Dietitian Julie Stefanski with Leg Up Farms offers up a list of foods and fluids that athletes should consume on training days, game days and both days. Jason Plotkin, Jim Seip, York Daily Record
Dr. Brian Bixler thought he was living a healthy life. He exercised. He thought he ate right.
Yet, the former Division I scholarship athlete couldn't deny obvious signs of trouble. His family history includes heart disease. And since he turned 40, he seemed to put on weight each year.
"I just knew, if you looked at the health parameters, it put me at risk," Bixler said.
After becoming a father again, he opted to make serious lifestyle changes. He researched medical studies on how to fix his body during the next four years. The more research he uncovered, the more he realized how many bad habits he found in his own diet.
As an orthopedic surgeon for OSS Health, he was surrounded by young athletes every day. Many of them were in the same position he had been in as a teen. They are young and active, and many have unhealthy habits they don't even realize are hurting their overall health.
He wanted them to know they could change those habits now, improve their overall health, and possibly improve their athletic performance. But more importantly, developing good habits could help them avoid a health issue or health risk years down the line.
Bixler began passing on his findings this year at places where he hopes it does the most good, in presentations at high schools.
"The underlying tone and the real reason I am here is to help you take care of yourselves like I am am trying to take care of myself," Bixler told a group of coaches at Red Lion High School earlier this year.
"All of this starts with kids," Bixler said. "Habits, with diet and sleep, start when we're children."
After being treated by Dr. Bixler for a stress fracture, Central York sophomore volleyball player Alexa Shorts dramatically changed her diet. She replaced soda with orange juice and milk. She ate more vegetables.
"It was really cool," Shorts said. "After I stopped drinking soda I started to feel a lot better."
Unable to get on the court, let alone stay there with her previous diet, she has not experienced a setback and has played and trained throughout the summer.
Beware of processed foods
It's common for teen athletes to compete on multiple teams, to pay to play on a travel team and to pay for personalized coaching.
Yet, shouldn't teenagers and their family members know the right fuel to feed this young athlete if so much of their lives revolve around sports?
Bixler notes all the costs and activities young athletes participate in, yet they are "forgettting the basic things."
Bixler and other health experts note young athletes should monitor their intake of processed foods, sugars and carbohydrates.
"A processed food is simply a food that has been changed in some way before it gets to your table," said Summit Health's registered dietitian Melissa Benzon, who is based in Chambersburg. "That includes foods that are frozen, packaged, or canned that have been changed with fortifying or preserving."
While it might not show up as a problem in their teenage years, with their ability to burn off empty calories, if left unchecked it's a recipe for trouble in years to come.
Instead, look to whole foods, Bixler and other experts said.
"Whole foods grow in the ground," said Angie Dye, who is a certified specialist in sports dietetics, a triathlete and a registered dietitian at Hershey-based Carpe Diem Nutrition. "Ask yourself if the food grows on the ground or in trees."
Bixler encourages youth athletes to eat unlimited fresh vegetables and fruit.
"The bottom line is if you are an athlete, you have to burn fat because fat is your endurance fuel," said author John Douillard, who has written numerous books about natural health and is the former director of player development for the NBA's New Jersey Nets.
"It’s also the sleep-through-the-night fuel. Sugar is a quick burn, it gives you energy and then dumps you."
Douillard recommends a teaspoon of quality coconut oil or flaxseed oil mixed in with a morning tea. It's a way of avoiding processed breakfast foods and adding important nutrients for children that need fuel to navigate a busy day.
Bixler knows this might catch some people off guard. Before earning a football scholarship to the University of Maryland out of Cedar Cliff High School, he was raised on a low-fat diet. He consumed wheat and dark breads and other carbohydrates for what he thought were healthy benefits in reducing the potential risk of heart disease and obesity.
It was the way many athletes were raised, and yet the childhood obesity rate in the United States more than tripled since the 1970s.
"We were low-fat everything, but what do you think they replaced the fat with? Sugar," Bixler said.
A diet high in sugar and carbohydrates creates problems, Bixler said.
"Bread or pasta is just a bunch of glucose molecules bound together," Bixler said. "Your body can't tell if you've eaten a slice of white bread or table sugar. There's no difference.
"When you have an abundance of glucose, or carbohydrates, it blocks the fat from being used. There is absolutely no dietary requirement for carbohydrates. None."
Bixler tells youth athletes to focus on nutrient density. Put another way, they and their parents need to find foods that pack the most nutrients with a lower number of calories. Instead of reaching for processed foods, like fruit snacks, reach for a whole food, like an apple or other fruit.
"Lots of things can lead to obesity," Dye said, "and processed foods is one of them."
Once athletes reach their 20s they will need to monitor their fruit intake because it contains natural sugar, Bixler said. But at a young age just avoiding processed foods is the right choice.
"Picking up an apple with nut butter is better than picking up a sugary snack for a quick boost of energy," Benzon said. "One-hundred percent whole grains and nuts will also give the body the energy it needs for optimal health and athletic performance.
"A suggestion for a student-athlete would be to keep some fruit and nuts in their backpack or locker so they can get that healthy snack before practice or after school."
Schedule and lifestyle are part of the problem.
"There are a lot of things tugging them in different directions," Wellspan Health's Dr. Mark Lavallee said about youth athletes. "There's club and travel teams and a school team on top of that. ... We're not even adding in Boy Scouts or student government or band, all of the extracurricular activities which are highly encouraged for colleges."
So in a time crunch, a student skips breakfast. Or they reach for processed foods.
Processed foods can be heated up or served in seconds or minutes. But convenience and nutrition are not the same thing.
"There is no processed food that is going to be good for your body," Bixler said. "I don't make the rules, I'm just telling you what they are.”
Sports drinks, with their name alone, sound healthy. For instance, Gatorade's website uses the language "thirst quencher" and "sports fuel" on its site.
Bixler asks people to look at that label.
Gatorade contains 21 grams of sugar in one 12-ounce serving. The company also sells a 32-ounce bottle, and it contains 56 grams of sugar. It remains a better option than soda — a 12-ounce can of Coke contains 39 grams of sugar — but it's not always ideal.
Running at marathon pace for an hour, Bixler said, an individual burns about 800 calories. That runner would need to run for about 2 1/2 hours at that pace to deplete his or her glucose stores to the point they'd need to be replenished.
"So why are kids at my son's 7-year-old soccer game at every break guzzling Gatorade bottles the size of their heads?" Bixler asked.
"It's just unnecessary, and it's been sold to us as a sports drink. But if you do the math and basic science, it's not necessary for anybody except maybe people running a marathon."
Water is the healthier choice.
But there is one reason to drink a sports drink.
"The rule of thumb that I share with athletes is if it’s really hot out, like the 95-degree days we've had and they're outside training, they should be using sports drinks from the get-go because it’s dangerous and they can become dehydrated," Leg Up Farm's registered dietitian Julie Stefanski said.
"But if your activity is less than 90 minutes and your training inside, you don’t need a sports drink."
Stefanski is a certified specialist in sports dietetics at Leg Up Farm, a non-profit therapy center in York County. She counsels individuals on weight management and sports nutrition.
Even grabbing something as simple as a "coffee," or what a young athlete might think is a coffee, can lead to empty calories.
"Unfortunately now at places like Starbucks kids are drinking their calories," Wellspan Health's Lavallee said. "They can suck down half their daily allotment of calories. Why don’t we just call it a milkshake?"
Don’t believe him, check out the nutritional facts on Starbucks' Caramel Frappuccino Blended Coffee. It has 420 calories, 66 grams of sugar and 9 grams of saturated fat in one 16-ounce serving. The Cinnamon Roll Frappuccino Blended Coffee has 510 calories, 85 grams of sugar and 10 grams of saturated fat.
By comparison, an actual cup of coffee from Starbucks, like the blonde roast, contains 5 calories, 0 grams of sugar and 0 grams of saturated fat in a 16-ounce serving.
The perfect machine
It's not easy trying to find the right foods for athletes.
"Nutrition can be complicated, and unfortunately it can be harder if you start looking online," Stefanski said.
That's why she stresses talking to a registered dietitian who can help youth athletes tailor a diet specifically for them. She often talks to teenage athletes looking to add weight and muscle.
"They can't get enough nutrition to put on muscle and gain weight because they are burning it off," Stefanski said.
But, she said, it's an easy conversation for a dietitian to have with an athlete who wants to find a healthy food or a food that might be easier on their stomach on stressful competition days.
Finding the right nutrition now will not only help them optimize their performance as a young athlete, but it sets them up to be healthier adults able to make healthier decisions about their diet for years to come.
A pre-race pasta meal for the cross country or track athlete could be changed to shredded zucchini, Bixler said. Even in choosing fast food, like a quick stop at Jimmy John's, can be made healthier by ordering the JJ Unwich, which replaces bread with an iceberg lettuce wrap.
The human body is still the perfect machine, Bixler said. It just needs to be taken care of and monitored.
"I don't have a way to alter the engine for it to burn something other than the fuel it was engineered to run on," Bixler said.
About the series
In a three-part series, the York Daily Record examines how youth athletes can improve their overall health. Find all stories at ydr.com/gametimepa
In Part 1, we examine nutrition.
In Part 2, we examine the importance of vitamin D. (Sports, Monday)
In Part 3, we examine the importance of sleep. (Sports, Tuesday)