Episode 9: Nutrition for Athletes with Cate Ward, PhD, RD

As coaches, we get tons of questions about nutrition for performance and health. In this episode, we’ve brought in an incredible expert to share her expertise in the domain of fueling for endurance athletes! Dr. Cate Ward holds a PhD in Metabolic Biology, is a Registered Dietitian, and is currently a postdoctoral fellow at Stanford studying human nutrition. She’s also an athlete, and she brings her love for cycling and other sports into her practice as a dietitian and researcher. We cover topics including: how to fuel long endurance days, supplementation, relative energy deficiency in sport, the physiology of zone 2, metabolic flexibility, and so much more. Thank you, Cate, for joining us! Check out her website ⁠here⁠.

Cate’s bio: 

  • PhD in Metabolic Biology from University of California Berkeley

  • Trained as a Registered Dietitian at UCSF

  • Currently a Postdoctoral fellow at Stanford

  • Athlete

Can you tell us a little bit about yourself and your background? What inspired you to become a dietitian and researcher? 

  • Always interested in science from a young age

  • Studied biology in undergrad, transitioned from molecular to metabolic biology 

  • Became interested in clinical human research and trained to become a dietitian 

  • Now doing research on human nutrition, particularly the microbiome, with Chrisopher Gardner and Justin Sonnenburg

One of the core focuses of our podcast is on the principles of endurance training and coaching. Do you have any principles of nutrition that guide your recommendations and approach, and what challenges related to nutrition do you see most often in the endurance community? 

  • Meeting clients where they are at in terms of nutrition experience, changes that are feasible to make, etc.

  • Underfueling = very common challenge; hunger signals can be perturbed after intense activity → need to be mindfully fueling even if you’re not feeling up to it at times

  • Intuitive eating is hard to rely on exclusively as an endurance athlete; think of fueling as like a medication you take before getting a procedure done

  • Fasted training: avoid as it hinders recovery and performance. Something is better than nothing, even a little bit of juice. Focus on easy, fast, digestible. 

What are your nutrition recommendations (in terms of macros, timing, ideas of what to eat, etc.)? Example of a weekend day with a long ride:

  • Morning pre-activity: Mainly carbs, lower fiber and lower fat as both can disturb GI tract or lead to GI distress, some protein. Examples: bagel and egg sandwich, bagel with peanut butter, oatmeal with milk (soy or dairy) and bananas

  • During activity: Simple sugars. You can generally tolerate more fiber in cycling (i.e., dried fruit, bars, muffins, cookies) than running (gels). Typically not tolerating any fiber in running.

  • Midday: Awesome to stop for a full lunch mid-ride (but not too high on fiber/fat); if not you need to compensate for those calories by taking them in during ride or after 

  • Dinner: Can incorporate more fiber/fat, playing catch up to compensate for not having as much throughout the day. Protein after. 

  • After dinner snack to make sure you are topped off and then honoring hunger cues the next day as you will likely be hungry

Q: Athletes often fuel less on off days. Thoughts on this?

  • People often equate working out to calories burned; instead, think about needing to fuel to work out rather than needing to work out to fuel. You don’t need to earn calories. 

  • Off day especially important to replenish the fuel tank. 

General nutrition throughout the day? 

  • Micronutrients, enough fiber on lower intensity days; but not too much fiber as you can end up not getting enough calories overall. Better to combine fiber with other macros that you need (beans, corn, whole grains = high fiber and high carb) than fill up on low calorie foods like lettuce. 

Do these recommendations differ at all across gender and/or age?

  • Older women often do not get enough protein; everyone should try for 20-30g at every  meal as a general rule of thumb 

  • College students often don’t fuel enough at the beginning of the day and backload calories; focus on getting a solid breakfast in, which can be hard with dining hall schedules.  

Do you recommend supplements? If so, which ones?

  • Best to start with getting labs done to see if you are deficient in anything before supplementing; if you don’t need it, you will just pee it out (which can be a waste of money).

  • Labs I ask for: full metabolic panel, full lipid panel, hemoglobin A1C, vitamin D, ferritin, iron, CBC, vitamin B6, B12, zinc; also need electrolytes (sodium, potassium, magnesium)

  • Anemia can be common in female athletes → iron supplement 

  • Hydration is important, although very individual-specific (sweat rate, activity level, type of electrolytes you are taking in); but do take in electrolytes during and before activity, especially in the summer 

  • First choice is to get the micronutrients you need via diet; supplementation only needs to be used when things are lacking 

Do you have any specific recommendations for athletes following vegan/vegetarian diets? Do you recommend going plant-based?

  • Definitely possible to get enough protein (soy, legumes, etc.) but need to be very mindful and make sure you are getting enough calories. If you’re getting enough calories, you can get enough protein. 

  • No stance on whether you should be plant-based or not, but always good to eat more vegetables; Cate incorporates meat as a supplementary role in diet 

We often see GI issues surrounding training for endurance athletes that can really impact race day or training. How do you approach this? 

  • Common in people training for first marathon; body not used to training and gut not used to handling new stimulus (gels, etc.)

  • Need to train your gut to handle more and more carbs per hour. Start with 30g/hour and work your way up by X grams per week depending on how they tolerated the previous week. Set up your run to have bathrooms along the way. Can’t predict how gut will respond until you train it

  • The grams of carbs you can absorb per hour does not actually depend on activity level, height, weight, etc. like daily caloric intake does; instead, it’s a function of training your gut. 

Underfueling: How do you know if you are getting enough? Symptoms of REDs?

  • Common symptoms: amenorrhea (lack of a menstrual period in females that would not otherwise be missing), low resting HR, high HR variability, unexpected cardiac abnormalities, dehydration, extra GI problems, stress fractures, persistent overuse injuries, weight loss, fatigue/weakness, low sex drive, persistent illness

  • Seek help -- primary care provider, dietitian, even parent/friend/coach

You work with people who have experienced disordered eating / eating disorders. We know this is very common in the endurance community. Why do you think these challenges are so common? What strategies are most effective for overcoming disordered eating / eating disorders? When should you seek professional help? 

  • A lot of social pressure in the endurance community can be a contributing factor (example: awkward to fuel on a group ride if no one else is)

  • Important to surround yourself with people who can support you 

  • Best strategy is to get help from trained professionals: psychiatrists, mental health providers, primary care provider, social work, dietitian, etc. -- centers that specialize in this. Reach out if you need help! 

  • Book recommendation: How to Nourish Yourself Through an Eating Disorder by Casey  Crosbie and Wendy Sterling

Weight loss and training/fueling. How do you approach it when endurance athletes are attempting to both train and lose weight at the same time? 

  • Can’t chase performance goals at the same time as weight loss goals; pursuing weight loss will usually come at the expense of performance (and leave you at risk for REDs)

  • Wait until after a goal event to be chasing weight loss goals 

  • As a dietitian, I’m never recommending weight loss and am leaving that up to the individual to come to me

  • For young athletes in particular, need to focus on fueling yourself 

Nutrition and Zone 2 training. How do glycogen stores work? How do you become more metabolically flexible?

  • Simple sugars taken in during a workout = best source of fuel; break down and give you the ATP that you need for your muscles to be working; carbs you take in are broken down and rebuilt into glycogen stores, the building blocks of glucose which is branched up and stored in muscles and liver; you access these while working out 

  • Glycogen stores range from 1600-2000 kilocalories; “hitting the wall” or bonking is when  you run out and have to switch to burning fat / working out at a lower intensity 

  • How to become more metabolically flexible? Train more in zone 2, as this improves your ability to use fat as fuel. Lactate testing can give you exact numbers

  • Becoming more metabolically flexible is almost entirely based on training status rather than what you eat, so avoid fasted training

We always end with a gear pick of the week. This week, I think we’ll do a snack pick of the week. What’s your favorite training-related snack?

  • Homemade trail mix cookies! Recipe here.

Are you currently accepting clients? Where can people learn more about you and your work?