Iron Deficiency: Fast Facts You Need to Know

Iron Deficiency: Fast Facts You Need to Know

Iron is a mineral that the body needs to grow and develop. Iron helps make healthy red blood cells that transport oxygen throughout the body. Iron is critical for normal immune function. Iron is the structural component of hundreds of essential molecules. Iron assists antioxidant enzymes.

  • Iron deficiency is the number one nutritional deficiency in the United States. According to the National Health and Nutrition Examination Survey (NHANES) II. iron deficiency occurs in approximately 11% of women,1-2% of all adults, and in approximately 12.5% of athletes.

 

  • It is the No. 1 cause of anemia in athletes. Iron deficiency rates (with or without anemia) in athletes range from 20-50% in women and 4-50% in men.

 

  • Iron deficiency anemia occurs when the body does not have enough healthy red blood cells due to a lack of iron in the body.

Two forms of dietary iron

  • Heme iron is better absorbed than nonheme iron; the absorption of nonheme iron is enhanced by vitamin C. 


  • National dietary surveys indicate that iron is under-consumed by adolescent and premenopausal females.

 

 

 

 


Iron recommendations vary between adults and teens

 


What causes iron deficiency

  • Iron losses occur from blood loss in the gastrointestinal (GI) tract, microscopic losses in urine, hemolysis of red blood cells (RBC) breakdown, menstrual cycle, sweat loss, and intense exercise. 

  • Non-steroidal anti-inflammatories (NSAIDs) like ibuprofen, Advil, and naproxen deplete iron and folate. Frequent use of medications with GI side effects such as aspirin and non-steroidal anti-inflammatories like ibuprofen or naproxen can cause or worsen iron deficiency.

 

  • Physical activity particularly high intensity and endurance types increase iron losses by as much as 70% when compared to sedentary populations. Athletes lose more iron due to heavy sweating as well as increased blood loss in the urine and GI tract.

 

Causes range from a variety of health issues to simply overtraining or even lack sleep.  Any athlete that experiences a decrease in training or performance coupled with symptoms should seek out their primary care doctor for further testing and analysis.


Signs and symptoms of low iron

Weakness, fatigue, decreased physical endurance, feeling hot or cold, diminished immune response, alterations in energy levels, cognitive performance, and overall behavior.  Iron deficiency is not the only cause of these common symptoms.  

 

 

 

 


Food sources

Iron in meat, fish, and eggs is easily absorbed by the body but the iron in plant sources is attached to phytates that bind iron in foods.

Following a plant-based diet and limiting animal iron sources can be a challenge. As a practitioner, I meet the client where they are at but do share that consuming animal protein will offer greater iron to support their health and performance goals.

 


Guidance on increasing iron as a plant-based athlete

  • Pair leafy greens (bok choy, kale, spinach) with a source of vitamin c (broccoli, strawberries, bell peppers, and kiwi) –This can increase the absorption by up to 67%! (3)

 

  • Cooking food in cast iron or stainless steel cookware also aids in iron absorption (cook all veggies and protein in the cast iron skillet)

 

  • Eat more beans, lentils, edamame, baked potatoes, and Iron-fortified oatmeal (higher sources of iron).
    • Lima beans
    • Red beans
    • Kidney beans
  • Drink tea or coffee separately from an iron-containing meal or snacks. Caffeine inhibits iron absorption.
  • Additional ways to combine vitamin C-rich foods with beans
    • Drain a can of pineapple cubes and add them to canned baked beans
    • Toss cooked black beans with shredded cabbage in your favorite coleslaw recipe
    • Sauté red peppers and onions in olive oil and stir into the white navy or Great Northern beans (cast iron pan)
    • Add any type of cooked beans to a spinach or kale salad with pineapple or fruit

Add fatty fish into your diet 1x/week (3 oz of salmon) or oysters (also a rich source of iron)!!

    • Blend up leafy greens and fruits rich in vitamin C with your smoothies (you can even add beans – I promise it is a neutral taste)
    • Eat more lean red meat, chicken, seafood, beans, lentils, edamame, baked potatoes, and Iron-fortified oatmeal (higher sources of iron).
  • Sauté red peppers and onions in olive oil and stir into the white navy or Great Northern beans (cast iron pan)
  • In a skillet prepare steak, spinach, or collard greens paired with berries (best way to increase iron)

 

 

 

 


When young athletes or adults we start with simple guidance to help increase iron

  • Set meal goals: 4 oz of flank steak 2-3 x/week paired with leafy greens
  • Snack idea: A side of roasted chickpeas paired with pineapple
  • Snack idea 2: A 1/2 cup of mixed berries paired with fortified oatmeal

Before taking an iron supplement to correct an iron deficiency you should contact your physician and work with a dietitian to raise iron levels properly. It is best to work closely with a dietitian to ensure you or your young athlete is getting the proper amount if iron to avoid health and performance consequences. We have worked with hundreds of teen athletes and plant-based adults that have struggled with low iron. We can help you too! Contact us for student-athlete coaching or for a virtual presentation for your sports team.

 

In good faith, health, and athletic performance,

 

Wendi Irlbeck, MS,RDN,LD,CISSN

 

 

 

 

 

 

 

 


Citations and resources to learn more:

National Health and Nutrition Examination Survey (NHANES) II.

 

Hurrell, R., & Egli, I. (2010). Iron bioavailability and dietary reference values. The American journal of clinical nutrition91(5), 1461S–1467S. https://doi.org/10.3945/ajcn.2010.28674F

 

Goldstein, J. L., Chan, F. K., Lanas, A., Wilcox, C. M., Peura, D., Sands, G. H., Berger, M. F., Nguyen, H., & Scheiman, J. M. (2011). Hemoglobin decreases in NSAID users over time: an analysis of two large outcome trials. Alimentary pharmacology & therapeutics, 34(7), 808–816. https://doi.org/10.1111/j.1365-2036.2011.04790.x

 

Hallberg, L., & Hulthén, L. (2000). Prediction of dietary iron absorption: an algorithm for calculating absorption and bioavailability of dietary iron. The American journal of clinical nutrition, 71(5), 1147–1160. https://doi.org/10.1093/ajcn/71.5.1147

 

Koehler, et al.  Iron status in elite young athletes: gender-dependent influences of diet and exercise.  Eur J. Appl Physiology, 2011.

Gentle Nutrition: A Non-Diet Approach to Healthful Eating

Let’s walk through a way of eating that is not restrictive, stressful, or judgemental but rather curious and satisfying. The pendulum swing from extreme dieting to overeating can be difficult. You will find yourself tired of Yo-Yo dieting where you lose some weight just to gain back even more. Are you battling cravings and feeling a lack of willpower. Gentle nutrition approaches cravings in a non-judgmental way. Instead of saying “I shouldn’t have eaten that”; Get curious and ask yourself, “Why am I craving this food?”, “Is there something I could have added earlier in my day?”. Nutrition Coaches can help guide you through the process of understanding “why”. 

Gentle Nutrition is a concept of Intuitive Eating which embodies foods that satisfy what your body wants and nutritional knowledge. It empowers people to listen to their internal authority. Let’s walk through how you start.

Reject Diet Culture

Diet Culture is everywhere and is a multiple billion-dollar industry. Ever notice how diets continue to evolve into something new? Maybe diet culture evolves because it does not work. Diet culture is rooted in the belief that appearance and body shape are more important than physical, psychological, and general well-being. Nutrition Coaches can help distinguish what is fact versus myth about nutrition.  

Honor your Hunger

Hunger is a body mechanism to signal the brain to start looking for food. Cravings can signify that you are deficient in a certain nutrient. An example might be craving meat when low in iron. Cravings can be physical or psychological; working with a Health Coach can help identify what your cravings are signifying. 

Practice eating when you are hungry and learn early signs of satiety. Fullness can take 15 minutes to hit, especially if you eat fast. Tips for feeling fullness: Take a sip of water between bites. Chew thoroughly. Taste all of the flavors. If you think you are full, wait 15 minutes and reevaluate if you are still hungry. Grab additional food, if fullness is not met. 

Make Peace with Food

Remember there are no forbidden foods and every food has a place in our diet. Some foods are great for fuel, others provide emotional satisfaction, and some foods satisfy cravings. Food is nourishment and can be there for celebrations and memories. Having forbidden foods is an “all or nothing” way of thinking, meaning once you have forbidden foods you are more likely to feel ravish toward that food item.  

Challenge the Food Police

Food is nourishment and can bring satisfaction. There are no “good” or “bad” foods. Rigid rules can result in increased stress and anxiety causing other complicated issues. There is a difference between rules that heighten anxiety and general guidelines that can be flexible.

Discover the Satisfaction Factor

Having the same simple nutrition food can be helpful with meal planning but as time goes on even your favorite foods get old. Discover new foods to satisfy your taste buds. Find foods that help you feel nourished and satisfied. 

Respect your Fullness

Snacks can be a beautiful way to bridge the gap between meals. Learn how to listen to hunger cues to improve your quality of each day. If extreme hunger or extreme fullness negatively impacts your day; then a Health Coach can help identify early signs of hunger and meal preparation to stay in the sweet spot of hunger and fulness optimizing concentration and performance. Respect your fulness by putting away the leftovers once full; knowing if hunger kicks in that the leftovers are in the refrigerator waiting for you. 

Cope with your Emotions with Kindness

We all have experienced snacking while not even hungry. Family gatherings, late-night snack runs, movies on the couch; Cravings can be psychological and that’s okay. Working with a Coach can help identify why the cravings their and alternative paths you can take. Sometimes a food craving can only be satisfied with food. A coach can help build your self-care toolbox giving you many options when the coping tool is needed. 

Respect your Body 

It is tough to not overthink how our bodies look despite the majority of the day we aren’t even looking at ourselves. A health coach will help bring importance to: How do you feel? Do you have the energy to do the things your love? Practice gratitude for what your body can do daily; rather than focus on what it looks like. Challenging your thoughts can empower you to change your negative feelings about yourself. Negative thinking has become normalized in society partially related to diet culture. Work with a coach to identify and practice reframing these negative thoughts.

Movement – Feel the Difference 

Movement can be fun, nourishing, mood-lifting, and more. Compulsive movement is very inflexible, rigid, and only focused on changing your body. When movement gets too rigid you will find yourself “all or nothing” when it comes to movement. Sometimes it is great to simplify movement. For example, when you get off from a sedentary job and want to work out without going to the gym. A 10-minute youtube video may be all that you need. Sometimes the movement is the transition you need to leave work at work and become present at home with your family.

 

Honor your Health with Gentle Nutrition 

Gentle nutrition is where satisfying your taste buds pairs with sustainably nourishing your body. Gentle nutrition is connecting the foods you eat to how you feel; It is understanding how medication impacts your hunger. Gentle nutrition will look different for everyone – talk with your health coach to see how gentle nutrition looks for you. 

🍉Healthy Lifestyle Coaching for Men

Registration for the next NWW Nutrition and Lifestyle Coaching program for men only is now LIVE!! That is right a program designed just for men.

As a participant and client, you will receive guidance from an experienced health professional, registered dietitian, former college athlete, physique competitor, and fitness coach, Wendi Irlbeck. With our support, you will learn how to:

  • Build a plate that supports your goals without rigid diets or deprivation.
    • 95% of the population that loses fat or weight ends up re-gaining it and it becomes even harder to lose.
  • Increase your activity levels no matter what fitness level you currently find yourself at.
  • Leave behind the “diet mentality” and misinformation around fad diets and diet culture by gaining confidence in what to eat, how much to eat, and when to eat it!
  • Build a routine that supports the life you want to live. Unsure what that life is? No worries, Wendi will help you come up with a plan that is built using lifestyle modification and establishing S.M.A.R.T. goals.
  • Set a realistic S.M.A.R.T. goal in any area of your life beyond nutrition, health, or fitness. Wendi believes in a spiritual approach integrating faith and Christianity to help solve challenging barriers within our life.

 

What about the results or outcome? You will:

  • Lose fat and lose the excess “weight” holding you back from being your healthiest, best, and strongest self. Sometimes the weight holding us back is not around our mid-section but behind our ears. Wendi will help you retrain and rewire your thought process to form a positive mindset to achieve your dream physique and self!
  • Build physical, mental, spiritual confidence and strength in your body!
  • Gain the mental clarity and confidence to approach life’s most difficult tasks that are holding you back from being your best self as a parent, coach, brother, sister, daughter, and more.
  • Gain peace of mind that comes from living a healthy lifestyle without the stress of knowing if you are doing the right thing.

Click here to enroll Or schedule a discovery call with Wendi to discuss other options and resources here.

 

Wendi Irlbeck, MS, RDN, LDN, CISSN is a registered dietitian nutritionist, former college athlete, physique competitor, and performance coach. Wendi utilizes evidence-based science to tailor nutrition programs for athletes to optimize performance, minimize health risks, and enhance recovery from training while focusing on injury prevention. She partners with parents, sports performance staff, and special needs and recreational athletes to offer nutritional guidance and optimal athletic performance and lifestyle plans. Wendi provides telehealth and on-site services. Wendi works with clients of all levels and ages across the US as well as Canada and the UK.

Should Youth Athletes Use Creatine Monohydrate?

17-year-old, Jenkins comes strutting out of the weight room after he just crushed a workout living his strongest, healthiest, and injury-free life. While walking out of the weight room Jenkins is using Nutrition with Wendi’s recommended “25-50-30 rule” and is downing a shaker bottle with chocolate milk and creatine paired with a banana. Jenkins is a smart kid and has focused on proper sleep, hydration, eating well, and managing his stress while training hard. But of course, many make comments like, “You know that powder he is mixing in there is steroids right? One of my parent’s friends said his coach has been encouraging the use of anabolic steroids for years!” YIKES RIGHT??

Ever heard this crazy misinformation before? Yes, me too. It has spread like wildfire.  It is even more gut-wrenching when it’s spread by doctors, trainers, health care professionals, influencers, or random people on the internet that know very little about science, sports performance, or even what creatine is. Insert facepalm. Good news! I am here to dispel those myths and provide the science to help combat the misinformation that is so toxic.

Creatine is one of the most effective ergogenic aids for adult athletes and is safe. Creatine effectively increases lean mass, strength, power, speed, and exercise capacity (1).  But what about youth athletes? I have had several high school coaches and concerned parents of youth athletes ask me questions like, “Is creatine safe for my kids? Should my female athletes be using creatine?” In almost every conversation, my first response is, “It depends.” Just like any other question I get, nutrition-, health-, fitness- or performance-related, it should be individualized. Creatine, however, is beneficial to all populations according to the science outlined in this article. As a registered dietitian, I strongly promote a “food first” and back-to-basics philosophy. For more information on healthy eating and performance nutrition, see a previous blog here. I empower anyone working with youth athletes to use the guidance in this article when considering “to supplement with creatine or not.”

Creatine Monohydrate 101:

  • 95% of creatine is found in skeletal muscle
  • The human body needs 1-3 g per day
  • Most creatine in the diet comes from animal products like meat, fish, & poultry
  • Enhances post-exercise recovery, injury prevention, and/or spinal cord neuroprotection and muscle growth

What is it?

Creatine is a naturally occurring compound formed by three amino acids, making it a tripeptide (tri- meaning three) of the amino acids L-glycine, L-arginine, and L-methionine. Creatine is assembled in a two-step process that occurs in the kidneys and liver. 

Creatine can be consumed via dietary sources, which include foods like eggs, milk, tuna, salmon, herring, cod, shrimp, beef, and pork. Consuming enough creatine from the diet is challenging given the total creatine pool available according to an article published in Frontiers in Nutrition Sport and Exercise Nutrition by Candow et al., 2019. This literature, along with the International Society of Sports Nutrition Position Stand on Creatine Supplementation and Exercise, suggests the body needs to replenish about 1–3 g of creatine per day to maintain normal (un-supplemented) creatine stores depending on muscle mass.  Creatine monohydrate is the most well-studied form of creatine in the literature. For a more detailed breakdown of other forms please check out Will Brink’s fantastic breakdown on Creatine HCL vs Monohydrate for a deep dive.

Creatine improves numerous factors including strength, power, sprint ability, muscular endurance, resistance to fatigue, muscle mass, recovery, cognition, and rate of muscle growth. Creatine is one of the most widely studied, proven performance enhancers available that also offers clinical benefits (4).

How does creatine work?

Creatine deposits high-energy phosphate groups in the form of phosphocreatine. This is given to adenosine diphosphate (ADP), regenerating it to adenosine triphosphate (ATP), the sole energy carrier in the human body, which can be called “energy currency” for cells to carry out their functions. For example, during conditions of short-term, high-energy demand activities (<30 seconds) with limited recovery time, ATP runs out quickly, which illustrates the importance of creatine stored in muscles in the form of creatine phosphate. This is explained here

Since creatine phosphate restores ATP, it gives muscle cells the ability to produce greater energy. The greater creatine stores you have, the greater energy your muscle cells can yield during high-intensity exercise, thus leading to increased exercise performance. Even though the most well-documented and primary benefit is higher energy production, this mechanism also supports muscle gain and strength increases, as explained here.

Despite creatine being widely tested since the early 1900s with significant data supporting its effectiveness, it is widely misunderstood by many trainers, coaches, athletes, and concerned parents of high school athletes. Yes, it is 2021 and people still think creatine monohydrate is a steroid due to misinformation generated across social media and the general population (4).

Disregard the false, outlandish, disproven claims. I am referencing the silly fallacies like, “creatine will make you fat,” “creatine will cause liver, kidney, or bone injury,” “creatine will dehydrate you,” or my personal favorite, “creatine is a steroid that will also lead to baldness.” I know. What a bunch of nonsense. I addressed these fallacies in a previous blog, Creatine Not Just for Men or Muscle. Please go check it out if you are a female because creatine can help you improve your lean mass and lose that fat.

Antonio et al. published a phenomenal paper outlining the common questions and misconceptions regarding creatine use available for open access here (1). I highly recommend you read it and share it with anyone who may have creatine confusion disorder. I made that up, but you get my point. Creatine monohydrate is beneficial for many things beyond performance, which is not my opinion but sc!

Potential ergogenic benefits of creatine supplementation in adults (4):

  • Greater training tolerance
  • Increased sprint performance
  • Increased work performed during sets of maximal effort
  • Increased lean mass & strength adaptations during physical training
  • Enhanced glycogen synthesis
  • Increased work capacity
  • Enhanced recovery
  • Increased anaerobic threshold

If you’re interested in my opinion as a dietitian and performance practitioner working with several athletes I highly recommend creatine. Creatine is like the Swiss Army knife of supplements! It can do so many things!

In November 2020 I had the fortunate opportunity to be a guest on Dr. Bradford Cooper’s podcast, Catalyst Coaching, where I discussed the role creatine plays according to science. Please check out the video or podcast here.

What about side effects?

There is robust evidence to support the effectiveness of creatine in the adult population. Among children and adolescents, there is mounting evidence to support the therapeutic benefits of creatine supplementation as well as clinical and exercise performance. Available studies in the adolescent population involving high-intensity exercise training indicate performance benefits as well as no reported side effects (1,2).

In relation to performance, the International Society of Sports Nutrition (ISSN) has concluded that creatine monohydrate is the most effective ergogenic supplement available to athletes in terms of increasing high-intensity exercise and supporting lean body mass during training. The ISSN has also concluded CM is safe. (4).

Does creatine work in young athletes?

Regardless of the limited data on the teen population, creatine is likely safe, beneficial, and well-tolerated among youth athletes as evidenced by the available data (2). 

  • Creatine supplementation improved time performance and strength in highly competitive swimmers (2,3).
  • Youth soccer players experienced improved sprinting, vertical jump, dribbling, and shooting (6).
  • Creatine can support brain health, offering neuroprotective effects following a concussive injury in athletes < 16 years old (4).

Check out a Creatine Supplementation in Children and Adolescents review carried out by Jagim and Kerksick, 2021, outlining the available studies involving youth athletes for more information.

Another podcast to check out is Gerry DeFilippo. Gerry kindly invited me on his podcast to discuss the different forms of creatine. To learn more download and listen to Episode #143 Everything You Need to Know About Creatine with Wendi Irlbeck.

Should my teen athletes be supplementing with creatine?

As always, food first, but creatine can be a safe and effective regimen for young athletes who meet the following criteria (1,5):

  • Consuming a well-balanced diet
  • Consuming a diet with a greater emphasis on plant proteins like soy and pea which do not provide creatine like animal proteins
  • Involved in high-intensity training, and competitive sports which include:
    • Track
    • Swimming
    • Lacrosse
    • Ice Hockey
    • American Football
    • Volleyball
    • Field Hockey
    • Basketball
    • Soccer
    • Tennis
    • Olympic Weightlifting
    • Rugby
    • Combat Sports (MMA, wrestling, boxing, etc.)

It is always best practice that athletes of any age fully educate themselves by consulting with a registered dietitian nutritionist, certified sports nutritionist, exercise physiologist, or sports-focused physician before the use of any supplement. Similarly, any products used should be NSF International Certified for Sport to reduce the risk of consuming any harmful or contaminated products. Supplements are regulated but not as heavily regulated as pharmaceuticals. Please see the reasons to use NSF Certified for Sport products in a previous blog.

“The USADA recommends that athletes use only dietary supplements that have been certified by a third-party program that tests for substances prohibited in sport. The USADA is responsible for anti-doping education and testing for athletes in the U.S. Olympic and Paralympic Movements as well as the UFC.”

Therefore, all supplements used should be third-party tested for safety, purity, and compliance. For the sake of convenience and safety, you and your athlete can download the NSF Certified Sport app. 

I preach food first, nutrient periodization, quality rest, good sleep hygiene, hydration, and appropriate training, all of which can be better enhanced using creatine monohydrate (CM). Based on the strongest science and studies, CM is the recommended form. CM is used in the studies. Therefore, it should be used in practice as well. I discussed the other forms in my guest appearance on Muscles and Management.

When to use creatine?

The science suggests creatine is most effective immediately post-workout when paired with protein and carbohydrate (7). Creatine consumed immediately post-resistance training is superior to pre-workout in terms of body composition and strength (7). The recommended dose is 3-5 g of creatine per day. Creatine can be used at any time of day. Creatine is safe and effective on rest days from exercise as well as training days. (Click here to follow on Instagram)

While CM is best paired with a carbohydrate-rich source (like oatmeal, whole-grain bread, rice, fruit, smoothies, or yogurt) to draw it into muscle cells, it can also be added to water or other beverages. A saturated cell is a happy cell! This supports recovery and muscle repair following resistance training. 

Most creatine supplements are in powder form and must be used in warm water to support the dissolving process. CM will dissolve slowly in cold water and often ends up in the bottom of a shaker bottle, which won’t do any good if it doesn’t make it into your mouth! Creapure is a great brand to use and offers more explanation on dosing. Check it out here! No, I do not have a partnership or any affiliation with Creapure. I just want to share that they make a great product.

My female youth soccer players have integrated CM post-training with their tart cherry juice and chocolate milk. I have taken time to discuss the safety, use, and benefits with my youth athlete’s parents, coaches, and even their PE teachers. I have 50% of my youth athletes supplementing with CM. CM is always a conversation we have after we wrap up their 6-week Nutrition with Wendi Coaching Program.

Do I need to load?

No, you do not need to “creatine load”. In fact, many studies use a typical creatine dose of 5-10 g daily or smaller doses like the standard 2-3 g. However, if you desire to do a loading phase, it would look something like 20-25 g for 5-7 days followed by a maintenance phase of 5 g daily for 4 weeks, 2 weeks off, and then repeat. I do not have any of my athletes do this cycling as it is unnecessary. See the ISSN’s Position Stand for more on this (4).

Studies support the benefits of CM supplementation regardless of the dose. However, that does not mean more is better. If you are a vegetarian and new to using CM, you would benefit from saturating the muscles with CM, leading to an acute increase in strength and body weight via water retention. However, please refer to the experts and those I respect most in the field like Dr. Darren Candow, Dr. Tim N. Ziegenfuss, Dr. Scott Forbes, Dr. Jose Anotonio, Dr. Rich Krider, Dr. Eric Rawson, and others who can further provide the research they have been doing for the last few decades.

Please see another podcast in which I had the opportunity to speak about creatine in the youth population via the Big Time Strength podcast.

Closing thoughts

There is robust literature to support the beneficial effects creatine has on body composition, physical performance, injury prevention, recovery, brain health, and clinical use. Currently, there have not been any negative effects associated with the use of CM in both the adolescent and adult populations. Adolescent athletes under the age of 18, and even children as young as infants, can safely consume CM. There is zero evidence to suggest CM supplementation would cause harm, dehydration, cramping, or any other outlandish claims that have been disproven by Antonio et al., 2021, and others. Not incorporating a CM supplement would be a disservice to your athletes or even yourself!

Key takeaways:

  • Anyone looking to improve their health of any age or activity level can safely consume 3-5 g of creatine monohydrate immediately post-workout paired with a carbohydrate. 
  • By supplementing with creatine monohydrate immediately following training, you’re able to support muscle growth and recovery, injury prevention, and overall health. 
  • Yes, creatine is safe to consume if you are a teen athlete. Yes, you should use creatine monohydrate.
  • No, creatine is not a steroid. No, creatine will not cause baldness. No, creatine will not dehydrate you. No, creatine will not cause cramps. No, creatine will not decrease your bone mineral density.
  • If you have a beating pulse, then creatine monohydrate is for you!

Sports physicians, athletic trainers, coaches, performance nutritionists, and others working with youth athletes should provide the best guidance to teen athletes based on the available science to support their principal interests. Kids are going to be using supplements like energy drinks and pre-workouts, which contain dangerous amounts of caffeine. I would rather we provide education on the safety and use of creatine, which is not dangerous but beneficial. I would like to see more people using creatine given the ergogenic benefits and no reported adverse effects. Creatine monohydrate is a safe, effective, and inexpensive way to support health and physical performance! Please don’t let, “Joe Public” from accounting or “Susie Quinn,” on Instagram tell you any different. 

In good health health, and physical performance,

Wendi Irlbeck, MS, RDN, LD CISSN

Wendi Irlbeck, MS, RDN, CISSN  is a registered dietitian nutritionist, and performance coach. Wendi utilizes evidence-based science to tailor nutrition programs for athletes to optimize performance, minimize health risks, and enhance recovery from training while focusing on injury prevention. She partners with parents, sports performance staff, and special needs and recreational athletes to offer nutritional guidance and optimal athletic performance and lifestyle plans. Wendi provides virtual services including telehealth but is based in Nashville, TN.  Wendi works with clients of all levels internationally.

What can hiring a sports nutritionist offer your program? Learn more here.  Interested in signing up for the NEW and upcoming NWW newsletter? Click here to sign up!

References

  1. Antonio, J., Candow, D.G., Forbes, S.C. et al. Common questions and misconceptions about creatine supplementation: what does the scientific evidence really show?. Journal of the International Society of Sports Nutrition 18, 13 (2021). https://doi.org/10.1186/s12970-021-00412-w
  2. Grindstaff PD, Kreider R, Bishop R, Wilson M, Wood L, Alexander C, et al. Effects of creatine supplementation on repetitive sprint performance and body composition in competitive swimmers. Int J Sport Nutr. (1997) 7:330–46.
  3. Ostojic SM. Creatine supplementation in young soccer players. Int J Sport Nutr Exerc Metab. 2004 Feb;14(1):95-103. doi: 10.1123/ijsnem.14.1.95. PMID: 15129933.
  4. Kreider, R.B., Kalman, D.S., Antonio, J. et al. International Society of Sports Nutrition position stand: safety and efficacy of creatine supplementation in exercise, sport, and medicine. J Int Soc Sports Nutr 14, 18 (2017). https://doi.org/10.1186/s12970-017-0173-z
  5. Jagim AR, Stecker RA, Harty PS, Erickson JL, Kerksick CM. Safety of creatine supplementation in active adolescents and youth: A Brief Review. Front Nutr. 2018;5:115. Published 2018 Nov 28. doi:10.3389/fnut.2018.00115
  6. Ostojic SM. Creatine supplementation in young soccer players. Int J Sport Nutr Exerc Metab. 2004 Feb;14(1):95-103. doi: 10.1123/ijsnem.14.1.95. PMID: 15129933
  7. Antonio J, Ciccone V. The effects of pre versus post workout supplementation of creatine monohydrate on body composition and strength. J Int Soc Sports Nutr. 2013 Aug 6;10:36. doi: 10.1186/1550-2783-10-36. PMID: 23919405; PMCID: PMC3750511.

 

Creatine: Not Just for Men or Muscle

If you’re a man or woman reading this, excellent. It applies to both genders. Are you an aging adult, or someone who has experienced a traumatic brain injury (TBI)? Then yes, keep reading. Next, if you’re an athlete or non-athlete reading this, even better because it applies to you as well. Still aren’t with me, do you have a beating heart? If this answer is no, please seek medical attention at once. All jokes aside, if you’re a living breathing homo sapiens (homo = genus , sapiens = species) this article is for you.

If you’re a parent of a young athlete, coach, athlete or bodybuilder you likely have read up on creatine and have supplemented with creatine monohydrate before. Creatine is one of the most well-research and effective supplements to date. Creatine can support exercise performance by quickly producing energy during intense activity. Furthermore, creatine may also provide cognitive benefits, but further research is warranted. Studies have consistently illustrated how creatine supplementation increases intramuscular creatine concentrations that can help us understand the observed improvements in high-intensity exercise performance and overall training adaptations at large. We know creatine supplementation can bolster post-exercise recovery, decrease risk of injury and support injury prevention, expedite rehabilitation, thermoregulation, concussion and or spinal cord neuroprotection. Additionally, clinical applications of creatine supplementation have been investigated in neurodegenerative diseases like (muscular dystrophy, Parkinson’s Huntington’s disease), diabetes, aging, osteoarthritis, brain and heart ischemia, adolescent depression and even pregnancy as cited in the International Society of Sports Nutrition (JISSN) Position Stand on Creatine Supplementation in Exercise, Sport and Medicine . Studies are demonstrating short and long-term supplementation (up to 30 grams per day for five years) is not only safe, but well-tolerated in individuals and a range of clinical settings from infants to the elderly.  So, creatine is not just for male athletes trying to build muscle and facilitate recovery. It is beneficial to all given the wide range of benefits associated with supplementation that have been documented in literature and several that are currently under investigation in a clinical setting.

Let’s review and clear up a common myth regarding creatine:

“Creatine is a steroid” Incorrect, please stop this nonsense from making its way into 2021 please. In my professional experience as a registered dietitian nutritionist , this must be one of the most obnoxious fallacies to date. Possibly behind “protein hurts my kidneys”, also false but that’s a whole other subject for a different blog. However, I am happy to direct you to the literature that dispels this myth publish in 2016 in the Journal of Nutrition and Metabolism compliments of Dr. Jose Antonio and colleagues . Now back to creatine, let’s clear this up quickly, creatine is not a steroid. It has no relation to a steroid structurally or with its mechanism of action. Why? Well, by scientific definition a steroid is any compound that possesses a common structural feature like 3 cyclohexane rings and a cyclopentane ring make up the structure that by definition is a steroid molecule. In fact, eggs contain a steroid compound which is called cholesterol and it is naturally produced in the body that become steroid hormones like testosterone and estrogen. But no, creatine is not a steroid.

What is creatine?

Creatine is a naturally occurring compound made up of three amino acids, which we would call a tripeptide (tri meaning three). Three amino acids (L-glycine, L-methionine and L-arginine) make up creatine. Creatine is largely made in the liver and to a limited extent, the kidneys and pancreas. It deposits high-energy phosphate groups in the form of phosphocreatine which are given to ADP, regenerating it to adenosine triphosphate (ATP), the sole energy carrier in the human body which can be called “energy currency” for cells to execute their functions. For example, in conditions of short-term high-energy demand activities (< 30 seconds) with limited recovery time, ATP runs out quickly, which brings us to creatine that is stored in muscles in the form of creatine phosphate explained here . Creatine phosphate can help restore ATP, giving muscle cells the ability to produce greater energy. The greater creatine you have, the greater energy your muscle cells can yield during high-intensity exercise, thus leading to increased exercise performance. Even though the most well documented and primary benefit is higher energy production this mechanism also supports muscle gain and strength increases explained here.

Creatine is naturally found in several of the foods we consume like, eggs, milk, tuna, salmon, herring, cod, shrimp, beef and pork.  Consuming enough creatine from the diet is challenging given the total creatine pool available according to an article published in the Frontiers in Nutrition Sport and Exercise Nutrition via Candow et al., 2019 . Which suggests, the body needs to replenish about 1.0–3.0 g of creatine per day to maintain normal (un-supplemented) creatine stores depending on muscle mass. Creatine improves numerous factors including strength, power, sprint ability, muscular endurance, resistance to fatigue, muscle mass, recovery, cognition, and speeding up muscle growth.

More women should use creatine:

I am a female who participates in regular strength-training (4-5 times per week) along with (2-3 cardiovascular sessions per week). I eat a whole foods diet, supplement with 2,000 IU of vitamin D3, whey protein isolate, 1,200 mg of fish oil and a multivitamin. Those are my supplements; these are not recommendations for “you”, your “young athlete”, “teammate” or “your friend”. I make this clear because there is no one-size-fits all in nutrition, health and fitness. What works well for me, does not mean it will work well for you. I see too many mistakes made with people trying to adapt the same diet, training and lifestyle of those in their cohort when it simply is not sustainable or appropriate. As individuals we have different genetics, hormones, environment stimulus, training styles, body composition, sport and performance goals, resting metabolic rate, and the list goes on. It would be absurd to eat and train the same way as someone else and anticipate the same outcome with the previously listed differences as humans.

One certainty is we can all benefit from eating real food, but given the benefits of creatine supplementation it is an undervalued and written off supplement among my fellow ladies. Hear me out ladies, creatine will not make you fat, bulky, retain water, turn you into a man or any of the other nonsensical claims that exist on the web these days. I don’t care what Linda at the gym said about “creatine making you fat or how it is a steroid that will make you a man”. I hear these claims often, and not only are they flat out wrong, they misinform my fellow ladies out there trying to gain strength, lean mass and other health benefits that would occur with appropriate creatine supplementation.

Here is a side by side comparison of me, roughly 10 years ago when I ate too many carbohydrates, inadequate protein, some strength training and an abundance of cardiovascular exercise. I ran lots of miles. Now, ten years later, I am happy to report I engage in strength training sessions no greater than 45-minutes, 4-5 times per week with some sprints and daily walking. I supplement with 5 gm of creatine monohydrate post-workout , w

hey protein isolate, take a multivitamin and consume 2 gm/kg/body weight per day in protein. I infrequently track calories because I fuel my body with high-quality protein, as many fruits and veggies as I can get my hands on. Creatine won’t make you fat, bulky or manly ladies. It will help support a lean body composition. Let me be more specific to my fellow ladies, creatine can may help you improve your health, fitness, recovery and overall physique.

Trying to turn up the intensity of your workouts? Use creatine! Creatine is like a Koenigsegg Agera RS , the fastest vehicle in the world. Creatine is a vehicle for producing ATP, which as you have learned drives muscle contraction. Kind of important when trying to sprint, lift heavy weights, jump and train with max output? By regularly supplementing with creatine monohydrate (3 -5 gm/day) for 8 weeks or greater can help maximize the body’s stores of phosphocreatine, the necessary compound to product ATP. Thus, allowing for skeletal muscle to produce more energy, bolster power output and exert more work overall. Fitness hack: The greater the intensity expressed fourth the greater your muscles grow stronger, bigger and faster should you train appropriately. Therefore, creatine supplementation is a highly underrated supplement among the female population. I encourage and empower my fellow ladies reading this article who have been on the fence about using creatine to take note of its effectiveness. Creatine has shown to bolster muscular size, power and strength. More muscle equates to more energy burned, healthier body composition, bone mineral density and a decreased risk for musculoskeletal disorders. Not to mention the link between muscle mass and risk of cardiovascular disease. Keeping aging muscles fit is also linked to better health later on in life according to a study published in the Journal of Epidemiology and Community Health .

Even sedentary women who utilized creatine long-term experienced increases in maximal muscle strength during resistance training by 20 to 25% when compared to women who were given a placebo in a study published in the Journal of Applied Physiology . Another study examined the effects of long-term creatine supplementation (12-weeks) combined with resistance training on one-rep max strength, motor functional performance tests and body composition in eighteen older women. The creatine group gained significantly more fat-free mass, muscle mass and were able to efficiently perform submaximal-strength functional test than the placebo group. Special note the creatine group was also able to increase training volume and one-rep max bench press. Creatine contains no calories and does not lead to fat gain. The increase on the scale you may see from use is drawing water into the cell which is a desired response with training.

Many benefits of creatine

A number of studies have shown creatine supplementation can increase brain creatine content by roughly 5-15% along with reducing mental fatigue, and improving cognitive function according to research referenced in the ISSN’s Position Stand on Creatine. Another study carried out by Rawson & Venezia, 2011 reported creatine supplementation of (20 g/day for 5 days or about 2g per day for 30 days) resulted in increased skeletal muscle creatine phosphocreatine which lead to the enhancement of high-intensity exercise tasks. Moreover, there is well documented benefits of creatine supplementation in young adults, increased strength, lean body mass and delayed onset fatigue during resistance training. All of which are critical for older adults striving to maintain cognition, bone mineral density and overall health.

Research is scant but, a randomized, double-blind, placebo-controlled trial was carried out in using creatine in type 2 diabetes subjects that was published in Medicine and Science in Sports and Exercise . The study illustrated creatine supplementation improved glucose tolerance in healthy subjects. When creatine was supplemented in the diabetic subjects that participated in an exercise program the results lead to an improvement in glycemic control. The underlying mechanism could be contributed to the increase in GLUT-4 recruitment specific to the sarcolemma. More research is warranted in diabetics, but the current literature is promising. Functional foods for brain health go mainstream

Another study examined the potential of creatine or phosphocreatine supplementation in cerebrovascular disease and in ischemic heart disease . The study illustrates the ability high-dose creatine supplementation has on cerebral creatine content and that it may have the capacity in humans to protect against stroke due to increasing not only the neuronal but also the endothelial creatine content. Emerging evidence also suggest that creatine supplementation with and without resistance training has the potential mechanistic effect to influence bone biology according to a study carried out by Candow & Chilibeck, 2010. A more recent study published in Experimental Gerontology examines pre-exercise and post-exercise creatine supplementation has similar effects on aging bone mineral density and content. A meta-analysis carried out by Forbes et al., 2018 illustrated creatine supplementation did not lead to greater bone mineral density during resistance training in older adults > 50 years of age.

Research in animals also suggested creatine supplementation to support managing Alzheimer’s disease, epilepsy and brain or spinal cord injuries. Furthermore, a study was conducted examining creatine supplementation following sleep deprivation, with mild exercise, on cognitive and psychomotor performance, mood state and catecholamines. The study eludes to creatine supplementation decreasing the negative effects, like mood, focus, impulse and emotional reactions that are reliant on the prefrontal cortex.

Creatine is safe and easy to use

As you have learned creatine offers many diverse benefits beyond muscle. It is one of the least expensive and safest supplements available on the market. It has been studied for over 200 years and an abundance of literature supports is safety, efficacy and no reported adverse effects in healthy individuals as referenced in the ISSN’s Position Stand: Creatine Supplementation and Exercise.

A good dose to begin with is simply taking 3.0 to 5.0 grams of creatine monohydrate post-exercise to support recovery, muscle growth and decreasing fatigue. If you’re a vegetarian or new to using creatine you may wish to start with a loading phase by taking (0.3g/kg/body weight/day). For example, if you’re a 60 kg female = 18 g total for the day but broken up into 4 doses for 5-7 days. This would mean a (4.5 g dose of creatine 4x/day) for 5-7 days. Then onto a maintenance phase of 5 g per day for 12 weeks. If you’re interested in looking at different phases of cycling creatine (short-term and long-term) you can refer to the literature in the Creatine Position Stand paper I have referenced throughout this article. For example, supplementing with (5g/day) for 12 weeks during training to truly help increase intramuscular creatine stores and support health and performance benefits outlined in this article. Dissolve the creatine in water or your protein-carb drink post-workout for best results. Take a break from supplementation after using for 12-16 weeks. Where to order creatine? I strongly advise supplements that are Informed Choice Certified, meaning they are free of any banned substances and ensure the product has been tested from any unsafe substances. Here is a comprehensive list of certified products updated March, 2020.

If you’re parent or coach of adolescent athletes and are considering creatine supplementation. Take note, limited research is available in this population highlighting the safety and efficacy of creatine supplementation in young athletes < 18 years of age. Jagim et al., 2018 published a review examining the limited studies in the adolescent population as a means to identify use of creatine in young athletes. The review suggests that adolescent athletes using creatine tolerated supplementation well, had no reported adverse events or incident. Ethically, we do not have enough research to recommend creatine monohydrate to young athletes, but many are using despite direction from professionals. My advice as a sports dietitian is to provide the literature and suggestions to support best interest of my athletes.

As registered dietitian nutritionist and sports nutrition specialist, I advocate for whole foods first and prioritizing nutrition to optimize your health, wellness, physique and performance goals. Creatine is a great supplement to incorporate in addition to great nutrition, enough hydration, adequate sleep and proper training. Creatine works best when paired with resistance training. I hope reading the science outlined in this article surrounding creatine has given clarity. Creatine can benefit everyone, if you have a beating pulse that’s you. Train hard, eat well and stay healthy my friends.

In good health,

Wendi Irlbeck, MS, RDN

Wendi Irlbeck, MS, RDN is a registered dietitian, nutritionist, and fitness coach. Wendi utilizes evidence-based science to tailor nutrition programs for athletes to optimize performance, minimize health risks, and enhance recovery from training while focusing on injury prevention. Wendi partners with parents, sports performance staff, special needs and recreational athletes to offer nutritional guidance and optimal athletic performance & lifestyle plans. Wendi is based in East Lansing, Michigan and is the founder of Nutrition with Wendi, LLC. Wendi is active on Twitter and other social media platforms as Nutrition_with_Wendi.

Carbohydrate and Protein Needs for Young Athletes Desiring to Make the Jump from Good to Great!

Bowls filled with granola and berries

There’s No “One-Size-Fits-All” Nutrition Approach

An athlete’s energy and nutrient needs depend individually on his or her age, body composition, goals, and training volume, and depends globally on the demands and intensity of the sport. Put simply, the greater the intensity, duration and frequency of the activity combined with the athlete’s weight or body composition, the higher the demand of protein, carbohydrate and calorie intake.

If you’re a coach, parent or athlete reading this, don’t become overwhelmed. This article intends to introduce to you some general guidelines on optimizing energy needs (i.e. calories, protein, and carbohydrates) to sufficiently support overall health and advance athletic performance.

First rule of thumb, ALL adolescent athletes should consume breakfast, lunch and dinner with 2-3 snacks in between meals to fully optimize energy levels. You must build a plate that includes a source of lean protein, a fruit, a vegetable, a healthy fat and a serving of dairy if you wish to get real and progress with your nutrition. A visual of the plate and practical nutrition strategies can be found in my previous blog here.

Fuel Up to Avoid Stalling Out

Youth athletes have significantly higher nutritional needs than their less-active classmates because athletes need more calories to support performance demands, normal growth, general development and maturation. According to the Academy of Nutrition and Dietetics, female teen athletes need roughly 2,200-3,000 calories and male teen athletes need roughly 3,000-4,000 calories per day (depending upon the individual and sport). Additionally, adolescent athletes training in multiple sports may need upwards of 5,000 calories per day to maintain weight and support growth needs. It’s paramount to encourage adequate calorie consumption during times of heavy training. For perspective, low-energy availability in female adolescent athletes can lead to short stature, increased injury, delayed puberty, poor bone health, metabolic and cardiovascular issues, menstrual irregularities, disordered eating behaviors – this according to a review published in the International Journal of Sport Nutrition and Exercise Metabolism published by Desbrow et al., 2019.

Relative Energy Deficiency Syndrome (RED-S) is a more comprehensive label that builds on the condition of low-energy availability, also known as “female athlete triad,” to describe an energy deficiency gap that results when energy intake is insufficient to support daily activities, living, growth and function. RED-S affects primarily females, but also young males.

Premium Fuel for the Young Athlete – Carbohydrates!

Carbohydrates are an athlete’s most important source of energy for optimal athletic performance. Several studies carried out during the last 50-60 years have consistently highlighted carbohydrates as the primary macronutrient to sustain and enhance physical performance. The Institute of Medicine (IOM) has established that 45-65 percent of calories in one’s diet should come from carbohydrates or between 3 and 8 grams per kilogram of body mass, depending upon the exercise intensity. For example, a 14-year-old female athlete should consume 2,000-2,400 Granola and yogurt with fruit, juice, and eggscalories per day, with 225 – 270 g (45% of total calories) to 325 – 390 g (65% of total calories) from carbohydrates. Keep in mind the dietary reference intake (DRI) remains at 100 g per day and recommended daily allowance (RDA) at 130 g day for all age and sex categories (children ≥ 1 year), both measures not related to physical activity. High-quality carbohydrates for athletes to consume include, but are not limited to, 1. whole grains like pasta, rice, tortillas, bread, oatmeal, low-fat dairy, and energy bars, 2. fruits like berries & bananas, and apples, 3. starchy vegetables like squash, potatoes and eggplant. To experience a boost in energy, consider adding items from this longer list of quality carbohydrate-rich foods to achieve enhanced athletic performance.

Performance tip: Make half your plate carbohydrates if you’re an endurance athlete, especially on heavy training days. The average athlete should be eating around 360-500 grams of carbohydrates per day. Failing to consume enough carbohydrates will cause a decline in performance, cognition, focus, and athletic performance. Time-to-fatigue and injury risk will also increase without enough dietary carbohydrates. To keep it simple, carbohydrates are not “optional”; they are essential. You can take it from an RDN whom stands for science or examine the science for yourself by checking out Nutritional Considerations for Performance in Young Athletes published in the Journal of Sports Medicine.

Power Up with Protein!

Protein is critical for building, maintaining and repairing many cellular structures, like skeletal tissues. Consuming enough protein supports synthesis of hormones, neurotransmitters, energy production, gene activity and transportation of biological molecules. The Institute of Medicine (IOM) has established that 15 to 20 percent of total calories, or about 70-160 grams should derive from high-quality protein sources.

To breakdown the science, consuming adequate protein is critical for proper growth, development and normal physiological function during adolescence leading into adulthood. Distinctive demands during adolescence, especially those that engage in high-intensity sport, call for a greater daily protein intake than that of adults. Currently the RDA for protein is 0.95 g/kg/day for children ages 4-13 years and 0.8 g/kg/day for adolescents between the ages of 14-18. Those that engage in regular training and endurance sports like swimming, rowing, distance running, and soccer may need 1.2-1.4 g/kg/day while power sports like weightlifting, gymnastics, football, wrestling shall require 1.0 – 1.5 g/kg/day .

High-quality protein sources include beef, poultry, bison, pea protein, pork, tuna, turkey, seafood, fish, and dairy products, such as milk, yogurt, whey, cheese and cottage cheese. To find out how much protein some of your favorite sources provide, check out this list from the Academy of Nutrition and Dietetics. Keep in mind that not all proteins are created equal. To deter you from going down the rabbit hole of plant proteins vs. animal proteins, I will simply link an article for you to review here. It’s important to just remember that foods rich in leucine, a branched chain amino acid found in animal proteins, will have the greatest positive affect on driving muscle protein synthesis. We could get really complex on this topic but it’s enough to simply emphasize the importance of consumption of high-quality proteins that are listed above due to their rich leucine content, especially since we are addressing protein intake for adolescent athletes. Most young athletes barely consume enough calories and protein as it is. To keep it simple, make sure your adolescent athlete consumes ¼ of their plate or a 4 oz. serving of a high-quality protein three-five times per day. As I always say, success starts with the basics and carrying them out on a consistent basis.

Failure by your adolescent athlete to consume adequate protein intake will cause declines in energy, weight, muscle growth, and strength, while increasing the likelihood of onset fatigue. Does this mean your adolescent athlete should be slamming protein shakes? Of course not, but they should be consistently consuming whole foods at regular mealtimes. Consuming good old fashioned chocolate milk on-the-go can even be a great way to increase calories while meeting additional protein intake demands. This is especially a great addition to refuel and re-hydrate post-practice or game! Make no mistake, a protein shake or chocolate milk will not make up for missed nutrients from consuming regular meals. Furthermore, supplements like protein powders are not regulated by the FDA and so it is important to select a protein powder that has been third-party tested with a NSF stamp of approval, which deems it certified for sport. This is paramount to ensure there are no banned substances on the label, that the product is manufactured in a facility that follows acceptable manufacturing standards, and that the contents of the supplement match what is printed on the label, ultimately being safe for consumption. To search supplements that are third-party tested and free of any banned substances, check out Informed-Sport.

Stirring it Altogether:

Knowing your carbohydrate and protein intake recommendations is great, but I encourage using the plate as a method of hitting your intake requirements. If you consume a balanced plate with all the components 3-5 times per day with high-quality snacks in between, you’re likely going to meet the energy demands of your sport. Again, it’s important to remember that carbohydrates are the body’s preferred source of energy.

Keeping with the basics such as eating breakfast, lunch and dinner with small snacks in between meals will help improve your health and sport performance. Don’t skip meals and make sure your plate is full of colorful fruits and vegetables. Always choose water or milk over sugary beverage to support hydration and better overall health. It’s time we get back to the basics, which I discuss in detail in the last article I published, available for reference here. As always, nutrition is a secret weapon that can help you perform optimally in the classroom and in sport.

Your sports nutritionist,

Wendi Irlbeck, MS, RDN