the year are at risk for poor vitamin D status.78,79,85-87


Tese athletes would benefit from supplementation with


enough vitamin D to maintain serum calcium concentrations within the optimal range of 40 to 70 ng/mL.81 Both vitamin D-3 (cholecalciferol) and D2 (ergocalciferol) are used in supplements and to fortify foods, in- cluding cow’s milk and some brands/types of soy and rice milks, orange juice, breakfast cereals, margarines, and yogurt. Vitamin D-3, obtained through ultraviolet radiation of 7-dehydrocholesterol from lanolin, is not vegan. Vitamin D-3 derived from lichen and vitamin D-2 produced from irradiation of ergosterol from yeast are acceptable to vegans.76,88


(See Chapter 5 and reference 78 for additional information on vitamin D assessment and needs of athletes.)


Box 16.3 Vegetarian Sources of Selected Vitamins and Minerals Nutrient Calcium


Good Food Choices


Calcium-set tofu, calcium-fortified beverages (orange juice and other fruit juices, soy and rice milks), broccoli, Chinese cabbage, kale, collard greens, mustard greens,turnip greens, almonds, tahini, texturized vegetable protein, blackstrap molasses, cow’s milk, certain cheeses, and legumes


Iron Iodine Magnesium Riboflavin


Legumes, nuts and seeds, whole/enriched grains, enriched/fortified cereals and pasta, leafy green and root vegetables, and dried fruits


Iodized salt and sea vegetables (kombu, arame, dulse, and other types of seaweed) Legumes, nuts and seeds, whole grains, green leafy vegetables, blackstrap molasses


Whole-grain and fortified breads and cereals, legumes, tofu, nuts and seeds, tahini, bananas, asparagus, figs, dark-green leafy vegetables, avocado, most sea vegetables (kombu, arame, dulse and other types of seaweed), and dairy products


Vitamin B-12


Vitamin Da


Yeast flakes, fortified foods such as ready-to-eat cereal, meat analogues, some types/brands of soy and rice milks, dairy products, and eggs


Fatty fish (salmon, sardines, mackerel), fortified foods (cow’s milk, some types/brands of soy and rice milks), orange juice, ready-to-eat breakfast cereals, margarines, yogurt, egg yolks, and sun-dried mushrooms


Zinc a


Legumes, nuts and seeds, whole-grain products, fortified ready-to-eat cereal, soy products, commercial meat analogues, and hard cheeses


Sun exposure (~5–30 min on the arms and legs between 10 AM and 2 PM non–daylight savings time, several times a week) is another source of vitamin D.


Adapted from the US Department of Agriculture National Nutrient Database for Standard (Release 28, revised May 2016) and reference 6. Iron


Iron depletion is one of the most prevalent nutrient deficiencies in athletes—especially female athletes.92-94 Iron depletion with anemia (stage III) and without anemia (stage II) can impair muscle function and maximal oxygen uptake and can decrease endurance.95-97


Whereas iron depletion among athletes is most


commonly attributed to insufficient energy or low iron intakes, other factors can affect iron status, includ- ing vegetarian diets, periods of rapid growth, training at altitude, acute inflammation, and increased iron losses through gastrointestinal bleeding, heavy sweating, foot strike, intravascular hemolysis, chronic dis- ease, hematuria, or heavy menstrual blood losses.7,92,98-102 Most of the iron in a vegetarian diet is nonheme iron, which has a lower absorption rate (2% to 20%) than heme iron (15% to 35%) and is sensitive to inhibitors and enhancers of iron absorption.103


Inhibitors CHAPTER 16: VEGETARIAN ATHLETES 337


doses (ie, 1,000 IU) but less effective at increasing and maintaining endogenous 25(OH)D concentrations when taken in higher doses (> 4,000 IU).89-91


Research has suggested that vitamin D-2 is as effective as vitamin D-3 at lower Natural and fortified sources of vitamin D are listed in Box 16.3.


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