Many endurance athletes eat too few carbohydrates. This often occurs unintentionally due to misconceptions of carbohydrate needs and what foods are high in carbohydrates as well as intentionally due to an unnecessary fear of carbohydrates. Yet, ensuring adequate carbohydrate intake is important for not only performance, but also health. In particular, athletes recovering from RED-S need to ensure that carbohydrate needs are being met as this is important for managing two health outcomes seen in situations of underfuelling: missing or irregular periods and poor bone health.
Meals high in carbohydrate versus meals high in fat cause different hormonal responses. Compared to meals high in fat, meals containing carbohydrate cause a greater increase in a hormone called leptin. This is important as leptin acts as a signal to a region in the brain that regulates the menstrual cycle. Low levels of leptin are seen in athletes with missing periods (known as functional hypothalamic amenorrhea) and giving leptin to those with missing periods restores periods. For an athlete recovering from RED-S and experiencing a missing period, the increase in leptin seen in response to eating foods high in carbohydrates may help in the recovery process. AKA if an athlete with a missing period has to deicide between a low carbohydrate and high carbohydrate food option they would be better off selecting the high carbohydrate food.
Inadequate carbohydrate intake may also have a detrimental effect on bone health. For instance, one study found that athletes following a low carbohydrate diet presented with elevated markers of bone breakdown compared to those eating ample carbohydrates, and other studies have reported that eating carbohydrates prior to exercise reduces the elevated markers of bone breakdown that is seen in those that exercised in a fasted state. Given that athletes with RED-S have an increased risk of bone stress injuries, eating ample carbohydrates is important in order to prevent the detrimental effects of insufficient carbohydrate intake on bone health.
Athletes trying to recover from RED-S should ensure that they eat ample carbohydrate prior to exercise and again after exercise. Additionally, each meal and snack throughout the day should also include foods high in carbohydrates. Here is some examples of high carbohydrate foods to include with meals and snacks:
Grain products: bread, bagel, tortilla, oats, rice, crackers, breakfast cereal
Fruits: apple, banana, oranges, berries,
Starchy vegetables: white potato, sweet potato, corn
Dairy products: yogurt, cow’s milk, soya milk
Other foods: honey, jam, maple syrup