Fitness questions and answers for March 14, 2005

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Form & Fitness Q & A

Got a question about fitness, training, recovery from injury or a related subject? Drop us a line at fitness@cyclingnews.com. Please include as much information about yourself as possible, including your age, sex, and type of racing or riding. Due to the volume of questions we receive, we regret that we are unable to answer them all.

Carrie Cheadle, MA (www.carriecheadle.com) is a Sports Psychology consultant who has dedicated her career to helping athletes of all ages and abilities perform to their potential. Carrie specialises in working with cyclists, in disciplines ranging from track racing to mountain biking. She holds a bachelors degree in Psychology from Sonoma State University as well as a masters degree in Sport Psychology from John F. Kennedy University.

Dave Palese (www.davepalese.com) is a USA Cycling licensed coach and masters' class road racer with 16 years' race experience. He coaches racers and riders of all abilities from his home in southern Maine, USA, where he lives with his wife Sheryl, daughter Molly, and two cats, Miranda and Mu-Mu.

Kelby Bethards, MD received a Bachelor of Science in Electrical Engineering from Iowa State University (1994) before obtaining an M.D. from the University of Iowa College of Medicine in 2000. Has been a racing cyclist 'on and off' for 20 years, and when time allows, he races Cat 3 and 35+. He is a team physician for two local Ft Collins, CO, teams, and currently works Family Practice in multiple settings: rural, urgent care, inpatient and the like.

Fiona Lockhart (www.trainright.com) is a USA Cycling Expert Coach, and holds certifications from USA Weightlifting (Sports Performance Coach), the National Strength and Conditioning Association (Certified Strength and Conditioning Coach), and the National Academy for Sports Nutrition (Primary Sports Nutritionist). She is the Sports Science Editor for Carmichael Training Systems, and has been working in the strength and conditioning and endurance sports fields for over 10 years; she's also a competitive mountain biker.

Eddie Monnier (www.velo-fit.com) is a USA Cycling certified Elite Coach and a Category II racer. He holds undergraduate degrees in anthropology (with departmental honors) and philosophy from Emory University and an MBA from The Wharton School of Business.

Eddie is a proponent of training with power. He coaches cyclists (track, road and mountain bike) of all abilities and with wide ranging goals (with and without power meters). He uses internet tools to coach riders from any geography.

David Fleckenstein, MPT (www.physiopt.com) is a physical therapist practicing in Boise, ID. His clients have included World and U.S. champions, Olympic athletes and numerous professional athletes. He received his B.S. in Biology/Genetics from Penn State and his Master's degree in Physical Therapy from Emory University. He specializes in manual medicine treatment and specific retraining of spine and joint stabilization musculature. He is a former Cat I road racer and Expert mountain biker.

Since 1986 Steve Hogg (www.cyclefitcentre.com) has owned and operated Pedal Pushers, a cycle shop specialising in rider positioning and custom bicycles. In that time he has positioned riders from all cycling disciplines and of all levels of ability with every concievable cycling problem.They include World and National champions at one end of the performance spectrum to amputees and people with disabilities at the other end.

Current riders that Steve has positioned include Davitamon-Lotto's Nick Gates, Discovery's Hayden Roulston, National Road Series champion, Jessica Ridder and National and State Time Trial champion, Peter Milostic.

Pamela Hinton has a bachelor's degree in Molecular Biology and a doctoral degree in Nutritional Sciences, both from the University of Wisconsin-Madison. She did postdoctoral training at Cornell University and is now an assistant professor of Nutritional Sciences at the University of Missouri-Columbia where she studies the effects of iron deficiency on adaptations to endurance training and the consequences of exercise-associated changes in menstrual function on bone health.

Pam was an All-American in track while at the UW. She started cycling competitively in 2003 and is the defending Missouri State Road Champion. Pam writes a nutrition column for Giana Roberge's Team Speed Queen Newsletter.

Dario Fredrick (www.wholeathlete.com) is an exercise physiologist and head coach for Whole Athlete™. He is a former category 1 & semi-pro MTB racer. Dario holds a masters degree in exercise science and a bachelors in sport psychology.

Scott Saifer (www.wenzelcoaching.com) has a Masters Degree in exercise physiology and sports psychology and has personally coached over 300 athletes of all levels in his 10 years of coaching with Wenzel Coaching.

Kendra Wenzel (www.wenzelcoaching.com) is a head coach with Wenzel Coaching with 17 years of racing and coaching experience and is coauthor of the book Bike Racing 101.

Steve Owens (www.coloradopremiertraining.com) is a USA Cycling certified coach, exercise physiologist and owner of Colorado Premier Training. Steve has worked with both the United States Olympic Committee and Guatemalan Olympic Committee as an Exercise Physiologist. He holds a B.S. in Exercise & Sports Science and currently works with multiple national champions, professionals and World Cup level cyclists.

Through his highly customized online training format, Steve and his handpicked team of coaches at Colorado Premier Training work with cyclists and multisport athletes around the world.

Brett Aitken (www.cycle2max.com) is a Sydney Olympic gold medalist. Born in Adelaide, Australia in 1971, Brett got into cycling through the cult sport of cycle speedway before crossing over into road and track racing. Since winning Olympic gold in the Madison with Scott McGrory, Brett has been working on his coaching business and his www.cycle2max.com website.

Richard Stern (www.cyclecoach.com) is Head Coach of Richard Stern Training, a Level 3 Coach with the Association of British Cycling Coaches, a Sports Scientist, and a writer. He has been professionally coaching cyclists and triathletes since 1998 at all levels from professional to recreational. He is a leading expert in coaching with power output and all power meters. Richard has been a competitive cyclist for 20 years

Andy Bloomer (www.cyclecoach.com) is an Associate Coach and sport scientist with Richard Stern Training. He is a member of the Association of British Cycling Coaches (ABCC) and a member of the British Association of Sport and Exercise Sciences (BASES). In his role as Exercise Physiologist at Staffordshire University Sports Performance Centre, he has conducted physiological testing and offered training and coaching advice to athletes from all sports for the past 4 years. Andy has been a competitive cyclist for many years.

Michael Smartt (www.cyclecoach.com) is an Associate Coach with Richard Stern Training. He holds a Masters degree in exercise physiology and is USA Cycling Expert Coach. Michael has been a competitive cyclist for over 10 years and has experience coaching road and off-road cyclists, triathletes and Paralympians.

Kim Morrow (www.elitefitcoach.com) has competed as a Professional Cyclist and Triathlete, is a certified USA Cycling Elite Coach, a 4-time U.S. Masters National Road Race Champion, and a Fitness Professional.

Her coaching group, eliteFITcoach, is based out of the Southeastern United States, although they coach athletes across North America. Kim also owns MyEnduranceCoach.com, a resource for cyclists, multisport athletes & endurance coaches around the globe, specializing in helping cycling and multisport athletes find a coach.

Advice presented in Cyclingnews' fitness pages is provided for educational purposes only and is not intended to be specific advice for individual athletes. If you follow the educational information found on Cyclingnews, you do so at your own risk. You should consult with your physician before beginning any exercise program.

Nutrition
Chronic upper lateral soleus pain solutions
Hematocrit and VO2
On the bike meals
Warming up
Training specifics question
Gaining lower body muscle mass

Nutrition

Hi,

I am a 56 year old and have been cycling now for just a year and am doing my first tour in a few weeks - I'm looking forward to it. Although I haven't been active for 15 years I have an endurance athlete's background and am aware of the nutritional requirements of heavy endurance training - particularly the need to replenish muscle glycogen in the "golden two hours".

While I am aware of the many studies carried out in this regard, and more recent work such as the use of highly bio-available protein/carbohydrate's or so-called "recovery formulas" I have never seen a study which looks at the long term performance impact of both loading or rapid replenishment - current studies all look at training performance which while not irrelevant, is definitely secondary to how effectively one races.

What I am getting at it this; part of the value of long endurance training is that it provides the body with the demand/stress required to engage the body's fat burning metabolism, and the longer one trains the more this effect is noticeable - in short this is the required adaptation. However, my understanding is that carbo-loading prior to an event actually switches off or at least reduces the fat burning metabolism by as much as 40% - as does rapid replenishment of glycogen stores with high glycaemic index Carbohydrates. This implies that the use of these techniques is of value short term rather than long-term interest.

So while the athlete may perform in training far better day in day out, long term there may be a compromise in terms of tuning the body's fat-burning capability off. It also seems that the reason coffee/caffeine is so widely used by cyclists is that it tends to actually reverse this process. It may be far better not to load but teach the body to burn more fat instead.

So, while rapid replenishment is valuable in a short cycling tour to ensure recovery (and certainly it is better for the athlete's state of mind during heavy training!) I suspect that it's only actually necessary to load Carbohydrates immediately after training in the few days prior to a long distance race so that the fat burning mechanism is still able to function effectively. I have always adopted a minimalist strategy of nutrition when training - i.e. taking in the minimum necessary to function effectively so that I maximise my fat burning potential - I then rapidly take on a recovery drink but don't go silly and try to replace every gram of Carbohydrates burned - has it worked? Well I lost 16Kg in 9 months and now weigh 74KG at 1.88m in height and it wasn't that painful! The real emphasis I seek in your reply is - what the effect is of such a regime on race performance, and what research has been carried out?

Robin Ducker

North Harbour, Auckland, New Zealand

Pam Hinton Replies

Hi Robin,

I think what you are asking is, "Does carbo-loading reduce the ability to use fat for energy during exercise?" The short answer to your question is, "No, it doesn't." Read on for an explanation of why consuming carbohydrate during exercise facilitates fat oxidation. During exercise muscles use fat and carbohydrate for energy. Exercise intensity determines which fuel will be used. At rest or during low intensity exercise (

There are several reasons why this happens. As exercise intensity increases, more Type-II-b (white, fast-twitch) muscle fibers are recruited. These fibers lack the enzymes to do aerobic metabolism and must rely on anaerobic metabolism, which requires carbohydrate as an energy source. In situations where oxygen demand is high, carbs have an advantage over fats because less oxygen is required to burn carbohydrate. Consuming carbohydrate during training increases fat oxidation because it allows us to maintain higher exercise intensity, thereby expending more total energy and utilizing more fat. Here are the numbers to prove my point. While it is true that a greater proportion of the energy comes from fat when we are exercising at low intensity, the total energy used will be less (if the duration is constant) and so the absolute amount of fat burned will also be less than if we exercised at high intensity.

For example, riding at 10 miles per hour uses 6 kcal per kg per hour and 80% of those kcal come from fat. So if you rode for an hour at that speed, you would use a total of 600 kcal and 480 of them would be from fat. Contrast that with riding at 18 mph, which uses 12 kcal per kg per hour, but only 50% of the energy from fat. At the faster speed, you would burn 1200 kcal total and 600 kcal would come from fat. You can see that if your objective is to burn fat, being able to maintain a faster speed - i.e - higher intensity, would allow you to expend more energy and use more fat.

After eating a meal that is high in carbohydrate, the body goes into energy storage mode. Glucose is stored as glycogen and fat is synthesized and stored using excess glucose and amino acids. Insulin, a hormone that is secreted by the pancreas in response to an increase in blood glucose, is responsible for these changes in metabolism. During exercise (or fasting), insulin production is suppressed and the body shifts from fat storage mode into fat burning mode. The decreased insulin levels also allow for the release and use of stored fatty acids and for the breakdown of muscle glycogen into glucose. So, carbo-loading on pasta the night before a long training ride won't impair your ability to use fat during the ride because your insulin levels will shift your metabolism from fat storage to fat use.

The key here is giving your body what it needs, when it needs it. During exercise, carbohydrates provide the fuel to keep you going. After exercise, you need to replenish the carbohydrate you used. The optimal way to do this is to consume 1.5 g carbohydrate per kg of body weight within 30 minutes after exercise and again every two hours for 4-6 hours. Another benefit of consuming carbohydrate post-exercise is that it reduces the protein degradation that follows a hard training effort. Studies that show benefits of regular carbohydrate replenishment during and after exercise assists performance in a controlled laboratory setting.

It is true that there are many factors, other than physiological differences, that affect race performance. However, most studies use exhaustive exercise protocols (e.g - maximal oxygen consumption, repetitive exercise bouts, sub-maximal exercise to exhaustion) that simulate the physical aspects of a bike race. Certainly, you don't need to replace every gram of carbohydrate, but, if you function effectively on a minimum, you might function optimally on a little bit more. Take care.

Chronic upper lateral soleus pain solutions

I have chronic right soleus muscle pain and possibly even fibular/peroneal musculotendenous pain (lots of pain in the leg). The muscle gets tender just inferior and postero-lateral to the fibular head. After careful consideration I feel this is upper-lateral soleus and not simply the peroneals. Initially I also had pain at my lateral distal hamstrings-biceps femuris- and was told that my seat was raised too high and that every pedal stroke was elongating (eccentrically) this tendon.

Magically when I lowered my seat the outside distal hamstring pain disappeared but the upper posterior-LATERAL calf pain has persisted! I am 6'2" with only a 34 inch inseam. I ride a 58cm Merlin Cyrene with a 115 stem and a CormiaC layed back reversible seat post with my seat pushed as far back as I can so that I have most of my weight comfortably on my ischial tuberosities. While I have found this positioning comfortable, I have began to wonder if I actually need to ALSO bring my seat forward and possibly also invest in a longer stem?

As a side note, pushing a harder gear is usually more comfortable, presumably because of the reducing number of rotations and irritation or transferring forces to larger muscles? (I would love to be able to mash gears or spin gears at my choice)

Other areas I have considered are:
1) My right foot tends to flare out more than my left foot so I would think that my cleats should match this external rotation but I have sensed during long rides that it actually feels better to have my cleat in neutral or rotated slightly in!

2) I have been using a simple over-the-counter orthotic "SuperfeetC" in both my running shoes and cycling shoes, but have also begun to wonder if these should be removed, as perhaps the medial posting has caused lateral stretching? In the past I have tried Speedplay pedals, Dura Ace 7800 pedals and even BMX style platform pedals (ultimate in float and inability to pull up with muscle!!), to no avail. Should I move my seat forward or a combo of seat forward and longer stem, or possibly other considerations, such as inward or outward foot movement, etc.

Star Stevenson

Steve Hogg Replies

G'day Star

Here is some educated guessing…

Why the right side only?

a) The likely answer is a longer right leg with, commonly, an anterior iliac crest and restricted right sacro-iliac joint which would possibly explain why the right footplant is the way it is on the pedal. While the leg may be measurably longer, often the restricted hip and lower back function that can accompany this makes it function like a shorter leg. Test: drop the seat another 5 mm. If this improves the pain, then you may be on the right track.

b) The less likely answer is a shorter or noticeably tighter right leg doing everything it can to reach the bottom of the stroke with force and enlisting every thing possible to stabilise while doing so. The painful soleus and peroneal all flex the foot, so it is likely that again you are dropping the foot forcefully in an effort to reach the bottom of the stroke.

Test: Same as for the likely answer - drop the seat 5mm and see if there is a reduction in severity.

c) Another possibility is that the cleat is too far forward on your right foot, causing soleus and peroneals to fight to flex the foot while it is trying to extend. Take a look at this letter and this one for info about cleat position.

If you try these things and they work to some extent, you then need to establish exactly what the structural issues are that are causing the problem. And no, unfortunately I can't recommend anyone in Seattle as I am an Aussie with no knowledge of the positioning scene in the U.S.

Why are you more comfortable pushing big gears than spinning?

Likely answers:

a) As you suggest, the seat may be too far back so try moving it forward 7 or 8mm. This will make a noticeable difference positive or otherwise. At least it will give you something further to go on.
b) If, as I suspect, you have noticeable asymmetries of function, it is often easier in the sense of stability and coordination to pedal more slowly.

Lastly, all of the above assumes that you have ticked the usual boxes in the sense that your cleat angle is such that you have potential freeplay either side of your natural footplant on the pedal. Additionally, if dropping the seat solves the problem in the short term and given that you have had no issues with the other leg, you may wish to consider fitting a packer under that right cleat and raising the seat back to the original height. If you do this, move the cleat 1 mm further rearwards on the shoe for every 5mm that you pack it up to negate the rocking torque effect.
Let me know what happens after you have played a bit.

Hematocrit and VO2

I have read a lot about hematocrit and I still have some questions regarding this area. I know that the hematorcrit level is not necessarily an indication of fitness (i.e. high hematocrit = high performance), but suppose a non-athletic person who has a high natural hematocrit, but actually a low VO2 max…does this person possess greater potential to reach a high VO2 max with proper training, more than a person who has a lower natural hematocrit? And if yes, how strong is this tendency?
I mean, a person who has a high hematocrit (i.e. 42%) will reach a high VO2Max properly training (i.e. 5 litres/min), for sure. Exists a strong tendency like that?

Christian Curitiba

Brazil

Scott Saifer Replies

Hi Christian,

Maximal aerobic power depends on numerous factors. Among them are peak heart stroke volume and maximum heart rate, because these two together determine cardiac output, the amount of blood the heart can move. A higher hematocrit allows more oxygen to be carried by the same volume of blood.
At the other end, aerobic power also depends on the ability of muscles to extract oxygen from the blood and deliver it where it is needed, and that depends on capillary infiltration of the muscle, and mitochondrial mass, among other things.
All other things being equal, a higher hematocrit can support a higher rate of oxygen delivery to muscle. Any healthy individual who does aerobic, endurance training will increase capillary density, stroke volume, mitochondrial mass and a variety of other factors that support aerobic performance. Maximum heart rate will drop by a few beats. However the extent to which these factors are changed by training is not the same for all individuals. An individual with a slightly higher natural hematocrit is likely to be able to achieve a higher aerobic power than a person with a lower natural hematocrit, but there is no reason to expect that he or she would necessarily achieve levels of these other important factors necessary to produce the VO2 max of a champion or even a much above average athlete.

On the bike meals

I have what is probably a simple question, but being new to competitive cycling and training I still have much to learn.

My question is - what do you recommend as food during long training rides. I've done four hour rides where I normally eat two or three PowerBars and stay plenty hydrated with four bidons of Gatorade. My pre-ride meals normally consist of a large bowl of whole grain cereal and one or two bananas. I'm just wondering if there is a more effective alternative to my simple PowerBar meal. I'm normally pretty well spent at the end of these long rides of low to moderate intensity averaging 17-18 mph. I read about professionals training for six to eight hours a day and can't help but wonder what they do to keep their energy levels up. I've read some pretty insane training days of Eddy Merckx - 270km, and this in a day where the sports nutrition industry was in its infancy at best. This leads me to wonder if there is some simple energy food out there that has been around for some time that I just don't know about. Any guidance you can recommend is greatly appreciated.

Mike Duschak

Milwaukee, Wisconsin

Pam Hinton Replies

Hi Mike,

At first glance, what I'm about to tell you may seem to have nothing to do with your question, but bear with me. I've been competing in endurance sports for about 20 years, but I am relatively new to cycling. I only have been racing two years, so I remember how steep the learning curve seems at first. The most difficult lesson to learn about bike racing is one that will help you become a more tenacious and aggressive competitor: when you are suffering, so is everyone else. Certainly, I don't mean to minimize the importance of years of training and racing experience, and you will learn and improve with time. My point is that you are not the only one who is "well spent" at the end of a four hour ride. You should expect to feel tired and there is no "energy food", new or old, that will eliminate the fatigue.

Having said that, there is no reason that you have to be stuck eating energy bars ad nauseam. Alternatives can be more effective if they taste better and are easier to eat. When eating on the bike, the main objective is to consume easily digested carbohydrate at regular intervals. You need 30-60 g of carbohydrate per hour. Drinking 500 ml (16 ounces) of a sports beverage will provide about 30 g of carbohydrate and most energy bars have 35-45 g of carbohydrate. Consuming carbohydrate at this rate will maintain your blood glucose and keep you from "bonking" when your glycogen stores are depleted.

Of course, since you will be trying to eat and ride at the same time, you want to choose foods that are easy to open, unwrap, bite, chew, and swallow. You also want to avoid foods that become unmanageable in either extreme heat or cold. So, read the Nutrition Facts labels of your favorite snack foods to determine the carbohydrate content. Fig Newtons, pretzels, apple slices, dried fruit, raisings, dates, and MoonPies, are all good options. Plus, you'll find that these "regular" foods cost a lot less than "energy bars". What you eat off the bike is just as important as what you eat on the bike. Endurance athletes need to consume 6-10 g of carbohydrate per kg of body weight per day to keep their glycogen stores full. The night before a long training ride or race, eat a meal that is high in complex carbohydrates, e.g., whole wheat pasta or brown rice, to ensure that your glycogen tank is topped up.

After your rides, consume rapidly digested (high glycemic index) carbohydrates, to start refueling for the next day. Sports beverages, fruit juice, crackers, and pretzels are good post-ride choices. And remember that Eddy Merckx wasn't called the cannibal because he ate magic food - it was because he devoured the competition.

Warming up

I am going to be doing a twelve kilometer time trial soon and would like to know the best way to warm up for the start. For my training rides I generally do fifteen to thirty minutes of easy riding before elevating my heart rate. I never do any stretching. For previous races I have kept the same routine-about thirty to forty minutes of easy riding before the start. However, if I go from the gun the way other riders can, I blow quickly. But if I sit in the group for a while I get stronger as the race progresses. By the way, the time trial course is quite rolling, with a couple of steep sections. Thank you for any advice you can offer.

Greg D

Japan

Steve Hogg Replies

G'day Greg

I am no coach but am known to do regular TT's.

The warm up routine I'm about to describe was given to me by a TT national champ who can ride low 49's for a 4Okm TT. You will need an indoor trainer of some kind and to know your exact start time.

0-10:00 minutes - Warm up to high E1 for 5 mins and continue till 10mins @ 100rpm.
10:00-15:00 minutes - Up heart rate gradually to high E2 @ 100rpm
15:00-20:00 minutes - Up heart rate gradually to high E3 @ 100rpm
20:00-25:00 minutes - Back to E2 @ 100rpm
25:00-30:00 minutes - Back up to high E3 at whatever cadence seems appropriate
30:00 - 40:00 minutes - Get off bike, take it out of the trainer and walk bike over to start line and do as little as possible. What I have found following this is that I can go hard out of the blocks without problems. The above assumes E1 to be 65-75% of Max HR; E2 to be 75-85% of Max HR and E3 to be 85-92% of Max HR. I'm sure that the coaches on the panel will have thoughts on this as well.

Training specifics question

Can you help me, and maybe others? I'm confused about setting training goals based on anaerobic vs. lactate threshold zones. For the sake of the discussion, let's imagine a road racer with max heart rate of 170; what will his lactate threshold training zone be and his anaerobic threshold training goals? My head is spinning, and I'd rather it be my legs on the pedals. Thanks,

James Thacker

Iowa

Dario Frederick Replies

Hi James,

Take a look at this recent posting and it should answer your question.

Let us know if you have further questions.

Good luck

Gaining lower body muscle mass

First off, I'd like to thank you for your prompt and helpful advice in the past. I have a question on a subject that is a little difficult for me.

At 6'1'' and 135 lbs, (currently age 18, male) I feel I could benefit from gaining leg strength. Last year I received help for an eating disorder and successfully gained approximately 10 lbs. Now that I've conquered my fear of gaining weight, I'd like a build some lean muscle mass, especially on my lower body. There is not much I can do to build upper body strength as my left arm was severely broken in a crash last summer and I will be unable to put it under extreme stress for at least a year to ensure the surgery has corrected all the damage.

I also tend to shy away from resistance training, not only because cyclocross extends so long into the winter, and racing starts up in late February, but mainly because every winter I've spent in the gym has left me with tendonitis in the spring; this year I seem to have avoided any such injuries. I have a pending cat 2 upgrade in the near future, and train about 2.5+ hours a day with five days a week on the trainer - longer if the weather is nice - and dedicate two days to recovery and core strength.

I have been doing low cadence drills all winter, and recently began more intense intervals to prep for racing. I figure I generally consume about 3300 calories per day, split fairly evenly between breakfast, lunch, dinner and snacks. There is a surplus of info out there on how to lose weight, but unless you're looking to be a bulky body builder, it's hard to find credible info on how to build strength for endurance events (in case you couldn't guess, I'm not a trackie. I do mainly XC mtb races and a mix of crits and RR). What are your suggestions for gaining strength (as related to diet, and intervals)? Thank you.

Pam Hinton Replies

Hi,

First of all, you should be commended for your progress towards full recovery from the eating disorder. Your accomplishment is more impressive and worth far more than any athletic achievement. You would benefit from gaining lower body muscle mass; The increased leg strength and power would help your cycling performance, especially in crits and sprints.

But more importantly, the increased muscle mass would improve your bone health. Given your history - low body weight, spending significant amounts of time in a non-weight-bearing activity, and less than optimal dietary intake, you are at risk for low bone density (osteoporosis) now and later in life. You are at an age when you should be continuing to add bone mass to your skeleton, so that when you start to lose bone mineral later in life (after age 70, in men) you won't develop osteoporosis and be a likely candidate for fractures.

Body weight is the strongest determinant of bone mass, so your low body weight isn't in your favor. Eating disorders decrease the sex hormones in men (testosterone) and women (estrogen and progesterone). Males who have eating disorders have low testosterone levels which cause a loss of bone mass. People with eating disorders typically have other hormonal changes that negatively affect bone density - decreased growth hormone and insulin-like growth factor-I and increased cortisol. So, on to your question on how to gain muscle mass. First of all, you need to consume enough calories to be in a positive energy balance of about 500 kcal per day. There are formulas to approximate energy requirements based on gender, age, height, and weight, but they are just approximations.

You will have more luck gaining muscle at the appropriate rate if you adjust your energy intake as you go. So, if you are not gaining muscle on 3300 kcal, then increase your energy intake by about 500 kcal for one week and check your weight gain. Individuals who have severely restricted their food intake because of an eating disorder often have trouble initially gaining weight. When they increase their energy consumption, their metabolic rates increase dramatically. Over time, the metabolic rate returns to normal and body weight stabilizes. Since you want to add lean body mass, you need to consume more protein than the typical endurance athlete. You need 1.6-1.7g of protein per kg of your target body weight.

For example, if your target weight is 150 lbs (68.2 kg), you need 110-115 g of protein per day. To translate this into foods, 3 ounces of meat has 25 g, one cup of milk or yogurt has 10 g, 1 ounce of cheese has 7 g and one egg has 3 grams of protein. It is also important that you eat enough carbohydrate. If you don't meet your minimum carbohydrate requirement, your body will breakdown muscle protein to make glucose. You need 6-10g carbohydrate per kg or body weight to maintain your liver and muscle glycogen stores. So for you, that would be about 500-600g of carbohydrate daily. Whole grain bread, pasta, cereal, and brown rice are the best sources because they haven't had the vitamins, minerals, and fiber removed in the refining process.

So there you have the mathematical formulas. They are a lot like strategies to win a bike race, as in they look perfect on paper, but the trick comes with the application and all the variables. In this case, all those variables pretty much boil down to one-you. And, so far, you've done well. Keep it up, and take care.

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