Season 2 is Now Live! Listen to the Fourth Episode Here

Season 2, Episode 2: Optimizing Elite Athlete Performance and Combating RED-S with Jill Lane

Show Notes

In addition to being a mom of 3, Jill Lane has spent over 15 years consulting, coaching, and teaching functional nutrition and exercise physiology. Her passion for helping pro athletes, sports families, and high achievers attain maximum strength, quick recovery, heightened energy, sharp focus, and optimal body fat for peak performance has become the cornerstone of her business. Some of her current and past clients include coaches and players from the NFL, NBA, and MLB as well as aspiring MMA and Olympic athletes. As a former High School All-American, Olympic Development Team Member, Collegiate, and Semi-Pro athlete herself, Jill has a clear understanding of what competitive athletes require to achieve and sustain their personal best. Her mission to support the next generation of student-athlete leaders (as well as those who lead them daily) comes full circle in her event, program, and academy called Fueling Champions™. Fueling Champions follows Jill’s proprietary 3-step process, FEED, LEAD, SUCCEED so families of student-athletes can achieve healthy success, together.

Together Jill and I discuss the health challenges facing elite student and professional athletes and the role that practitioners can play in optimizing their performance. Jill highlights the negative impact of RED-S (Relative Energy Deficiency in Sport), the importance to functional medicine practitioners of understanding RED-S, and offers tactics to help practitioners have more effective conversations with their patients. Together we address key supplements for athletes, including protein intake, fish oil, and Vitamin D. Jill also offers recommendations based on her vast experience for injury prevention and illness reduction and shares the advice that practitioners need to hear to keep their elite athletes on the field, in the pool, or on the track.

I’m your host, Evelyne Lambrecht, thank you for designing a well world with us.

Episode Resources:

Jill Lane

2014 IOC Consensus Statement on RED-S

2023 BJSM RED-S Update

Nicky Keay RED-S Endocrine diagram paper

Injury and Rehab Nutrition

Fueling Champions

Design for Health Resources:

Designs for Health

Blog: Krill Oil for Muscle Health and Recovery

Science Update: Meta-analysis Investigates Efficacy of Vitamin D Supplementation on Bone Health

Blog: The Synergy of Vitamins D and K on Bone Health

Sports Performance Protocol

Nutrition Notes: Fuel Exercise Properly

Visit the Designs for Health Research and Education Library which houses medical journals, protocols, webinars, and our blog.


[0:00] Intro

[2:02] Jill’s journey into sports nutrition was born out of necessity and personal experience.

[5:02] Key changes Jill has seen in performance nutrition in recent years.

[7:15] RED-S (Relative Energy Deficiency in Sport) in a timeline and a detailed description of chronic low energy availability.

[17:05] The importance to functional medicine practitioners of understanding RED-S and having effective conversations with patients about it.

[19:44] The negative impact of RED-S on hormone, bone, and organ development.

[22:38] 3 effective communication tactics for setting student-athletes up for optimal performance.

[29:21] Key macronutrient needs differences between endurance and strength athletes.

[32:22] RED-S intake form resources for practitioners and the importance of raising awareness.

[36:47] Nutritionally supporting clients in injury prevention and returning to performance.

[45:04] Protein powder age and dosing recommendations.

[46:45] Fish oil and Vitamin D action items for injury prevention and risk reduction.

[49:26] Evelyne shares an encouraging supplement concussion recovery success story.

[52:34] The importance of using Certified For Sports products for all athletes.

[58:12] Jill’s top three personal supplements, favorite health practices, and the viewpoint on carbohydrates that she has changed her mind about throughout her career.


Voiceover: Conversations for Health, dedicated to engaging discussions with industry experts, exploring evidence-based, cutting-edge research and practical tips. Our mission is to empower you with knowledge, debunk myths, and provide you with clinical insights. This podcast is provided as an educational resource for health-care practitioners only. This podcast represents the views and opinions of the host and their guests, and does not represent the views or opinions of Designs for Health, Inc. This podcast does not constitute medical advice. The statements contained in this podcast have not been evaluated by the Food and Drug Administration. Any products mentioned are not intended to diagnose, treat, cure, or prevent any disease. Now let’s embark on a journey towards optimal well-being, one conversation at a time. Here’s your host, Evelyne Lambrecht.

Evelyne: Welcome to Conversations for Health. I’m your host, Evelyne Lambrecht, and I’m excited to welcome to the show today, sports nutrition specialist Jill Lane. Welcome, Jill.

Jill Lane: I’m so excited to be with you. Thank you for having me.

Evelyne: Thank you so much. Jill Lane is the founder of Fueling Champions, and she has spent over 20 years consulting, coaching, and teaching functional nutrition and exercise physiology. Her passion for helping pro athletes, sports families, and high achievers attain max strength, quick recovery, heightened energy, sharp focus and optimal body fat for peak performance has become the cornerstone of her business.

Some of her current and past clients include coaches and players from the NFL, NBA, and MLB, as well as aspiring MMA and Olympic athletes. As a former high school All-American, Olympic development team member, collegiate, and semi-pro athlete herself, Jill has a clear understanding of what competitive athletes require to achieve and sustain their personal best. She also works for Designs for Sport, Designs for Health’s Certified for Sport line as our sports nutrition specialist.

So Jill, how did you get into this field and what fuels you each day to keep doing this year after year?

Jill Lane: Oh my gosh, that’s such a big question. I think a lot of us get into it by necessity. So part of the reason why I do what I do with Fueling Champions is because I wish I would’ve known it sooner. But my undergrad’s in Ex Phys and I thought I was going to work in cardiac rehab until I got to my internship and the people who were supposed to be there, the ones in retirement and with gray hair, were not the ones who were there. There were people that I thought looked healthy and looked young, but they were there getting stents, and open heart surgery, post-heart attack, and I was confused and perplexed.

And we had an amazing dietitian by the name of Regina who started piquing my interest on the nutrition side. And I had taken some nutrition courses as part of my undergrad, and at that time, it was all things low fat. We don’t eat eggs, they’re bad for your heart. We don’t eat fat, it’s bad for your heart. But it just wasn’t adding up for me.

And so I got a job as a personal trainer, just trying to figure out what I was going to do with my life after that because I didn’t understand what I was seeing. It didn’t equate to what I was taught. And it was then that I really was exposed to the lifestyle choices that people make outside of exercise being a main component of what drives their health.

And I was also then post my athletic career and my health was a disaster. And so I got a job in a gym with another guest of the podcast and industry great, JJ Virgin. I really was super blessed really early in my career in my young 20’s, as a horrible personal trainer to be around the functional medicine industry greats and to be able to have a front row seat to what was then all the conversations around functional medicine, nutrition.

And I used those tenets to really heal myself from I think some things we’ll get into today, the side effects of a career-long, probably partnership with RED-S. And then I was able to start to use those tenets in my clientele at that time. And it’s how I’ve approached performance nutrition for the 20-plus years I’ve been in this industry.

Evelyne: That’s amazing. And I love that when I interviewed JJ, we talked about this, she also got me into this industry, and I also come from personal training. So it’s just amazing, JJ has that magical effect on so, so many people we are surrounded by. It’s amazing.

You mentioned RED-S, I want to talk about that. That’s relative energy deficiency in sport, by the way. But before we do, where is performance nutrition in 2023? How have you seen that change over your career?

Jill Lane: It’s a really interesting question. So I’ve been in this industry, like I said, for over 20 years. I’ve been working exclusively with athletes for about 15 years. And at the beginning of my career, I approached my work with very high profile at the time, professional athletes from a functional medicine nutrition approach.

And at that time that was extremely taboo. I was the pariah or left out of a lot of conversations because the type of testing I was doing on my athletes at the time. Because athletes are people first, and that’s how I was taught to approach everything, whether it was performance or weight loss.

And because of that, I got great results and most of my clients stayed with me until retirement, but fast-forward 15 years, that approach to working with student, or with pro athletes, excuse me, is really kind of, sort of now, just now in the last four to five years, being adopted by the organizations that influence performance nutrition a bit more.

So I would say performance nutrition, from my vantage point outside of the functional nutrition and functional medicine approach, has been behind on really what it takes to get an athlete well and keep them well and keep them in their sport for as long as they choose to be. But it’s slowly catching up, and I’m happy to see that there’s a lot of amazing teams that have performance practitioners that know the functional medicine approach. And so because of that, their athletes are being served well.

But we still have a lot of work to do. We still have a lot of education to spread throughout the industry, and we still have a lot of collaboration to be had amongst the members of performance teams, both in the private sector and at collegiate and pro teams. So there’s some work to do still.

Evelyne: Very encouraging though.

Jill Lane: Yes. We’re getting there.

Evelyne: And that you were a pioneer. So I want to go back to RED-S. So Jill, you’re known in the industry for teaching and speaking about RED-S in athletes, which is relative energy deficiency in sport. Can you tell us more about what that is? I remember learning about the female athlete triad back when I was studying kinesiology, and I don’t think I even heard the term RED-S until just a couple of years ago in my sports nutrition class. And so why is it important for practitioners who are listening to understand what these are?

Jill Lane: I think especially if you interface with student athletes or professional athletes, you must understand RED-S. And so I’m going to just give a quick timeline because I think it helps set the stage for how RED-S came on the scene.

So right around 1992, the female athlete triad was coined as terminology. And for those of us that are student athletes of the ’80s and ’90s, we completely missed any sort of way that people could be helping us. So there’s a lot of female athletes from the ’80s and ’90s, and I’ll say it’s still happening today, that trained and played in their sport without a period for a very long time. And so I could count on one hand how many times a year I would have a period, and that happened for a decade for me as a student athlete.

So the female athlete triad was coined as a term right around 1992. Right around 1997, I believe, the ACSM published a paper taking their stance on it. So it was like their position paper on the female athlete triad. So it’s really not that long ago. And the female athlete triad really has to do with something called low energy, excuse me, low energy availability.

So when an athlete, a female at that time, because at that time the triad only was recognized to be happening in female athletes. And so if a female athlete wasn’t consuming enough energy, calories, to match their need for performance and training and growth and development, which we’ll get into, then they would have generally one of three things happen. They would have some hormone disruption that would cause issues with bone health and their cycle, their menstrual cycle.

And so that’s where the triad came from, those three things, caloric, low energy availability, menstrual cycle dysfunction, and osteopenia, osteoporosis if left unchecked, although we know that starts to happen quite soon in the process. But that’s what the triad was.

So after 1997, somewhere around the early 2000s, the Olympic committee also posts a position stand. And then in the early 2000s, and for those of us that have been working with athletes for a really long time, I could tell you that I was already seeing this. I didn’t know what to call it, but I could see the metabolic dysfunction happening in my athletes when they weren’t eating enough calories to match their training volume. And I can see it in the men I was working with at the time that were adult athletes, professional athletes, 20 years and above.

Evelyne: I have a question about that. Sorry. What did that actually look like when you’re seeing this?

Jill Lane: So I would start to see labs come back, whether it was from the team, at that time, a lot of times it was blood work from the team. So you’d have a young, fit, low body fat male in their 20s with low testosterone, high cholesterol, low thyroid. And then if I was doing any other functional medicine type testing, issues with cortisol, issues with gut health. And of course the standard of care from the teams for liability reasons was a statin for someone who outside of every other metric was the epitome of health from a performance standpoint.

And then they of course would have fatigue, injury risk, injury recovery issues, lengthened recovery time, frequent illness. And so it was just kind of this web of all of these overlapping things that didn’t match how these people looked. And that’s a different conversation to be had, but just because someone looks a certain way doesn’t always mean they’re healthy. But because these athletes looked a certain way, a blind eye would be turned to all these other symptoms.

And so it was often by those experiences they were having, Evelyne, and then labs from the team. And it was a very common occurrence at that time that it’d be low testosterone, high cholesterol, low thyroid, and then it would be dysregulated cortisol patterns and some metric of gut health and sleep issues. And of course the team approach would be, for liability reasons, they needed to be on a statin to manage the cholesterol, which we know is a complicated discussion, probably other stuff going on.

So you would start to notice this in someone who you wouldn’t expect would have all of that based on the way they look. So in the early 2000s, the International Olympic Committee advanced their thought process of the female athlete triad to what’s now called RED-S, relative energy deficiency in sport. And RED-S is really the triad, but now for all athletes.

And so the triad was only thought to really be something that affected high volume, lower age, aesthetic sports at the time, so gymnastics and dancers, if you will. So what really broke open the RED-S conversation, what really made RED-S really important was that now this is for men, women, team sport athletes, cyclists. Anybody that trains and practices on a regular basis at a high intensity could fall into RED-S. And even general population women and men can fall into it, but we’ll just focus on athletes today just for the sake of the scope.

And so RED-S really became this catchall symptomatology of all the metabolic dysfunction that can happen when an athlete isn’t eating enough calories to match training load, volume, and injury repair needs because that’s actually a very caloric-rich environment. You need a lot of calories, especially post-surgery to heal.

And so RED-S is really … And there’s an update which we can talk about in a second because a new paper was just published this year. It’s been five years since the last position stand. So a new article was published in the British Journal of Sports Medicine. That’s a really important update just a few months ago.

But really RED-S is chronic low energy availability, and we can get into what that means in a second, and all of the metabolic dysfunction that comes from that performance decrements just being one small slice.

Evelyne: Gotcha. So tell me what was in that update? What do we need to know about that?

Jill Lane: So just as, again, a wrap up, RED-S is chronic low energy availability. That’s what RED-S is. Energy availability is the amount of calories that we take in every day minus the calories that we expend and exercise. So just for the sake of easy math, if we take in 1,500 calories and we expend 500 calories through exercise, then we have 1,000 calories left available, 1,000 calories of energy availability.

Those calories kind of act like our basal metabolic rate calories. They go towards just our daily metabolic function, our heart rate, our respiration, the calories our body needs to just do its daily job. So that’s what energy availability is. Low energy availability is when we don’t have enough calories to manage the metabolic function.

And so if that’s chronically happening, it makes sense that all the areas of metabolic need from mental health to cardiovascular health, to endocrine health, to respiratory health, to bone health, to musculoskeletal health, and on and on and on, are negatively impacted.

So the cool thing about the paper that was published this year, because what’s made it tricky for some people to wrap their heads around this is that sometimes people are in an intentional planned caloric deficit. And so, especially people that work in body comp or aesthetic sports or even in general population, trying to wrap our head around, okay, well, sometimes we do go into an intentional timed or planned caloric deficit to achieve a goal. Or sometimes we increase training volume and load to achieve a certain goal acutely.

And so what the new paper did is it categorized the different aspects of low energy availability to account for acute energy availability to serve a purpose. There’s maybe just a few under the surface metabolic shifts, but there’s no major dysregulation that happens. And then what they term as problematic low energy availability where, okay, the energy coming in is so low and it’s been happening for so long that now the body, to protect itself, is shifting a bunch of metabolic metrics to account for having to be in survival mode. But oh, by the way, this person is also a high performing athlete. So it makes it really complicated on the metabolism when that happens.

Evelyne: Very interesting. We’ll make sure to link to that paper in the show notes.

So Jill, in my daily work with practitioners like chiropractors, functional medicine doctors, I guess I don’t talk a ton about sports nutrition and maybe I should be asking more. And I think the practitioners who do use, say, Certified for Sport products are the ones who work with weekend athletes, maybe a few who work with professional athletes. And so is it common for practitioners to be asking the kind of questions that would help them determine, okay, somebody has RED-S and I need to do something about this? Or is that only in your world?

Jill Lane: I think that’s a great question. It’s why I’m so passionate about teaching about low energy availability and RED-S because I think most practitioners, functional medicine practitioners actually included, don’t ask enough questions about fueling, and that’s just across the board, everybody.

But then if I’m going to just … Okay, for the sake of the scope of this conversation, if you work with student athletes all the way up to any type of pro athlete, and in whatever you’re doing, whether it’s sports medicine, chiropractic, functional medicine, whatever your title is, and you’re not understanding how much they’re eating in comparison to their training load or intensity, then you’re missing a huge part of the puzzle.

Because it’s great to get all those functional medicine labs back and see all the things that we can fix and do. But what if a large portion of those abnormalities come from the fact that they’re under-recovered and under-eating? And instead of maybe, I’m a big fan of supplements, instead of just maybe throwing some supplements at those labs, we need to first get them adequately fueled and adequately rested in accordance to their training volume, intensity and their current goals.

And so it’s why I’m so passionate and that I teach about this quite frequently because most people that work with student athletes don’t have a clue what low energy availability and RED-S are. If you’re a strength coach, again, or any sort of licensed practitioner, even pediatricians should really, really understand this because the impact of RED-S and low energy availability in growth and development is huge. So now those added extra calories, that energy availability also is important to growth and development.

Evelyne: Tell us more about that.

Jill Lane: If there’s not a lot of calories left there, it negatively impacts all of the stuff that’s still happening in preteen and adolescents. And we know the male brain is still developing until their early 20s. And so it definitely impacts organ development, hormone development, bone development for sure. I’ve had student athlete clients of mine that were told they weren’t going to grow anymore. Early teen, 13, 14-year-old athletes who once they got well-fueled, one of them was a 13-year-old swimmer, she grew two additional inches.

So you need energy for growth and development, and if there’s not enough energy coming into the body, then there’s not enough energy for all of those things. And student athletes and students as a whole, we really have a health crisis happening now with our teens and our preteens. And I think one of the first places to start is to make sure that they’re adequately fueled, especially if they’re a student athlete, because a big aspect of RED-S is mental health correlated or adjacent, concentration, depression, anxiety.

And so fueling is critically important, to not just performance, but everything else that goes with an athlete’s wellness. And for student athletes, they’re sitting in school all day long, they have to learn, they have to focus. It becomes even more important for them.

Evelyne: I think this is so important and I want to make it practical for practitioners listening. So two ways I’m thinking about this. One is how to actually fuel, like what are the foods, what are we looking at? But also, are you using certain calculations to calculate the amount of calories that they need? I know we have three equations that we use in sports nutrition. Are you using one of those? Are you changing it depending on the season?

And is that something that, say, somebody’s listening and they’re also a parent like you are of teens and a preteen, is that something that parents should be doing? Do they need to send them to a sports nutritionist? Do doctors need to be doing this? Whose role is this?

Jill Lane: Yeah, no, it’s a great question. I mean, I think the answer is it’s everybody’s. It’s everybody’s role to participate in making sure that the fueling is happening well. It’s the parent’s job to understand and make sure that there’s the right foods at home. It’s the physician’s role to understand so they can ask the right questions when athletes present at an annual physical or for their sports physical to make sure they understand how to eat enough food for the sport that they’re in.

And it’s the student athlete’s job to actually take responsibility, quite honestly, I believe. And it’s how I teach my own athletes that are my kiddos and the student athletes in my business to understand how to take care of their body to achieve their goals.

So I want to start first with the communication methods that I think are best with student athletes, and then I can move into, okay, well, then how do you figure it out?

First of all, when you’re approaching student athletes about fueling, you need to know first and foremost, what are their personal goals around what they’re trying to achieve. Being healthy doesn’t sell to student athletes. So if you’re as the doctor or as the mom or dad or strength coach trying to say, “Hey, you need to eat more protein because it’s healthy for you,” or, “You need to stop eating this because it’s not healthy,” that’s not going to move the needle with 9 out of 10 teenage or preteen student athletes because it doesn’t mean anything to them.

And I would say I don’t even think that works in general population. We have a health crisis on our hands and doing things to be healthy isn’t motivating most people to do it. So it’s certainly not going to win the teenage population.

So you have to understand what their goals are. Are they trying to make a starting position on the team they’re on? Are they trying to get stronger and add muscle? Are they trying to get faster? Are they trying to dunk the ball? What is real for them that’s a goal for the next season or for the acute off-season that they’re in? Do they have a scholarship that they’ve signed and they have to report at a certain way to that college when they get there in three months or six months?

You have to know that first because everything you then teach them has to correlate back to their goal, not your goal, not my goal, their goal. And so if little Johnny wants to add 10 pounds of mass because he knows that will help him be stronger on the basketball court and body up against the guys under the basket, then everything I’m teaching him about nutrition going forward correlates back to that goal because that’s how the teenage brain works and that’s meaningful to them.

So that’s the first thing. The second approach is that consistency is better than perfection. And so parents and health-care practitioners, I think understand this, but for some reason we forget and have too high of an expectation that kids are going to go completely off of fast food or junk food or pizza or cupcakes. We’re just looking for consistency. Athletes get this. They’re used to practicing their skill all the time to get better at it, and the food is no different. The more times you can be mindful and do better, the better the result you’re going to get.

And then the third most important thing, I actually have four things, but we’ll just cover three for now, is to teach things they need to add first before things you need to take away. So when I get hired in my private business to talk with parents of student athletes, the parents just want me … “Jill, tell them all the things they shouldn’t be eating. No fast food, no …” And I’m like, “No, actually that approach doesn’t work. Has it worked for you? No? Okay, well, that’s because it doesn’t work.”

We add before we take away. Psychologically it’s better and easier and it’s more of a positive approach. And so I’m always looking for the gaps to fill calorically or with a specific macronutrient, or maybe it has to do with sleep. I dive a little into mindset and of course a few other things when I’m working one-on-one with my athletes.

But that’s really the approach anybody who works with student athletes and I would say pro athletes too, needs to take. What are their goals, acute goals for the next three to six months? We address that first because everything we teach goes to that. We’re going to add before we take away.

And if you work with parents or if you’re a parent, you have to model this behavior. You can’t expect your kid to give up soda and eat more vegetables if you’re not going to do it. And so I do spend a lot of my time talking with the parents of the student athletes because even teenagers who parents think don’t want anything to do with them are paying attention to what you’re doing and saying. And so I have two teenagers and an 11-year-old, I get it. And the biggest way I can teach them is by modeling it through my behavior and the choices that I make.

And so once you get the communication down to the student athlete and you involve the parent, or you get this communication down to the pro or semi-pro athlete that you might work with or even weekend warrior, you need to understand those things. Then you can start to get into, okay, now how do I approach this?

So you asked me about calories. I don’t give calories out to anybody because I don’t want people being upset about tracking their calories on a tracker. We know the data long-term isn’t good. They might do it for a month and then they’re going to stop. And because it’s fluid and there’s nothing that ever exactly will tell you. You can do the Harris-Benedict equation and all this other stuff. I’m going to work those things in my head based on training load, age, and their goals, so I have a rough bullseye.

If we’re looking at a bullseye, I’m getting a rough idea of where’s the center, where do I think is my best guesstimate for their caloric need. But what I teach people more about is their macronutrients, the protein, carbohydrates and fats and plants that need to be at that meal because that’s real to them.

If they’re at the lunch line at school, if it’s a pro athlete on the road where there’s a buffet of food that’s been chosen for them, no one knows the calorie count in any of those foods. So trying to track calories to me is not something people will do long-term. I have a rough idea.

So the education they’re getting from me about what should be at those meals is filling those gaps, but they’re looking for about how much protein, about how much performance fats, about how much plants, about how much carbohydrates. And my goal is just to teach them to understand how it feels to be well-fueled versus how it feels to not be well-fueled.

And most athletes will tell you they have had at least one game or practice where they know they were dragging. In fact, my own daughter last night from soccer practice came home. I wasn’t here before she went to soccer practice. She came home at 8:00. She comes into my room and says to me, “Mom, I was so tired at practice. I didn’t eat enough beforehand.” She’s 11, so I’m like, “I’ve done my work here.”

And so, she was able to correlate how she felt and look back to see what could she have done different. She could have eaten more. And so as a parent or as a coach or as a practitioner, that is our job to teach people to correlate how they feel to their actions, so that they can then start to self-govern and self-regulate and learn as they go so they can just do it better and better and better each time.

Evelyne: And then with the macronutrients, I assume that those are going to be different depending on whether you have an endurance athlete or a strength type athlete and which muscle fibers you need and which sport you’re playing and the age and all of those things. So is that just through trial and error that you’ve developed that or how do you recommend that part?

Jill Lane: I mean, I think the one macro that doesn’t change for anybody is protein. Everybody gets the same protein. And in my realm, it’s somewhere between 0.75 to 1 gram of protein per pound of body weight.

Evelyne: Okay.

Jill Lane: Now the reason that is, is because I don’t care what sport you play, protein does the same thing for everybody. It’s not only triggering muscle protein synthesis, but it’s like LEGOs to the body. My kids love LEGOs, and so I always use this analogy.

And the practitioners I’m sure are familiar, but the protein breaks down into various amino acids and then our body like disassembling a house made of LEGOs, there’s lots of different colors and shapes. Those represent the amino acids. And then our body can use those LEGOs to rebuild other tissue, mood chemicals, bone structure, hair, skin, and nails, ligaments and tendons, our collagen, which is the glue that holds us all together and is a big component of the white tissue, which is hugely important for athletes in joint health.

And so protein is the same for everyone. I don’t care if you’re an endurance athlete. The only time I might go higher than that is in a post injury state because the data supports going acutely higher in protein intake post-injury, especially if you’re concerned about managing body composition.

What vacillates the most for the different groups you mentioned, endurance athlete, youth, team sport athlete, golfer are the energy rich macronutrients, which are carbohydrates and performance fats. So those will differ based on training load, volume, current body composition, and the athlete’s goals. And so we’re always taking all of that into account.

We’re taking … You said something about seasonally or periodization. When we can, we should periodize nutrition. What athletes might be doing in season could very well be different than what they’re doing on the outside of a season.

If you’re in a high collision sport like football, hockey, after the season, these athletes are inflamed, destroyed, injured. And so we may ramp up performance fats and we may bring down carbohydrates and we may increase protein, like it’s a post-injury state, even though it’s just post-season. Because they are so big and strong and fast in those leagues now that the collisions are just so rigorous and so hard on the body that we’re in an acute phase of just really, really dense healing with certain macronutrients to help with healthy inflammatory response and tissue repair.

Evelyne: Yeah, thank you for that. I have one more question before we talk more about injuries. And I feel like we could do a whole other podcast just on nutrition during an event. You know what I’m talking about, GLUT transporters and all that fun stuff. Maybe another time.

So when a practitioner is working with a student athlete or even a professional athlete, is there some sort of intake form related to RED-S that somebody has created that they can use?

Jill Lane: Yeah. So there are a couple RED-S questionnaires, for lack of better words, and you can just Google them to find them. What I’ll say is that you can have what I’ve deemed, and the functional medicine industry I think will appreciate, the subclinical RED-S. It’s like subclinical hypothyroid. You don’t have overt, all of the metrics aren’t in red on the lab report, but we know based on the symptomatology and other stuff that’s going on that this person has some mild hypothyroid going on.

The same thing in my opinion, can happen with RED-S. So someone might answer that questionnaire and they might not tick enough boxes to then be, you have RED-S, because if you have RED-S, if you’re “diagnosed,” quote, unquote, with RED-S as a system symptomatology, you’re not supposed to be playing your sport right now. It’s like everything’s stopped. You need to get nourished. You need to get well.

But where most athletes are flying under the radar, especially the student athletes is what I call in subclinical RED-S. They’re starting to stack up a few of these things. The girls aren’t having their period, but they’re too embarrassed to tell their mom or their coach or their practitioner because it’s like a taboo conversation still in 2023. We’re still afraid to talk about our periods, which is crazy. I mean, I was in that boat, but that was 25 years ago.

And so nothing much has advanced there and we really need to start doing more work. I mean, it’s your superpower. There are potentially times during the month, and I teach the female athletes I work with that you could be stronger and you could have more endurance depending on where you are in your cycle and you can use it to your advantage.

And so I just think we have such an opportunity to teach our young female student athletes to not be afraid to talk about it and to understand it and to track it and to know if you miss it more than a couple months in a row, someone needs to know right away.

There could be some stuff starting to fly under the radar that doesn’t make someone check all the boxes to have enough of the different categories. So in the new British Journal of Sports Medicine article, they have some really nice categorizations for if you have a couple of the symptoms, then you’re just in the yellow zone, then you go to orange, then you go to red.

And so where we should be trying to catch people is in this yellow. And then we need to then say, “Okay, well, are these symptoms from low energy availability? Are they really under-eating or is this something else? Is something else going on?” And so we just have to ask better questions as practitioners and coaches, which takes time and knowledge.

And so my hope from teaching about this is that it just raises the awareness of low energy availability that people want to read the papers. I would read the original IOC paper and I would read the new one from this year, and there’s been a few other really good ones. There was one just a few years ago that has a really beautiful graphic of all of the axis of the hypothalamus, pituitary, and gonadal axis and all of the hormone and endocrine systems that are down-regulated from low energy availability. Nicky Keay, K-E-A-Y, is the lead author on that paper.

There’s some beautiful papers on it that are very short and easy to understand. And if you’re a practitioner that works with student athletes or athletes, you must read them. You must understand the impact of energy availability on wellness and metabolism in student athletes and pros because it impacts every physiological system, every system.

Evelyne: Thank you, Jill. I love your passion about this topic. I feel like we could actually continue talking about RED-S for the whole rest of the time, but there are some other topics I would love to get into.

So you mentioned injury prevention and returning to performance. How do we best support patients or clients nutritionally, whether it’s … You mentioned the protein, so if you’d like to expand on that, talk about supplementation. What are some of the things that we can do?

Jill Lane: I mean, in the last five to six years, there’s been some really nice papers that have come out about injury risk reduction, correlations we’re starting to make both with sleep, recovery time training load, volume, nutrition, and even supplementation. So this I find really exciting. For the group of people that don’t act until there’s research, we have nice papers and nice research on really some actions that we can take.

So first, honestly, with injury risk reduction, the first thing we have to do is make sure someone is well-fueled and well-rested because even being under-slept or under-rested, I can think of three separate references, increases injury risk. So missing sleep alone by two hours a night, reduction in two hours of sleep per night for someone who gets an on average of seven to eight hours increases injury risk as its own line item.

And so first, to prevent injury, we just have to make sure we’re recovered well, well-slept and well-fueled. So that’s why we spent so much time on energy availability and RED-S. Because if we’re a practitioner trying to keep our athletes on the court, on the field, in the pool, on the track, whatever it is they do, for as long as they choose to, and we want to as much as we can help them be injury-proof, then we have to make sure they’re well-slept, well-recovered, and well-fueled outside of just the skills and the things they need to compete.

Once an athlete is injured, there are again a handful of really nice papers that show basically five things from a supplement standpoint that we know can impact and improve and support the rehab process: creatine, collagen, omega-3 fatty acids, vitamin D, and protein. So again, really nice papers. The data is out there. I can give just the general metrics or the general dosages that most of those papers concur on.

The protein I already covered, so somewhere between 0.75, excuse me, 0.75 and 1 grams per pound of body weight of protein. And again, in a bigger body weight athlete with a severe injury, I might go acutely higher. Especially if I’m trying to manage body composition and their mobility is limited, we might shift that up and shift carbohydrate load down.

Although there was an interesting paper that showed that we may need more carbohydrates than we think during the healing phase after an injury. And so that’s had me rethinking carbohydrate dosing in the post injury phase, especially if body composition isn’t a concern for me, and again, depending on how much rehab and movement they’re getting. And so that’s really something interesting for us to keep our eye on. So that’s the protein component.

The collagen data is somewhere between 10 and 20 grams. So 10 and 20 grams of collagen best dosed before and after rehab if they’re in a rehab setting. I love collagen before, somewhere in the 60 to 90 minute window. If we think about the white tissue that collagen is mostly feeding, so ligaments, tendons, and fascia, there’s not a lot of direct blood supply to that tissue, but it’s attached to things that get a lot of blood supply like our muscle.

And so when muscle is working, there’s a greater amount of blood supply to the working muscle, which then means there’s more oxygen and nutrition going to the working muscle. So in the case of tendons, they then directly benefit from that. So that’s why we like collagen in that pre-work or pre-rehab window. And then if you’re in a rehab setting, there is an injury, I might like to get another dose after, so we can get that 10 to 20 gram dose in.

Creatine, it can be based on body weight. In males for sure, it’s like 0.1 grams per kilogram body weight. I like to start women off a little lower. Creatine has an osmotic effect on the cell, it’s a cell volumizer, and sometimes women don’t like to feel volumized initially. They might want the strength and power benefits and the healing and brain benefits of it. But I just like to go by dose, so two to three grams, and then I might work up to a max of five grams in women. But I find that women do best around the two to three grams of creatine per day dose.

Evelyne: Do you do a loading dose with everybody or just with females? And then how long do you do a loading dose? Or you just start with two to three grams and then maybe … When do you work up to five? How do you determine that?

Jill Lane: So I think it’s a personal preference. I never load creatine. The data shows you can load. The one instance I might load is if I’m working with a vegan, vegetarian that’s agreed to take creatine because they’re not getting it in their diet, which the research would show those are the people who are most efficient in it and that who then have the most dose response to starting creatine.

Evelyne: Gotcha.

Jill Lane: I might load a male vegan, vegetarian who’s really desperate to add some body weight, strengthen power to saturate their cells quicker. Everybody else, I just start on the dosing recommendations I just gave because we get creatine from the food we eat. And so I’m just trying to top off. And the data does show that somewhere around five grams per day is enough maintenance dose for most people who are meat eaters.

And so I give women just a little bit less. And then again, I might give a little bit more depending on that 0.1 gram per kilogram. But I find that five grams per day is a nice sweet spot for most men. And again, I give women just a little bit less, and I might give lower body weight student athletes that female dose as well.

Evelyne: At what age do you start supplementation with creatine?

Jill Lane: That’s a good question. I get asked that a lot in my private sector business because everybody wants to know what little Johnny can take to get jacked, but Johnny has to eat food. Johnny has to eat food first and sleep before he gets creatine. So I’m not opposed to student athletes taking creatine because of the … I just got this question last week with a group of strength coaches I was with. The coach had a concern about it and I said, “Well, do student athletes eat protein? Yes? Then there’s no issue with them taking creatine.”

In fact, I think the data on creatine for neuro-protection and the other benefits is so convicting right now that if your student athlete plays football, plays hockey, I mean even maybe soccer at this point, gymnastics is the highest rate of concussion in females because of falls and accidents, that along with fish oil and the data we know about fish oil when it comes to just helping with TBI and concussion that it’s something to consider.

But I will, if the goal aligns with what creatine can provide, then it is something I think any student athlete can take, but I want them working on daily habits first. So they’re going to work on their fueling. We’re going to make sure they’re sleeping decent. We’re going to make sure they’re well-hydrated, and then it might be step three or four. They kind of have to earn their way to it to let me know they’re serious about getting the goals.

Because you can’t just take creatine and be under-fueled and expect it to do magical things for you, especially if you’re trying to add mass or muscle. You have to have all the raw materials. You have to have those LEGOs for muscle protein synthesis and building new tissue. And creatine doesn’t provide that, that’s not how it works. It’s not an amino acid in that sense. And so you need to have all the other stuff on board to really get the max benefits of creatine from a strength and power and addition of muscle standpoint.

Evelyne: And before you go back to fish oil, one more question on protein. I know a lot of practitioners who give their kids additional protein in the form of protein powders. Do you think that there’s a certain age where that’s appropriate or not appropriate to supplement with protein powder?

Jill Lane: I think it’s appropriate anytime you want them to have more protein. So as long as it’s a Certified for Sport protein-only powder, then I think it’s akin to eating chicken or eggs or turkey or beef or bison or fish because that’s what it is. It’s just a food raw material. It’s probably the closest thing in the supplement world to being like a food.

And so, as long as it’s just a protein powder, it’s a solid whey protein, it’s beef protein, it’s maybe a plant-based protein mix if you need that, then it could be like eating protein. And I have a lot of my student athletes who need it because the average student athlete, especially those who are trying to add muscle and body weight has to eat six times per day.

And so that’s a decent amount of food and we can augment protein load very easily by making a protein shake. So it’s not uncommon for a student athlete to have three meals, two protein shakes, and then another high calorie snack to meet those needs.

Evelyne: Okay. So, sorry for interrupting you. I just had a lot of questions in there.

Jill Lane: Sure.

Evelyne: So we talked about collagen, we talked about protein. Let’s go back to fish oil.

Jill Lane: So for the functional medicine practitioners that might be listening, if you can draw an omega-3 index, then you can get a snapshot on what your client or athlete needs. So really the data shows to just make sure that omega-3 index is in the right zone. I mean, I don’t see any that are normal when I do an omega-3 index test on an athlete. And so because of that, if they’re a fish eater, we’re getting more of the right types of fish in their diet. And especially if they play a high collision sport, we’re supplementing with fish oil because I think the data on the neuro-protection of it is really important.

If you can draw those labs, you do that. And if you can’t, then you’re just again asking, do they eat fish? Do they like fish? And seeing can they work to find a couple recipes where they might like the taste of salmon. Give them something, give them an action item, something to do.

And if they just absolutely won’t have it or they just can’t get enough, the American Heart Association’s recommendation, I believe, is two servings of fatty fish per week. Most people aren’t doing that. And so I just think because of that, fish oil becomes really important. And again, the data in the return to performance and rehab and injury risk reduction papers all correlate with that.

Evelyne: Great. And what else for injury prevention and then returning to sports?

Jill Lane: Vitamin D has some interesting papers. I mean, I think we can’t learn enough about what … I mean, I think vitamin D at this point does everything. But there was a paper in the journal Nutrients, sometime in the last five years or six years, which talked about vitamin D’s role in injury risk reduction, musculoskeletal health, and illness, which is really important as an athlete escalates in their eliteness.

On the pro athlete side, I have three jobs with my athletes. I have to make sure they’re available when their name is called. I have to help them make sure they produce when they’re on their court, their field, whatever. And I have to make sure they can do it as long as they possibly choose to. And so injury and illness reduction is important.

If you’re sick, you might not get a play. If you’re injured, you might not get a play. And the better you get at your sport, the more there’s another guy or gal right behind you to take your place. And so being available as often as possible is really, really important.

So vitamin D, optimizing vitamin D levels, which I think we all know is important, is really important in athletes because of its correlation to healing, not just the bone, but also musculoskeletal injuries.

Evelyne: Thank you. And since you mentioned concussions, we could again probably talk about that for a whole hour, but I actually just want to share a success story.

So someone I know from high school was in a serious cycling accident a few years ago and she had posted about it on Facebook, and I reached out to her and I just said, “Can I send you a few supplements?” Well, I first asked her, “Are you getting the help you need?” And she was out of work at this point. So she was a lawyer, wasn’t working because of this serious injury and concussion from the cycling accident. And so I sent her a few things and then she continued using them.

But I just got a message from her recently and she said she’s been back at work. She’s able to work again. Nobody else had helped her. And she was seeing specialists I think at some prestigious schools, I won’t name them, in California. So it was crazy. But I think I had recommended glycerophosphocholine, curcumin, probably some brain nutrients, fish oil for sure. I think those were some of the biggest ones. Oh, and magnesium threonate.

And it was just amazing. I mean, I don’t know which of those had the most impact. I think it’s definitely a combination of working on everything. But it was just such an amazing story because there are so many things available that people don’t know about that actually could help and that do have research behind them.

With something as serious as a TBI, I just can’t believe that people … I mean, we read about it in professional athletes and what happens, and it’s just so sad to me because there are ways that we could help and it’s just not being done.

Jill Lane: I mean, that’s an area of medicine I feel that could be advanced a long way if we took a more integrative approach for sure. Two of my kiddos had concussions this year, one from heading the ball in soccer and one from taking a volleyball to the face during a volleyball practice. And they utilized almost all of those supplements you mentioned along with high performance fats in the diet and managing blood sugar and just getting the appropriate rest.

I kept mine out a little longer than some of the typical recommendations would be for return to play, because in a youth, I feel like you really need to make sure the healing is all the way there. There’s just too much at risk in the developing brain to rush them back. So yeah, I think that’s great. I’m so happy to hear she had great results, and I do think there’s a lot that can be done with supplements and other sorts of therapies.

And I actually think people go back to sport sooner than they should just because of the pressure and this, that, or the other. And it would be great if we could just revisit that conversation and really look into the rest of the things that can support a healing brain and what the brain’s metabolic needs are after a TBI because its metabolic need is really high, really high.

Evelyne: Super interesting. So Jill, before I ask you some personal questions to wrap this up, we mentioned the Designs for Sport Certified for Sport, and you mentioned it in the protein conversations. What is the importance of using a Certified for Sport product? When is it not necessary? To me, I feel like it’s if you’re working with a professional athlete maybe who gets tested, I think it’s important then, but are there other instances where you think it’s necessary? Or I guess in NCAA as well.

Jill Lane: So just to make sure everybody’s clear, so NSF Certified for Sport is the gold standard third party banned substance testing in the United States. In major leagues like Major League Baseball and the National Hockey League, the NHL, those teams are not allowed to use any product that’s not certified NSF Certified for Sport. Some of the other leagues, it’s heavily suggested.

But there are other testing entities that are more globally recognized, but in the United States, NSF Certified for Sport is really the gold standard. It’s a third party test that tests for over, I think it’s up to almost 300 entities that could cause an athlete or anybody, including people like first responders who are subject to banned substance testing because of their jobs, so sometimes CEOs. So we think of it as for athletes, but honestly I think it’s for everybody.

And JAMA, the Journal of American Medical Association in ’90, or I’m sorry, four or five years ago, during the pandemic, so I apologize, I can’t remember, published a research paper in the Internal Medicine JAMA. And in partnership with NSF, they bought 24 multivitamins, OTC, over the counter multivitamins and tested them for banned substances. Half of them failed for banned substance testing.

Evelyne: That’s crazy.

Jill Lane: So we like to think of NSF as only for athletes and only for things like weight gainers, protein powders, pre-workouts, stuff that lives in the performance sector. And while yes, we need to have those products tested clean for a variety of reasons, half of these multivitamins fail for banned substance testing.

And they get warning letters, that’s how it works with companies, that their label claim isn’t matching and there’s something in there that’s failing for banned substance testing. And when they went back to test the products, again, half were still testing and the rest of the companies had went out of business.

So it’s a different discussion about how the supplement industry works, but because of that, I believe that everybody can benefit from taking something that’s Certified for Sport. As a mom of student athletes, I don’t want my kids taking something unknowingly that would cause someone to fail a banned substance test.

And the top categories are hormone mimickers, stimulants, and blood doping agents. And so I don’t want my kids that are in a very robust stage of growth and development to be on a hormone analog or something that acts like a hormone or influences hormone metabolism unknowingly. I don’t want them to be on a stimulant unknowingly. And I don’t want them to be on some type of masking agent or blood doping agent without me knowing it.

And so NSF tests for those items. They also check label claim. Things that NSF doesn’t do or they don’t really take a stance on, they don’t take a stance on things that I care about, like artificial sweeteners and colors and things like that. And so while NSF is good just to check to make sure what’s on the label is supposed to be on the label, they don’t really take a position on the form of the nutrient, the dose of the nutrient, or additives that might be in there, like artificial colors and flavors and things like that.

So as someone who might utilize or recommend or buy supplements, you want the best of both worlds. You want to work with a professional company like Designs for Sport or Health, who cares about those things and use the NSF testing to check the math of that company, but then also check for the potential banned substances.

And so that’s what NSF really helps us all sleep well at night. It’s for everybody, but athletes can start being subject to banned substance testing as early as their youth, especially if they’re at a private school. I’ve done consulting for private schools where the kids get random drug tested. You definitely get tested on the NCAA level.

And by the way, caffeine is a banned substance in the NCAA. It’s a urine test based on intake. And so probably like the ice tea from Chipotle at lunch isn’t going to cause someone to fail a banned substance testing, but a pre-workout, a few Monsters, a few Celsius, and then it stacks up. And if you have poor caffeine metabolism, that could be a problem for you.

And so if you work with athletes, you need to know these things. You need to know the difference between what’s considered a banned substance at the collegiate level and what’s considered a banned substance at the pro level. Each league has different banned substances, the IOC has a stance on it. And the bottom line is for the most part, NSF covers all of it, except for there still may be products that have caffeine in them that you should be aware of for the group of collegiate athletes that are under NCAA governing.

Evelyne: Thank you for sharing that, Jill. I think some days I might fail a banned substance test for cappuccino intake. So I’d love to ask you a few questions that we ask every guest on Conversations for Health. First of all, what are your top three supplements that you take?

Jill Lane: Great question. So creatine, I just started supplementing with creatine a couple months ago and I can hands down tell you for sure that it’s made a difference in my strength and power in the gym, and I just generally feel like I have a bit more energy. So that’s been really fun and exciting.

I’m a big fan of nicotinamide riboside, so I supplement with that every day. And gosh, the third would be a tie between magnesium threonate that you mentioned and collagen. I love the tripeptide collagen that we have. I love the data on an athletic population. And so as someone who’s just trying to prevent from falling apart as I age and as a former athlete that didn’t know any of the stuff that I teach, I love collagen just for my joints and my skin. So I gave you four. I cheated.

Evelyne: That’s all right. And we haven’t talked about nicotinamide riboside on the show. I think it’s interesting because talking about the energy availability and deficiency, I think that causes mitochondrial issues, right? So it’s interesting to think about using supplementation that can help with the mitochondria. But of course, we have to address all of those underlying things first before supplementing to improve that or lead to mitochondrial biogenesis, but very interesting.

What are your favorite health practices that keep you healthy and resilient and balanced, especially traveling all over and teaching and Momming and all the things?

Jill Lane: I love it. Sleep, number one. I love my sleep and I love magnesium threonate for that. When I wear my WHOOP, which I do just periodically to just check in to see where I’m at, my sleep tracker and HRV tracker, I always notice when I’m on magnesium threonate that I get more time in deep and REM sleep. And so I really appreciate it for that. So I always tell people just to experiment and see if you notice that. So sleep for sure. I got to get my sleep.

I strength train a minimum of three times per week and just took up boxing. I felt like I needed to learn a new skill that really challenged my brain. And so I’m into my fifth boxing lesson, and that’s been really good just to step outside the box and do something I would’ve never thought that I would do from a physical standpoint.

And the third would be just to be around people that make me laugh. Everybody has a lot on their plate and I just feel like laughing is the best medicine to a busy lifestyle. So yeah, strength training and adding some new stuff into my repertoire when it comes to just exercise and fun with the boxing, sleeping and laughing.

Evelyne: I love it, Jill. You’re such a badass. I’ve known you for, gosh, more than 10 years now, and we’ve had the chance to work together over all those years and yeah, that’s really cool regarding the boxing. You’re amazing.

Okay, last question for you. What is something that you’ve changed your mind about through all of your years doing this? I’m sure there are lots of things.

Jill Lane: I mean, I think for sure a hard pivot I had to take when I went from working in general population with functional medicine training into athletes was carbohydrate intake. So I went from the early functional medicine days of no carbohydrates, low to no sugar. And not to say that doesn’t get results, and just hear me that I know that that has a place. But as soon as you start working with athletes, you have to immediately understand that there is an exception to the rule because it is the body’s primary fuel source. And I’m not going to get into keto athletes and all of that. I think that’s something I don’t do. But carbohydrate intake and low energy …

So in the new paper, the new British Journal of Sports Medicine paper, there actually is a carve-out in low energy availability and RED-S for low carbohydrate availability and the impact that too low of carbohydrates may have on the metabolic need of athletes based on their training load and volume and their growth and development phase.

And so I have to dance between those two knowledge sets that I know there’s a time and place for low carbohydrates and lower sugar intake. And that if I need my athlete to go out and play 90 minutes of the best, highest, intense soccer they’ve ever played in their life, they need to have carbohydrates on board. And we need to have been fueling that for 48 hours beforehand to prepare because we never wait to the pregame meal to get that squared away. And they have to perform, and so we need carbohydrates.

And so that’s where the nutrition periodization comes in. We may be able to get away with a bit less in the off-season or during certain times of the week. Or I’m working with an NFL player, there may be days in the middle of the week where it’s lower. There’s the strategy and a strategic approach you can take that makes nutrition fun, to be honest with you.

But that was a pivot for sure. I had to really get my hands around that there’s a time and place for carbohydrate intake and you have to be able to accept both worlds to have the best impact.

Evelyne: Well, thank you so much for sharing that, Jill. This has been such an informative conversation. I really enjoyed it, and I could talk to you for another hour or two. I have so many more questions that we could go into. This was so much fun. So thank you and I love working with you.

Jill Lane: Thank you so much. I really appreciate the opportunity to share. I owe a lot of my education from my early days to Designs for Health and all the education that you put out. So it’s an honor for me to be able to give back and pass it on, which is the point of my career I’m at right now. And I love spending time with you, Evelyne. So thank you for having me.

Evelyne: Thank you, Jill. And thank you for tuning into Conversations for Health. Check out the show notes for resources from this conversation, and please share this podcast with your colleagues, follow, rate, leave a review wherever you listen or watch. And thank you for designing a well world with us.

Voiceover: This is Conversations for Health with Evelyne Lambrecht, dedicated to engaging discussions with industry experts, exploring evidence-based, cutting edge research and practical tips.

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