Nutrients give us life! Macronutrients include proteins, fats and carbohydrates, and serve as the body’s main source of energy. Micronutrients include vitamins and minerals and support the body’s energy metabolism. They help us transform what we ingest through food into what feeds our actual cells and gives us the ability to function (Huskisson et al., 2007).

Macro and micronutrients combined affect all degrees of performance. They impact mental clarity and cognition, and recovery processes like relaxation and sleep. They impact immunity and general resiliency. And they impact our ability to respond to training stress, make gains and perform.

In recent years, performance-minded communities—both in sports science and in the field—have shined a light on macronutrients. Conversations and debates abound regarding topics like nutrient timing and macronutrient intake ratios (e.g., 20% protein, 30% fat and 50% carbohydrates of total daily calories) for optimizing performance.

Likewise, we have expanded our related understanding and respect for energy availability and the meaning and implications of energy deficiency. For example, what was once called the female athlete triad is now known as relative energy deficiency in sport (RED-S). This update, among other important changes to definition and reach, acknowledges how energy syndromes such as RED-S affect both males and females (Mountjoy et al., 2014).

“The cause of this syndrome is energy deficiency relative to the balance between dietary energy intake and energy expenditure required for health and activities of daily living, growth and sporting activities,” reads a 2014 consensus statement issued by the International Olympic Committee (IOC) (Mountjoy et al., 2014, abstract).

Notice the weight and relationship of terms including energy, energy deficiency and expenditure, and dietary energy intake.

There is a logic supporting today’s focus on macronutrients, which, again, are the body’s main source of fuel. The focus, however, risks neglecting an important—no, critical—part of the conversation and diverts attention away from potential keys to health and performance-related concerns.

Athletes, Athletics and Fatigue

Let’s take a brief look at fatigue. Fatigue, particularly if prolonged or persistent, can be a symptom of RED-S (Todd et al., 2022). It can also indicate overreaching, overtraining or simple improper fueling. It can serve as a sign of poor sleep, increased stress or the onset of illness. Or it can result from an uptick in busyness and life demands like added work stress, school pressures, family commitments or travel.

An athlete’s relationship to fatigue is similarly important to consider. Despite advances in sport science, the “no pain, no gain” mentality, glorified in the 1980s, continues to prevail. Athletes learn to push through the body’s signals to stop and, frankly, the “pushing through” is a real and valid part of most sports.

Couple that with 1) coaching mandates to win, 2) coaches’ desires to get the most out of their athletes and, sometimes, sense of responsibility to motivate or “push,” and, 3) athletes’ inherent desire to train and compete, in addition to sense of responsibility to program or team, and an incredibly nuanced and complicated picture begins to emerge.

What Does That Have to do Micronutrients?

Micronutrients include water-soluble vitamins like B6 and B12, fat-soluble vitamins like A, E, D and K, and minerals—inorganic substances like calcium, magnesium, iron and zinc that cannot be made in the body and must be obtained from our diet (Karr et al., 2023).

In the Role of Vitamins and Minerals in Energy Metabolism and Well-Being, authors Huskisson et al. (2007) note that, “Even mild micronutrient deficiencies can result in a lack of well-being and general fatigue, reduced resistance to infections or impaired mental processes (e.g., memory, concentration, attention and mood” (p. 282).

Low iron status, for example, can show up as fatigue, increased heart rate during training, light-headedness, pale skin, shortness of breath, and dry or damaged hair (Bubbs, 2019). Low zinc can manifest as frequent colds, delayed wound healing, low testosterone and hair loss (Bubbs, 2019).

When we consider athlete fatigue and its nuance, as well as other symptoms that can appear unremarkable or vague, micronutrient status should be called into question. This holds true for symptoms including repeated illness, injury, repeated lapses in focus and concentration, and chronic apathy or low mood.

Does it sound like I am stating the obvious?

Talk to your athletes. From high school to college-age up through elite, it is striking how ill-defined, sometimes low-grade, sometimes persistent, symptoms are minimized or completely brushed off.

Pros and Cons

Macronutrient mentality

Pros: From an athlete perspective, a macronutrient mentality has the potential to facilitate ownership of what goes into your body and how you manage your fuel. With devices and apps like Cronometer, we can easily measure and track the macronutrient content in food. We can change and regularly adjust the composition of meals, and learn the differences in protein content, for example, in a breakfast of oatmeal compared to eggs.

However, from a diagnostic perspective, there is potential to fail to uncover a critical key to a problem. Let’s return to the athlete presenting with persistent fatigue. They seek help from their coach or nutritionist and the conversation turns the athlete’s typical day of eating.

Is the athlete eating enough? Are they specifically eating enough carbohydrates for fuel during training and competition? What is in their water bottle at practice? What do they reach for when they first leave the gym or come off of the field? Are they showing any other signs of RED-S?

The athlete turns inward, mulling over a supposed fueling problem that they themselves need to fix. Perhaps more carbohydrates before practice or more total calories. Perhaps more lean meat… less lean meat… no meat at all. Do they need a multivitamin or a different type of protein powder post-practice?

The result is confusion, frustration, and an athlete still without answers now also feeling at fault or to blame.

Macro and micro approach

A different picture emerges when we consider macro and micronutrient status combined.

With the right testing, we can:

1) Identify, ideally early, any potential underlying issues such as a malabsorption illness. These include ulcerative colitis, irritable bowel syndrome, Crohn’s disease, celiac disease, gastrointestinal ulcers and colon cancer (Karr et al., 2023).

2) Prevent of a cascade of related issues. For example, prolonged low ferritin can lead to problems with thyroid and adrenal health (Karr et al., 2023).

3) Eliminate guesswork and enable informed decision-making.

4) Empower the athlete (and their support team) and facilitate a quicker return to optimal performance and health.

Cons that come to mind include time, expense and expertise. Determining whole health status requires lab work, like a blood test, and actual clinical intervention, which is not always easy to access for all. It can also require ongoing follow-up to assess if a dietary change or supplemental intervention is having the desired effect. Separately, lab results might reveal a real need for time off, which almost no athlete wants to hear or admit. Yet, if rest is inevitable, why not embrace it and return a stronger, more vibrant version of you?

References

Bubbs, M. (2019). Peak: The New Science of Athletic Performance That Is Revolutionizing Sport. Chelsea Green Publishing.

Huskisson, E., Maggini, S., & Ruf, M. (2007). The role of vitamins and minerals in energy metabolism and well-being. The Journal of International Medical Research, 35(3), 277–289. https://doi-org.pacificcollege.idm.oclc.org/10.1177/147323000703500301

Karr, T. J., Bell, K., Guptha, L. S. (2023). Our Journey with Food (3rd ed.). Summerland Publishing.

Mountjoy, M., Sundgot-Borgen, J., Burke, L., Carter, S., Constantini, N., Lebrun, C., Meyer, N., Sherman, R., Steffen, K., Budgett, R., & Ljungqvist, A. (2014). The IOC consensus statement: Beyond the Female Athlete Triad—Relative Energy Deficiency in Sport (RED-S). British Journal of Sports Medicine, 48(7), 491–497. https://doi.org/10.1136/bjsports-2014-093502

Todd, E., Elliott, N., & Keay, N. (2022). Relative energy deficiency in sport (RED-S). The British Journal of General Practice: The Journal of the Royal College of General Practitioners, 72(719), 295–297. https://doi-org.pacificcollege.idm.oclc.org/10.3399/bjgp22X719777