[M]aking sure that they are getting enough nutrition for recovery as well.
Megan Robinson specializes in dietary and nutritional health in athletes with diabetes. Megan will discuss the nutritional challenges athletes with type 1 diabetes endure and how to build better nutritional health.
Megan Robinson a registered dietitian and nutritionist (RDN) since 1994 has worked at The Children’s Hospital of Philadelphia (CHOP) for the past 20 years. She is a Board-Certified Sports Dietitian and Certified Diabetes Educator specializing in sports nutrition and diabetes education. Megan also has a private practice in sports nutrition where she works with individuals to enhance their athletic journey through nutritional health.
[00:00:46] Shireen: Megan Robinson has been a registered dietician nutritionist since 1994 and has worked at the Children’s Hospital of Philadelphia for the past 20 years. She is a board certified sports dietician and certified diabetes educator specializing in sports nutrition and diabetes education. In addition to working at the Children’s Hospital, Megan has a private practice in Sports Nutrition, Wealth, and Megan.
[00:01:14] Megan: Welcome. Thank you so much. Appreciate your inviting me to come on.
[00:01:17] Shireen: Absolutely. So, Megan, diving right in, why this field? Like, what drew you to become a registered dietician, nutritionist, diabetes educator? What led you here?
[00:01:27] Megan: Yeah, well it all goes back to when I was a teenager. I’m a competitive runner, and when I started running I would say probably around my sophomore, junior year of high school, I was noticing that my running times were kind of falling off where I should, you know, should have been training a little bit harder and a little bit getting the results that I expected.
And what I noticed is that they weren’t happening. And amazingly, this is way back in the eighties, that my coach was even able to say, Hey, something’s going on. I think maybe you need to meet with somebody to talk about your eating. And back then sports nutrition was not a thing. It was not a common practice, but somehow this person, whether or not they were dietician or not, if I didn’t, I don’t remember they kind of helped me in formulating a meal plan to help me with my training and so that I’m fueling my activity.
And that just sparked in a real big interest in sports nutrition and just learning about how the body requires certain nutrients around training. It’s, that really sparked my interest in, in nutrition and to become a dietician. So then I became, you know, went to college, got my four year degree in dietetics, and then became a dietician.
And like most young dieticians, you just kind of take your first job. You know, it, it’s not, obviously I had no idea really what I wanted to do, even though I was an athlete and loves love nutrition. Like I said, sports nutrition was really not a field yet back in the early nineties. And so then I went into a typical clinical hospital setting and started working with a lot of patients with type two diabetes.
So I would say my first exposure in the field of diabetes was mainly adults with type two diabetes in working with weight management, cardiovascular disease and kind of at that time carbohydrate counting was starting. So it’s very interesting. I kind of saw this evolution with diabetes over the years and worked in the field with di two diabetes for, for I would say a good five or six years.
And then really kind of I would say also personally, I had children at that time and really got more into pediatric nutrition. So that’s when I switched my practice over to working at Children’s Hospital in Philadelphia and found a real interest in working with kids with type one diabetes so that was a whole different genre in working with kids, but also with type one versus type two diabetes.
So like I been there for over 20 years and over those 20 years my sports nutrition interests still continued. So in the background with also working at chop, I was always attending conferences and reading up on sports nutrition, and it wasn’t until, 2017 that I decided to finally get my boards exam completed so I could become a certified sports dietician just to kind of validate what I had been doing and to also open a private practice in sports nutrition.
So tying those two specific casual teams together. That’s
[00:04:27] Shireen: That’s great. And so help us understand this world if type one diabetes a little better. What are the difficult challenges that athletes would type one diabetes face? Can you walk us through some of
[00:04:38] Megan: those?
Yeah. So at every summer since probably 2000 and I wanna say 15, 14, 15, I have been volunteering at a camp.
It’s called the Diabetes Training. And this is a camp for athletes with type one and type two diabetes. And it started out initially as more competitive athletes, more triathlon and working with these athletes and helping them train, but also teaching them how to manage blood sugars while they’re exercising.
Over the years, it’s really evolved into more of a fitness camp, which has been great. So they opened it up to working with athletes with type two diabetes and weight management. But also just in general, cuz most people are not competitive athletes. And just trying to teach them how to fuel your body, even if you’re just doing general exercise, but really in maintaining blood sugars and the number one concern that every athlete comes into camp with, and also in my practice at Children’s Hospital when I’m working with kids with type one diabetes who are also athletes, is hypoglycemia low blood sugars.
That is the number one reason why most people consult me for nutrition advice and help in adjusting insulin and also in adjusting their nutrition to prevent those lows. Because they really don’t wanna be pulled out of their exercise they want, The kids don’t wanna be pulled off the field because they have a low, So that’s the number one concern.
[00:06:00] Shireen: Next, can you talk about the, and help us understand the effect exercise has on an athlete’s blood sugar.
[00:06:07] Megan: So that is highly variable. It really depends on the type of exercise that they are doing. It depends on the time of day that they are exercising. It depends on their duration, depends on what they ate.
It depends on, you know, there’s so many things, but traditionally, when we’re initially educating families and kids about how exercise influences their blood sugar, normally when we think about an intense exercise, so something like a. Like activity or weight training. This typically causes a more of a hormonal shift.
Adrenaline increases, and that can cause a blood sugar to spike and go high, which is sometimes there’s people surprised by that. They’re like, Really? So exercise can actually increase the blood sugar. But more traditionally when somebody is going for a walk or a slow run or easy bike ride or I would say even a sport where you aren’t as intense say a practice versus a competition, the blood sugar more likely is going to go low and that blood sugar could drop anywhere from 50 to a hundred points within 30 minutes of exercise.
So you know, you have to be very mindful with experience and training and understanding how your body responds cuz everybody’s a little different.
And can you speak
[00:07:24] Shireen: to some of the exercises or the best times to avoid exercising for this?
[00:07:29] Megan: I’m always encouraging exercise in everybody. You know, I never wanna discourage somebody in saying, Well, if you exercise this time of the day, you might have more of a low blood sugar compared to another time of day.
So I’m always really saying, Listen, when is the best time for you realistically to get in exercise? And if they say to me, nine o’clock at. That’s the time they need to exercise. And especially when I’m working with kids, their schedules are all over the place. You know, sometimes these kids who are involved in hockey, they might be exercising at 5:00 AM or 10 o’clock at night, depending on when they can get ice time.
Versus the adult who is, you know, coming home from work and can only fit it in after dinner. So everybody’s a little different and when they can fit it in. So there’s no time that I would say don’t exercise. But one of the things you have to understand with diabetes, Is that first thing in the morning.
You are more insulin resistant, meaning that your liver is making a little bit of extra sugar in the morning because of hormonal shifts as you wake up. And with diabetes. What this means is that you tend to maybe wake up with a little bit of a higher blood sugar. You don’t need as much insulin, or actually you actually need more insulin for food.
But if you’re exercising, you’re gonna less likely going to have a low blood sugar. Compared to later in the day. So there are plenty of athletes that will say, Oh, I only stick to exercising first thing in the morning because I know I’m gonna have less likely gonna have a low blood sugar compared to if I did that workout at five o’clock at night or nine o’clock at night.
So you’re more sensitive to insulin as the day goes on. So your risk of having a low sugar is greater as the day goes on. Now if you are a nighttime exerciser, we do have concerns with low blood sugars in the middle of the night. It’s called a delayed onset low blood sugar. But there was ways to prevent that.
I mean, we talk about nutrition and making sure you’re eating something after exercise to refu your muscles to prevent those lows. We talk about adjusting insulin, long term insulin, short term insulins, to prevent those lows. So it’s very doable. It’s just once again, If you are taking on any kind of new exercise routine, checking your blood sugars regularly before, during, and after exercise, and understanding your patterns is best way to then prevent lows rather than always reacting and having a low and having to treat that.
[00:09:55] Shireen: What are the factors that differentiate an athlete’s workout from a non-athlete and is it the intensity of the workout or restricted dieting
[00:10:05] Megan: or both? Yeah, so I feel that anybody who’s moving their body is an athlete, so . So I, you know, there’s obviously the difference between a competitive athlete and then somebody who is out there maybe jogging or bike riding 30 minutes.
Three times a week. So obviously the duration and the intensity of the exercise will vary when I’m working with a competitive athlete. So if I have somebody who I’m working with who is exercising up to two or three hours a day because they are training for a specific event. So I do work with a lot of endurance athletes training for Marathon or Iron Men or just really long bike rides, things like that.
When you think about those types of activities the nutrition changes. It changes not only because they probably need to eat more carbohydrate throughout the day to make sure that they are having adequate nutrition to support the amount of energy that they’re burning from all of that exercise, but they also need to be more mindful of not only just maintaining blood sugars in con in range when they’re exercising.
But really more fueling the body while they’re exercising. So I always say if somebody’s doing a more recreational activity that’s less than an hour, that’s not that intense. You just need to be mindful of more blood sugar management during that exercise and being mindful that you might need to take in some quick acting carbohydrate to prevent a low blood sugar.
But once we get over 60 minutes of continuous exercise, that’s when we start thinking, let’s fuel the body. Let’s not cut back too much on insulin. So this is something we teach at camp about not reducing basal insulin too much. So you can adequately fuel the body. So most athletes, and I always explain this to athletes with diabetes, that regardless if you have diabetes or.
If you are an endurance athlete, most likely you will need to take in anywhere from 30 to 60 grams of carbohydrate per hour to fuel that activity. Where as a person with diabetes, they may think, Well, I’m taking in carbohydrate just for my blood sugars, but in reality we wanna make sure that they’re taking in carbohydrate to fuel the muscle.
And so that, that, that can be really challenging for somebody with diabetes cuz. Now not, you know, they’re always thinking about blood sugar management versus thinking like an athlete and eating like an athlete. So we teach and I also teach families in kids and endurance athletes and adults about how to best fuel their activity over the hour, two hour, three hour time period to not only keep the blood sugars in range, but also to adequately feel the.
[00:13:02] Shireen: Nutritional needs of an athlete are vastly different than a non-athlete to some of the things that you mentioned there, based on their sports preference and athlete’s diet would be dissimilar to another athlete. So perhaps a swimmer versus a football player. How do you navigate
[00:13:18] Megan: that? So every, every athlete has different individual needs.
And so if anybody were to come to me and ask me, Well, how much carbohydrate should I eat? How much protein do I need to eat? Generally for the more recreational athlete, it’s more of just general health, getting in enough nutrition throughout the day. I’m really encouraging everybody, regardless of diabetes or not just up to fuel their bodies earlier in the day.
Not do what we typically do. Very little breakfast, very little lunch, and then all of a sudden watch out. Here comes the eating, which is, I see a very common pattern with everybody. So I’m really trying to teach people, regardless of whether they are a competitive athlete or just a recreational athlete, to get in enough nutrition throughout the day to support, just overall just energy, but also to support any kind of training they may.
Now if they are more of a competitive athlete, that’s where we really have to make sure that they are threading out protein throughout the day, more evenly which helps with muscle recovery. So that’s a common, like I said before, most people eat very little breakfast, very little lunch, and then a large dinner.
So I’m trying to spread that protein out more evenly throughout the day, every three to five hours and getting some source of protein. And that would be in the form of chicken or fish or eggs or cheese. It could be vegetarian sources like nuts and peanut butter or GOs, tofu. So really trying to get that protein throughout the day rather than it just one or two times.
And then when it comes to carbohydrates, when I look at those nutrients for our competitive athlete, compared to a more of a non-athlete or less competitive athlete the, the carbohydrate needs are gonna be much greater. In a competitive athlete, but once again, depends on the sport. So if I look at a soccer player or a swimmer or a basketball player or a runner, their bodies are demanding a lot more carbohydrate compared to maybe a golfer or a baseball player, because the baseball player and the golf are more skill based.
Yes, they are moving their body. They may be doing weight training, they may be doing a little bit of endurance training, but not as much as compared to maybe a competitive runner or a swimmer who is in the pool or on the on the roads exercising two, three hours a day. So once again, fueling the body, fueling the muscle throughout that exercise, exercise, but also making sure.
That they are getting enough nutrition for recovery as well. So I see this often in the gym. You know, somebody who’s maybe on the treadmill or on the elliptical for 20 minutes and then they’re like, downing of recovery shake. I’m like, You don’t need a recovery shake. . We’re getting enough nutrition from your daily, you know, your daily eating at meals and snacks.
But for a competitive athlete, yes, a recovery snack or a recovery meal. In a timely, you know, within 30 minutes to an hour after exercise is really, really important for recovery. So I’m talking a little bit more differently for a competitive athlete, somebody out there much longer compared to somebody who might be just doing exercise for 20, 30 minutes.
[00:16:32] Shireen: You mentioned examples for protein. I think this would be a good spot for us to talk through some of the meals that you recommend, snacks that you recommend for for
[00:16:40] Megan: athletes. Yeah. So when I, I, I, I tried to explain to athletes we wanna get foods from each of the different food groups, or at least from different nutrients at each meal.
So I’m always asking people to think about, what are you missing, rather than restrict. So for instance, if somebody were just to have say eggs for breakfast, if they’re trying to reduce their carbohydrate I may say eggs are fine, but we need to really think about fiber. Where are we getting our fiber from?
Are we getting it from fruits? Are we adding some vegetables? Are we adding some whole grains? So that’s, I’m always trying to balance people’s eating because what, once again, if you just isolate to just one type of food at a meal, you’re gonna set yourself up for being really hungry later in the day. So I’m always like, If you wanna have that, Maybe have some avocado toast with it or maybe have some bowl of berries with it.
That will be a much more well balanced meal versus just the eggs. So I’m always thinking about where are you getting your protein from? Where are you getting your carbohydrates from? Are they coming from the grains? Are they coming from vegetables? Are they coming from fruit? And really focusing on fiber.
So lunches, you know, I see this all of the time with athletes. I used to coach cross country high school kids. The kids, you know, they come see me around three o’clock for training and I could tell from just the workout, I’m like, What did you have for lunch? And they’re like, You know, a salad. I’m like, A salad is not a lunch for an athlete.
It’s not enough nutrition. So I always talk about the athlete salad would be a giant ball of mixed greens with a bunch of veggies. But where are we getting our protein? Are we adding in nuts? Are we adding in chicken? Are we adding in tofu? Where are we getting that protein from? And are we also adding some good healthy fat?
Are we adding in some, you know, whether again, nuts again or avocado, some healthy dressing. And then finally we’ve gotta add a grain. We’ve gotta add some good health, healthy carbohydrates. So throw some berries in that salad. Throw some roasted potatoes or some quin. So that’s a hardy salad. If you’re a salad person for lunch, make it a more balanced salad cause this little, little mixed greens is not gonna hold you and give you enough energy later in the day.
Snacking, whether or not it’s necessary depends on your hunger. You know, I feel like a lot of athletes tend to need a lot more calories throughout the day so they can get that through. And I always say snacks should be a nice combination of different types of nutrients rather than just grabbing a handful of pretzels.
So I’m, I’m talking about getting some good protein, healthy fat, and carbs at your snacks. So that might be a yogurt with berries, it might be toast with peanut butter and a banana on top. It might be a bowl of cereal. You know, there’s a endless list, a handful of nuts and a piece of fruit. So having a little something that’s gonna hold you for a longer period of time, you’re not doing the traditional grazing and picking on foods that just really don’t fill you up
But if an athlete’s eating something really close to exercise, that’s where I say that small little handful of pretzels or a rice cake, or maybe even a fig bar. Something small that’s low calorie, that’s strictly just carbohydrate, that’s easily digesting. That’s what you wanna shoot for right before exercise if you’re hungry.
Cause if you have too much protein or fat right before exercise, the fat and protein take too long to digest and that can sit in your gut and you might have some gut issues while you’re exercising. Well, with that mean, we
[00:20:17] Shireen: We are toward the end of the episode. At this point. I would love for our listeners to know how they can connect with you and just learn
[00:20:22] Megan: Of course, of course. Yeah. You can always find me on my website, which is megan sports rd.com. And on my website, I have some questionnaires on there if you’re interested in my services. Also my email is listed on there and my phone number is on there. I am also on Facebook, Facebook and Instagram.
My Facebook is Megan Sports r d, and my Instagram is Megan Sports, r d. Hmm. Okay. All right.
[00:20:52] Shireen: Got it. . That’s great. And to our listeners listening here today head over to our Facebook, head over to our Instagram, Find this podcast post and let us know how has diabetes changed the way you train. So if you are someone we type one diabetes, Who is also an athlete or even a non-athlete, an athlete by spirit.
Tell us how, how diabetes has changed the way that you train. Again, head over to our Facebook and Instagram at Yumlish and let us know about that with that. Megan, thank you so much for your time
Here today. Oh, thank you. Thank you very much for having me.
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