassium, fiber, vitamins A and C, calcium, and iron.

Look at the serving size listed on the label and think about how many servings you are actually eating. If you double the servings you eat, you double the calories and nutrients, including the % DVs. Look at the calories on the label and compare them with the nutrients you are also getting to decide whether the food is worth eating. Remember that when one serving of a single food item has over 400 calories per serving, it is high in calories.

Pay attention to the calories in your diet

Calories are a way to measure the energy value of food. Your body burns calories to use for basic body functions. There is a right number of calories for you to eat each day. This number depends on your age, activity level, and whether you are trying to gain, maintain, or lose weight. You could get all the calories you need from a few high-calorie items, but chances are you won’t get all of the vitamins and nutrients your body needs to be healthy. Choose the most nutritionally rich foods you can from each food group each day: foods packed with vitamins, minerals, fiber, and other nutrients but lower in calories. Pick foods like fruits, vegetables, whole grains, and fat-free or low-fat milk and milk products more often.

If you eat 100 more food calories a day than you burn, you will gain about 1 pound in a month. That’s about 10 pounds in a year. The bottom line is that, if you want to maintain your weight, the number of calories you eat every day should equal the number of calories you burn. If you want to lose weight, you need to eat fewer calories and increase your physical activity.

Be physically active.

Regular physical activity is important for your overall health and fitness. It also helps you control body weight by balancing the calories you take in as food with the calories you burn each day.

• Be physically active for at least 30 minutes most days of the week.
• Increasing the intensity or the amount of time that you are physically active can have even greater health benefits and may be needed to control body weight. About 60 minutes of moderate exercise a day may be needed to prevent weight gain and 90 minutes a day to lose weight. Moderate aerobic exercise is generally defined as requiring the energy it takes to walk 2 miles in 30 minutes. Follow your healthcare provider’s recommendations.

More information about healthy eating may be obtained from:

• The Dietary Guidelines for Americans Web site: http://www.healthierus.gov/dietaryguidelines.

Adapted from “Finding Your Way to a Healthier You,” US Department of Health and Human Services, US Department of Agriculture, www.healthierus.gov/dietaryguidelines, Feb. 2005.
Published by RelayHealth.
© 2009 RelayHealth and/or its affiliates. All Rights Reserved.