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Competitive road cyclists are at risk of developing the health and performance consequences of low energy availability described in the relative energy deficiency in sport (RED-S) clinical model. Low energy availability can arise unintentionally and/ or intentionally from restrictive nutrition, as cycling is a gravitational sport where low body weight confers a performance advantage, up to a point, until cumulative low energy availability leads to adverse clinical outcomes such as low bone mineral density and other important hormonal imbalances such as low testosterone that can impair cyclists performance and jeopardize their health.
Some of these carelessness may be avoided by bringing “real” graduated dietitians/nutritionists into the sport. Not self proclaimed nutritional coaches nor other professionals already working with the teams such as physiotherapists, doctors and strength coaches whose role in a cycling team is essential but its surely not prescribing diets, managing nutritional recovery, fueling up for/during races and everything that proper sports dietitians/nutritionists were trained to do.
I say its time for a change! Its time to bring US into cycling!
One of the consequences of not having nutritionists on pro cycling teams is the unfortunate topic of today’s episode. Today we are talking about bone mineral density of cyclists with Dr. Nicola Keay.
Dr. Keay is a medical doctor with clinical and research expertise in sport and dance endocrinology. As a research fellow at St Thomas’s Hospital, London she was part of the international medical team tasked by the IOC to develop an anti-doping test for growth hormone. Nicky has also undertaken research in dancers and more recently in cyclists to examine the effects of training on hormones, bone health and performance.
Dr. Nicola Keay has written the world first educational website on RED-S: www.health4performance.co.uk for the British Association of Sport and Exercise Medicine. She also runs the UK first NHS RED-S clinic for athletes and dancers at the Royal National Orthopaedic Hospital, London. Nicky is the medical advisor for TrainBrave campaign, which raises awareness for RED-S and eating disorders.
On this episode:
1. Low bone mineral density in cyclists
2. How are cyclists and dancers alike in terms of bone mineral density and food behavior
3. Main risk behaviors of cyclists and their consequences for bone health and performance
4. The positive effects of including proper dietary practices and load bearing exercise routines in cyclists bone health and Cycling race points
5. The urgent need to include “real” graduated dietitian/nutritionists in cycling teams urgently.
Research Papers discussed on the show:
Keay N, Francis G, Hind K. Low energy availability assessed by a sport-specific questionnaire and clinical interview indicative of bone health, endocrine profile and cycling performance in competitive male cyclists. BMJ Open Sport Exerc Med. 2018;4(1):e000424. Published 2018 Oct 4. doi:10.1136/bmjsem-2018-000424
Keay N, Francis G, Entwistle I, et alClinical evaluation of education relating to nutrition and skeletal loading in competitive male road cyclists at risk of relative energy deficiency in sports (RED-S): 6-month randomised controlled trialBMJ Open Sport & Exercise Medicine 2019;5:e000523. doi: 10.1136/bmjsem-2019-000523
Impey SG, Hearris MA, Hammond KM, et al. Fuel for the Work Required: A Theoretical Framework for Carbohydrate Periodization and the Glycogen Threshold Hypothesis. Sports Med. 2018;48(5):1031–1048. doi:10.1007/s40279-018-0867-7
Dr. Nicky Keay’s contacts:
Educational website for RED-S (do check it out)