There is no evidence to support choosing one diet or another for the high-level athlete. Health gurus, nutritionists, famous athletes, and coaches love to sing the praises of whatever diet they follow, but it is nearly impossible to control all the variables of someone’s health and nutrition to pinpoint what actually makes the difference.

Most diets improve an athletes performance as follows…new diet gets them to eat regular meals, gets them to eat adequate protein, reduces the amount of added sugar and highly refined/processed foods that are displacing other valuable nutrient dense foods in the diet, gets them to drink more water, and so on.  

What you have to consider is that it may not be the diet in and of itself that caused your athlete’s body to feel better, injuries to heal faster, and performance to improve; it could be what the diet caused them to “do”, i.e. eat consistent meals and snacks, focus on more nutrient dense foods, more whole foods which provide a rich array of antioxidants and nutrients, etc.

My concern for any kind of specialized diet that eliminates certain foods or food groups goes back to the motive behind the change. You must ask “why” and consider that not all motives are as pure as “I just want to be healthier”.

Why are plant-based diets popular?

Plant-based diets have been all the rage lately. Largely this is in part to several Netflix documentaries that although their research is cherry-picked and taken out of context at times, the public find them catchy and compelling. These diets do not guarantee health. You can be plant-based and overweight or plant-based and malnourished, it’s all about the food choices and adequacy of the diet.

We first need to define “plant-based” as this term is ambiguous (like many terms in the diet world).

Vegan is a diet free of all animal products (chicken, beef, fish, dairy, eggs and products made from or with animals).

Vegetarian is a diet free of some, but not all, animal products. For instance, a lacto-ovo vegetarian chooses to consume dairy and egg products, but not beef, chicken, fish, pork, etc. A pescatarian would eat fish among their vegan diet, but not other animal products. Just eggs, ovovegetarian, or just-milk, lacto-vegetarian also exist.

It goes without saying that some individuals follow plant-based diets for religious, cultural, or ethical reasons, and that is fine. But, the motivation behind going plant-based are not always pure.

When going plant-based disguises disordered eating

It’s a lot easier for a young athlete to say they’re going plant-based for ethical reasons even though deep down their choice is motivated by a desire to lose weight, get leaner, etc.

I’ll first start with I have no issue with plant-based diets nor the individuals who choose to follow them. I think adding more plants to the diet is something all of us need to do. What I do have concern for is when plant-based diets are adopted under the guise of “health” when they are motivated by disordered eating and body dysmorphia, which is especially common for young athletes. This is my realm and my bias in terms of working with a vulnerable population, gymnasts and other aesthetic sports, that have high rates of disordered eating and eating disorders.

As a pediatric/adolescent sports dietitian nutritionist, more often  than not when an athlete comes to me on a vegan or vegetarian diet, the diet is not motivated by ethical reasons but more-so a desire to lose weight or beliefs entrenched in exaggerated promises from the latest documentary. Or, the diet has been chosen for them by a family member which can be a difficult situation when the diet is not meeting their individual needs or is exacerbating existing disordered eating behaviors.

Going plant based for weight control and “health”

Many documentaries and advice you’ll find in the internet tout the superiority of plant-based diets (meaning vegan, vegetarian) for weight loss. The short of it is that any diet can work for weight loss as long as it puts an individual into a caloric deficit. Despite what some like to claim, calories do count and for many going “vegan” is a way for them to eliminate a large portion of highly processed, refined, and hyper-palatable foods that they tend to overeat.

It’s a lot harder to overeat on beans, rice, greens, fruits versus swinging by McDonald’s and grabbing a Big Mac + Fries on the way home from gym. But it’s also hard to overeat grilled chicken, eggs, cheese, Greek yogurt, and other high-quality animal-based proteins. There’s a big difference between a grilled chicken breast versus a piece of fried chicken.

The other “health claims” touted by plant-based diets are lowering inflammation and risk of heart disease, improving blood glucose control and lowering risk of diabetes, lowering risk of certain kinds of cancer like colon cancer, and improving “longevity” through increasing nutrient dense foods in the diet that are rich in vitamins, minerals, and antioxidants.

Are plant-based diets healthier?

Plant-based diets are not inherently healthier than those that contain animal protein. A vegan cookie doesn’t make it healthier than a regular cookie, and I’d argue that a high quality lean ground beef burger has more nutritional benefits (high quality, high bioavailable protein, rich in heme iron) than a plant-based patty with fillers and additives.

I do not support “moralizing” food into “good and bad” categories as this can set an individual up to over-restrict foods and struggle with guilt and anxiety over what they eat, which is not healthy or normal. Regardless of what diet you follow, we can all agree that large portion of it needs to come from whole foods, minimally processed, with limited added sugars, salt, and fat. But this does not mean the entire diet has to be like this.

You can have a very well-balanced diet that includes lean proteins, dairy products, and rich sources of omega-3 fatty acids like salmon while still emphasizing plant foods (which is every other food category). If you look closely, the “standard American diet” per the dietary guidelines is actually a plant-based diet by definition, with a higher percentage of the diet coming from fruits, vegetables, whole grains/starches, and healthy plant-based fats like avocado, olive oil, nuts/seeds. The thing is, as a population the US does not meet the nutritional standards set forth by the US Dietary Guidelines, so you cannot claim these guidelines cause the Obesity Epidemic. Here’s a great article by nutrition expert Stephen Guyenet to learn more.

What can go wrong?

The main concern with plant-based diets is that they require more planning and attention to ensure adequacy of nutrients. The pre-adolescent/adolescent gymnast may not have the skills to do such or are just unaware and are left with inadequate fuel and nutrients to support growth, development, performance, and recovery. If your gymnast has gone plant-based and is fatigued, having difficulty recovering, experiencing overuse and stress reaction injuries or poorly healing injuries, has lost their period (or not started menstruation by 16 years), or is just not adapting to training as expected, you need to look into the following issues.

The main issues are as follows: 

Plant-based diets and inadequate overall nutrition (energy, aka calories)

You can absolutely get adequate energy (calorie) from a plant-based diet. But, often these diets are used in effort to lose weight (and for most high level gymnasts, weight they don’t have to lose) which puts them in a dangerous situation of under fueling. Or, they are not properly formulated and result in inadequate energy for the high level gymnast.

I’ve talked about RED-S before, but inadequate energy availability to the body is like metabolic injury. If you don’t give the body adequate energy, building blocks so to speak, the body cannot repair, recover, and maximize training adaptations. I tell my athletes that not fueling their bodies properly is like walking out of practice half-way through. Their efforts in the gym cannot be fully realized when their body is starving.

Plant-based diets and inadequate dietary protein

You can also absolutely get adequate protein from a plant-based diet, especially if vegetarian and consuming eggs, fish, or dairy.

The main issue is that most plant proteins (grains, beans, starches, corn) are not “complete”, meaning they do not contain all the amino acids (protein building blocks) that the body needs for optimal muscle protein synthesis, growth, and repair. The body cannot make 9 of the 20 amino acids, and these are termed “Essential”. You must get them through the diet, and if you’re not consuming animal proteins which are “complete” and contain all of the essential amino acids, you must very carefully combine plant-based proteins to obtain all of these essential amino acids. Rice and beans are the perfect combination to ensure adequacy of amino acids.

Seitan, a meat-substitute made from wheat gluten, is not complete unless cooked in a soy-rich sauce.

There are some complete plant-protein sources like quinoa or soybeans.

The other issue with plant proteins is quality or “bioavailability”. Proteins have a rating score that shows how “absorbable” they are in the body. For instance, whey or egg proteins are absorbed 100% gram for gram, meaning if you take a scoop of protein powder that has 20 g of protein, your body will be able to use all of it.

Plant based proteins like soy have the highest “bio-availability” of all plant proteins, and close to animal based. Other popular plant-based proteins like hemp, pea, and rice have lower bio-availability which mean you’re only getting 50 to 80 percent of the protein you think you’re eating. This can lead to inadequate stimulation and support for muscle protein synthesis which is essential for training adaptation, growth, recovery, and repair.

The bottom line is that you need to ensure you are combining grains/starches/rice with beans for complete protein (like hummus and pita, beans and rice, peanut butter and wheat bread, etc).

Plant-based diets and inadequate Calcium + Vitamin D

Calcium and vitamin D are essential to proper bone mineralization and other life-sustaining cellular functions. Dairy products are the richest sources of calcium and vitamin D, along with fish like salmon or sardines. There are several plant-based sources of calcium like spinach, etc but the calcium in the plant foods is often bound by compounds like oxalates, making them less available for the body to use.

The adolescent needs 1300 mg of calcium per day, and most dairy products have 200-300 mg per serving, thus they need about 4-5 servings per day. Plant-milk alternatives and non-dairy products are not always fortified with calcium, and they lack high quality protein along with vitamin D, phosphorous, and other valuable nutrients.

Sure, you can take a supplement to meet your calcium and vitamin D needs, but “food first” is the tag-line of all dietitians because there are so many other benefits to food sources of nutrients.

For instance, a glass of milk will have high quality whey/casein proteins, calcium, phosphorous, and vitamin D. Plant-milks are fortified with calcium, vitamin D, and sometimes B12, but they do not contain the protein and are often filled with added sugars to make up the taste.

Plant-based cheese and yogurts have minimal nutritional value outside of some calories. The plant-based yogurts often have large amounts of added sugar, minimal protein and same of the cheese except less sugar.

Some individuals will choose to consume plant-based non-dairy products due to milk allergy or intolerance. If someone has a lactose intolerance, there are still many options to enable them to consume dairy products, like lactose-free milk and yogurt, hard cheeses (contain very minimal lactose), etc.

Plant-based diets and inadequate iron

Iron is also essential to the athlete’s diet to prevent iron insufficiency or iron deficiency anemia which can lead to poor performance, endurance, recovery, and repair.

There are two kinds of iron found in our food. Heme-iron is the most “bio-available” to the body and comes from animal proteins (beef, chicken, oysters, and turkey). Females need 9 mg per day from 9-13 years old and 15 mg per day between 14-18. For perspective, a 3 oz serving of beef has 1.6 mg of iron.

Non-heme iron comes from plants and is not as available to the body. It takes nearly double the amount of non-heme iron to meet an individual’s needs. A cup of spinach has 6.4 mg of iron, but not all of that can be absorbed by the body. This is the same premise behind why plant-based sources of calcium are not as absorbed. The compounds (phytates, oxalates, lectins, tannins, etc), often called “anti-nutrients” in plant foods bind the nutrients and make it difficult for the body to extract. Care needs to be taken to ensure that meals are balanced, and minerals are supplemented appropriately.

Plant-based diets and inadequate B12

Vitamin B12, known as an “energy vitamin” is most derived from animal proteins as it is rich in the muscle tissue. This vitamin is involved in folate metabolism and energy metabolism, along with keeping the nerve and blood cells healthy, and supporting DNA synthesis (genetic material of all cells).

The only plant-based source of B12 is nutritional yeast, and large amounts need to be consumed to meet the Recommended Dietary Allowance (RDA) of 2.4 mcg/day for an adolescent athlete (14-18 yrs).

B12 is also added through fortification to foods like plant milks, cereals, but an individual that is vegan may still need a daily supplement.

Plant-based diets and Omega-3 fatty acids

Omega-3 fatty acids are fats found in fatty fish like salmon or sardines and small amounts in foods like flaxseed, walnuts, and hemp seeds. These fats has powerful anti-inflammatory properties and are really beneficial for managing overall inflammation along with cognitive performance (the brain is a large proportion of DHA, an omega 3 fatty acid), and muscle protein synthesis.

Yes, you can take a high-quality omega-3 supplement each day (which could be warranted regardless of the diet you follow), but “food first”. A serving (3-4 oz) of fatty fish like salmon can provide the same amount of omega-3s you’d get from a daily supplement, and you also get the valuable high-quality protein from the actual fish.

Plant-based diets and dietary rigidity with increased eating disorder symptomology

Not everyone who goes vegan or on a plant-based diet has an eating disorder or disordered eating. Fact.

But often, the reality is that often “going vegan” is motivated by a desire to lose weight, etc that while not always a bad thing is often misguided and inappropriate for high level gymnasts. Food doesn’t have to be “all-or-nothing”. You can enjoy all foods while still focusing on most of the diet coming from nutrient-dense sources of food (lean proteins, fatty fish, whole grains, fibrous fruit/veggies, healthy fats, etc) without having to go on a specific diet.

I’m also all about learning to enjoy all foods in moderation. Humans like the extremes, and it’s common for individuals to adopt certain diets (low carb, low fat, vegan, etc) in effort to eliminate the foods they love yet have a hard time regulating. This often boils down to an unhealthy relationship with food and over-restriction. My stance is that food will always be around, and you can’t “quit food” like you can alcohol or drugs. It’s gut-wrenching hard work, but learning to give yourself permission to enjoy the foods you love and make peace with them is a far more sustainable approach to just eliminating food groups and hoping you can tough it out (until you can’t).

What do you do if your pre-adolescent/adolescent gymnast wants to go “vegan”, “vegetarian”, or “plant-based”?

Sometimes this is just a phase and it may be short-lived. As a parent, you can support them by ensuring they’re consuming adequate plant-based proteins by replacing the animal protein with beans/grains or tofu. They need to get several servings of fortified plant-milk per day for adequate calcium/D, and fortified grains and other products for iron and B12 although they still may need to supplement. A well-planned vegan or plant-based diet and proper supplementation can meet the high-level athletes nutritional needs.

 

I would recommend having the pediatric or sports medicine physician check labs for your high-level athlete, regardless of diet, to ensure they don’t need any sort of supplementation. You want a complete blood count with iron panel, serum B12, and potentially folate, methylmalonic acid, and homocysteine to check for iron, b12, or folate deficiency (which can all lead to fatigue, leathery, etc). For vitamin D, you want 25-OHD (25, hydroxyvitamin D) as the proper form of Vitamin D to check regarding bone health.

A daily chewable or tablet multivitamin with iron and vitamin D could be used as “nutrition insurance”, but the athlete still may need more calcium, vitamin D, iron, and B12. As for all vitamins/minerals and when considering supplement, we should “test, not guess” and then make sure the supplements that are prescribed have been third-party verified by a lab like the NSF (National Science Foundation), Informed Choice, or USP.

How do you know if your gymnast is just wanting to be healthy or if they’re struggling with disordered eating?

If your athlete goes plant-based and starts eating significantly less, refusing to combine foods to make complete proteins, etc…you need to keep vigilant watch. 

The two most-common eating disorders that are disguised as going vegan or plant-based for “health” are anorexia nervosa and orthorexia. Anorexia is an eating disorder characterized by weight loss, difficulties maintaining appropriate body weight for height, age, and stature, and in many individuals, distorted body image. People with anorexia generally restrict the number of calories and the types of food they eat” (NEDA 2016). Orthorexia is an unhealthy obsession with otherwise healthy eating. Literally means ‘fixation on righteous eating’. Orthorexia [can] start out as an innocent attempt to eat more healthfully, but those struggling with orthorexia can become fixated on food quality and purity”.

If your athlete starts to get rigid and anxious around food, becomes secretive or defensive, you need to get some help for them from a professional like a registered dietitian nutritionist.

In Summary

In summary, it is very possible for a gymnast to follow a plant-based diet and meet their nutrition and performance needs. 

Care needs to be taken to ensure adequacy of the diet as well as mental health. 

If you or your gymnast is curious about plant-based diets or are currently following one and want to ensure adequacy for optimal health and performance, please reach out and I’d be happy to schedule a free 20 minute consultation call with you.