A Few Nutrition Nuances for Active Females: caloric Intake, calcium, Protein, L-glutamine, cinnamon

The narrative review by Wohlgemuth et al. (2021) explains most research for nutrition and sports performance is on males instead of females and it is females who have a variety of fluctuating nutrition and metabolic changes depending on their cycle. For example, eumenorrheic women metabolize fat and protein at a higher percentage in the luteal phase compared to the follicular stage. Basal metabolic rate (BMR) and training recovery rate/ capacities also vary across the cycle. This phenomenon could be one of the factors why Wholgemuth et al. (2021) explain that a major dietary need in athletic women is simply consumption of more daily calories and macronutrients. Therefore, it would be prudent to investigate the unique needs of nutrition for eumenorrheic athletic women for promoting health, hormones/ proper cycles and adequate performance.

Holtzman & Ackerman (2021) also stress the importance of intake of enough caloric intake for all females in sports with a general daily recommendation of 45 kcal per kg of fat-free mass. The authors highlighting the importance of identifying RED-S (relative energy deficiency in sport) in the female adolescent athlete which when present can lead to a host of negative health and performance outcomes such as increased risk of injury, mental disorders like depression, decreased strength, decreased endurance, and suppress ovarian hormones or amenorrhea. One study by Vanheest et al. (2014) examined 10 adolescent female swimmers over 12 weeks. Two groups were evaluated consisting of an eumenorrheic group and an amenorrhea group. At the end of the study, the amenorrhea group on average had 9.8% slower times compared to the beginning of the season while the eumenorrhea group improved with time on average of 8.2%.

These statistics stress the importance of adequate calories in adolescence females to promote eumenorrhea and subsequently improved sports performance.

Furthermore, pertaining to adolescents, since these females are still growing, they have increased demands for both total energy and proteins macronutrients. As Desbrow et al. (2019) explain if inadequate caloric intake is present, then the body will begin to metabolize proteins to provide energy further reducing protein availability in the body for growth and adaptation from sport demands. A general recommendation of 1.5g per kg of bodyweight per day of protein was a recommendation. Thus, a dual emphasis on sufficient protein intake in conjunction with total caloric intake for adolescents is key to promoting health and performance.

Fueling for female athletes age 20-40 remains like adolescents, but with less emphasis on protein volume except during the luteal phase. Since protein oxidation occurs at a higher rate in the luteal phase, it has been recommended to intake sufficient protein from foods or supplements (Wohlgemuth et al., 2021).  Also, for those whose sports are high volume of repetitive impact (i.e. long-distant running) or have heavy menstrual cycles and/or vegetarian diets, adequate intake of iron for both general health and performance (Holtzman & Ackerman, 2021). Additionally, to help prevent anemia suggestions are to ensure adequate dietary intake of folate, B6 and B12 to support hemoglobin synthesis (Wohlgemuth et al., 2021). Calcium intake in the luteal phase may help premenstrual symptoms. Transient periods of hypocalcemia have also been postulated to be a significant cause of premenstrual syndrome. As estrogen increases in peak serum levels in the latter half of the luteal phase it results in lower serum calcium via inhibition of bone resorption. Lower extracellular calcium concentrations may have stimulatory effects on neuromuscular junctions along with mood disorders like irritability, mania and agitation (Arab et al., 2020).

Regarding postmenopausal and masters female athletes, one main concern is maintaining bone health. Research has suggested that supplementation specifically with collagen peptides of only 5g/ day for one year can both increase osteoblastic activity while reducing net bone catabolism (Wohlgemuth et al., 2021). A study to support bone health tested ingestion of 1350mg via calcium rich food or supplements before exercise and demonstrated this to help mitigate the volume of bone resorption during exercise since calcium is excreted in sweat (Larrosa et al., 2024).

Postmenopausal women have altered ratios of estrogen-to-progesterone this results in some degrees insulin resistance (Larrosa et al., 2024). One study demonstrated some benefits of specific amino acid supplementation like L-glutamine at 10g/ day for 30 days to improve both endurance and resistance exercise performance with simultaneous positively affecting blood glucose levels (Rocha-Rodrigues, Afonso & Sousa, 2022). To increase glycemic control, a recent systematic review of 24 RCTs by Moridpour et al. (2024) concludes that supplementation with cinnamon in adult type II diabetes improves fasting glucose and A1C levels. So, there may also be benefits in postmenopausal women with glycemic control issues to consider supplementing with cinnamon.

References:

Arab, A., Rafie, N., Askari, G., & Taghiabadi, M. (2020). Beneficial Role of Calcium in Premenstrual Syndrome: A Systematic Review of Current Literature. International journal of preventive medicine, 11, 156. https://doi.org/10.4103/ijpvm.IJPVM_243_19

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://doi.org/10.1123/ijsnem.2018-0269

Holtzman, B., & Ackerman, K. E. (2021). Recommendations and Nutritional Considerations for Female Athletes: Health and Performance. Sports medicine (Auckland, N.Z.), 51(Suppl 1), 43–57. https://doi.org/10.1007/s40279-021-01508-8

Larrosa, M., Gil-Izquierdo, A., González-Rodríguez, L. G., Alférez, M. J. M., San Juan, A. F., Sánchez-Gómez, Á., Calvo-Ayuso, N., Ramos-Álvarez, J. J., Fernández-Lázaro, D., Lopez-Grueso, R., López-León, I., Moreno-Lara, J., Domínguez-Balmaseda, D., Illescas-Quiroga, R., Cuenca, E., López, T., Montoya, J. J., Rodrigues-de-Souza, D. P., Carrillo-Alvarez, E., Casado, A., … Domínguez, R. (2025). Nutritional Strategies for Optimizing Health, Sports Performance, and Recovery for Female Athletes and Other Physically Active Women: A Systematic Review. Nutrition reviews, 83(3), e1068–e1089. https://doi.org/10.1093/nutrit/nuae082

Moridpour, A. H., Kavyani, Z., Khosravi, S., Farmani, E., Daneshvar, M., Musazadeh, V., & Faghfouri, A. H. (2024). The effect of cinnamon supplementation on glycemic control in patients with type 2 diabetes mellitus: An updated systematic review and dose-response meta-analysis of randomized controlled trials. Phytotherapy research : PTR, 38(1), 117–130. https://doi.org/10.1002/ptr.8026

Rocha-Rodrigues, S., Afonso, J., & Sousa, M. (2022). Nutrition and Physical Exercise in Women. Nutrients, 14(14), 2981. https://doi.org/10.3390/nu14142981

Vanheest, J. L., Rodgers, C. D., Mahoney, C. E., & De Souza, M. J. (2014). Ovarian suppression impairs sport performance in junior elite female swimmers. Medicine and science in sports and exercise, 46(1), 156–166. https://doi.org/10.1249/MSS.0b013e3182a32b72

Wohlgemuth, K. J., Arieta, L. R., Brewer, G. J., Hoselton, A. L., Gould, L. M., & Smith-Ryan, A. E. (2021). Sex differences and considerations for female specific nutritional strategies: a narrative review. Journal of the International Society of Sports Nutrition, 18(1), 27. https://doi.org/10.1186/s12970-021-00422-8