Practical Dietary Hacks to Combat RED-S

Dr. Heather Salzer // #ICEPelvic // www.ptonice.com

In today's episode of the PT on ICE Daily Show, ICE Pelvic faculty member Heather Salzer discusses a case study involving helping a patient increase her calorie & protein intake during postpartum to improve her recovery & performance.

Take a listen to learn how to better serve this population of patients & athletes or check out the full show notes on our blog at www.ptonice.com/blog.

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EPISODE TRANSCRIPTION

HEATHER SALZERGood morning, PT on ICE Daily Show. Happy Monday. I'm Dr. Heather Salzer and I'm here with the Pelvic Division at ICE. And this morning we are going to talk about hacks to hit protein and calorie needs to help us stay out of low energy states and avoid RETs. So at the ICE Pelvic Division here, We talk a lot about REDS, also known as relative energy deficiency in sport. It's something that can have widespread effects. It can affect our immunity, sleep, energy across the day, muscle building function, and then a lot of pelvic kind of class specific things like fertility, increase our risk of urinary incontinence. If you want to deep dive into REDS, please join us in one of our pelvic we go into it in great detail, but when we talk about it, we always get the question of, okay, well, if I need to be eating that much, or if my clients need to be eating that much, that feels like a lot. How can we actually get there? So for the podcast today, we're gonna go through a case example, and as we talk about that, discuss overall calorie needs from Red's perspective, and protein needs, because that's something that a lot of people struggle with as well. And as we go through that example, we'll go through hacks of little changes that someone could make in their diet to make these things a little easier. So meet Kristen. She is our client today, and she is 32 years old and around 160 pounds. She's got a three-year-old at home and a 10-month-old that she is breastfeeding. Kristen runs two to three days a week at a pretty moderate, sometimes higher intensity, and she also crossfits around three days a week. She's also pretty busy chasing around her three-year-old and while carrying her 10-month-old with her as well. So how much does Kristen need to be eating a day when you ask her and are getting some feedback from her? So someone with her general demographics would need relatively about 1,500 calories just at absolute baseline doing nothing else. When we add in her activity across the day, we're looking at closer to 2,500 calories. Then we add in breastfeeding on top of that and she's sitting at close to 3,000 calories a day in terms of her caloric need. if we're thinking about how much protein we want her to be getting, likely we're trying to be somewhere in that close to one gram of protein per pound of body weight, just because of her high activity and breastfeeding. So we're looking at like 150, 160 grams of protein. That can be a lot. When we ask this question to our clients, a lot of times, her it's like, whoa, I am not getting anywhere close to 3,000 calories and you want me to eat how much protein? Don't you know that I have kids that I'm chasing after? When am I supposed to meal prep enough to make all of that happen? So let's go through her day, talk about what she might be eating to start with, and then little tweaks we can make to change it along the way. So we ask her, Kristen, what do you eat for breakfast? And she says, well, some days I have got, I do like two eggs, some toast and some fruit. And other days I do some oatmeal with berries and milk. Okay, if we think about that, we're maybe getting 15 grams of protein and probably like 300 calories on top of that. That's not a super strong start to the day. So we ask her, hey Kristen, Do you think you can add another egg or maybe some egg whites to those eggs and a breakfast sausage on top of it? She's like, yeah, that seems reasonable. Or on oatmeal days, can we do overnight oats instead of hot oats and put a scoop of protein powder and maybe a couple tablespoons of chia seeds in there? And then all of a sudden with either of those options, we've upped protein closer to 30 to 40 grams and now we're sitting at like 700 calories. So starting off strong with a good breakfast is a nice way to already help us get those totals earlier in the day. Side note on the oatmeal, I don't know about you but I have tried putting a protein powder in hot oatmeal and it gets chunky. Overnight oats are fantastic and that protein powder scoop is a good way to up the protein on that. So moving on to Kristen's day, we are about mid-morning and she's like, yeah, usually I don't really have time to eat again till breakfast or till lunch. I get going with my day. I'm pretty hungry when I'm breastfeeding, but then I keep going and I really just don't have time to eat again until lunch. So we say, What can we do to make it easier for you to get a snack? Can we have a protein shake that you make with breakfast that's sitting in the fridge ready to go? Can we have some yogurt that can be easily grabbed? Where are you doing your breastfeeding right now? Do you have a station set up? Can we put some protein bars there? Can you grab your yogurt on your way there? Can we stash some protein bars in your car? So finding a way to get her a snack in the morning that can pack an extra 20 grams of protein and maybe another 200 cals on top of that. Breastfeeding, for this specific example, can be a great time to get it. Baby's getting their nutrients in. I promise they won't mind with some crumbs on their head. Fuel yourself while you're fueling baby. That can work great. So, we've already increased by adding in some snacks, packing her breakfast a little bit fuller, now we get to lunch. And we ask her, okay, Kirsten, what are you eating for lunch? And she's like, well, I've been trying really hard to be good about my nutrition and getting in healthy things, so I've been meal prepping turkey and cauliflower bowls. I say, okay, awesome, I'm so excited that you're taking the time to meal prep, that can take a lot of time. And how much are you eating? And she's like, well, I've got this little Tupperware. And you go through it together and you calculate it. And really, she's getting like maybe 400 calories and maybe 20 grams of protein in her little Tupperware. And you ask her, are you full by the time you're done eating lunch? She's like, eh, maybe. You're like, do you think you could eat a little bit more? And she's like, yeah, probably. So you say, girl, you gotta get rid of your tiny Tupperware. The big mixing bowls with a lid, that is where it's at. And we see if we can increase her serving size just a little bit. Can we add especially a little bit more protein into that, up that turkey percentage? Or also she's using cauliflower rice, which great to get some veggies. but maybe we're not getting enough calories overall, so can we add some brown rice and white rice into that mix in addition? Now, we've taken her lunch from 20 grams of protein to maybe closer to 40, and 400 calories closer to 800, just by slight small ups in that serving size. We hit mid-afternoon, we're back to breastfeeding, happens again, And we have some other snacks set up by her station. Maybe she's grabbing a handful of trail mix with some unsweetened dried fruit and some nuts. And so we're getting another 10-ish grams of protein, maybe 400 calories. And we made it back to dinner. We ask her the same thing. Do you feel really full after dinner? And she's like, Eh, not necessarily. And then, so it's like, okay, her family's making tacos for dinner tonight. And she's like, yeah, normally I eat like two-ish tacos. And then I get distracted trying to feed my three-year-old who's thrown their taco meat to the dog on the floor. And then before I know it, all the food's gone and we're on to the next thing. We say, let's prioritize getting you an extra taco. So yet again, without doing more work from a meal prep or food prep standpoint, we're able to increase protein a bit and increase over calories. So say that bumps us up to maybe again, like another 40 grams of protein and 800 calories. So if we look back at our day, Kristen maybe started off with maybe hitting 75 grams of protein and 1500 calories. which will definitely not be enough. That's like baseline function if she were to do nothing else across the day. With a few of our little swaps, we've gotten her really hitting that 2,900 calorie mark that we talked about would be ideal for her and closer to 150 grams of protein. So again, we boosted up her breakfast, adding in a little bit more, made snacks convenient that she could grab, and upped what she was eating just a little bit for lunch and dinner and made a big difference. Now, obviously, you wouldn't want to jump somebody who had been eating very low to a ton all at once. They may feel way more full, so that might be more of a gradual transition. But if you can even start with just, hey, let's really prioritize adding in one more protein-heavy snack. How can we make that easier? Is it making some protein balls over the weekend that you have in the fridge that you can grab? Like I mentioned, is it stashing that protein bar in the car by the breastfeeding station? How can you make that easy to hit those numbers? Now, in an ideal world, when somebody is dealing with, when we're noticing as we ask them questions about their diet, that we're not getting enough calories if we think they need to have a little more protein, it would be wonderful to refer them to a registered dietitian. It is great to have resources in your community of places that you can refer people out to. But the reality is, a lot of the time, they're not going to make time for another appointment. So you are their nutrition resource. The APTA says that it is within our scope of practice to talk about nutrition. So start asking. You will be surprised about the answers you get Especially, our example today was within that postpartum population, but this could be transferred over to any of your clients. Another great group that we really need to be asking about this is our teenage athletes, especially our female teenage athletes. And it is sometimes wild how low of a calorie count those people are getting in a day. Now, if we're wanting realistic Like if we're really wanting to know exact numbers, it is helpful to track for a day or two and see where they're at. Tracking, you can use like MyFitnessPal as a free app that allows you to track across the day. And that's a good idea to be able to see where the calories at versus where we want them to be and where's the protein at versus where we want it to be. I know tracking can be definitely triggering for some people, especially when we're talking about this population I like to recommend, can we do it for a couple days to get a baseline of what you're eating? And then a couple more days on top of that so that you can see, oh, wow, this is where I actually need to be with that. And maybe it doesn't have to be a long-term thing, because it also takes a lot of time in addition. If that's off the table, again, just go back to what are some of those little changes that you can ask them to make and maybe start with just one change at a time. So again, can we add that snack in or can we increase serving size at one meal? SUMMARY If this feels like a topic that you're like, man, I really wish I was a little bit more comfortable talking about nutrition, ICE does have a self-paced nutrition course. If you go to free resources on the app, you can access that. And if you're interested in learning more about REDS and its impact on all things pelvic, such as fertility, urinary incontinence, you should jump into one of our pelvic courses, either live or online. We've got some coming up. Our next online level one cohort is going to start on September 9th. and level two starts on August 19th, and then there's lots of opportunities to join us on the road as well. We'll be in Hendersonville, Tennessee on September 7th, Wisconsin on the 14th of September, and then Connecticut on September 21st. I hope this helps give you some ideas about little changes that we can make to make sure that our clients and you are getting the calories you need to do all of the awesome stuff that you want. Happy Monday, everyone, and go crush some breakfast.

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