Sport Nutrition Archives | The Diet Consultant

Optimized-Male-Athlete-Eating-Disorder-1.1

Disordered Eating in Athletes – The Male Athlete Dyad

Posted by | Fitness, Food for thought, Sport Nutrition | No Comments

Eating disorders/disordered eating and the athlete triad are often associated with females but there is a growing amount of evidence to suggest that it is becoming more prevalent within males too.

Indeed in my own clinic this year, around 1/3 of the cases of disordered eating I have worked with, have been in males ranging in age from 15-40 years.
In all cases, working with eating disorders is a challenge; there is no straight line to recovery.
However, In the case of a female sufferer, the physical signs of low energy availability, over exercising and restricting food intake are made apparent physically by weight loss but also physiologically via the cessation of menstruation.

In the male sufferer there are few visible physiological signs, making it more difficult to assess the degree of damage to the body.

In the female athlete triad it is widely accepted now that athletes can actually hold a fairly normal weight but still be affected due to having low energy availability. When a female athlete consumes less than 30 Kcal/Kg fat free mass either as a result of restricting their intake or being unable to meet their training demands, it affects the hypothalamic hormones and stops the production of Oestrogen. This in turn can then have an impact on bone density especially if menstruation stops for as little as 3 consecutive months. If a sufferer is also very low in weight and showing signs of disordered eating, there will be concerns regarding her blood pressure, pulse rate and increased pressure on heart, lungs and skeleton as her body fights to stay alive.

How does this differ in boys/men?

As already mentioned, there is a missing corner with regards to the actual triad (suggesting its more of dyad) as there is no link to cessation of menstruation but surely low energy availability in males will also see a reduction in the sex hormone testosterone and what effects does this actually have?

Indeed, studies in male bodybuilders have demonstrated that prolonged energy restriction does cause a reduction in testosterone and growth hormone. 

Effecting anabolic pathways, even when the athletes consume high protein diets. In the case of the body builder as long as this is just short term in the lead up to a competition, there is no lasting damage or concern.
Interestingly the male sufferers I have worked with have all presented with very low body fat composition, increased desires to be lean but strong and have an excessive relationship with lifting weights in the gym. What may have started as a general interest to build muscle soon becomes an obsession with controlling their food intake; becoming fixated on reducing carbohydrate and fat from their diet to a dangerous level, while still spending hours exercising daily.

Disordered Eating in Male AthletesAs is often seen in cases of disordered eating and body dysmorphia, there is a drive for control and “perfection” usually unrelated but soon becomes expressed through food restriction. The determination to achieve a strong athletic body in male sufferers can quickly develop into a negative cycle; they reduce their dietary intake, push their bodies through punishing exercise programmes, all the time telling themselves that they are actually enjoying their new found “healthy lifestyle”. Ironically this new regimen is doing the complete opposite; preventing anabolic pathways and increasing catabolic pathways, breaking down muscle to provide energy and moving further away from their body composition goals.

A low weight and restricted energy intake is always accompanied by irrational thought processes and a louder inner voice as the eating disorder takes on an even stronger hold. As well as affecting anabolic pathways, a reduction in these sex hormones will result in low bone density; some of this may well be counteracted by the fact that the male sufferer performs a higher percentage of weight bearing exercises but damage to bone health is still a problem that needs to be highlighted when working in this field.
If energy intake and weight can be restored fairly quickly then there does not seem to be long term damage; but if it is a lengthy return to normal weight and eating, the individual may be more at risk of stress fractures and osteoporosis in later life.
So while the third point of the (triad) triangle may be missing in males, there are still symptoms to look out for:
• Low energy (although initial this will present with endless amounts of “restless” energy)
• Low mood
• Poor sleep patterns
• Increased irritability
• Withdrawal from social circle
• Loss of libido
• Lack of concentration

Male or female it is always difficult to ask for help when dealing with disordered eating but I think it is even harder in males. As wrong as it is, it is accepted by society that women generally have issues with their body image and poor relationships with food. This is not so the case for males, making this condition even more isolated, secretive and dangerous if left unaddressed.

What are your thoughts on this often sensitive area?  

 

Have you or somebody you know experienced disordered eating within their sport?

 

Sharing is Caring….lets raise general awareness of an increasingly common issue within sport!

Thank you to Renee for writing this insightful blog, its certainly an area that requires much more attention, appropriate discussion and qualified support. You can also check out Renee’s previous blog; ‘Performance Scales’ (www.eatwellfeelfab.co.uk/blog/perfromancescales) exploring the increasing problem of disordered eating and the negative effects it can have on health.

 

Renee McGregor

Renee McGregor, Sports Nutritionist and Registered Dietitian BSc (hons) PGDIP (diet) RD PGCERT (Sportsnutr.)

 

About the Author 

Renee is Sport Dietitian with Team Bath, a keen runner and is extremely passionate about making sport nutrition practical and simple to follow. She provides advice to a range of athletes from recreational to elite; including athletes competing at both the Olympic and Commonwealth Games. She also works to support patients through the National Eating Disorders Charity, Anorexia and Bulimia Care as well as Somerset and Essex Eating Disorders Association.

Check out her website here eatwellfeelfab.co.uk  and follow Renee here on Twitter 

 

Triathlete

Nutrition to Fuel your Triathlon

Posted by | Fitness, Healthy Eating, Sport Nutrition, Uncategorized | No Comments

Training for a triathlon, from a sprint distance to an Ironman requires a lot of extra time and grit, putting in the hard graft a train for 3 disciplines (swim, run and cycle).  A disciplined attitude towards nutrition is also useful, since training alone will only get you so far.   Specifically, amateur and elite triathletes should be aware of their own carbohydrate needs and intake, ensuring they are consuming enough to optimise their training performance and ensure that carbs are distributed over the day to fuel before a workout and aid recovery following.  If you are serious and you want to do well, then fuelling your training with a healthy nutritious diet and one that provides an adequate amount of carbohydrate should be one of the things at the top of your list.

Carbs to Go!


Carbohydrates are your body’s main and preferred source of fuel especially during an endurance sport such as triathlon.  Carb food sources such as bread, potato, pasta and rice are digested and stored in your muscle and liver as glycogen, ready to use as energy, as and when we need it.  The problem is however, that we can only store approximately 2000 kilocalories from carbohydrate.  Which sounds like a lot, but if you imagine a half – ironman triathlon requires approximately 4500 calories to complete, the energy stored doesn’t even meet half of the energy required.   That’s why a regular intake of carbs is required during the event as well as during your triathlon training. To put it simply, a higher muscle glycogen level will allow you to train harder for longer and a low muscle glycogen will result in early fatigue and a lower training threshold.
Take home message A regular intake of carbs in your diet can help you to train harder and perform better.

Calibre of Carbs


You may have heard of the glycaemic index (GI). It’s basically the value at which carbohydrate food and drinks affect blood glucose levels. High GI foods and drinks cause a higher blood glucose response and low to medium GI foods cause a lower blood glucose response.   It’s recommended that we consume carbohydrate foods that are considered low to medium GI most of the time.  However, in reality a mixed meal, which contains carbs, fats and protein, will reduce digestion time and thus the rate at which a high GI carb (like a jacket potato!) affects the blood glucose level anyway.  Plus high GI sources are particularly important during exercise (greater than 1 hour), since they supply a rapid uptake of glucose to sustain energy production and performance.
The amount (which I’ll come on to) and ‘quality’ of the carbohydrate food appears to be more important for health and energy levels.  By ‘quality’ carbohydrate I mean, carbs that are unrefined, e.g. wholegrain breads and cereals, fruits and vegetables as well as dairy; foods that provide many other nutrients and physiological benefits besides energy alone.  Sweets and sugar (are also carbohydrate) do just that and have been unfairly demonised of late.  While they shouldn’t be consumed regularly, an infrequent intake will cause you no harm.  Plus, we are only human – who doesn’t like the odd biscuit or sprinkle of sugar!
Take home message :Eat nutritious unrefined carbohydrate sources most of the time and save sweet foods and those with added sugar to occasional treats or for during exercise lasting more than 1 hour.  

Carb counting – how much?

We all need carbohydrates as part of a healthy balanced diet but regular exercisers and triathletes need more than inactive, sedentary individuals. The amount of carbs you require is very much dependent on how active you are, and specifically how many hours per week you spend training.  Carb requirements are calculated on an individual basis using total body weight (in kgs) multiplied by carbs (in grams), which increases proportionately with time spent training.

Carb req vs Training needsTake Home Message: To estimate your carbohydrate needs, use the information in the table to establish the amount of hours you typically train each week and calculate the suggested carbs in grams by your weight in kilograms.

Carb Guide

This is probably all gibberish if you do not know the carb content of your fav’ foods!  So to help, see our Carb Food Guide below; which shows you a variety of different carb rich foods and the amount that provides around 50g of carbohydrate.  I would suggest keeping a food diary for a few days, being sure to note accurate weights or servings sizes.  Once complete, cross-refer with the Carb Food Guide to estimate your current carbohydrate intake, comparing it to your calculated requirements.  It may be that you consume more carbs than you need or that you do not consume enough to support your triathlon training.  Either way, adjusting your intake should help you to meet your carb needs and ultimately support your triathlon training and performance.
Take Home Message: Different foods contain varying amounts of carbs, getting to grips with your current carb intake and making appropriate adjustments to the amount and ‘quality’ you consume, will help you to meet your energy needs whilst fuelling your sport and supporting your health.

Please note: that I have included a variety of foods within this table to help show their carb content.  Foods such as sugary cereals, chips, white bread and biscuits should be consumed in moderation – think ‘quality’ unrefined, whole foods.

Carb guide table

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

50g exhange Carb guide

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Marathon

5 (Must Do) Tips to Prepare for the London Marathon

Posted by | Fitness, Sport Nutrition | 3 Comments


vmlm-logo-base

 

With the 34th Virgin Money London Marathon kicking off this Sunday (13th April 2014), there is an incredible buzz in the capital! Over 36,000 runners have signed up to take on this amazing challenge; having put in the miles week in, week out, the days ahead is their time to relax and recover. However, if you are running the Marathon or know somebody that is, there are some important considerations to make to fully prepare for the 26.2 miles this Sunday morning.

Here are my top 5 things to tick off the ‘to do list’….

1. Get your Head Down

With just 6 days to go, you may have scaled down your training hours, this combined with a common case of pre-race nerves; has started to impact your usual (habitual) nights sleep. Poor sleep has been shown to alter ‘perceived effort’ during endurance exercise, which means if you’re not able to get your usual zzzz’s in the week leading up to the Marathon; the race may feel (even) harder to run than normal! Of course, I would recommend the usual sleep enhancing rituals before bed; turn off electronics (at least 2 hours) before, optimise room temperature and take time to relax.
TIP: Adjust your normal bedtime hours early this week, so that you are going to bed at the same time you plan to on Saturday evening, allowing a full nights sleep, prior to, an earlier than normal start on Sunday. Adjusting bedtime hours now will reset your body clock, increasing the likelihood of a much needed deep sleep before the race.

2. Stay well Hydrated

Dehydration is cumulative, which means if you start the week dehydrated and fail to drink enough to adequately hydrate; you may end up starting the race in a performance compromising state. It’s therefore, important to ensure you drink well all week. The easiest way to do this is to drink regularly throughout the day, particularly with meals (the natural salts within your food, further enhance hydration). You don’t need to go crazy on the fluids, just enough to ensure that you are peeing regularly and that your urine is a pale straw colour.
TIP: With that said you might want to stop drinking larger volumes the closer you get to bedtime, as needing the loo during the night is certain to scupper your perfectly implemented sleep prep!

2. To Load or not to Load

The carb loading strategy has changed considerably over the years, with research suggesting a less aggressive, non-depleting and more realistic approach is sufficient to saturate muscle glycogen stores (the energy we store in our muscles from carbs). With the aim of going from 5-7g carbs per kg of body weight per day to 8-10g, two-three days before the Marathon. Your plan should look a little like this….

Monday – Training day -eat and drink normally (i.e. High fibre carb based meals and snacks, with lean protein and lots of veg’)
Tuesday – Same as Monday – with slight taper in training
Wednesday – Same as Monday – with slight taper in training
Thursday – Rest day – Start to adjust the proportions of protein (meat/fish) and carbs (pasta, rice, potato) at meals, so that you are slightly increasing your carb serving whilst at the same time decreasing your protein serving (maintain a large serving of veg’ as usual)
Friday – Light training day – Repeat Thursday’s serving sizes.
Saturday – Rest day – Repeat Thursday’s serving sizes.
Sunday – The Marathon-  Large carb based breakfast about 3-4 hours prior.

The aim here is to eat more calories from carbohydrate not more total calories! This is why I recommend reducing serving sizes from protein such as meat and fish to counteract the extra calories from bigger servings of carbs. Eating regular meals and snacks based on wholegrain carbs (sweet/old/new potato, brown pasta, basmati rice, cous cous, wholegrain bread, oats and muesli) are perfect!
TIP: If you are struggling with your appetite, then you can always add honey and dried fruit to your cereal and yoghurts or drink extra carbs by replacing some of your daily fluid intake with low fat milk and/or fresh fruit juice.

3. Bland isn’t boring, it’s reassuring!

The last thing you need on race day is a dodgy tum! Stick to foods you know, like and tolerate. Friday and Saturday are not the best days to try the new local Indian restaurant and while the local Italian might offer a reliable serving of pasta to help satisfy your 8-10g.kg.bw of carbs, steer clear of chilies and spice. In fact, I would highly recommend cooking at home where you can rest comfortably in the knowledge that you are eating a well planned meal with all the ingredients you need, minus the ones you don’t.
Tip: If you are susceptible to runners tum (diarrhoea and cramping) before and during your event, swap your wholegrain carbs sources with white refined options from the Friday. Reducing the fibre in your diet could help to ‘slow things down’ a little and reduce the symptoms you commonly experience.

5. Plan Race Day Nutrition

You’ve done all you can to ensure you are ready; you’ve slept well, maintained hydration, you’ve saturated your glycogen stores and avoided foods that may cause you tummy upset. Don’t fall at the last hurdle; plan your race day nutrition! Plan to: -

  • Consume your breakfast 3-4 hours prior to the race (~6am), it should provide you between 1-4g.kg.bw of carbohydrates, either wholegrain or refined options (depending on your usual gut symptoms).
  • Carbs in Pictures, 160g breakfast (2g.kg.bw) for an 80 kg man, might look a little like but like this (all of it)….
55g Oats, 150mls SS milk, 1 tbsp of raisins & 1 tbsp of honey

55g Oats, 150mls SS milk, 1 tbsp of raisins & 1 tbsp of honey

 

2 x thick slices of toast with strawberry jam

2 x thick slices of toast with strawberry jam

200 mls Fresh Orange Juice

200 mls Fresh Orange Juice

Check the scheduled Marathon fluid and fuel stops (pages 16-17 of your Final Race Instructions), cross-reference this with your planned fluid intake (adjustable depending on the weather) as well as your carb intake throughout. The race organisers are offering Lucozade Sport drinks and gels throughout. If you plan to use another brand of products (preferably a range you have used during training), then think bout how you’ll carry them and when you will take them. Ideally, you will have measured your fluid needs and practiced your fuelling strategy within training, however if you haven’t the general recommendations are as follows;

  • Aim to drink ~ 4-800 mls of fluid/hour (gradually) during the race, most of your drinks should contain electrolytes (sodium), to replace those lost in sweat.  Check your sports drink contains sodium (ideally > 0.5 g/litre).
  • Aim to consume 30-90g of glucose/fructose containing drinks or gels gradually, every hour, after the first hour.

Tip: Do not try anything new on race day! If you haven’t tried out any particular sports nutrition drinks or gels, try them now. It won’t be the same as race day (as you won’t have trialled them during a long training session) but at least you’ll know you like it!

As with all big sporting events, its vital that the final days are well planned.  The Virgin Money London Marathon is no exception and with many participants running 26,2 miles for the first time, the smallest of details could have the biggest impact on their performance. After months of blood, sweat and tears, these extra considerations should if nothing else help runners to feel prepared, in control and ready to smash it on the day!

I’ll be cheering you all on from the busy, spectator lined streets of London! I’d love to hear how you are getting on, with your marathon planning in the comments section below?

 

 

 


References

Burke, L. Nutrition strategies for the marathon : fuel for training and racing. Sports medicine (Auckland, N.Z.) 37, 344–7 (2007).

Burke, L., Hawley, J., Wong, S. & Jeukendrup, A. Carbohydrates for training and competition. Journal of sports sciences 29 Suppl 1, S17–27 (2011).

Noakes, T. Fluid replacement during marathon running. Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine 13, 309–18 (2003).

Oliver, S., Costa, R., Laing, S., Bilzon, J. & Walsh, N. One night of sleep deprivation decreases treadmill endurance performance. European journal of applied physiology 107, 155–61 (2009).

Stellingwerff, T. Case study: nutrition and training periodization in three elite marathon runners. International journal of sport nutrition and exercise metabolism 22, 392–400 (2012).

rugby

Rugby – Big Hits and Tackles; Recovery Nutrition is Key

Posted by | Fitness, Recovery, Rugby, Sport Nutrition | 2 Comments

Getting your recovery nutrition right within rugby is a key factor in ensuring players are ready to train and/or play well in the days following an intense session. Read on to find out why recovery is so important, why it is often overlooked and how you can easily implement recovery nutrition strategies into your routine.

Whether its recovery from the last training session or a number of strong tackles on the field, consuming the right nutrients can help enhance overall performance, by improving adaptation; the body’s response to exercise ‘stress’, whilst also reducing the likelihood or extent of muscle soreness and fatigue experienced.

Since rugby is an impact sport, players often carry multiple injuries throughout the season thus making tissue repair and full body recovery even more important to the ongoing development of a player.

Yet, within all levels of Rugby Union it’s the one area that’s often overlooked. Whether it’s due to:

  • A lack of nutrition knowledge – are fresh orange wedges still given to players after a game? I’m aware of a team that have are given doughnuts post match!
  • Poor preparation – there is so much for players to think about before a big game, the last thing on their minds are postgame nutrition strategies.
  • Accessibility – elite teams have the luxury of support staff that offer them protein containing shakes, snacks and fluid after the game.  Followed up by a hearty meal in the player’s canteen.  However players in lower leagues need to cater for their own recovery needs.
  • Conflicts between recovery strategies – such as ice baths or massage, elite teams need to ensure a seamless routine post match to ensure players include recovery nutrition within the full recovery plan.
  • Cultural habits – Many players enjoy celebrating/commiserating with fans in the clubhouse after a game over a few pints.  This isn’t the best plan for recovery since excessive alcohol intake can have a negative impact on a players sleep and resultant nutritional intake in the days following, but can also ‘blunt’ muscle protein synthesis and therefore adaptation, as recent research has shown.
  • A lack of appetite – In my experience, many players report a lack of appetite or feeling nauseous after a match, a ‘lighter’ food/drink alternative for these players is a way of satisfying recovery needs without causing digestive discomfort.

Whatever the reason, one way to directly improve a player’s performance and game form is to ‘be prepared’ and practice effective recovery nutrition after each training session and game. 

Rehydration ‘Advantage’

Research has demonstrated that elite rugby union players often finish a match with a mean weight loss of 0.94kg this is equal to approx. 1 litre fluid loss.  To effectively rehydrate after the game, a player should drink with the aim to replace 150% of the fluid weight lost during the game.
1 kg = 1 litre
So, if you start the game weighing 100kgs and your post game weight is just 99kgs then aim to consume 1.5 litres of fluid within the hour after the match. Combine this with a sodium containing snack or as a commercially available sports drink (check that it contains electrolytes) to replace the electrolytes lost in sweat further supporting rehydration.

Reduce ‘Breakdown’ with Protein

Muscle tissue damage occurs during a game of rugby following, since muscle is made up of protein it makes sense that a high quality complete source of protein is consumed afterwards.  Rugby players have higher (than average) protein requirements, owing to their heavier mass and hypertrophy (muscle building) goals.  However, the optimal amount of protein required post match to satisfy recovery and stimulate muscle protein synthesis is about 20-25g.  A complete protein source is one that’s higher in the essential amino acids (the amino acids the body cannot make, thus is required from diet), one of the branched chain amino acids considered particularly important for muscle recovery is Leucine.  In this instance and in my experience, dairy foods and drinks provide the easiest, most accessible and palatable source of complete protein to satisfy a players recovery needs post game.

‘Use it or Lose it’ – Replenish with Carbs

A full game of rugby may not completely deplete a player’s glycogen stores (muscles energy stores).  However this will vary from player to player, depending on playing duration, effort level, as well as individual glycogen stores level at the start of the game.  Plus the added muscle damage caused by impact, and the isometric contraction in the scrum may increase a players need for a carb recovery source.  Players should consider consuming carbs very soon after a match to help optimise glycogen replenishment, in preparation for their next training session or game.

‘SCRUM’ptious Recovery Options

Post-match options need to be affordable, accessible, convenient and palatable for players to consume and coaching staff to provide.  Here are a few suitable suggestions:

Keeping it ‘Real’

  1. A pint of milk and a slice of malt loaf
    Provides:  444 calories, 67g carbs, 25g protein, 11.1g fat, 523 mls fluid, and 400 mg sodium/1g salt
    or
  2. A large flask of homemade chicken and sweet potato soup, see our recipe here
    750ml serving provides: 353 calories, 51g carbs, 33g protein, 3.4g fat, 650 mls fluid and 974 mg sodium/2.4g salt

 

Homemade chicken soup

Homemade soup, perfect following a cold and wet rugby match!

Convenience at a Price

Maxinutrition’s – Protein milk
330mls Provides: 193 calories, 16.5g carbs, 30g protein, 0.7g fat, 277 mls fluid, 231 mg sodium/0.6g salt

 
MyProtein’s – One Promilk
330mls Provides: 251 calories, 19.5g carbs,3 8g protein, 2.3g fat, 277 mls fluid, 208 mg sodium/0.5g sodium


Kinetica – 100% Recovery
75g serving Provides: 267 calories, 41.3g carbs, 24.8g protein, 400mls fluid, 0.3g fat, 40 mg sodium/0.1g salt (you could add a small pinch of salt to this to increase sodium content)

The DIY

Recovery banana shake

Homemade high protein banana shake

 

  • Banana ‘Blitz Defence’ shake – recipe available here 
    550ml serving provides: 345 calories, 39g carbs, 20g protein, 13.3g fat, 476 mls fluid, 397 mg sodium/1g salt
    Ingredients can be easily blended with a hand blender in a jug the morning before the game.  Store in a shaker (without the gauze) and in a cool bag for after the game.

Take Home Message

Whether you are a rugby coach or player, encouraging your team to practice effective recovery nutrition strategies is easier than you think. Just by being prepared and choosing the option that’s affordable and convenient to you means that you are ensuring optimal recovery, adaptation, reduced soreness and ultimately readiness to play.


 

References

AIS Sports Nutrition (January 2014), Rugby Union. Australian Sports Commission.  Retrieved from: http://www.ausport.gov.au/ais/nutrition/factsheets/sports/rugby_union

Burke, L., Kiens, B. & Ivy, J. Carbohydrates and fat for training and recovery. Journal of sports sciences 22, 15–30 (2004).

Churchward-Venne, T. et al. Leucine supplementation of a low-protein mixed macronutrient beverage enhances myofibrillar protein synthesis in young men: a double-blind, randomized trial. The American journal of clinical nutrition 99, 276–86 (2014).

Fahey, T.D and Chico, C.A (1998). Adaptation to exercise: progressive resistance exercise. In: Encyclopedia of Sports Medicine and Science, T.D. Fahey (Editor). Internet Scociety for Sport Science: http//sportsci.org. 7 March 1998

Meir, R. & Halliday, A. Pre- and post-game body mass changes during an international rugby tournament: a practical perspective. Journal of strength and conditioning research / National Strength & Conditioning Association 19, 713–6 (2005).

Moore, D. et al. Ingested protein dose response of muscle and albumin protein synthesis after resistance exercise in young men. The American journal of clinical nutrition 89, 161–8 (2009).

Parr EB, Camera DM, Areta JL, Burke LM, Phillips SM, et al. (2014) Alcohol Ingestion Impairs Maximal Post-Exercise Rates of Myofibrillar Protein Synthesis following a Single Bout of Concurrent Training. PLoS ONE 9(2): e88384. doi:10.1371/journal.pone.0088384

Prentice, C., Stannard, S. & Barnes, M. The effects of binge drinking behaviour on recovery and performance after a rugby match. Journal of science and medicine in sport / Sports Medicine Australia 17, 244–8 (2014).

Stensel, D. Exercise, appetite and appetite-regulating hormones: implications for food intake and weight control.Annals of nutrition & metabolism 57 Suppl 2, 36–42 (2010)

Find the right nutrition plan for you View our services