Nutrition for the Bariatric Athlete (Endurance Events)

Hello everyone! I’m Anna Polucha, a registered dietitian at the Weight Center. I’d like to thank Janet again for allowing me to guest post on her blog.

Let me just say, it’s exciting to know that there are enough post-bariatric athletes out there that we have to write a blog post for you! I’m so happy to see this population of people embracing exercise and fitness.

There is not a lot of information out there for bariatric athletes, so I’m going to try to shed some light on that. First, a big disclaimer: if you are exercising at a low to moderate intensity for less than 1 hour, you probably don’t need extra nutrition/calories to support your exercise or recovery.  In fact, taking extra calories in this case may hinder your weight loss. My advice for those of you who fall into this category would be to structure your existing meals and snacks so that they support your workout.

For example, after surgery you should be eating about 6 times per day (3 meals, 3 snacks). If you work out at 5pm after work, make sure you save one of your snacks to have about an hour before you work out, then have dinner within the hour after you work out. You’re not taking in extra calories, but the timing of your snack and meal support optimal performance and recovery.

When you start an exercise regimen or increase the intensity of the one you are currently doing, you may experience an increase in hunger. For example, going from light walking 30 minutes per day to doing a 45-minute boot camp class 5 days per week would represent a big increase in exercise intensity. Adding an extra 100-200 calories to your day would help to curb hunger but would still allow for continued weight loss. Try adding the following 150 calorie recovery shake within 30 minutes of completing your workout:
1-2 Tablespoons protein powder
½ cup frozen fruit
1 cup skim milk
(Blend until smooth)

Please use the following guide to assess your calorie needs after weight loss surgery:

• Man or Woman less than 1 year out from surgery needs 800-1000 calories per day
• Inactive woman, more than 1 year out from surgery needs 1200-1300 calories per day
• Active woman, more than 1 year out from surgery needs 1400-1600 calories per day
• Inactive man, more than 1 year out from surgery needs 1400-1500 calories per day
• Active man, more than 1 year out from surgery needs 1500-1700 calories per day

Endurance Athletes
As a note, many of the below nutrition requirements are based on an athlete’s weight. If you are overweight, considering using your ideal body weight (IBW) in place of your actual weight when doing the calculation. IBW for women is 100 + (5 x every inch over 5 feet). IBW weight for men is 106 + (6 x every inch over 5 feet). To get your weight in kilograms, divide pounds by 2.2.

For those who are training for long distance cardiovascular events, you have increased nutritional needs. You will need more calories and carbohydrates to support the large amount of energy you will be using during your training sessions and the event itself. For this reason, training for an endurance event should not be used as a way to lose weight. Completing long training sessions without enough calories or carbohydrates to fuel your body can lead to sub-optimal performance, burn out, or injury.

If you are still trying to reach your goal weight but would also like to train for a race, try a shorter distance race like a 5k or 10k. You can still fuel like an athlete, but you likely won’t need so many extra calories during the day to support your physical activity. An extra 100-200 calories per day would likely be enough to combat the increased hunger that will likely come from adding an exercise regimen to your lifestyle.
Calculating calorie needs for a post-bariatric patient is difficult and should be very individualized. For patients who have reached their goal weight, we generally recommend 1400-1600 per day for active women and 1500-1700 per day for active men. Your needs will go above and beyond this on days that you have longer training sessions.

It is recommended that endurance athletes eat 60% of their calories from carbohydrates. To calculate this, take your calorie intake for the day and multiply it by 0.6. Then divide that number by 4. That is the number of carbohydrate grams you need daily to support optimum performance. For a 1500 calorie per day diet, that number is 225 grams.

The bariatric athlete may not be able to hit such a high number due to pouch space constraints or fear of dumping syndrome. In this case, try increasing your carbohydrate count slowly over time and use a number of high quality carbohydrate sources. Whole grains, fruits, vegetables and low fat dairy products are good choices. Be careful not to sacrifice your protein intake for carbohydrates.
Protein requirements for the endurance athlete are 1.2-1.4 grams per kilogram of body weight. For a 180 pound person, that is 98-115 grams of protein per day.

Keep in mind, most whole grains and vegetables have small amount of protein in them, so you can count the protein in those items towards your daily intake. A half cup portion of cooked steal cut oatmeal has 27 grams of carbohydrates and 5 grams of protein. Try mixing in half a scoop of protein powder or a few egg whites and you’ve got a perfect breakfast for the bariatric endurance athlete!

Before the Endurance Event

Before a long distance training session or event, the typical recommendation is for an athlete to take in 1-4 grams of carbohydrate per kilogram of body weight. For a 180 pound person, that is anywhere between 80 and 330 grams! Bariatric athletes may not be able to reach that number, so the goal would be to increase carbohydrate consumption before an event to a level at which you are comfortable and see performance improvement.

Carbohydrates before an event should be easily digestible. Bananas, figs and white breads are popular. Foods high in protein and fat are digested more slowly, and you may need to avoid them in the hour before the event. Liquid nutrition (sports drinks for example) may be preferred because they empty through the pouch quickly. Experiment with pre-race fueling during your training runs to see what works best for you.

During the Endurance Event

During long distance training or events, the athlete should take in 30-60 grams of carbohydrates every hour. The bariatric athlete will want to spread this out in smaller portions. Popular items for race fuel include carbohydrate gels and drinks. Gummy candies also work well for quick and easily digestible energy. Energy gels may have between 20 and 25 grams of carbohydrate per packet. Sports drinks have around 15 grams of carbohydrate per 8 ounces. Bariatric athletes may consider competing with hydration back packs, which would allow them to drink small amounts continuously while racing.
After the Endurance Event
Nutrition during recovery is vital for good performance. Aim to have 15 grams of carbohydrate (equivalent to about 1 slice of bread or 8 ounces of a sports drink) within 30 minutes of finishing. One to two hours after finishing, have a larger portion of carbohydrate rich food with some protein mixed in for muscle recovery. Good examples include a banana with peanut butter, a glass of milk or a turkey sandwich.
Special Considerations for the Bariatric Athlete

Taking in too many simple carbohydrates can cause dumping syndrome and will need to be avoided in those who have had gastric bypass surgery. There is some thought that glucose ingested while exercising is less like to lead to dumping syndrome, but this should be tested individually and carefully. Try taking a sport drink or sports gel during one of your training runs with facilities nearby. As a general rule, foods like bread and fruit do not cause dumping syndrome and could be used in place of sports drinks and gels.

Dehydration is common in bariatric patients and should be monitored closely while training. Getting a before and after workout weight is an excellent way to determine hydration status. If the post-workout weight is lower than the pre-workout weight, that indicates water lost through sweat and respiration. Make sure to replace those water losses during the event and shortly thereafter. Consider using a hydration back pack while running, cycling or hiking so that small, frequent sips can be taken during exercise.

Bariatric patients are advised not to drink 30 minutes before and 30 minutes after meals, so as not to stretch the pouch. This may make taking in enough nutrition difficult. Try using liquid nutrition, like sports drinks, protein drinks or shakes if this is an issue for you. Liquid nutrition often counts as both fluid as well as calories (carbohydrate or protein). In fact, chocolate milk is often touted as the perfect recovery drink for endurance athletes!

Micronutrient Considerations
Training for long distance endurance events can change the athlete’s requirement for vitamins and minerals. This is especially important to note for bariatric athletes, who may have altered or limited absorption of some of these micronutrients. Below are some micronutrients worth considering.

Micronutrient Recommendations

• Vitamins C, E, A:   Increased needs may be found in some endurance athletes. Taking a complete multivitamin should offset any possible deficiency.
• Calcium, magnesium, potassium, sodium and chloride:  These electrolytes are often lost with excessive sweating, which is common in endurance training, especially in hot environments. Take a complete multivitamin with minerals. Rehydrate using an electrolyte rich sports drink (for example, Gatorade or Powerade).
• Iron:  Runners may experience increased iron needs. Take a multivitamin with iron as well as the recommended iron supplement. Have your blood work done annually to ensure no iron deficiency has developed.

Check out this website  as an additional resource for recipes and advice specific for bariatric athletes.

Please post your comments on this topic…

Thank you!