Chris G. Koutures, MD, FAAP Pediatric and sports medicine specialist

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Pediatric Sports Medicine: Essentials for Office Evaluation

Orange County Physician Of Excellence, 2015 and 2016

 

Filtering by Tag: chocolate milk as recovery drink

3 Whole Food Recommendations for Young Athletes

When making sports nutrition recommendations, I tend to favor the collateral benefits, lower costs, and the "knowing what you are getting", of whole food sources rather than individual vitamin or nutrient preparations. 

I was energized to  share the podium at the 2015 CHOC Children's RD's in Practice: Pediatric Sports Nutrition Conference with some truly amazing colleagues, and in reviewing their handouts, I found some new whole food thoughts that I felt needed to be shared.

I want to give full credit to both Shondra and Jessica Brown of CHOC Children's Sports Nutrition Program for organizing the conference, and to Becci Twombley, RD, CSSD who presented on the following important food sources for young athletes:

  • Importance of Whey Protein and Leucine
    • Whey protein is a quickly digested protein which can lead to more immediate muscle recovery
    • Whey protein is also high in the amino acid leucine, which can be decreased 30% after high intensity exercise
    • Good sources of whey protein (and thus leucine) include Greek Yogurt, eggs, steak and milk.
      • Yet another nod for Chocolate Milk as a post-exercise recovery beverage- not only do you get the whey protein and leucine, but the associated carbohydrates enhance the protein absorption and don't forget the calcium and Vitamin D!
  • Make a Beeline for Beets
    • High in betalines and beta-carotenes which include anti-oxidant and anti-inflammatory properties for boosting immunity 
    • Beets also have a high content of nitrates which increase nutrient delivery through augmented blood flow to working muscle, allowing for more efficient exercise
    • Best to eat either beet juice shots or 3-5 raw or juiced beets 2 1/2 hours before training (prolonged cooking of beets kill the betalines)
  • Probiotics for health of your digestive tract
    • Probiotics are live micro-organisms in the digestive tract that support absorption of nutrients and enhance immune function
    • Use of probiotics can reduce both the number of days and overall severity of respiratory illnesses
    • A solid probiotic source is none other than Greek yogurt....1/2 to 1 cup either daily or every other day will also give you that whey/leucine fix mentioned above and further stress the importance of whole food nutrition sources!

 

 

Top Nutrition Concerns Seen in Adolescent Sports Medicine

Trying to figure if your young athlete needs iron to boost performance?

Uncertain if water or sports drinks would be be the best choice for the next practice or game?

Looking for healthy post-game snacks that will assist in muscle recovery?

Hearing a lot about protein and creatine supplements but not sure if adolescent athletes should use them?

You've come to the right place for practical answers to these and many other nutrition questions that I regularly hear in my sports medicine practice.

In appreciation of CHOC Children's Hospital inviting me to speak on Top Sports Nutrition Concerns Seen in Adolescent Sports Medicine first at their RDs in Practice – Pediatric Sports Nutrition conference and following up with a Pediatric Grand Rounds on the same subject,  figured I would compile a list of past blog posts that will form the backbone of those presentations.

Click on the above links to view the relevant post.

Eager to hear of any additional nutrition or other sports medicine based questions- will offer initial responses via email but always available for office consultations and more in-depth recommendations

5 Tips to Improve Recovery with Short Rest Periods Between Games or Practices

Dealing with double-day practice sessions, multi-event competitions over a weekend, or a quick turn-around from an evening event to the next morning practice? 

What are some sensible tips for young athletes to replenish energy, reduce post-exercise soreness, and be best prepared for that next practice or game?

1) Get that post work-out protein

Protein is the building block of muscle tissue, and the first 30 minutes after exercise is an ideal time for protein intake to allow muscle repair and growth. A good rough suggestion is 30 grams of protein mixed in with some carbohydrate to increase the protein absorption. Good tasting, easily accessible and rather inexpensive suggestions include a glass of chocolate milk, a container of Greek yogurt, or a large serving of peanut butter.

Click here for more info on the virtues of chocolate milk

2) Don't miss out on necessary fluids

Being under-hydrated after exercise can be a major set-up for poor performance in the next workout or game. Ideally, any fluid losses from exercise should be fully replaced, and one easy way to monitor is to do pre and post-exercise weights. Young athletes should return to their pre-practice weight before the next exercise session. 

For suggestions on fluid choice (water vs. sports drinks), click here.

3) Berries and Cherries can attack muscle soreness

Either immediate or delayed post-exercise soreness can put a damper on future sport activity. Good studies have shown that berries, cherries and even tart cherry juice have natural anti-inflammatory properties that can reduce muscle soreness with far fewer potential side-effects than both over-the-counter and prescription anti-inflammatory medications. Not only do those fruits taste much better than medications, they also provide important fluid and salt sources.

For more on tart cherry juice, click here

4) Best time to stretch is after activity

Many of us adult-types were taught that stretching before exercise was best. That though is definitely old-school and been replaced with recommendations for after exercise, when the muscles are warmed up and more able to benefit from stretching. Now, probably the last thing anyone wants to do after a hard game or practice is to take the time to stretch, but those valuable efforts that take only a few minutes can prepare muscles to better handle upcoming demands.

5) Ice Bath Challenge?

Many athletes seek out a cold water tub for their lower legs or even their entire body (below the head) to reduce soreness and help foster elimination of muscle waste products after exercise. The evidence in support of ice baths is mixed- so probably a situation where some athletes will find benefit, while others will not. 

Do you have any other recommendations for assisting in post-workout recovery to better prepare for the next practice or game?


Recommendations for Children and Distance Running

The risks of injury and illness in distance running may be related to the total mileage and number of hours training per week. There is no agreement amongst sports medicine professionals about distance limitations for children. Until further data are available concerning the relative risk of endurance running at different ages, the American Academy of Pediatrics recommends that if children who enjoy distance running and make the individual choice to train free of injury or ailments, there is no reason to preclude them from training for and participating in such events.

Let me re-emphasize that bold point.

Children should be the ones selecting to run, free of any pressure from peers, parents, coaches or other influences.

Most running injuries include overload injuries to muscles and bones of the legs and feet, and there is the real emotional "burnout" injury from excessive exposure to running.

Concerns have been raised over possible damage to bone growth plates from high amounts of running, but examples of this type of injury have not been consistently found in medical studies.

Looking at running injury patterns and statistics, it is fair to say that when the young athlete is generating the interest and eagerly participating in a sensible training progression, there is a fairly low risk of physical or emotional injury.

To help develop an appropriate program, many recommend using the 10 percent rule is an appropriate guide and considering certain variables:

  • Weekly running distance
  • Intensity (range includes long slow runs to hill training to speed work)
  • Number of training days per week

An athlete should only increase one of those three variables, and no more than a 10 percent increase from the previous week.

Not having number of training hours per week exceed the number of years in the child's age has also been shown to reduce the risk of overload injury.

A comprehensive program should also ensure adequate sleep and nutritional support that can assist with recovery from training.

Studies have shown that sleeping less than 8 hours per night may lead to an increased risk of injury or illness.

Consuming protein right after exercise (one gram of protein for roughly every 2 pound of body weight) can assist with muscle repair and recovery. Chocolate milk is a particularly good choice along with Greek yogurt or peanut butter.

Finally, putting more focus on developing the running experience and less on competitive outcomes (medals won, finish times) very likely will reduce the risk of injury and foster a more productive healthy outlook on running for the young athlete. 

Chocolate Milk: A Solid Post-Game Snack Choice

Looking for an inexpensive post-exercise or post-game snack that aids in muscle recovery, delivers several key nutritional components, tastes pretty good, and will make both young athletes and their parents happy with your choice?

Look no further than chocolate milk.

Now, some might say that I have an inherent bias towards chocolate milk due to my medical school and residency years in the dairy state of Wisconsin followed by work in California (another prime milk producing region).

However, when one looks at the science, chocolate milk carries a fair amount of support.

What's even more exciting is that not only does one get the benefits of post-exercise carbohydrate (this is one form of carbohydrate  intake that can be endorsed even by a low carb diet advocate such as me) and protein, but let's not fail to mention other essential nutrients found in chocolate milk:

  • With about 150 milligrams of sodium and 425 milligrams of potassium in a typical 8 ounce serving. chocolate milk can replace sweat losses of these key elements.
  • Chocolate milk also contains about 300 milligrams of calcium that is more easily absorbed that other forms of calcium in food or supplements. Given the importance of adequate calcium intake especially for teenage females (about 1500 milligrams/day), chocolate milk can provide a significant daily contribution.
  • Vitamin D fortified chocolate milk can provide 100 international units of Vitamin D/8 ounce serving to acts as a  key component for bone health.

So when it comes time for your post-game snack duty, or if looking for a favorable post-exercise recovery beverage, again, look no further than chocolate milk and don't forget to take in a few final key thoughts:

  • Best to drink chocolate milk within 30 minutes of finishing exercise.
  • Low fat chocolate milk has been studied the most, though overall fat content should not affect carbo:protein ratio or amount of other nutrients.
  • If cannot tolerate or allergic to cow-based milk, can try alternatives such as almond, soy, or rice milk products.
  • Best if served cold to enhance enjoyment.

 

5 Sensible Tips Guiding Nutrition and Recovery After Exercise

For centuries, athletes have searched for any substance or technique that could enhance exercise and allow for more effective weight gain/loss or increases in strength and endurance. Many available performance enhancing products may report claims of potential amazing efficacy but use of them can be clouded by concerns over true scientific support, side effects, and financial cost.

Here are 5 sensible tips to guide you on nutrition and recovery with your exercise program:

1.       The Importance of Sleep

Can’t begin to tell you how sleep deprivation can derail even the best constructed exercise program, as skeletal muscle needs adequate recovery time to rebuild damaged fibers and to increase the working capabilities of contractile units. Multiple studies support the efficacy of a minimum of 8-9 hours of sleep a day to foster such recovery. Insufficient sleep can also reduce mental alertness on the job or at school and has also been associated with statistically higher risk of illness or injury.  Establish a regular bedtime and not allow deviation of more than ½ hour and also encourage daytime naps of under one hour per day which have been shown to be restorative, add to the cumulative daily sleep amount, and not adversely affect nighttime sleep patterns.

·         TIP TO ASSIST WITH SLEEP: Stop any type of screen device use no later than one hour before bedtime, and do not have screen devices in the sleep area, as use right before bedtime or alerts/temptation to check during sleep have been associated with reduced amount and quality of sleep.

2.       The Timing and Amount of Protein

Protein is the building block of skeletal muscle and is needed to assist in that reparative and rebuilding process after exercise. Good data suggests that the best time for workout-related protein intake is within 30 minutes after completing exercise. A post workout protein amount of 25-30 grams along with a total daily intake of 0.5-0.7 mg protein/pound of body weight are both solid recommendations. I have always favored dairy or meat/bean/egg sources of protein as readily available products that confer well-absorbed collateral benefits of calcium, Vitamin D, and iron. Amino Acids are the building blocks of proteins, and intake of specific individual amino acids has been touted for both weight loss and strength building. However, there is a lack of rigorous support for high amounts of individual amino acids, so stick with whole food protein sources.

·         TIP TO ASSIST WITH PROTEIN INTAKE: 8-12 ounces of chocolate milk within 30 minutes of exercise is a sensible recovery drink that has a ratio of carbohydrate to protein that allows enhanced transport of protein to recovering muscles. Other good post workout food-based protein sources include Greek yogurt and peanut butter.

3.       What About Creatine?

Creatine is a natural substance that assists with regeneration of short-acting energy sources that fuel contraction in working skeletal muscle. Increased amounts of creatine in working muscles can potentially contribute to more intense workouts and also assist in muscle recovery after workouts. Powdered and liquid creatine supplement products have been studied, with trials that include higher loading doses for the first few days, followed by lower daily maintenance doses and other regimens that include medium daily doses without any higher loading amount. Positive results have included increased speed and ability to complete multiple short-burst activities such as 80-100 yard sprints. Possible side-effects include water retention, bloating, muscle cramping, and potential kidney injury (currently only reported with individuals that had pre-existing kidney concerns).  Anecdotally, many athletes using creatine have reported enhanced recovery with increased ability to work harder in subsequent workouts, and documented strength increases support increased muscle size not being simply due to water retention, but to increased contractile abilities.  Take note that many United States-based sports medicine advisory organizations do not endorse creatine supplementation in children under 18 years of age.

·         TIPS ON CREATINE USE: Creatine monohydrate in either liquid or powder format has been the best studied form of creatine. If using any supplement, ensure that you are getting exactly what is on the container and not any additional substances (see below). Reductions in creatine dose have been shown to assist with bloating, cramping or extreme water retention. Good food sources of creatine include wild game meats or wild-caught fish which also have those collateral benefits of protein, calcium and iron. Domestic meats and fish (especially free-range meats) still have reasonable amounts of creatine.

4.       Are Pre-Workout Supplements Safe and Efficacious?

Advertised preworkout supplements or “energy drinks” report to enhance athletic performance and routinely contain multiple components such as caffeine and taurine. While a few small studies support the performance enhancement of stand-alone agents, published data on combination products is scant, inconclusive, or confusing.  Safety concerns exist with use of products that have cross reactivity of multiple agents or larger than studied amounts of a certain product.

·         TIPS ON PREWORKOUT SUPPLEMENTS: Read labels! If using any preworkout supplement in addition to usual daily caffeinated beverage of choice, you might be getting an enormous caffeine load with possible dangers that outweigh possible benefits to your workout.

5.       What’s the Lowdown on other Supplements?

Use of a vast array of pre and post-workout supplement products has been touted to enhance athletic performance and exercise capabilities. Many of these products will work- no doubt about it, - however the gross majority of products do not have any rigorous practical scientific result to support clams and there is a tangible risk of adverse consequences from both known and potentially unreported elements in supplement products.  What is on the label of many products is not the same as what is in the actual container. Personal experience along with results found by national sport organizations have found a significant number of supplements that have additional, unreported elements that are potentially dangerous and might be banned for sporting competition. While most of you are not subject to drug testing for performance-enhancing agents, suffering real and possibly long-term health consequences is not worth the short-term gains in strength and endurance.