nutrition and sports

Question

My 11 year old son with CF is involved in a lot of sports: intensive hockey training (1,5 to 2 hours, 3 times a week), hockey competition of 1,5 hours and 2 times 1 hour tennis training a week.
His trainer mentioned recently that he was “empty” at the end of the competition, there were no signs of breath shortage, but he had no energy left. His lung function tests are positive until now and he uses pancreatic enzymes (Creon), vitames en antibiotics (cotrimoxazol); no other medication.
My question is: is extra nutrition needed, such as supplements or salt (e.g. chips), during breaks ? Is his limited fat mass a symptom of his ‘emptiness’?

Answer

Dear parent,

Thank you for your question. It is very positive that your son is so active. I understand that you want to know if extra nutrition is needed when doing all these trainings and competitions.
The answer to this question is mainly based on a workshop at the 2007 North American CF-meeting.
The presented history illustrates that even for people with CF the sky is apparently the limit, but we should avoid imposing higher skies on those with CF than on healthy ones. We should bear in mind that even highly trained professional athletes are exhausted at the end of a sport event. Moreover people with CF should pay additional attention to their specific needs for fluids and salt, especially during long intensive exercise in a hot environment.
An adapted nutrition should be provided based on the classical recommendations of high protein and fat intake, always accompanied by an appropriate quantity of pancreatic enzymes (Creon). As carbohydrates are the preferential fuel for muscles more sugar, light pastry and pasta are served on sporting days. Especially if it’s hot, at least 2 liters are consumed of a non-gaseous, naturally sugared beverage like juice, sweet tea, sport or soft drinks. Ideally, the beverage should contain 8-12% sugar and 30-50 mmol/l salt. A further source of salt may be salty crackers or 3-4 capsules filled by the pharmacist with 250 mg table salt. During the half time of the match one more capsule is administered together with at least 25cc of a sport drink containing sugar and salt.
It is important to mention, that CF patients need to drink far more fluids than they think as they do not feel thirsty. Here, the Hypohydration, meaning the loss of salt and fluid, could also be the reason for the problem of your son. It could be advisable to weigh the boy before and after such a day to see whether all measures taken are effective. Last but not least, a consultation with the trainer and the physician could be good.
It is highly improbable that the low fat stores cause the exhaustion during intensive exercise. After all they are not specific for CF since they are also low in the best trained top athletes. During exercise carbohydrates are the fuel for muscle activity and fat mainly plays its role during the recuperation.
These recommendations will allow people with CF to intensively perform sports. It remains however paramount to recognize the body’s signals of exhaustion for which the only appropriate reaction is to stop and rest!

Kind regards,
Prof. Dr. E. Robberecht

28.04.2009