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83. How Low Energy Can Impact Your Health as an Athlete · Eat More Carbs | A Period Recovery Podcast

0:00
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Com. This is the Eat more Carbs
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podcast. Hello and welcome to the Eat
0:41
More Carbs podcast. My name is Jenna Fischer and I'm
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here with my Co host Riley Beatty.
0:44
This episode is a two-part series in which Riley and I are
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sitting down with a dietitian and a physician from from
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Children's Hospital in Colorado. During these episodes we are
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going to be talking about relative energy deficiency in
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sport and we will include topics such as eating disordered and
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disordered eating. We just wanted to let you know
1:00
before we get into some of these really heavy topics.
1:02
If you're an athlete and you're listening to this podcast and
1:04
you start to recognize some of these symptoms and these signs
1:07
might be something that you are experiencing.
1:08
As we encourage you to reach out to Riley and I or join our wait
1:11
list for a one-on-one concierge sports nutrition program.
1:14
We hope you enjoy this series. Before we get into it, Riley,
1:16
what's your high and low both? My high and my low have to do
1:19
with my current move, which by the time this podcast goes live,
1:23
I really hope is old news and we have officially sold our house.
1:27
But today I'm going to be starting off with my high.
1:30
First, it has been pretty challenging having a baby and
1:33
trying to move and sell a house and buy a new house, especially
1:37
with the housing market right now.
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A huge shout out to my family and then also Rob's family for
1:44
really helping support us during this really hard time.
1:47
They've been so amazing. And I'm currently at my parents
1:50
house as we're recording this and they have Charlie, they're
1:52
going to the park with her. And I'm just so thankful that we
1:55
have so much family support right now because this would not
1:58
be possible, especially running a business with you right now
2:01
and everything. So just a huge shout out to
2:03
everybody who's being so supportive of the move right
2:06
now. So that's my high.
2:07
My low also has to do with a move.
2:09
And I've been dying to tell you this, but I had to keep it a
2:11
secret for the low this week. This is one that you all want to
2:15
sit down for. We are currently relocating to
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Winston Salem, NC and our house is currently in Charleston, SC
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Rob's, my husband has to be in the office five days a week and
2:25
we're obviously moving to Winston Salem.
2:27
So we've been trying to spend as much time as we can there to get
2:30
acclimated, to get Charlie used to it, to get, you know, set up
2:33
with our community and our new life.
2:35
We spent two weeks away from our house in Charleston and at the
2:39
beginning of October we went back down to Charleston to move
2:43
out all of our stuff to put it into storage.
2:45
So we're just not tied back to that location.
2:47
We've just driven 5 hours from Winston to the house.
2:50
We haven't been in the house in two weeks.
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Our house smells completely terrible, Jenna, I'm not
2:54
kidding. It smelt like there was a dead
2:56
animal in the house. We walk in, we're just
2:58
exhausted, toes screaming. We are like, what happened?
3:02
Our house is still in the market.
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It smells like a dead animal. We've had like at least three or
3:06
four showings this past week with the house in this
3:09
condition. We're like no wonder people are
3:10
spending literally 5 minutes in our house because the house
3:13
smells so bad. We're like what the heck smells
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like this? Like we're like something like a
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possum called in something died. We're walking around the house.
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Robbie opens the fridge. It is completely filled with
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black mold. The fridge lost power because of
3:29
the hurricane. Everything in our fridge has
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like black molded. The whole fridge is like a fuzzy
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black mold. We cleaned out the fridge pretty
3:38
good, but the freezer everything melted and has just been sitting
3:42
in the heat. The entire freezer is black.
3:46
Mold. Oh my word.
3:49
Was a very our house is elevated.
3:52
We live in like an elevated home.
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So like we had to get the fridge out the house and we can't get
3:56
it down the stairs because it's just Roddy and I.
3:58
So then we have this like black mold fridge sitting on our porch
4:01
for like 3 days before the movers could come and like help
4:03
us get it down the stairs. I would have asked the movers to
4:05
bring it down the stairs and then I would just lit it on
4:07
fire. How do you come back from that?
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Did it clean out OK or was it like, I can't imagine.
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I can't imagine just the thought of having to clean out a fridge
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covered in mold. Like I would just imagine myself
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like in a face mask gagging, like being the most dramatic
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ever and then just being like, we just have to get rid of it.
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Well, that's what. Happened is throw it away.
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We need to we need to clean it out.
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So grabby like rest of soul starts cleaning out the fridge
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and he's like I can't do this we just have to get it out of here.
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So we were like we're getting rid of the fridge like we're
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getting rid of the fridge. We're moving.
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Sorry y'all, you're gonna have to buy a new fridge.
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We take the fridge, we put it on the curb because the trash
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people come by and like they'll pick it up or, you know,
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sometimes people come and take it.
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Some guy took it for scrap metal.
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I was like. That brave soul, more power to
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him. But my gosh, I would have been
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like, I'm leaving this. Yeah.
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I'm still haunted by the smell. Oh my gosh.
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What about you? What are your high and your low?
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I don't have any black mold in my house, so I feel like I'm
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doing pretty good. I actually was thinking about it
5:00
before we jumped on the podcast. I feel like I have so many
5:03
things that I could share for my high, but I'm going to choose
5:05
the thing that was most recent because I got a letter in the
5:08
mail today and I looked at the like return address and I was
5:12
like, I don't know who these people are.
5:13
I opened it up and it was a save the date from a previous client
5:17
of mine who had decided to invite me to the wedding.
5:20
And the reason why I didn't recognize the return address, it
5:22
was because it was the parents of the fiance.
5:24
So I didn't recognize the name. And it was just so touching and
5:29
so heartwarming. And of course we don't expect to
5:31
be invited to every single one of our clients weddings, but to
5:34
establish a relationship like that.
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This client is one of the sweetest, kindest people I have
5:39
ever come across in my career as a dietitian.
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It would just like really warmed my heart.
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I could cry just talking about it.
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This person and their fiance felt compelled to invite me and
5:48
my husband to their wedding. Just like really hit me in the
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fields. So that's definitely my high.
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Maybe for like the entire year. It really made my day.
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I hung it up on my fridge. That's so.
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That's my high, which I wanted to share that first.
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My low is not nearly as a traumatic experience as yours,
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but I love to cook. I love to make a delicious meal.
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I love to make a balanced performance plate in a single
6:10
pot. Those are my jam kind of
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recipes. I am not a good Baker and I will
6:15
openly admit to that. And last night my husband had
6:19
some work things to do. And so I was like, you know
6:20
what? Like he's going to come home and
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I'm going to have baked something delicious to be like,
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look what I did while you were gone.
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That seems like such a wonderful way to spend my evening.
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And I really didn't read the recipe that closely.
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I'm just like going through the motions and I had accidentally
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added double the amount of butter.
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I don't know it's. So.
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Interesting. It needed 1/2 of a cup and I
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added a cup of butter. When I was thinking about it, I
6:45
was like melting the butter because it was like a stick of
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melted butter and I guess their sticks were half stick, you know
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what I mean? Like sometimes they're half a
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cup. I.
6:53
Agree with you because sometimes you're like, is this a half a
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stick or is this a whole stick? I got you.
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I'm supportive of this, I would have made it possibly the same
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OK. Thank you.
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Because I was like, this isn't right.
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Like this is not the right consistency.
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I put it in the oven and I'm watching it cook and I'm like,
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what did I do? Like the butter is seeping out
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everywhere. And I was like, this is wrong.
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And then I looked at the instructions again and I was
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like, oh, you have unintentionally really doubled
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some ingredients here. We can't be good at everything.
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And for me, baking is one thing that I am not good at it.
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That is so funny. Honestly though, we need a poll
7:28
because I think that a lot of people would have also made that
7:30
mistake or have made that mistake before we.
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Really do hope you take a lot away from this episode of the
7:35
Eat More Carbs podcast. Please enjoy.
7:38
Aubrey and Amanda, welcome to the podcast.
7:39
Hi, thanks for having us. We're so excited to chat with
7:42
you today. Before we get into some of the
7:44
questions that we have, can you guys share just a little bit
7:46
about your background and the work that y'all do at Sports
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Medicine Center and Children's Hospital in Colorado?
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Sure, I can start. So I'm Aubrey Armento.
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I am a pediatric sports medicine physician at Children Colorado
8:00
and an assistant professor in the Department of Orthopedics at
8:04
the University of Colorado and my background is first in
8:07
Pediatrics and then did a fellowship in primary care
8:11
sports medicine, all of my training in Colorado and then
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was lucky enough to come on as faculty at Children's after my
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fellowship. So I have been here for going on
8:23
or going into my 9th year now and my special area of interest
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is in the athletes triad, relative energy deficiency in
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sport and eating. Disorder.
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I'm Amanda McCarthy. I am the program coordinator for
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sports nutrition at our Sports Medicine Center, and then I'm
8:39
also the primary sports dietitian in our facility as
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well. I did my undergrad in dietetics
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and then master's in dietetics at Missouri State University and
8:48
then the University of Kansas Medical Center respectively.
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And then kind of did a little loop around the country and
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ended up in Colorado. I've been here for 12 years now
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and my role at Children's, I do a lot of one-on-one counseling
9:00
with young athletes that our physicians are seeing.
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So oftentimes they have some type of injury or an under.
9:05
Fueling concern is the majority of my role.
9:07
And then I also do a lot of outreach and education within my
9:10
role. And then I'll also support
9:12
physicians research projects that are around nutrition.
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As well, in today's episode, we're going to be talking a lot
9:17
about Reds and how that evides you a lot of the athletes that
9:20
we work with. Before we jump in to talking
9:22
about some of the nutrition application for Reds, I would
9:25
love for you both to help us define red.
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So what is relative of energy deficiency in sports?
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Sure. So RED is the OR encompasses the
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physiologic, psychologic and performance impairments that can
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occur in the setting of low energy availability or LE A.
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So LE A is inadequate energy available to support normal
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functioning in those various capacities so physiologically
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but also from a sport performance perspective.
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And so the model of Reds describes all of these different
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bodies, systems and different sports performance areas that
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can be negatively affected and an athlete who has low energy
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availability, typically more chronic or more severe low
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energy availability overtime. What athletes are most commonly
10:15
seeing Reds in? Athletes that tend to have a
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larger focus on a lower weight ratio for their sport, lower
10:22
weight to power ratio are often at higher risk.
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So a lot of your endurance athletes, so I think of runners,
10:27
cyclists, triathletes, but then like wrestlers oftentimes
10:31
because they're trying to make weight for their specific sport,
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aesthetic based sports. So gymnastics and dance are
10:37
higher risk as well, any anti gravitational sport.
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So gymnastics would fit into that.
10:42
But also like rock climbing, those athletes who are very
10:45
aware of their weight in relation to their performance.
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And I would say generally the culture of the sport can tend to
10:51
encourage lower body weight. Those are the highest risk
10:54
athletes. Is this something that we're
10:56
seeing in only female athletes or can it affect male athletes
10:59
as well? We see it in all athletes.
11:01
So female athletes may be more at risk for Reds and disordered
11:06
eating. Although I think that there's
11:08
probably a component of underreporting or under
11:12
diagnosis or recognition in male athletes.
11:15
So Amanda and I see lots of male athletes in addition to female
11:19
athletes with. Reds.
11:20
You mentioned some physiological implications.
11:23
What would those be for someone diagnosed with Reds?
11:26
So essentially the body works to concern energy in various ways
11:32
in the setting of low energy availability.
11:35
And some of those adaptations can include things like GI
11:39
distress that comes from the gut slowing down South, we see a lot
11:44
of athlete that complain of getting full very quickly,
11:47
feeling bloated, Constipation. Other stomach complaints we'll
11:52
see decreased heart rate and blood pressure, so low resting
11:56
heart rate or orthostatic intolerance, micronutrient
12:00
deficiencies, iron deficiency, vitamin D deficiency being the
12:03
most common that we typically see.
12:06
And then there are basically everybody system can be
12:10
negatively affected in the setting of Reds.
12:13
And then you also have these performance impairments, so
12:17
decreased power strength, endurance, impaired recovery,
12:22
sleep disturbances, psychological consequences as
12:27
well. So it really covers the whole
12:29
gamut of an athlete, health and well-being just generally, but
12:34
also in their sport. So it sounds like it's a lot
12:36
more intense than maybe just. Losing our period, correct.
12:39
Yeah. So I didn't even mention, I
12:41
didn't even mention that when we talked, talked about Reds to
12:43
start. Another consequence of Reds is
12:47
hormonal suppression. In particular, reproductive
12:51
health can be affected. So in female athletes, we see
12:54
the loss of a regular period. In male athletes, we'll see low
12:59
testosterone and consequences of low testosterone including
13:03
decreased sex drive, increased fatigue, changes in body hair
13:07
patterns and things like that. So consequence of low estrogen
13:12
primarily and the female and then low testosterone and male
13:16
athletes and then bone health as well.
13:18
So when we think about the triad more specifically, that's going
13:21
to highlight the reproductive hormone consequences and the
13:24
bone health consequences of low energy availability.
13:28
You mentioned the triad or somebody listening who isn't
13:31
familiar with that. Can you define what that is?
13:33
Sure. So the triad focuses on the bone
13:38
health and then in the female athlete, menstrual health and
13:41
the male athlete more testosterone related changes
13:45
secondary to state of low energy availability.
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And the triad was described back in the 80s for the first time
13:53
and has been around for a long time.
13:55
There's a lot of research on the triad more recently around the
14:00
male athlete triad, but certainly kind of decades of
14:03
research on the female athlete triad.
14:05
I still like to consider the triad as its own kind of
14:08
distinct clinical entity, but Red sort of goes beyond the bone
14:13
health and the menstrual health or reproductive health
14:16
components to include these other body systems that can be
14:19
affected. But at the heart of both of them
14:22
is low energy availability. I'm so glad that you brought
14:24
that up because it can be really confusing for an athlete who is
14:28
maybe struggling with low energy availability because there are
14:31
these like terms and different things that are thrown around.
14:34
So I'm really glad that you helped kind of differentiate
14:36
between Reds in the triad. And I'd like to add, I think
14:39
that as female athletes, I mean we're all female athletes here
14:42
in the room. And so for female athletes
14:44
specifically, when we look at adequate energy availability,
14:47
it's different than that of male athletes, right?
14:49
So research is showing that female athletes need 45 calories
14:53
per kilo of lean mass at baseline without added exercise
14:57
on top of that just for normal work and function, just for the
15:00
HPA access to work normally. Whereas in males, research is
15:04
suggesting maybe they're closer to like 30, 40, so they don't
15:08
need quite as high of energy needs compared to what we do per
15:12
kilogram of lean mass. And I think you know that that's
15:14
really telling when you're actually looking at the picture
15:16
and looking at how many female athletes end up in this
15:18
situation of low energy availability.
15:20
We just have higher demands per kilo of lean mass than male
15:24
athletes. Do I think that's important,
15:27
especially if you find people comparing themselves to other
15:32
athletes or certainly a female athlete to a male athlete?
15:36
And the fact that the threshold at which we start to see these
15:40
negative consequences occur is different, honestly, for
15:44
everyone, even in female athletes, we're seeing there is
15:46
likely some variation in that threshold at which, you know, we
15:50
start to see that hormonal disturbances and loss of a
15:52
period. But generally, as far as what we
15:55
know, male athletes can tolerate lower energy availability before
15:59
they start to experience the negative consequences of it than
16:03
female athletes. And I think that is helpful to
16:05
explain to people, especially if they're sort of in that
16:08
comparison trap of like, well, this person can do this and
16:11
they're totally fine and they're not injured and they're not
16:14
having these problems, but you know, I am.
16:17
And so kind of explaining that individual variation and sex
16:21
differences in energy availability I think is
16:24
important for people to understand with Reds.
16:27
It kind of sounds like that there are a lot of things that
16:30
someone might be seeing as far as those have physiological
16:32
effects. Is it that someone diagnosed has
16:34
all of them, or could they only see some of them?
16:36
Oh yeah. That's a great question.
16:38
You do not have to have all of those in order to make the
16:40
diagnosis. The diagnosis of Reds is in a
16:43
lot of ways you want to exclude other things that could be
16:47
leading to. So for example, if someone's
16:50
lost their period, right, like we need to make sure that they
16:52
don't have PCOS, for example, or something else that that would
16:55
be an underlying disease that would be leading to those
16:58
changes. So you want to make sure you're
17:01
excluding other pathology and sort of coming to this more like
17:04
functional, you know, amenorrhea in the case of that example.
17:09
But we see athletes that may just have one or two components
17:13
of that Reds model, but with all the other pieces from a history
17:17
perspective, from Amanda's diet analysis and from their labs,
17:22
for example, rights, like all of these different things sort of
17:25
go together and making the diagnosis of Reds, there's not
17:29
really one test or a certain number of symptoms you have to
17:33
show in order to meet criteria for that diagnosis.
17:37
I'm sure we'll touch on it a little bit later, but I think
17:39
this already goes to show how important it is for an athlete
17:42
to meet with a physician, a dietitian, like a whole team of
17:45
people when approaching something like.
17:47
A Reds diagnosis? Absolutely.
17:49
I agree. You'll hear.
17:50
Us say this probably like at least five times today.
17:52
We always talk about how this podcast should be called it
17:54
depends and instead of eat more carbs because it's such an
17:57
individualized approach. Like all of this is when it
18:00
comes to nutrition, when it comes to Reds And I think you
18:02
just highlighted it there as well as it really depends and we
18:06
have this diagnosis, but the symptoms aren't going to be the
18:08
same in. Everybody.
18:09
Yes, for sure. And I think what's also tricky
18:11
is like sometimes athletes can start under fueling, like they
18:14
start flirting with under fueling themselves to see what
18:17
can happen with their performance or with their weight
18:19
or whatever they're looking for. And I think what's really hard
18:22
initially is that sometimes athletes do see performance
18:24
enhancement from that initial restriction.
18:26
I like to call it the honeymoon phase of restriction, right?
18:29
So like they get a little addicted to it and they're like,
18:31
oh, this is working. Like why don't I try a little
18:33
bit more? And often when we're catching
18:35
them with a Reds diagnosis, it's because they get drawn into that
18:38
cycle of restriction and they want to do a little bit more
18:40
because their performance improved slightly initially,
18:43
which we have data that supports that, right?
18:45
Like small amounts for short periods of time probably does
18:48
improve performance. But how do you stop that from
18:50
becoming a cycle of just chronic restriction and chronic
18:54
underfueling, which then turns into relative energy deficiency?
18:57
So I think it can be really tricky and really hard for
18:59
athletes to kind of swallow that pill when they're like, I was
19:02
performing so well six months ago and now I'm falling apart.
19:04
Like what's going on? I think also a lot of that's
19:06
dependent on the sport. A runner, for example, right,
19:09
with a 5 LB weight loss, if that's what they're going for,
19:12
like Amanda said, initially, they may see some faster running
19:17
times and unfortunately that ends up acting as oftentimes
19:20
positive reinforcement for those restrictive eating behaviors,
19:24
but ultimately it's not sustainable.
19:26
So I think a big take home point Amanda and I like to make when
19:29
we're doing education to young athletes is that there are so
19:33
many other things that you can do to optimize your performance
19:37
that don't come with the risk of low energy availability and
19:41
sustained low energy availability, right?
19:43
Like to name just a few, sleep, eating more carbs.
19:46
There are things that we can do that have really no downside.
19:50
And so why sort of take the risk of flirting with that
19:54
restriction for those potential transient performance gains when
19:58
there are plenty of other things that we can do to optimize
20:01
performance that don't come with that risk?
20:04
I see that all the time where we have athletes that come to us
20:07
and they're convinced that their performance is going like one
20:10
way or the other because of their weight.
20:12
And I think we're so quick as a society to say, like, it's
20:15
because of my weight. I didn't perform well today.
20:17
I ran a little bit slower because I need to lose weight.
20:20
And you just mentioned there's all these other factors there as
20:22
well. You know, I even had an athlete
20:24
who was feeling probably properly, she was preparing for
20:26
an like an Iron Man competition and she was really upset that
20:29
she didn't PR. And then afterwards she actually
20:31
found out she was pregnant and she had just competed.
20:34
But it could have easily been like, Oh my gosh, like this is
20:37
because of my weight and was like, there's all these other
20:39
factors that go into performance.
20:41
Totally. What might be some of the long
20:42
term implications for an athlete's career if they get
20:45
stuck into that low energy availability that chronic under
20:49
fueling state? My initial thought, especially
20:51
since we work with a young athlete population, is if an
20:54
athlete's chronically under fueling during these critical
20:57
bone building years, it's very possible that they could end up
21:00
with low bone density long term. So we know that up until about
21:03
the age of 18 is where we built the majority of our bone density
21:06
for our life. Just scary and exciting all at
21:09
the same time. Like it's fascinating and really
21:11
terrifying because I don't know how you guys, how smart you guys
21:14
were at 18, but I was not very wise at that age.
21:16
But. If they're under fueling and
21:18
that is negatively impacting their bone density, that could
21:20
be a lifelong struggle that they're dealing with.
21:23
And if they want to be an athlete and they want to be a
21:24
lifelong athlete, you know, that's something they are going
21:27
to have to manage for a really long time.
21:29
I think one of the positives is that what we do know is if we
21:33
reverse that energy availability and get them in adequate energy
21:36
like their muscle glycogen storage is going to improve and
21:39
their muscle protein synthesis is going to improve and bone
21:40
density will improve to some degree depending on what age
21:44
they are and where they're at in that cycle.
21:46
So we can see those improvements coming back, but especially the
21:49
bone health, it can be more of that long term impact.
21:52
Yeah, I think I probably put the most emphasis on the long term
21:56
implications of bone health in the population Amanda and I
21:59
mostly work with, which is that adolescent population and and
22:03
trying to really hammer home this idea that like now is your
22:07
time to make your bones as strong and dense as possible.
22:12
And I know it's hard as a 16 year old to really think about
22:15
you as a 60 year old, right. But when we think about like
22:19
osteoporosis risk, if you are here, when really you could be
22:24
here with your bone density if you did more to optimize it
22:27
right now, your chance of slipping into that osteoporosis
22:31
range. When we think about, you know,
22:33
making that diagnosis from a DEXA scan, you've much more at
22:36
risk for that into your adulthood.
22:39
And so I spend, I feel like a lot of time trying to provide
22:42
education around that. But I also think like in the
22:45
female athletes, specifically for someone who is not having a
22:48
menstrual period with low estrogen, estrogen is a super
22:52
important hormone for lots of other things just besides bone
22:56
health. We put a lot of emphasis on bone
22:59
health because that's a really important piece of it.
23:01
But estrogen also supports a lot of other body functions and and
23:06
being in a state of estrogen suppression for a prolonged
23:09
period of time is so not good. And then the other thing Amanda
23:14
and I see, I'm just thinking back to just a few patients we
23:17
saw together a couple weeks ago is like, we do see some athletes
23:21
who end up falling off of their growth curves in adolescents who
23:25
don't attain, you know, probably what their peak height velocity
23:29
would be and end up with either delayed puberty or changes to
23:34
their growth that you can recover if you act quickly
23:38
enough. But I mean, we saw an athlete
23:39
that was a couple years years past puberty and had fallen off
23:43
their growth curve, right? And we're like, well, we
23:45
probably don't have a ton of a window of opportunity at this
23:49
point to really make up that loss.
23:51
And so I think especially in that adolescent population as
23:54
they're going through puberty, emphasizing the importance of
23:58
nutrition to support that in addition to all of the other,
24:02
you know, exercise energy demands that they have as an
24:05
athlete. That's actually something that I
24:07
saw when I worked in college athletics during the 2020
24:09
pandemic, because a lot athletes were removed from sport and for
24:13
the first time they were actually having adequate
24:15
energies. So we had a number of athletes,
24:18
like go through delayed puberty and it was a very like,
24:20
interesting, I guess like side effect of the pandemic.
24:22
Yeah, that is interesting. It's like a forced break from
24:25
port and almost like a forced enhanced nutrition, right?
24:29
But it shouldn't be that way. Like ideally we need to prevent
24:33
athletes from even getting to that base.
24:35
But it's hard. We see that with athletes who
24:37
have those longer injuries. So like if they rupture their
24:40
ACI and they've been under fueled and now they're
24:43
sedentary, and then there's the mental health component that
24:45
comes with that and then they also start going through puberty
24:48
and then there's all kinds of feels about that.
24:50
And it's it's a lot for the athlete to deal with.
24:53
You mentioned injuries. I'm so curious, do you get a lot
24:55
of referrals like that are from injured athletes that are then
24:58
coming over to you? Because potentially that was the
25:01
first diagnosis was like a repetitive injury or something
25:04
like that. And then we kind of had to take
25:05
a step back and look and say what's the root cause?
25:07
Like why are we having injuries like this?
25:09
Is that something that you guys often?
25:11
Yeah, I would say from my side of things, all of our physicians
25:15
are very, very good about referring whenever there is a
25:18
stress injury or menstrual irregularity going on.
25:22
I feel like I get looped into a lot of Doctor Armando's cases
25:25
because she gets a lot of those athletes.
25:27
But all of our docs will refer for those and we're slowly
25:30
spreading the news, I feel like to outside providers and we're
25:33
getting more referrals from them as well.
25:34
So especially kiddos that have been struggling with like
25:36
recurrent injury, they oftentimes end up in my office.
25:40
Yeah, it's. Say, I think bone stress
25:42
injuries, super common diagnosis that leads some athletes to our
25:47
care. And then as we've been growing
25:50
our practice, we're getting more referrals for like disordered
25:53
eating or eating disorder concerns in athletes as well.
25:57
Thank you so much for listening to this episode of the Eat More
25:59
Carbs podcast with Doctor Aubrey Armento and Amanda McCarthy.
26:03
If you have questions for Riley and I, you can find us on
26:05
Instagram. You can find Riley at easy dot
26:07
sports dot nutrition and you can find me at Jenna dot Fisher dot
26:10
nutrition. Thank you again for listening.
26:12
Please make sure you rate, subscribe and review.
26:14
And as always, remember to eat more carbs.