Nutrition for Female Masters Swimmers - Through Menopause and Beyond

When I completed my IOC diploma in Sport Nutrition, my final assignment was to complete a compilation of nutrition recommendations on a specific sport and/or sport population. I have long been interested in the changes a women's body goes through during menopause and postmenopause and the impact it has on sport performance. I would love to share some of this information with you! I'd like to focus today on the challenges that these athletes face and some nutrition strategies that may be useful. I will create a second post to summarize nutrition recommendations for this group.

Introduction

Although we have seen an increase in research specific to females concerning nutrition and sporting performance, there is still much to uncover.

Menopause typically occurs between the ages of 45-55, when the female body stops menstruating (Erdelyi et al., 2024). With it comes its own set of challenges, with body composition changes, risk of low energy availability, gut microbiome dysbiosis, fatigue and mood swings, vasomotor symptoms, impaired thirst mechanism, vaginal discomfort, incontinence, and increased risk of disease including osteoporosis, diabetes and heart disease (Greendale et al, 2019; Erdelyi et al., 2024; Sims & Yeager, 2022; Sims et al., 2023). At the root of these challenges are irregular declines in estrogen (particularly estradiol (E2)) and progesterone levels, causing imbalances in the ratio of estradiol:progesterone (E:P). This wreaks havoc on the processes in which they are involved.

Masters swimming is seeing a growth in popularity as it promotes aerobic fitness, is easier on joints, and is quite widely accessible with masters programs available in many towns and cities (Brilliant et al., 2021). A study on masters swimmers (average age 68 (n=18; 7 female, 11 male)) noted that motivations for maintaining training included enjoyment for the sport, reducing physical decline, and the sense of community within the team (Brilliant et al., 2021). 

This paper aims to provide nutrition recommendations for the female masters swimmers during and post-menopause. Recommendations will be prefaced by discussion regarding the nutrition challenges facing female masters athletes through the menopausal transition, after which, the demands of training and competing in masters competitive swimming will be analyzed and recommendations summarized.

Challenges of Masters Swimmers Through Menopause and Postmenopause

Body composition changes

Sarcopenia - age related loss of muscle mass which occurs at a rate of 3%-8% every 10 years after the age of 30. Females develop sarcopenia earlier than men with incidence increasing rapidly during the menopausal period.

To combat changes in body composition, nutritional recommendations to improve insulin sensitivity and support the building and maintenance of FFM are integral. Research indicates that for women in postmenopause, as much as a 60% increase from habitual protein intake may be required to build and maintain muscle mass (Sims et al., 2023). Combining resistance exercise in particular with increased protein intake at opportune times is helpful in the building and maintenance of LBM. Daily protein intakes of 1.4-2.2 g/kg body weight/day are recommended for women who are in perimenopause or postmenopause. Protein intake of 30-40 grams (ideally high (6-8g) in leucine) as quickly as possible after training is desirable to overcome anabolic resistance and promote MPS. Protein should otherwise be spread evenly throughout the day to improve the muscle anabolic potential (30g/meal, 15-20 grams at snacks). (Sims et al., 2023; Sims & Yeager, 2022; Burke et al., 2021; Mercer et al., 2020; Clifford et al., 2020). 

If seeking weight loss, female athletes may use the guide of reducing total caloric intake by 15-40% of or 500-700 kcal less than their current energy requirements with a focus on nutrient timing around exercise to improve training adaptations, performance and health. It is recommended to increase satiating foods including those high in fiber and protein, ensure that training and competition sessions are properly fueled according to time and intensity and reduce energy intake on rest days (Burke et al, 2021). Research suggests that it is not ideal to take in less than basal metabolic rate as it can exacerbate metabolic disorders and lead to micronutrient deficiencies (Erdélyi et al., 2024; Sims et al., 2023). During periods of energy restriction, protein requirements are greater (1.6-2.4 g/kg/day) to preserve lean muscle mass (Strasser et al., 2021).

 Intermittent fasting and other restrictive diets are best avoided for masters athletes, as these diets require the athlete to refrain from consuming adequate macronutrients and micronutrients, as well as protein boluses throughout the day in the case of intermittent fasting.

 It is highly encouraged that athletes seek the guidance of a sports dietitian to navigate nutrition and body composition changes through menopause, and not simply turn to diets viewed favorably online

Low energy availability

Low energy availability occurs when energy expenditure regularly exceeds energy intake and in active individuals, this can lead to Relative Energy Deficiency in Sport (RED-S).In a study of masters triathletes, post-exercise energy and protein intakes relative to body mass were significantly lower than the recommended dietary allowance (RDA) with female masters athletes in particular consuming significantly fewer carbohydrates (0.7g/kg) post-exercise than recommended (1.0 - 1.2g/kg) (Strasser et al., 2021). Another study identified that in a group of 86 masters athletes, none of the study groups adhered to the dietary reference intakes of healthy foods, particularly whole grains, dairy, and fish (Ratajczak et al., 2021). LEA has negative implications for chronic disease progression and mortality rate (Strasser et al., 2021).

After just 4 days in LEA, thyroid function and bone formation start to be disrupted (Sims et al, 2023). This can become a vicious cycle in which the body does not receive enough energy, the endocrine system signals for the body to break down muscle and store more fat, power declines and metabolism reduces to further conserve energy. Unfortunately, many female athletes take this as a sign to eat less and train harder, causing further harm. Appetite and food intake are also affected negatively by estrogen reduction, which is amplified by aging, especially at the age of 65 and above (Strasser et al., 2021). Signs of LEA could include decreased training response, diminishing bone health, decreased immunity, increased gut distress, worsening coordination, and chronic hunger combined with poor mood (Sims & Yeager, 2022). 

It is essential that female masters swimmers identify their energy requirements and ensure they are meeting them to avoid LEA.

Chronic illness - osteoporosis, diabetes, and heart disease

Increased risk of developing chronic illnesses must be considered in relation to nutrition goals for performance. Chronic illnesses including osteoporosis, cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM) can negatively impact sport performance through their symptoms and sometimes via their treatments as well. 

Increase Calcium and Vitamin D-rich foods: dairy, fish, meat, eggs and fortified foods. Consider supplementation with vitamin D.

Enjoy a healthy plate: 1/2 plate fruits and veg, 1/4 plate protein, 1/4 plate grains and starches.

Increase intake of polyunsaturated fatty acids (PUFAs) such as fatty fish (2-3 servings/wk), nuts and seeds, and vegetable oils.

Limit Saturated Fatty Acids (SFAs) including red meats, butter, lard, and high fat dairy.

If medications are being used to treat chronic conditions, it is important to work with a sports dietitian to address any drug-nutrient interactions. Some medications are banned in international and national competition and require special medical authority be given prior to competition (Burke et al., 2021). 

Gut discomfort

A poorly functioning gut may cause some unpleasant symptoms such as constipation, diarrhea, bloating, excess gas, and indigestion, all of which can negatively impact training and performance. A healthy gut microbiome may have beneficial outcomes for menopausal women in relation to mental strength, body composition, ability to absorb and use nutrients, sleep quality, reduced inflammation, improved energy and more (Sims & Yeager, 2022).

Enjoy a diet rich in the following to support a healthy gut:

Polyphenols: e.g berries, vegetables, nuts, seeds, beans, dark chocolate, olive oil, coffee, tea, red wine.

Probiotics: yogurt, kefir, kombucha, tempeh, sauerkraut.

Prebiotics: garlic, onions, leeks, asparagus, green bananas, and artichokes.

Sleep Disturbances

Studies have concluded that deviation from the recommended 7-8 hours of sleep/day increases risk of overall mortality and CVD. Those who sleep less than 5 hours/day are at greater risk of developing CVD. 40-56% of women report an increase in sleep disturbances during perimenopause and postmenopause (Erdélyi et al., 2024). Specific to training and competition, a lack of sleep reduces reaction time, endurance performance suffers, and perceived exertion increases. Menopause tampers with good sleep. From difficulty falling and staying asleep to hot flashes disrupting that sleep. Nutrition strategies for improving sleep can include:

Avoiding alcohol

Tryptophan rich foods: poultry, dairy, eggs, fish, soy, oatmeal

Drink a glass of ice-cold tart cherry juice. It is high in melatonin and boasts anti-inflammatory properties and antioxidants, and the coolness of the drink helps core temperature drop, which can assist in falling asleep.

Regularly spaced meals help to maintain the body’s circadian rhythm.

Valerian root (tea or capsules) - 400-600mg before bed can help you fall asleep.

Melatonin 0.3mg-1.0mg 30 minutes prior to bed.

Black cohosh - may be useful in reducing hot flashes but don't use for more than 6 months at a time.

Hydration

Temperature regulation, kidney function and thirst sensation all decline with aging. Fluid requirements are not one-size fits all and should be approached with female athletes pre and post menopause by creating individualized fluid replacement plans based on the environmental conditions (water temperature, indoor vs outdoor pool/air temp), training/competition situations and sweat rate.

As you can see, there are a variety of unique challenges facing these athletes.

If you would like to discuss your own goals and challenges with me, contact me or book an appointment. I would love to work with you!

References

Barnard, N. D., Kahleova, H., Holtz, D. N., Znayenko-Miller, T., Sutton, M., Holubkov, R., Zhao, X., Galandi, S., & Setchell, K. D. R. (2022). A dietary intervention for vasomotor symptoms of menopause: a randomized, controlled trial. Menopause (New York, N.Y.), 30(1). https://dayoi.org/10.1097/GME.0000000000002080

Brilliant, S. L., Claver, M., LaPlace, P., & Schlesinger, C. (2021). Physical Activity and Aging: Exploring Motivations of Masters Swimmers. Gerontology and Geriatric Medicine, 7, 233372142110446. https://dayoi.org/10.1177/23337214211044658

Burke, L., Deakin, V., & Minehan, M. (2021). Clinical sports nutrition (6th ed.). Mcgraw-Hill Education (Australia) Pty Ltd.

Clifford, T., Hayes, E. J., Scragg, J. H., Taylor, G., Smith, K., Bowden Davies, K. A., & Stevenson, E. J. (2020). The Effects of a High-Protein Diet on Markers of Muscle Damage Following Exercise in Active Older Adults: A Randomized, Controlled Trial. International Journal of Sport Nutrition and Exercise Metabolism, 30(5), 323–329. https://dayoi.org/10.1123/ijsnem.2020-0113

Desbrow, B., Burd, N. A., Tarnopolsky, M., Moore, D. R., & Elliott-Sale, K. J. (2019). Nutrition for Special Populations: Young, Female, and Masters Athletes. International Journal of Sport Nutrition and Exercise Metabolism, 29(2), 220–227. https://dayoi.org/10.1123/ijsnem.2018-0269

Domínguez, R., Jesús-Sánchez-Oliver, A., Cuenca, E., Jodra, P., Fernandes da Silva, S., & Mata-Ordóñez, F. (2017). Nutritional needs in the professional practice of swimming: a review. Journal of Exercise Nutrition & Biochemistry, 21(4), 1–10. https://dayoi.org/10.20463/jenb.2017.0030

Dopsaj, M., Zuoziene, I. J., Milić, R., Cherepov, E., Erlikh, V., Masiulis, N., di Nino, A., & Vodičar, J. (2020). Body Composition in International Sprint Swimmers: Are There Any Relations with Performance? International Journal of Environmental Research and Public Health, 17(24), 9464. https://dayoi.org/10.3390/ijerph17249464

Erdélyi, A., Pálfi, E., Tűű, L., Nas, K., Szűcs, Z., Török, M., Jakab, A., & Várbíró, S. (2024). The Importance of Nutrition in Menopause and Perimenopause—A Review. Nutrients, 16(1), 27. https://dayoi.org/10.3390/nu16010027

Ferreira, M. I., Barbosa, T. M., Costa, M. J., Neiva, H. P., & Marinho, D. A. (2016). Energetics, Biomechanics, and Performance in Masters’ Swimmers: A Systematic Review. Journal of Strength and Conditioning Research, 30(7), 2069–2081. https://dayoi.org/10.1519/jsc.0000000000001279

Fien, S., Climstein, M., Quilter, C., Buckley, G., Henwood, T., Grigg, J., & Keogh, J. W. L. (2017). Anthropometric, physical function and general health markers of Masters athletes: a cross-sectional study. PeerJ, 5, e3768. https://dayoi.org/10.7717/peerj.3768

Geraci, A., Calvani, R., Ferri, E., Marzetti, E., Arosio, B., & Cesari, M. (2021). Sarcopenia and Menopause: The Role of Estradiol. Frontiers in Endocrinology, 12. https://dayoi.org/10.3389/fendo.2021.682012

Greendale, G. A., Sternfeld, B., Huang, M., Han, W., Karvonen-Gutierrez, C., Ruppert, K., Cauley, J. A., Finkelstein, J. S., Jiang, S.-F., & Karlamangla, A. S. (2019). Changes in body composition and weight during the menopause transition. JCI Insight, 4(5). https://dayoi.org/10.1172/jci.insight.124865

Guthrie, S. K., & Erickson, S. R. (2016). Masters Swimmers Use More Dietary Supplements Than a Large National Comparison Population in the United States. International Journal of Sport Nutrition and Exercise Metabolism, 26(2), 123–127. https://dayoi.org/10.1123/ijsnem.2015-0043

Hoogenboom, B. J., Morris, J., Morris, C., & Schaefer, K. (2009). Nutritional knowledge and eating behaviors of female, collegiate swimmers. North American Journal of Sports Physical Therapy : NAJSPT, 4(3), 139–148. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2953338/

Ko, S.-H., & Kim, H.-S. (2020). Menopause-Associated Lipid Metabolic Disorders and Foods Beneficial for Postmenopausal Women. Nutrients, 12(1). https://dayoi.org/10.3390/nu12010202

Larson, H. K., Young, B. W., McHugh, T.-L. F., & Rodgers, W. M. (2021). Participation profiles of current masters swimmers and their (lack of) retrospective associations with youth experiences. Psychology of Sport and Exercise, 53, 101878. https://dayoi.org/10.1016/j.psychsport.2020.101878

Larson, M., Morgan, A., Kiss, J., & Ludy, M.-J. (2022). Body Composition Assessment in Masters Level Swimmers. International Journal of Aquatic Research and Education, 13(3). https://dayoi.org/10.25035/ijare.13.03.05

Lima-Borges, D. S., Portilho, N. O., Araújo, D. S., Ravagnani, C. F. C., & Almeida, J. A. (2022). Anthropometry and physical performance in swimmers of different styles. Science & Sports, 37(7), 542–551. https://dayoi.org/10.1016/j.scispo.2021.07.007

Louis, J., Vercruyssen, F., Dupuy, O., & Bernard, T. (2019). Nutrition for Master Athletes: Is There a Need for Specific Recommendations? Journal of Aging and Physical Activity, 28(3), 1–10. https://dayoi.org/10.1123/japa.2019-0190

Mercer, D., Convit, L., Condo, D., Carr, A. J., Hamilton, D. L., Slater, G., & Snipe, R. M. J. (2020). Protein Requirements of Pre-Menopausal Female Athletes: Systematic Literature Review. Nutrients, 12(11). https://dayoi.org/10.3390/nu12113527

Ratajczak, J., Czerniak, U., Wieliński, D., Ciekot-Sołtysiak, M., Zieliński, J., Gronek, P., & Demuth, A. (2021). Pro-Healthy Diet Properties and Its Determinants among Aging Masters Athletes. International Journal of Environmental Research and Public Health, 18(14), 7614. https://dayoi.org/10.3390/ijerph18147614

Rejman, M., Łukasz Tyc, Kociuba, M., Agata Bornikowska, Rudnik, D., & Sławomir Kozieł. (2018). Anthropometric predispositions for swimming from the perspective of biomechanics. PubMed, 20(4), 151–159.

Shaw, G., Boyd, K. T., Burke, L. M., & Koivisto, A. (2014). Nutrition for Swimming. International Journal of Sport Nutrition and Exercise Metabolism, 24(4), 360–372. https://dayoi.org/10.1123/ijsnem.2014-0015

Sims, S. T., Kerksick, C. M., Smith-Ryan, A. E., Janse, K., Hirsch, K. R., Arent, S. M., Hewlings, S., Kleiner, S. M., Bustillo, E., Tartar, J. L., Starratt, V. G., Kreider, R. B., Greenwalt, C., Rentería, L. I., Ormsbee, M. J., VanDusseldorp, T. A., Campbell, B., Kalman, D. S., & Antonio, J. (2023). International society of sports nutrition position stand: nutritional concerns of the female athlete. JOURNAL of the INTERNATIONAL SOCIETY of SPORTS NUTRITION, 20(1). https://dayoi.org/10.1080/15502783.2023.2204066

Sims, S. T., & Yeager, S. (2022). Next Level. Rodale Books.

Strasser, B., Pesta, D., Rittweger, J., Burtscher, J., & Burtscher, M. (2021). Nutrition for Older Athletes: Focus on Sex-Differences. Nutrients, 13(5), 1409. https://dayoi.org/10.3390/nu13051409

Velez, N. F., Zhang, A., Stone, B., Perera, S., Miller, M., & Greenspan, S. L. (2008). The effect of moderate impact exercise on skeletal integrity in master athletes. Osteoporosis International, 19(10), 1457–1464. https://dayoi.org/10.1007/s00198-008-0590-6