The Official Dietitian’s of the Crohn’s Crusaders are Jaci Barrett of Diet Solutions and Michelle Holt of South Melbourne Physiotherapy Clinic.
Appointments:
Jaci Barrett
DIET Solutions (for Gastrointestinal Disorders)
Consulting room: Cabrini Medical Centre
Suite 27, Isabella Street, Malvern 3144
Tel: 0405 22 88 76
email: gidiet@aapt.net.au
Michelle Holt
South Melbourne Physiotherapy Clinic
183 Bank Street, South Melbourne
03 9645 7955
email: dietitian_smpc@live.com.au
Jaci is a specialist dietitian for people with gastrointestinal disorders while Michelle focuses on sports nutrition. They will both be helping Damian with his eating plan throughout the project and providing some nutrition advice on this page of the Crohn’s Crusaders website.
From Michelle (Sports Specialist):
On average for the days you are riding around 200 km, you would need around 20 000 kJ. Compare this to an average of 8000 kJ for a male your age.
Your carbohydrate requirements can be calculated on how far you ride and you should be aiming to get in around 60g carbohydrate for every hour that you are riding. In addition, the pre and post meals should also be high in carbohydrate.
Remembering that carbohydrates are found in bread, rice, pasta, starchy fruits and vegetables, sugars, sports drinks and sports gels. It’s going to take a bit of work to get in all the fuel that you need. I used your recent 215 km bike ride as an example. From what you described, overall you consumed during the ride 9000 kJ / 380 gram carbohydrate.
Obviously this is not accounting for breakfast and your evening meal but this amount would supply enough carbohydrate for around 6 hours of riding, depending on the intensity you were riding at. So if the ride took a longer time, you would want to aim to add 60 g carb for each hour of riding. You can include the carbs that you eat in your breaks. Refer to table 1 for examples.
If I assumed that you had 1 cup muesli, apples, and pasta with sauce (portion size 2 cups cooked pasta) in addition to what you specified you had on the ride, then this would bring you up to an intake of approximately 13 000 kJ which would be significantly under what your estimated energy (kJ) requirements for this distance (20 000kJ as per table above). (Note that I have calculated your requirements on studies conducted on athletes who have previously cycled the tour so may not be completely applicable to yourself).
What is known however is that you will need around 40 - 60g carbohydrate each hour of exercise to keep your fuel supply up. For this you can include the food and fluid that you consume in your break. A focus on carbohydrate during recovery and before you ride will also be important to keep your tank topped up.
It is possible that I have underestimated your intake for the day but thought I would just use this as a demonstration. To get you nearer to the 20 000 kJ figure, you would need to add something similar to the following across the day: 4-6 biscuits, 1-2 Carmen’s muesli bars; 2 L sports drink, 1 gel, 1-2 jam/honey sandwiches.
I am pleased to see that you will be having regular breaks during the ride and rest days. This will really assist in refuelling and rehydrating your body. Having solid foods as opposed to just liquid nutrition is important in long distance events as you may become hungry and ‘bored’ if you just have gels or sports drinks.
Food options that contain 60 g carb
- 1L sports drink
- 3 bananas
- 2 PB energy gels
- Sandwich made with 2 tbs jam or honey
- 100g sugar based confectionary (snakes etc)
A comment on sodium… Including sodium helps to retain fluid that you have consumed. Ideally the sodium levels in your sports drinks should have a concentration of 50 - 70 mg of sodium per 100ml of fluid. Gatorade is close to this level with 47 mg sodium/ 100 mL and Powerade quite a bit lower at 28 mg / 200ml. The PB sports electrolyte drink contains 58 mg / 100ml so is a good choice. Sometimes the palatability of the high sodium content drinks are not great so it does depend on what you can tolerate. So if you have found you manage Gatorade and Powerade best, the Gatorade would be a better selection from a sodium perspective.
Sodium can be replaced not just through the sports drink but from other food you have before, during and after your ride - it might be in the food naturally or added.
The following is suggested by Sports Dietitians Australia (SDA):
“Immediate replacement of sodium is very important when the athlete needs to rehydrate quickly … Oral rehydration solutions used in the clinical treatment of dehydration contain a higher concentration of sodium (50-90 mmol/L) than found in commercial sports drinks … this can help optimise electrolyte and fluid recovery but the salty taste may make the drinks not that palatable and decrease the amount consumed. Overall, you can replace salt losses using a combination of sodium-containing drinks and the sodium found in post-exercise recovery meals and snacks, either as a component of the food or added to the meal”.
Please refer to the following which is a summarised table of nutrition requirements for the ride.
| When | What | How much? | Fluid |
|---|---|---|---|
| Pre ride meal | |||
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Meals & snacks to include at least 50 g of carbohydrate:
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| Just before you start | |||
| If you were able to get something in 2-4 hours, have carbohydrate rick snacks in about the last hour or so before the start - liquids or solids |
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| During ride | |||
| Throughout ride after 1st hour. | Easy to consume fluids and snacks that are a rich sources of carbohydrate and familiar. | For each hour of riding, aim to have ~40-60g carbohydrate * Good options whilst on the move (these combinations contain closer to 60g):
You can include the carbs that you eat during your breaks. Also important to start replacing salt losses in longer lasting events |
The amount of fluid consumed to be aiming to match fluid that is lost. May need more in warmer conditions Base on calculated fluid and sweat losses. General guide : 150 - Sports drinks provide a source of fluid, fuel & sodium - important in endurance events. Gatorade or PB energy and fluid replacement drink have a higher sodium concentration. |
| During breaks | |||
| If tolerated, opt for solid foods to help with replacement of carbohydrates & sodium. A meal or snack will assist with satisfactions any flavour fatigue that you may experience |
Good options include what you have been having on training.
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| After the ride | |||
| Depending on the time of day, you may just go straight to your evening meal and then maybe a snack before bed or start with a snack and have a meal later | Main focus is on refuelling, rehydrating and preparing for the next day’s ride. Therefore:
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Good snacks / refuelling (what you select may be depending on your appetite):
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| Evening meal | |||
| As above | As above | Portion sizes for hot meals | Ensure carbohydrate of a good portion is incorporated. Include a minimum 2 cups of cooked pasta /rice / noodles or make up with bread /large mashed /baked potato Other components of meal as desired, as long as portions sizes of meat etc are so big that they displace opportunity to consume carbohydrates. Try to get an idea of fluid loss over day and replace as necessary. |
| Supper | |||
| Depending on timing of evening meal or whether you have an early start a carbohydrate based snack can top up fuel levels | Refer to previous suggestions under ‘during’ and ‘after ride’ | ||
In summary:
So to get enough in carbohydrates and energy in:
Breakfast followed by light snack before ride (as tolerated)
*Aim for intake of 60 g carbohydrate per hour (Given that you are routinely stopping throughout the ride each day the whole 60g carb may not need be consumed while riding - if you are eating more during his breaks we could aim a bit lower 30-40g an hour while riding, and then the rest would be topped up at the breaks. I can comment on how you are going with this on your day to day food diary entries.
Take advantage of significant breaks by having some carbohydrate based solid foods
When finished ride, have a post ride snack such as sports drink and muesli bar as above
Evening meal - always include carbohydrate of a good potion
Have a carbohydrate based supper
Include sports drinks pre, during and after ride.
From Jaci (Crohn’s Specialist):
As Damian does not have active Crohn’s disease, or evidence of any underlying irritable bowel syndrome (IBS), then there are no special considerations for his diet, except to ensure nutritional adequacy. Michelle Holt has ensured this.
The most common symptoms experienced in patients with Crohn’s disease are described as “functional” symptoms. These include abdominal pain, bloating, distension, wind, diarrhoea and/or constipation. These functional symptoms are usually evidence of an additional functional disorder such as IBS, which occurs in ~60% of patients with Crohn’s disease. These symptoms can also be the result of active disease and it can be confusing trying to distinguish between the two. Functional symptoms are less likely to improve with medication and more likely to respond to dietary manipulation.
Hypothetically, if Damian did suffer functional symptoms, he may find they are exacerbated when he increases his activity level. This can be frustrating for many people who are trying to maintain a healthy, physically active lifestyle. There are certain dietary sugars that can contribute to symptoms, with dietary restriction helpful in providing alleviation. These sugars have been termed FODMAPs. Anyone with Crohn’s disease and functional symptoms may find they need to reduce their FODMAP intake to assist with symptom management, and that they need to be more strict with their elimination of FODMAP foods when they exercise.
| High FODMAP foods are as follows: | ||
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As such, choosing alternative fruits such as bananas, mandarins, kiwifruit, cantaloupe etc can help to minimise any functional symptoms. Additionally, gluten free products, spelt bread, oats, and wheat free cereals are good options. Carmen’s have wheat free, fruit free muesli and muesli bars that are suitable options as they are low in FODMAP ingredients.
Some people may also have been instructed to avoid skins, seeds, grains and nuts. This is only necessary during active flare up of Crohn’s disease and is only a temporary requirement. It should always be discussed with your gastroenterologist and dietitian to ensure you are not avoiding anything unnecessarily. This may also be recommended for people with adhesions after surgery, but again should be discussed with your specialist and dietitian.
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