Breakfast & Sports Nutrition – PediaCast 385

Show Notes

Description

  • Sports nutrition expert, Jessica Buschmann, joins me in the studio as we consider breakfast and food as fuel for student athletes. We discuss meals, snacks, supplements and hydration. You’ll hear tips on helping picky eaters and others at risk from poor nutrition. We hope you can join us!

Topics

  • Breakfast
  • Sports Nutrition
  • Dietary Supplements

Guest

Links

Transcription

Announcer 1: This is PediaCast.

[Music]

Announcer 2: Welcome to PediaCast, a pediatric podcast for parents. And now, direct from the campus of Nationwide Children's, here is your host, Dr. Mike.

Dr. Mike Patrick: Hello everyone, and welcome once again to PediaCast. It's a pediatric podcast for moms and dads. This is Dr. Mike, coming to you from the campus of Nationwide Children's Hospital. We're in Columbus, Ohio. 

It's Episode 385 for September 6th, 2017. We're calling this one "Breakfast in Sports Nutrition". 

Before we get started today, I just want to take a moment and say that all of us here at PediaCast and at Nationwide Children's Hospital, really our hearts and thoughts and prayers go out to the families in Houston, Texas that they are dealing with the aftermath of the Hurricane Harvey and the flooding that's out there. Just really, and I think I even speak for the rest of America in saying that we really do care. And really, you see new stories of folks coming together and offering help from all over the place. 

And you just think any of us in our community could experience some sort of a natural disaster. It's good to know that their folks around the country who would step in and help us out if we were in the similar situation. 

So, I know folks in Houston and in that area — even if I didn't know anyone in the Southeast Texas — my heart intend prayers and thoughts would still be going out with all of you. 

0:02:01

So, tough times, communities coming together. Hopefully, the country coming together and I just wanted to say that. If I seem a little late to the game, the way that production works here at PediaCast is we prep the show one week. There's a lot of information really to explore and research and make sure that everything is current and up-to-date. And then, on the second week, we recorded and then on the third week, it actually gets released. So sometimes things may seem lagging behind, but thoughts and prayers are there and have been and will continue to be there.

All right, let's move on. We recently have covered some back-to-school sorts of topics. Few weeks ago, we talked about the importance of school recess and then couple weeks ago, I put in a plug for immunizations and making sure that your child is up to date, because for the overwhelming majority of kids — in fact, really for most children — the huge, huge benefits of vaccines greatly outweigh the extremely rare risks that are involved. It is safer to get your child a vaccine than drive in your car to get the vaccine. So highly, highly recommended and I just wanted to put a plug in, And I went into a much more detail a couple episodes back.

Today, we are continuing our new school year kickoff by briefly covering the importance of breakfast. And then, we'll engage in a longer and much more detailed conversation regarding sports nutrition with our residence sports nutrition expert, Jessica Buschmann. 

She'll be here in a few minutes to remind us about the importance of thinking about food as a fuel empowering your student athletes with the right mix of nutrients for great energy and optimal performance. Very important topic for lots of families out there as the fall sports season gets underway.

We'll also cover ideas for meals before big important competitions. Snacks prior to practice and exercise and what to eat after competing. How much fluids do students athletes need to drink and what kind of fluids? Is water okay? Or should you go with a sports drink? And can you make your own sports drink at home? And in fact, you can just to give little hint in preview and we'll provide a recipe for you, if you want to do that.

0:04:27

We'll also consider student athletes who are picky eaters. And we'll talk about the warning signs that maybe your child is not getting enough fuel or too much fuel. And how do you identify nutritional problems in student athletes and what do you do about them? So, lots coming your way shortly. 

By the way, if all of these sound somewhat familiar to you, Jessica Buschmann did stop by the studio couple of years ago for a similar discussion. But it's an important one that impacts so many families. And truth be told, we'll probably have a similar conversation again in a couple more years, maybe even next year because it's so important. And I do want to get timely and relevant information into your newsfeeds and your headphones and your speakers — what you need to know, when you need to know it.

All right, so before we get to sports nutrition, let's consider what some call the most important meal of the day — breakfast. Study by researchers at King's College London has found that children who skip breakfast regularly may not be consuming the daily amount of key nutrients for growth and development that are recommended by the British government. 

Now, sure, the bulk of our audience is in the United States, so why do we care about the nutritional guidelines recommended in Great Britain? Well, it turns out, those guidelines are evidence-based and they're similar to nutritional guidelines here in America, so this is relevant. 

So, what do the investigators find? We'll it turns out that children who ate breakfast every day were deemed to have overall superior nutritional profiles compared to those who didn't. While the study was unable to identify a causal link, breakfast-eating children were found to have higher daily intakes of key nutrients such as folate which is important for the production of red blood cells, nervous system growth, and DNA-building or synthesis. Also calcium, which is important for bones, iron which is also important for oxygen-carrying red blood cells, and iodine which is necessary for proper thyroid function. These compared to children who skipped breakfast.

0:06:29

The team of researchers used food diaries collected for the National Diet and Nutrition Survey Rolling program between 2008 and 2012 from a group of 802 children aged 4 to 10 years and 884 children between 11 and 18 years of age. Nutrient intake was assessed using a food composition databank from the UK Department of Health. And breakfast was defined as any food consumption regardless of these specific food items — so it could be anything, didn't have to be bacon and eggs or cereals or pop tarts — that was over 100 calories and took place between 6 and 9 AM.

Investigators found that 32% of kids who skipped breakfast did not meet, so third of them, did not meet the recommended intake of iron compared to only 4% of kids who ate breakfast.

19% of them did not get enough calcium, compared to 3% of kids who ate breakfast. 22% did not have enough iodine intake compared to 3% of breakfast eaters and 7% did not get enough folate while a 100% of breakfast eaters were found to consume adequate levels of these important nutrient.

The study which was published in the British Journal of Nutrition and conducted by the Lemon School of Hygiene and Tropical Medicine also compared breakfast habits and nutrient intake of individuals within the study group. Younger individuals between 4 and 10 years of age, on days when breakfast was eaten, had higher intakes of folate, calcium, vitamin C and iodine compared to those same kids on days when they skipped breakfast. While older children between 11 and 18 years of age only have an increase of calcium intake on those breakfast eating days compared to days without an early morning meal.

0:08:20

The authors say these findings is probably related to more parental control when young children choose what to eat for breakfast compared to the older kids who choose breakfast foods that might not be as nutrient rich. 

Investigators also point to the possibility of misreporting in food diaries, particularly in the older children who reported their own intake. 

Dr. Gerda Pot, senior author of the study and lecturer in Nutritional Sciences at King's College London, says "This study provides evidence that breakfast is key and parents should ensure that they're children are getting the nutrition they need by providing a good breakfast." She adds further study is needed to investigate specific foods and dietary quality that would help identify if the differences are due to the types of breakfast foods being eaten by different age groups, as well as provide more insights in the impact breakfast has on overall diet quality.

In terms of the total number of kids skipping breakfast every day, the study showed only six and a half percent of the 4 to 10-year-olds missed the morning meal every day compared with nearly 27%, so close to a third of the 11 to 18-year-olds missed breakfast. 

Investigators say girls were more likely to skip breakfast than boys and household income was found to be higher in families whose children ate breakfast everyday compared to those who went without.

So, a few points to be made here. First, and just a quick note comparing the United States and the United Kingdom, iodine deficiency isn't as big of a problem here in the United States because of our widespread availability of iodized salt. So most salt that you buy in the grocery story has iodine added to it. 

Although if you buy fancy salt — you know the kind I'm talking about, the designer sea salt which is just salt, so the bigger coarser salt that you grind flavored salts —  if you buy those, check to see if iodine is added. And if it's not, be sure that you also gets some iodized salt into your child's diet. Although not too much, moderation of salt intake is also important.

0:10:24

In the United Kingdom, however, it is more difficult to find iodized salt, with one recent study showing only 12% of salt brands found in grocery stores in United Kingdom have iodine added, compared to 88% of brands which did not add iodine. So most of the brands here in the United States do add it but check those labels. 

Take-home point number two, breakfast really is important. Your child's body needs nutrients and fuel to grow and develop and function throughout the day. So, you want to start with fuel, no surprise there. 

Take-home point number three, supervise what your kids eat for breakfast so you can make sure that it's well-rounded and healthy, especially for those older kids. You're probably already supervising what your younger kids are eating for breakfast, but also get involved with choosing breakfast foods for those older kids. They may need little additional help at choosing nutritious food.

And then, finally and perhaps the most important point of all which really sort of goes back to what I was talking about, with America coming together to help out the victims and those dealing with the aftermath of Hurricane Harvey, significant number of kids especially older kids don't eat breakfast ever — nearly third of them — and many of those come from low-income families. 

So, are they not eating breakfast because they don't want to eat breakfast? Or because they don't have anything to eat? Food, poverty and scarcity and hunger are very real problems in America. And here's where you can really make a big difference in your community. Does the place you live, the schools your children attend, do they have a breakfast program in place? If not, maybe you'll be the catalyst that starts one.

0:12:10

And if a breakfast program is already in place, could you contribute time and/or resources or talents to the project? Or could you help connect kids who have need with the existing program? Important things to think about and talk about as we care for all the members of our community. 

Or maybe that need isn't present in your community, although I suspect it is. But maybe it's the next community over? Or two communities over where there really is a large food problem and that there are kids who are going hungry and not getting breakfast. 

The question becomes when you think about the kids in the community that's two communities over, are these really separate communities or is your region of the world, your county, your state, you country really one community? Kids fare better when we expand our vision and take care of all the children in our sphere of influence. That's why I became a pediatrician but I think it's true, for most parents would agree with me. 

And in this digital age, our sphere of influence is much, much further than it has ever been before. So, make a difference not just for own children but all children, as we consider the importance of breakfast.

All right, let's turn our attention now to student athletes and sports nutrition. As promised, Jessica Buschmann, clinical dietitian and sports nutrition expert is joining me in the studio. 

Two quick reminders before we get to her. First, it is possible to get your ideas and thoughts on PediaCast, just head over to PediaCast.org and click on the Contact link. I do read each and every one of those that come through and we'll try to get your thoughts and ideas and questions and topic suggestions on the program.

Also, remember the information presented in every episode of the program is for general, educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. So if you have a concern about your child's health, be sure to call your doctor and arrange a face-to-face interview and hands-on physical examination. 

0:14:09 

Also, your use of this audio program is subject to the PediaCast Terms of Use Agreement, which you can find at PediaCast.org. 

Let's take a quick break, I'll be back with Jess Buschmann to talk more about sports nutrition, it's coming up right after this. 

[Music]

Dr. Mike Patrick: Jessica Buschmann is a clinical dietitian and sports nutrition expert at Nationwide Children's Hospital. She's a regular contributor to this program and joining us for discussion on the female athlete triad back in Episode 285 and chatting about sports nutrition in Episode 325. I'll have links to both of those programs for you in the Show Notes for today's episode, 385, over at PediCast.org so you can find them easily, if you'd like to learn more from Jessica. 

By the way, the 325 episode, it's similar to what we're covering today and yet also different and certainly worth to have a listen. Jessica is back for more conversation regarding nutritional concerns in students athletes, which is always a topic of interest for athletes and parents. 

So, let's extend another warm welcome here at the beginning of a new school year to our resident sports nutrition expert, Jessica Buschmann. Thanks so much for being here today.

Jessica Buschmann: My pleasure Dr. Mike. I always love being here.

Dr. Mike Patrick: Really, really appreciate you taking time out with us. And I wanted to start actually — rather than jumping right into nutritional topics — I think there are lot of student athletes out there who may be thinking about a career related to sports. And some of the things that quickly come to mind,  physicians such as sports medicine docs, orthopedic surgeons, athletic trainers, physical therapist, sports psychologist and another terrific and important field is sports nutrition. 

0:16:16

So, if someone is interested in getting into that, how do they go about becoming a sports dietitian?

Jessica Buschmann: Yeah, so first and foremost, I wanted to say that I definitely didn't know about sports nutrition, number one, was really a thing when I was an undergraduate at Otterbein University — now, yeah, Go Cardinals. But I was an athletic training student, so I was in the sports medicine world and always had an interest in nutrition. But I didn't even think about making a career out of it. 

So, there's a lot of different ways that you can become a dietitian now. The most traditional way is getting an undergrad degree in nutrition and dietetics. There's no sports nutrition undergrad per se but it's never too late to start job shadowing, to see if that's what you want to do, as well as volunteering or offering your time and to get immersed in the world and see if that's what you're really interested in. 

And then, if you want to do sports nutrition, there are masters program available in sports nutrition or exercise science or something to that effect. And even further, if you're interested in sports nutrition, you can get what's called the CSSD credential, which is a board certified specialist in sports dietetics. You have to be a registered dietitian, have your RD credential for two years. And then, you have to accumulate 1500 hours in the field of sports nutrition. 

So, that's a little difficult. It was a blessing, able to get that sport nutrition experience being here at Children's as a dietitian in the Sports Medicine Department but I couldn't use that credential till I then have the hours and then pass an exam as well.

Dr. Mike Patrick: Yeah, I would imagine there are a lot of job opportunities in terms of being involved with teams. And especially professional teams, I'm sure have a dietitian that's involved with them and their athletes.

0:18:03

Jessica Buschmann: They do. And my profession is a little unique in the sense it's pediatric and adolescent sport nutrition. But the norm really in sports dietetics is working with professional athletes at all various levels, the Major League baseball, NFL and things like that. All major leagues have dietitians now for the most part. And then also, D1 universities and even trickling now into D2 and D3 universities.

I worked at Ohio Dominican University with our D2 athletes and it's becoming more of a standard and a precedence now that there's dietitians in D2 and D3 athletics. And that's awesome. Those athletes need it, too.

Dr. Mike Patrick: Yeah. And I would imagine, you love what you're doing and would recommend that if someone else is interested.

Jessica Buschmann: Oh, I do, absolutely. And if there's ever any questions about that I can certainly help answer them, get to direct to that way, too.

Dr. Mike Patrick: Yeah, absolutely. That's fantastic. And so, career, something to think about, parents who are listening to this right now with students athletes at home, remind them that that is a career option if they're thinking about doing something sports related.

Jessica Buschmann: Right.

Dr. Mike Patrick: So, let's begin with just a reminder of the importance of healthy eating. I think we all have the sense that we're supposed to eat healthy, why?

Jessica Buschmann: Yeah. So, it's important to learn this good habits early, right? As an adult, it's hard for me to make changes and adapt to things. So, learning these habits early is crucial. 

And also for parents, setting that example and that standard and offering that support at home is good. 

For athletes, of course it's going to help optimize their performance both on and off the field. They're student athletes, so that's in the classroom as well. It's going to help with injury prevention and management of injuries, if they're hurt currently or have been hurt in the past. And also strengthen their immune system, to help keep them well and out of the doctor's office and in the classroom, and things like that. 

So healthy eating really is a key tool with the sports nutrition. They work hard, they work long hours, both on the field and off the field. This can only enhance their performance.

0:20:06

Dr. Mike Patrick: Yeah, definitely. And I love what you say about setting those habits because with student athletes, they're young. And if you can get those habits and kind of ingrained the importance of healthy eating right from the beginning, it does make a lot easier during adulthood.

Jessica Buschmann: Yeah, it's really hard. I'd tell my athletes often and it doesn't make me the most popular person. You know what I say, "This is really hard and you feel like this is challenging you, then you're doing it right."

Dr. Mike Patrick: What are some good rules of thumb really for all of us when it comes to daily nutrition? 

Jessica Buschmann: So, thinking ahead is key. And you have to set yourself up for success. So thinking ahead, do I have a practice today? Do I have games today? Do I have conditioning today? What are the times? What is the layout of my day? Even taking 5 to 10 minutes to really think ahead and do that. And then, do I need to pack a lunch? Do I need to pack a small meal? Do I need to pack a snack? What am I doing as far as my water? Is it a hard practice outside in the middle of July? Do I need to grab some sports drink? It's just taking that time to pre-plan is really crucial. 

Also, I'm a big fan of designating a day each week to go grocery shopping and maybe even meal prepping for the whole week. That's a little cumbersome and challenging for a lot of families, especially my athletes and their families, because their schedules are crazy.  I have yet to run into a family that's like, oh, we just have a plethora of time, you know? 

[Laughter]

Jessica Buschmann: Like no, it's usually opposite way, "I'm trying to find these little subsets of time that we can get them to fuel appropriately." So, designate a day each week to go grocery shopping, to meal prep, to snack prep, to set yourself up for success the rest of the week.

Dr. Mike Patrick: Yeah. And then, the planning part of it not even begin the night before.

Jessica Buschmann: Oh, yes. 

Dr. Mike Patrick: Because if you wait until the morning, you may not have time or you're sleeping in a little later and then you're rushing out the door.

Jessica Buschmann: Absolutely. Breakfast is the key thing. When you're packing your lunch, I'll tell my athletes, "Why don't you just pack your breakfast along with it if you know that you're going to sleep until 7:57, and then you have to be out the door 8:07? Then packing your breakfast is better." 

And the,  also the same thing with snacks, if you're buying snacks in bulk, you can sometimes then pre-package them already for you. So you grab and go and even that just couple of extra seconds it takes to put in a zip lock bag sometimes can be a time saver in the morning. 

0:22:28

Dr. Mike Patrick: Yeah, yeah. Absolutely. One thing that I think lot of us and not just as student athletes but as adults as well. And when we're thinking about our younger kids, you hear conflicting things about various nutrients. Which can make it hard as you're sort of making those plans and deciding what to eat and what to put together. 

Just this morning, I read in my newsfeed that low fat diets aren't necessarily the be-all, that it's more important to focus on lowering our carbs and maybe not paying attention to fats. But then, next year, I'm going to hear the opposite and it just seems like you're being inundated with different information. What are some really hard fast rules that are timeless when it comes to thinking about what we should be eating?

Jessica Buschmann: Reassurance for everyone listening out there, it's even hard for dietitians to balance all of those out. I'm also inundated with all of those different stories. And it's alluring. They write them well, they're crafted well. Like why would we not believe what the article says? So important key to that is to see who's writing the article and where that source of information is come from? Who's quoted? Things of that nature. 

But hard and fast rules that is the hardest rule to teach is balance — balance and moderation. I kind of go for it, what resonates well with my athletes oftentimes is 80% of the time, you're doing what you should, 20% of the time, you're allowing for those desserts or sweet items or splurging. Then, go with that rule, 80-20 rule if that works for you. 

0:24:08

Don't restrict your foods, your food groups to any degree unless you have like allergies or intolerances. But, yeah, balance is really the key. And as I mentioned, the absolute hardest to teach with the carbohydrates, not bad for you. There are certain types that are better for you, but that's your quick energy for exercise.

Protein is key for muscle recovery but a lot of myth that I debunk oftentimes is that eating excess protein gives you bigger muscles. I'm like no, you can't sit on the couch and eat protein all day and you got bigger muscles. Unfortunately, that's not the way it works. It has to be the exercise component. 

And that often low-fat diets are healthier for you and it's like, well, it depends what you mean by that definition. There are healthier fats for you than others. 

Dr. Mike Patrick: Yeah. They sneak in somewhere in the article, extremely low-fat diets are associated with early death. But that's not in the headline and you've got to get about paragraphs down before you see that we're talking about really low-fat diets, that it had that effect.

Jessica Buschmann: Yes.

Dr. Mike Patrick: So, really as you think about all the different food groups, you really want a little bit of everything but not too much of any of them.

Jessica Buschmann: Right. Exactly, even too much spinach can have adverse effects.

Dr. Mike Patrick: Right, yeah. And I love how you put this idea that food is fuel for students athletes. What is the best fuel prior to games and practices and exercises. There are certain food groups that they should be focusing on before exercise?

Jessica Buschmann: Yes. So, big fan of the fuel, it often resonates better with my athletes as well, using the terms fuel and energy. Because that's what they hear and then you say, this is going to better fuel your body or energize you through practice. Especially for an athlete that's fatigued and ran-down. We get to this point of the season, pre-season has ended, we're into regular season. You think they'd be energized and ready to go but they just worked really hard in August. 

0:26:09

So, the timing matters with this. So, even the best laid plans as far as food groups — which I'll  go into in just a second —  make sure we're not undervaluing the timing of that, too. So, anywhere general rule is a meal two to four hours before exercise or practice or a game and then a snack 30 to 60 minutes prior to exercise. Because you want to give your body that time to digest and relax and have that peace of mind that what your eating is going to fuel your body well. 

Now,  of course, those are general rules and some athletes need more time than that. And that's fine as we work with my athletes to come up with the best timeframe that works best for them. But also, we want to look for choices that are avoidance of high in fat or high in protein or high in fiber because we want to avoid them for risk of gastrointestinal issues during exercise. So, emphasizing the importance of carbohydrates for that energy. 

Also another carbohydrate we're talking about our grains. So things that often go well are breads or crackers or pretzels, pastas, rice, sort of other grain of that option. Fruit is also a carbohydrate. So, things that will sit well maybe like apple or even applesauce or bananas or pears, grapes. There's a lot of grape fruits still in season right now. You all get it while you can.

Dr. Mike Patrick: Yes, yes.

Jessica Buschmann: Before it goes away. And then, adding a small amount of protein with that because actually the protein will help go recover your muscles during exercise and help heal them from the inside out more quickly.

Dr. Mike Patrick: Yeah. I'm thinking, what sort of things combine all of those together that you could just throw into a gym bag? Yeah.

Jessica Buschmann: Yeah. Any of the above that I mentioned. So, let's start there. So, that will be like crackers or pretzels. You can pair that with any nut butter. So, that's almond butter, peanut butter, cashew butter, I saw pistachio butter the other day. I haven't tried it yet but it's a little green and looks like a lot of fun. 

You can also do cheese sticks and crackers or fruit and some peanut butter, fruit and some nuts or trail mix which combines dried fruits and nuts and a grain.

0:28:21

Dr. Mike Patrick: Yeah, granola bar?

Jessica Buschmann: Granola bar, yes. Easy grab and go, half of a sandwich of any kind — turkey, ham, peanut butter, something like that. And yeah, often, especially for my young high school athletes, middle school athletes, too, they're grabbing and going on their way to practice right after school.

Dr. Mike Patrick: Yeah. But the high fats and high fiber kind of stuff you want to avoid? 

Jessica Buschmann: Yes.

Dr. Mike Patrick:  Now you mentioned the meal, I hear a lot of especially I think distance runners talk about carb loading like the night before. Is there anything to that or should the meal really be three or four hours before you participate, not eight hours before?

Jessica Buschmann: Right. So, I think that is most often — especially my younger athletes–  easier to focus on. Instead of thinking about there's a whole strategy to carbohydrate loading. And if I was talking about professional athletes or professional endurance athletes today, I might be able to go into that protocol a little bit. 

But outside of that, yes, a meal, the most important thing would be something that sits comfortably, something that's not really high in fat or creamy, like something that's creamy or fried. So, let me give an example, something like Alfredo, really buttery, cheesy, heavy, something like fried meat, fried chicken. Just kind of sits heavy and doesn't offer quality fuel will make your stomach feel good. You don't want to feel like bogged down while you're performing, anything of that nature.

Dr. Mike Patrick: So the exact form that the meal comes in, as long as it's well-balanced and avoids those heavy things. Because, again, we're not talking right before they exercise but a few hours ahead of time.

Jessica Buschmann: Few hours ahead.

Dr. Mike Patrick: So, hopefully, they'll have a little time to digest it.

Jessica Buschmann: Right. And where it gets tricky is early morning races. Early morning, I have a lot of cross-country athletes that I'm working with right now and they say, "My race is at eight." And the recommendations are two to four hours to eat beforehand. They're like, "Do I have to wake up at 4 o'clock?" Like no, some of them were fine like two hours, maybe that works as well.

0:30:21

And the first time athletes, they're even okay with an hour and a half beforehand. And other athletes are not. So, I'm not recommending avoiding meals, especially before exercise but more so, finding something that sits well with them that's often bland, right? It's often simple. And it doesn't have to be breakfast foods if it's an early morning race. If they want to have a turkey sandwich before race, let them, that's fine.

Dr. Mike Patrick: So the meal, two to four hours ahead of time and then the snack about an hour ahead of time or so? 

Jessica Buschmann: Yeah. If needed, yes. So that would be like a typical school day. If they will have lunch, somewhere in the ball park of 11 to 1. And then, if they could have a snack 30 to 60 minutes prior to practice in the afternoon, somewhere like 3 or 3:30 is generally practice. They could have their snack in the last period of the day and then go to practice. And then come home.

Dr. Mike Patrick: What about student athletes who are hungry before activities? And especially in the morning, it seems like there are a lot of folks who just the idea of a substantial breakfast doesn't really sit well with them. What do you do if you're not hungry?

Jessica Buschmann: That's always a tough battle. Yeah, that's individual for every athlete. Again, the emphasis that we want to be eating something. So we find something again that sits well, that's often bland and they want to eat it. I guess we'd like something that's alluring to them.

Dr. Mike Patrick: You might have to get creative.

Jessica Buschmann: You have to get creative sometimes. And I have an athlete that I'm working with right now, that before every single football game for now five years, he's had  a peanut butter and jelly and a banana and pretzels. And because he knows that's what sit well. He knows that's what's comfortable and he's not necessarily hungry because he gets a nervous stomach. And but that's what he knows and what's works well for him. 

0:32:09

So, if you can try to be eating something before activity, that timing is often key. To set that even further apart from on the races, so they can even have that comfort that it will digest, it won't sit heavy. Get creative, find something that they will eat. We're not saying I don't want it to be like brownies or cookies, or ice cream sundaes or anything. But something that they will eat. 

And sometimes, again, going back to the pre-planning, that goes down and just like sitting there with a parent saying, "Okay, let's brainstorm things that you will always like, no matter what."

Dr. Mike Patrick: Yeah, yeah. Because a lot of kids are picky eaters.

Jessica Buschmann: Very picky, yeah.

Dr. Mike Patrick: And so parents get concerned, is it really healthy that they're picking the same things over and over again. But as long as they are, overall, as you look at sort of their week, things are balanced and they're getting a little bit of every food group. And they're healthy. So, they're growing okay. Teenage girls are having their periods regularly. There aren't any weight issues or concerns. Is it okay that they eat the same things over and over again? How picky is too picky?

Jessica Buschmann: Yeah, I know. And like that, I might have to refer that to our wonderful feeding clinic specialist as far as that definition but, you know I do get a lot of picky eaters inevitably. My pickiest eater I've ever had just ate nothing but sandwiches all the time.  So we want to avoid food jags, which is their constant eating and requesting of the same food days and days, back to back to back. Because then, they often leads to burn out. 

So, again like sitting down with mom, with dad, and saying like, "Okay, let's come up with five things that you will eat, in addition to peanut butter and jelly, in addition to cheese and crackers." Or  whatever their chosen or re-chosen food is over and over and over again.

And so, I don't know if like picky is too picky. In my clinic, I challenge — I guess is the word– my athletes to try new things and also keep trying things over and over again. Because there's a lot of different ways to eat the same food. And I also don't let my athletes say that they don't like it if they've never tried it.

0:34:20

Dr. Mike Patrick: Yes, yes. And sometimes, you have to try it a few times before it kind of takes.

Jessica Buschmann: Yeah. It is hard educating, like vegetables aren't meant to taste as good as fats are, for example.

Dr. Mike Patrick: But then, when you take the focus off of, "Okay, we're not necessarily eating this for taste, we're eating this for fuel." And so, again by having that picture of fuel and energy that may help using those terms, kind of perching it from that viewpoint may help some of those picky eaters try some other things if they know it's going to help them perform better.

Jessica Buschmann: Yeah. And sometimes, I hear a lot of parents say, it's coming from a different voice. It's coming from the mouth of a sports dietitian, a sports medicine physician, someone they value that's not with them day in and day out.

Dr. Mike Patrick: Yeah, that can definitely make a big difference. What about after performing? So after exercises or after practice, after big games, when should you eat afterwards?

Jessica Buschmann: Afterwards, the general recommendation is that you want to try to eat something 15 to 60 minutes post-exercise. Now, that's again a general rule. If you missed that window, it's okay, especially if it's a high school athlete, a recreational exerciser, that's okay. It's not the end-all be-all but that's generally recommended also to help avoid eating too much at dinner. Because oftentimes, athletes will come home and just eat and eat and eat and eat and they're eating so fast. They're not letting their brain catch up with their stomach. And they often feel sick after they eat so much at dinner because they're just playing catch-up, right?

Dr. Mike Patrick: Yeah, yeah. That sounds like a good advice for all of us. If you're a little hungry, you may eat a small healthy snack to get you through till dinner and then eat slowly.

0:36:05

Jessica Buschmann: Yeah. I offer my athletes with chocolate milk. Chocolate milk has a great ratio of carbohydrates to protein. I think I got this question on a Facebook Live recently, was "Is white milk okay?" Yes, absolutely. I've met an athlete today that doesn't like chocolate. That's crazy. That blows my mind. But yes, you all do exist. So white milk is fine.

Dr. Mike Patrick: Strawberry?

Jessica Buschmann: Strawberry milk. Yeah. It's really the sugar which boils on to the carbohydrate with milk. There is a good ratio, white milk is 3:1 and chocolate milk or strawberry milk 4:1 ratio of carbohydrate to protein, which is ideal post-exercise.

Dr. Mike Patrick: Yeah. And they even have the chocolate milks like in a box that don't even have to be refrigerated now. 

Jessica Buschmann: Yeah. Those are great options, too. And generally speaking, and for D2 and D3 universities that have smaller more constrictive budgets, it's cheaper, it's easy, it's cost effective, and generally well accepted for most athletes.

Dr. Mike Patrick: Yeah. So, general rules in terms of eating a well balanced meal — no fats, high fibers, two to four hours  before an event. And then, a snack 30 to 60 minutes before and then another snack, 15 to 60 minutes, sometime within the first hour after really heavy activity.

Jessica Buschmann: Yeah, that can be a snack or first time athletes, it will be dinner. It depends for every family what the layout of their evening or the rest of their day looks like. So, it's just trying to eat something whether that's a snack or whether that's a meal.

And another emphasis that I'd like to place is that we want to make sure it's carbohydrate-based, it has carbohydrates to replace lost energy. And then, also protein to help recover those muscles. 

Don't forget to add those fruits and vegetables. We've got to get that color in there. And you can load up with your good healthy fats, too.

Dr. Mike Patrick: Before we move on to hydration and the fluids in student athletes, one thing I've heard you talked about before as we're thinking about picky eaters — and I should have mentioned this earlier– but sneaking food in. 

[Laughter]

Dr. Mike Patrick: So, yeah, yeah. So give us some advice on that. So, you have a kid who really, they're not a big fruit and vegetable eater but you might be able to get them some of it, right?

0:38:23

Jessica Buschmann: Yes, so I'm going to put a plug here for Facebook Live. If you head over to the Nationwide Children's Hospital website and go to the Videos tab, there are a couple of Facebook Lives that I've actually done and demonstrated how to sneak in fruits and vegetables into different things. I really like in my poor future kids, I'm just saying. But you can sneak it, you can puree it, right? 

So you can puree fruits and vegetables and put it in muffins. You can put it in pasta sauces, you can put it in smoothies. Or smoothies sometimes for my younger athletes, I say put it in a different color cup, so they're not looking at this smoothie. Because sometimes if they might see the color, they might know, "Mom, there's something weird here." Right?

Dr. Mike Patrick: Yeah, yeah, yes.

Jessica Buschmann: But you can also do popsicles. So sometimes it's about how you present it like they  don't want a smoothie in a cup but okay, a popsicle that sounds pretty awesome. So buy some popsicle molds at your local store and you can pop them in the freezer and eat them as a popsicle. That's great, too.

And then, also finding…

Dr. Mike Patrick: A veggie  pop.

Jessica Buschmann: A veggie pop, but don't call it a veggie pop because they're going to avoid this. 

But another rule — and I should set this earlier, too, so I'm glad we're revisiting this — is pair something that they like with something that they don't like. So, something that is acceptable and pleasing to them and then — make it pressureless — say, "I want you to try this. Let's try it. You love guacamole, right? You have pineapple, you love guacamole. Let's pair with this pretzel or celery stick." Or whatever it is that you're trying to… That way, it's less scary. When you're pairing it with something that's more pleasing or acceptable.

0:40:07

Dr. Mike Patrick: Yeah, yeah. It really comes down to being so individualized for each family. That's I'm going to put a plug-in for actually seeing a sports dietitian, so that you can get an individual plan that's going to be helpful for your family. 

So, let's move on to fluids, what advice do you have on the importance of hydration for student athletes? This is really important.

Jessica Buschmann: Hydration is key. So, for many of the body's physiological processes like including body temperature regulation, lubrication of joints, transportation of nutrients around the body, things of that nature. And it's a big hot topic, basically we have a hot summer and when it came to tow-a-days and things like that. So, hydration is really important, especially for athletes that are practicing out in the hot, humid conditions that we can see here in June, July and August in Central, Ohio.

So, hydration is key, not only for students athletes, but really everybody. But the students athletes, especially, who are sweating a lot. And I have athletes that are super sweaters. They can take off their shorts oftentimes and just wring it out and water just comes dripping out in the form of sweat. And that's crazy, but we have to make sure that we're replacing those fluids appropriately for all the reasons that I mentioned already and adequate health.

Dr. Mike Patrick: Yeah. Because as we do get dehydrated, we have less blood volume. And then, if you have less blood volume you have less capacity to carry oxygen to your brain and your muscles.

Jessica Buschmann: Right, so important.

Dr. Mike Patrick: Very, yeah, very important. So, it is really a good idea to stay hydrated.  Can you pre-hydrate yourself, so that you're more prepared to lose that water when you're sweating during exercise?

Jessica Buschmann: Yes, you can. And so, there's some good rules of thumb like regarding water and fluids. So, the key for athletes is to pay attention to the color of your urine and also don't undermine your thirst. 

0:42:10

So, looking at your urine, we want to make sure that your urine is closer to like a pale light yellow to clear versus… So looking like lemonade to water versus apple juice or iced tea looking. And if your urine looks like apple juice to iced tea consistently throughout the day, I'm going to recommend that you see your pediatrician, because something might be up there.  

But generally speaking, as long as we're hydrating well throughout the day, so some general rules, two to three hours before exercise, trying to get about 17 to 20 ounces of fluid, 10 to 20 minutes before exercise trying to do 7 to 10 ounces of fluid. Then throughout the day, having a little salt with meal or snack to help promote water retention. So when you're actually drinking that fluid, your body's holding on to it for you for when you actually are exercising. 

And then, of course, this varies. These are just general guidelines. So, this varies from athlete to athlete, what they might be able to achieve and what makes them feel  well and perform well.

Dr. Mike Patrick: Yeah, just kind of get a visual picture of that. So, basically like a 20 ounce bottle of water, like bottled water that's about the size that you want to do couple of hours before. And then, there's another reason for pretzels to be included in the pre-exercise snack. And the reason that that helps is because as you eat salt, it increases your blood sodium level. 

And then, your body does not want a high sodium level and so you get a fluid that enters into the bloodstream to dilute that salt, which gives you more blood volume. Which in turn increases your blood pressure if you're prone to high blood pressure and that's why we say in adults, you should have a low salt diet. But in athletes, in healthy athletes, that's a different case and actually, the salt can help you.

Jessica Buschmann: Yes, it can. It's very important and it's often hard. I have this conversation with parents a lot is that where we need to focus on what your young athletes should be eating, not maybe the diet adherences or restrictions we need to be evaluating for you, right? So that's often a hard differentiate. And grandparents, oh my, yes, bless them. Yes, we need to make sure that our kids are having, in this case, a little bit of salt as all the great benefits that you mentioned.

0:44:25

Dr. Mike Patrick: Yup. And then during competition, it's important that there's water available.

Jessica Buschmann: Yes, oh, yes. Water available and also, there's such a thing as  dehydration, of course, not drinking enough. But there's also the concern that we're drinking too much. So, really focusing on these keys that we're listening to our thirst. As long as we're drinking the thirst, and there's fresh water available and we're hydrating well throughout the day, we generally don't need to be too concerned unless there's other factors that I'm sure we'll go into later.

Signs that we need to look for that someone might be dehydrated or overhydrated. So generally speaking, we just need to stay calm and provide fresh available free water and pay attention to our thirst and watch our urine, everything should be okay in terms of hydration. So, during exercise, I'm looking for 7 to 10 ounces of water every 10 to 20 minutes during activity, if tolerated. 

Now, of course, this varies and really, this recommendation is really hard for most athletes because they might not get water breaks or they feel like they get what I affectionately call bubble guts. All that water just sloshing around in their stomachs. So sometimes, for some athletes, what works best is we really focus on the prehydration. And then, during exercise, then we just swish the water in our mouth. Or just take small, about one mouthful is about one ounce of water. 

So, they'll do one ounce of water just to kind of get them through, rehydrate their mouth, feel a little better and that's what they're able to achieve. But the recommendations are, generally speaking, try to do a 7 to 10 ounces of water every 10 to 20 minutes if you're able. But truthfully speaking, most athletes really have challenge. 

Dr. Mike Patrick: Yeah. So, about an ounce a minute? 

0:46:08

Jessica Buschmann: Yeah.

Dr. Mike Patrick: I mean, just trying to make it easy in my mind in terms of that.

Jessica Buschmann: No, I very much appreciate it, so yeah.

Dr. Mike Patrick: But the most important thing is going to be to pay attention to your thirst and you may have less of an issue with that thirst if you pre-hydrate well.

Jessica Buschmann: Exactly. And different athletes also have different sweat rates. Some athletes sweat a lot more than others. And athletes that are like, "I just get a glisten on me when I'm running." And others are like, "I am pouring sweat ten minutes in." So, it all is variant, based on patient to patient, too. So, again, that's just the general guidelines. We just go with what works best for them.

Dr. Mike Patrick: Yeah, absolutely. And then, the post-competition after exercise, really that's when that thirst thing comes in. If you're thirsty, drink. And also  pay attention to your urine after you've exercised. And if it's kind of dark, you need to drink.

Jessica Buschmann: You need to drink. And then, also for my athletes that just got out of two-a-days and pre-season. So, my football, my soccer, athletes especially and sometimes…
  
Dr. Mike Patrick: Marching band.

Jessica Buschmann: And marching band, you are right. Yes, and so pre-exercise, you want to try. And a lot of football teams, soccer teams do this in the area. They'll weigh in before and weigh out after practice, and then also the same for the second practice. So, the goal is between the first and the second practice to replace every pound lost with 16 to 24 ounces of fluids.

Dr. Mike Patrick: Wow.

Jessica Buschmann: Yeah. So, that's a lot. And sometimes, we have to keep in mind, too, that fluid just isn't limited to water. So water, it can be milk or it can be juice, or it can be sports drink. High volume fruits, like high water volume fruits like watermelon or pineapple or melon and things like that that have a lot of fluids in them also count towards your overall daily fluid intake, too.

Dr. Mike Patrick: Are there general rules of thumb for when you ought to substitute sports drinks with water? Is water okay all the time or are there situations where you really do want the sugar and the electrolytes that come with the sports drink?

0:48:13

Jessica Buschmann: So, water is a great rule all the time. Generally speaking, throughout the day, especially water, water, water. I get the complaint a lot that water is really boring. Like well, yeah, it can be. But there's lots of ways to flavor it. You can take advantage of the fruits before they go away this summer and really flavor your water with berries and herbs  — I've lots of good combinations to that, you can really look some ideas up online, too — to help flavor the water to make it a little more appeasing or palatable as well. 

Sports drink is generally recommended for after an hour of really heavy exercise or moderate to intense exercise. And sometimes, that rule goes away when it's really hot and humid outside. We want…

Dr. Mike Patrick: And those heavy sweaters.

Jessica Buschmann: And those heavy sweaters. Exactly, great point. To make sure that they're replacing the carbohydrates that they're using for energy, the  calories that they're burning as well. And then, also replacing those electrolytes that they're losing through sweat and then rehydrate their bodies as well.

Dr. Mike Patrick: Yeah. There are lots of commercials and different brands of sports drinks to try to influence your purchasing dollar. Are there certain ones that are better than others? And can you just make it at home yourself? 

Jessica Buschmann: Yeah. So, I think again, a good rule for my athletes is to find one that works best for them. Yes, you can make. I am a big fan of making it yourself at home. I have a really easy recipe that I'm happy to provide. It's water, both hot and cold water, and salt and lemon juice and 100% fruit juice and sugar. That's it. 

Dr. Mike Patrick: Oh, yeah. That's easy.

Jessica Buschmann: Yeah. Nice and easy. And I mean, I encourage my athletes to experiment with different flavors to see again what might be more pleasing or palatable to them. And athlete come to me the other day. and he's like "That grape is on point."

Dr. Mike Patrick: Yeah.

[Laughter]

0:50:08

Jessica Buschmann: "That orange-mango can take a hike." And like, "That's fine, man." And so, whatever works.

And also another rule of thumb, let's say you're on your way to a game. You have a heavy salty sweater or your athlete is going to be exercising for a long time and you have to buy a commercial sports beverage, go to your local gas station, grocery stores, get a sports drink and then dilute it. If it's just too concentrated or sugary or strong for them, sometimes that just lead to gastrointestinal distress or GI upset. That's not the goal. We want to…

Dr. Mike Patrick: Yeah. If you have too much sugar, you may not be able to absorb at all. And then, that gets down into the large intestine and draws water in, which can make some cramps and diarrhea and all that stuff.

Jessica Buschmann: Yeah. Not fun stuff, not things we want to be happening on the field.

[Laughter]

Dr. Mike Patrick: Yes, yes. Exactly. Now I know I'm going to have parents ask about your homemade sports drink. So, I think we need a recipe.

Jessica Buschmann: I'd be happy to. 

Dr. Mike Patrick: Okay. 

Jessica Buschmann: So, sports drink recipe is a quarter cup of sugar, a quarter teaspoon of salt, a quarter cup of hot water — don't forget the hot water for this part — a quarter cup of your favorite 100% fruit juice, whatever flavor you prefer. As my athletes, I'm a big fan of the grape myself, but there's lots of other options, too. Two tablespoon of fresh lemon juice and three-and-a- half cups of cold water. 

So, what you'll do in the bottom of the pitcher, or whatever a bowl, whatever you're preparing it in, dissolve the sugar and the salt and the hot water. So, you're going to stir that around until it's all dissolved. And then, you're going to add the juice and the remaining cold water. And then, you're going to chill it. So, I think on a Facebook Live, I did this exact recipe and then I put it in the freezer in popsicle molds. And I've been eating sports drink popsicles after long runs.

Dr. Mike Patrick: Yeah, yeah.

Jessica Buschmann: It's a little bit summer. And they've been a nice to mix up to the grind, something different. And this, I mean, really easy. You could really even have your student athlete do this while you're preparing dinner tonight. Really encourage them to try different flavors and also adjust accordingly. If you think something's not right, sometimes I made this recipe and it's too salty, add a little more juice. Make it appealing for them, too.

0:52:28

Dr. Mike Patrick: Yeah, yeah. That's great advice. So, make sure folks go to Facebook, search for Nationwide Children's Hospital, go to the Videos tab and then, all of your Facebook Live where you're sneaking food into recipes and you're making sports drinks — all there. So folks, you can get it up there on your mobile device while you have the ingredients out and just make it along with you.

Jessica Buschmann: Absolutely. Yeah. It's nice and easy, like I said. And I actually credit this recipe to Nancy Clark. She's a sports dietitian at Boston that has been doing sports dietetics far more years than I've been alive. And she's one of the gurus in the field that I admire and respect very much. And I actually pulled this recipe from her sports nutrition guidebook and tweak it as I need.

Dr. Mike Patrick: Yeah, Yeah. Absolutely great, great stuff. Now, so we talk about water is always great. If it's a vigorous exercise or if they're a heavy sweater, it's been more than an hour of exercise if you're a normal sweater, then you need to think about a sports drink.  And you also mentioned how fruits are great, flavoring water is fantastic. But are there drinks that students athletes should avoid?

Jessica Buschmann: Yes. So, I'm not a fan of energy drinks. So these energy drinks sometimes will use the terms synonymously, like sports drinks are the same as energy drinks, and they're not. We know they're very separate types of drinks. Energy drinks have stimulants that trigger cardiovascular system and GI challenges potentially, so increased blood pressure, increased heart rate,  can cause upset stomach or diarrhea or things like that. Things that obviously have adverse effects when you're performing, but also especially because these are stimulants. They're stimulating the body, they're not meant to do that at the young age, right?

0:54:22

And something else that you should be focusing on, good quality food, and exercise will also stimulate your cardiovascular system, get your blood flowing, increase your energy levels and things like that throughout the day. But energy drinks can be very dangerous to your young athlete. And generally speaking, also limiting the sugary, water, beverages and soda as well just… I'd rather you eat a dessert a couple times a week, actually eating your food or calories rather than drinking them as beverage.

Dr. Mike Patrick: Yeah, yeah, that definitely make sense. What about dietary supplements?

Jessica Buschmann: So, dietary supplements benefits? You might need it. When I talk dietary supplements, meet with a dietitians. See if there is vitamins and minerals you might be lacking in your diet. Blood work can also tell you that, if you think that there is something you're missing. And really, unless an athlete is deficient in one of those vitamins or minerals, I'm not supplementing it. Because there's plenty of ways that we can hopefully ideally get it through food. 
The risks are, the regulation standards for vitamins and minerals and sports performance supplements are that it's not regulated the same way that food and other medications are by the US government. So the way that it goes is that they're not tested before they are placed on store shelves. So, it's a very buyer beware market.

If you're not certain if a vitamin or mineral, or again, sports performance supplement is tested or okay for your young athlete to take, I encourage you to reach out to your pediatricians, sports medicine physicians, sports dietitian or other healthcare professional that, hopefully, if they don't know the answer, can defer to an expert.

0:56:04

Dr. Mike Patrick: Yeah. And we're talking about protein powders, amino acid supplements, megadose vitamins and minerals, weight loss aid. And then, also your friend's ADHD medicine, not a good idea to share those kind of things at all.

Jessica Buschmann: Not a good idea, yes.
   
Dr. Mike Patrick: And if you feel like you need some sort of supplement, then that's definitely a kid and family that really ought to get in touch with a sports dietitian to talk this through and really help in terms of guidance.

Jessica Buschmann: Right. And  it's one of those things that's when we can actually sit down and overall look at what you're eating on daily basis and what type of level of exercise you're doing — whether that's types of sports, that's intensity, that's duration. What are your goals? Is it just to be a recreational athlete? Is it to play the pro level?

I can get the whole big picture, educate on good solid food. And generally speaking, most athletes are for eating more, they just didn't know. They didn't have the knowledge. And same thing with the supplements. It's that at the end of the day, if they test positive for a tainted supplement or a banned substance, it's on them. No matter what, no matter who told them the advice.

Dr. Mike Patrick: Yeah. And for parents out there, you really want to know your kids enough to know what they're looking into, what it is that they're asking, maybe trying to seek. A recent report from the American Academy of Pediatrics showed that 8% of girls and 12% of boys admitted at some point in the past to using supplements to boost athletic performance. And that does include using different ADHD meds in order try to get energy. 

And so, you really want to know what your kids are doing and asking them those tough questions and kind of being in their business. So you can help them perform at optimal levels without needing dangerous substances.

Jessica Buschmann: Right. And as I mentioned, it's a harder route to go. When we're looking at the diet, hydration practices, and good sleep habits and things like that, it's good habits that will carry them, not only through their sports seasons but lifelong.

0:58:10

Dr. Mike Patrick: Yeah, absolutely. So, how can a parent tell if the student athlete is getting adequate nutrition and hydration?

Jessica Buschmann: So, you know your child best no matter what. No pun intended but trust your gut as a parent, trust your gut. 

Just some signs that we're looking out for and things I often ask in clinic to is how is your fatigue? Like do you have any fatigue with exercise all throughout the day? How many naps are you taking? How much are you sleeping? Have there been any major weight changes that's an increase or decrease? For my female athletes, I'm asking about a menstrual history. Are there any menstrual irregularities that are sending up red flags? Headaches or headache frequency, how consistently they're getting sick or they're getting injured? If they're on their fourth stress fracture potentially? And then, like let's ask some more questions, right?

Dr. Mike Patrick: Yeah, yeah.

Jessica Buschmann: And then also, if they're having poor recovery after workout. Some of them, in any new presenting signs or symptoms that you're like this isn't the way things usually are. But those are some things to look out for.

Dr. Mike Patrick: Yeah. And then when should a family see a sports dietitian? 

Jessica Buschmann: Well…

Dr. Mike Patrick: All the time. Every single…

[Laughter]

Jessica Buschmann: So obviously, every day of the week. No, but when we want to make sure that we're… As I mentioned, for everything above. A lot what I talked about with my athletes is the importance of the female athlete triad and also REDS, which relative energy deficiency in sport. And that also include male athletes. We talked a lot about the triad and the connection between overall energy intake and menstrual irregularities and bone health. Well, guys have that, too. They may not be eating enough and their bone health might be hindered as well. So, REDS really does encapsulate those male athlete as well. 

1:00:04

But when they need to be concerned is when we're seeing those major weight changes. And like both up or down, really looking at down. Have they started cross country seasons and their weight has dropped 20lbs in a month. What's going on there? 

And then, also severe mood changes or abnormal vital signs. I take vital signs. In every sports nutrition, there's a blood pressure, heart rate, temperature and sometimes those point me in the direction that an athlete might not be eating enough or something else might be going on.

And who should see a sports dietitian? I say everyone. Everyone who simply wants to improve their performance or overall eating habits, managing a medical condition, food allergies or intolerances, picky eating habits, any of those. And for some parents are just like, "I need some help in doing this. I'm not quite sure how to manage it."

Dr. Mike Patrick: Yeah. Now, here at Nationwide Children's Hospital if someone's interested in seeing a sports dietitian, they do that through the Sports Medicine Clinic? Do they have to see a sports medicine doctor and get referred to you or can family refer themselves?

Jessica Buschmann: Yeah. So, both now, this is great. This is a newer thing. I don't exactly know how many months live it is now. But you can do it a couple of different ways. Absolutely, if you're already being seen in our Sports Medicine Clinics, our sports medicine physicians, as well as a lot of other departments in the hospital, too, refer athletes to me. And that's just the general referral. Pediatricians can also refer from the outside community as well. They can just send that referral on our virtual Central Scheduling Department or it can be placed in EPIC, our medical record system. 

And then, but parents can also call in to our Central Scheduling department. So they would call 614-722-6200 and await the Sports Medicine prompt and request a Sports Nutrition appointment. And for those of you that might be listening that are like, "I don't know if sports nutrition is the best." Maybe it's just some general nutrition advice. You can also call Central Scheduling and ask to be scheduled with Clinical Nutrition.

1:02:13

Dr. Mike Patrick: And I'll put a link to Sports Nutrition at Nationwide Children's Hospital, to the website that has all the information as well with contact phone numbers. So, that folks can get in touch with you. Now what about families who aren't necessarily near a big city? Maybe there's not a dedicated pediatric sports nutrition person. How do you find just a clinical dietitian?

Jessica Buschmann: Yeah. That has vary in every city. I actually I have a voicemail sitting in my inbox right now. A guy from Jackson, Mississippi called me and asked me the same question today.

Dr. Mike Patrick: Yeah, he saw you on Facebook Live.

[Laughter]

Jessica Buschmann: He probably did, sneaking broccoli in some muffins. Yeah, so you can go about it a couple different ways. With a sports dietitian, you can go on the SCAN website, which is  the Sports, Cardiovascular, and Wellness practice group website. And you can type in your area code and it'll bring up sports dietitians in your area. 

But my general advice is if you have a kiddo or an adolescent that you're concerned about, try to find… Start with your pediatrician and see if they have any dietitian in their pocket that they use and that they refer to. You'll never know if you don't ask the question.

Dr. Mike Patrick: Yeah. And there may be just a dietitian who has specialized because they're the only person to community who deals with athletes. It may be special training but they have life training. 

Jessica Buschmann: Right. Exactly.

Dr. Mike Patrick: And that maybe a wealth of information in your community.

Jessica Buschmann: Definitely. And  another good one is even finding the closest city and finding the pediatric hospital there. See if they have any sports nutrition resources online for you that can give you a general guidance of handouts and information of where to go. And then if you try those options, listen to this PediaCast and if you still not really figuring it out, then maybe seek even a more individualized consultation with sports nutrition.

1:04:07

Dr. Mike Patrick: Yeah, absolutely. What about payments, in terms of does insurance usually cover consultation with the dietitian or is it kind of different from plan to plan?

Jessica Buschmann: Different from plan to plan. My encouragement to all of you listening today and also to my patients in clinic, I say the same thing, call your insurance company and say that you are looking to see if services with a registered dietitian are covered under both your insurance and your individual plan. Tell them what you want to be seen for.

And some insurance company say, "We offer nine visits a year, as long as it's medically necessary." Some say, "You get three per year, whatever you want to use them for." Some say, "Sorry, services with the dietitian are not covered." So always be proactive and see if services are covered because otherwise you'll be responsible for that bill.

Dr. Mike Patrick: Yeah. And this is another example where getting in touch with your primary care doctor and letting maybe them make the referral and being an advocate for you with the insurance company may be helpful as well.

Jessica Buschmann: Right, yeah. And  there are some dietitians out there who are strictly fee for service. They don't bill through insurance companies and it just depends if they're working at a hospital or they're working in private practice, or they're working for a small community wellness program. Every area's different, has its pros and cons, of course. So, it's just also has to be what works for your family, too.

Dr. Mike Patrick: You may be able to barter with them. 

Jessica Buschmann: You might be.

[Laughter] 

Dr. Mike Patrick: A little bit of a discount

Jessica Buschmann: Yeah, right.

Dr. Mike Patrick: All right. Well, Jessica Buschmann, clinical dietitian and sports nutrition expert here at Nationwide Children's Hospital, thank you so much for joining us again today.

Jessica Buschmann: You are so welcome. My pleasure.

[Music]

1:06:17

Dr. Mike Patrick: All right, we are back with just enough time to say thanks to all of you for taking time out of your day and making PediaCast a part of it, really do appreciate that. 

And thanks to Jessica Buschmann, clinical dietitian and sports nutrition expert with sports medicine here at Nationwide Children's, really appreciate her stopping by and enlightening all of us on the ways of good sports nutrition and really good nutrition for all of us.

Lots of links in the Show Notes for you —  the two previous episodes that Jessica has been a part of. One on the female athlete triad, PediaCast 285, and the previous episode on sports nutrition couple years back. Still good stuff though, PediaCast 325. And I'll have links to those two episodes.

Also a link to Sports Nutrition at Nationwide Children's Hospital if you want to get connected with them. And then Nancy Clark's homemade sports drink brought to you courtesy of Team USA, I have a link to that. And Sports, Cardiovascular, and Wellness Nutrition or SCAN, their website where you can find a clinical dietitian in your neck of the woods.

Don't forget, you can find PediaCast in all sorts of places. Maybe there's an easier place than were you discovered us. Maybe you clicked on a link on Twitter and we're listening to Twitter. We're also available in iTunes, Google Play, iHeart Radio, Stitcher, TuneIn and most mobile podcast apps. Just search for PediaCast.

There's also the landing site where we have our archive of all of our shows, all 385 of them. Also Show Notes, written transcripts of many of the programs, our Terms of Use Agreement and the Contact page if you'd like to ask a question or suggest a topic for the program. 

We're also part of Parents On Demand Network at parentsondemand.com which is a collection of parent-friendly podcasts that can help make your life and job as a parent a little easier. So be sure to check them out. They also have a mobile app and you can find PediaCast in the Parents On Demand app as well. 

1:08:14

We're also on social media, Facebook, Twitter and Google+. Also, LinkedIn, you can find me. Just a search for PediaCast in any of those areas. And, of course,  we do always appreciate it when you connect with us in social media and share our show with your own online audience to help spread the word.

Be sure you tell your family, friends, neighbors, co-workers, babysitters, daycare workers, grandparents — anyone who has kids or takes care of children — next time around talking about your kids, let them know about PediaCast. Also your child's doctor because they have a connections with lots of other families in your community who would benefit from the information that we have here on the show.

We also have a podcast for healthcare providers who provide pediatric care. It's called PediaCast CME. CME stands for Continuing Medical Education. Similar to this program, we turn up the science a couple of notches and we do offer free Category 1 Continuing Medical Education credit for those who listen and participate. Shows and details for this, again, free program is available at the landing site for that show which is PediaCastCME.org.

That's also available in all the places you can find to this program. So iTunes, Google Play, iHeart Radio. Just search for PediaCast and you should be to find both the regular shows and those CME programs as well. 

Thanks again for stopping by and until next time, this is Dr. Mike saying stay safe, stay healthy, and stay involved with your kids. So long, everybody. 
   
[Music] 

Announcer 2: This program is a production of Nationwide Children's. Thanks for listening. We'll see you next time on PediaCast.

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