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Sports Nutrition: Male vs. Female Athletes with Kira Sutherland

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Sports Nutrition: Male vs. Female Athletes with Kira Sutherland

Should men and women athletes be training differently? Do carbohydrate requirements vary between the sexes? Should female athletes use the OCP to control their hormones? What does the research show? Does the research into these topics even exist at all?

In this episode we welcome back naturopath and sports nutritionist Kira Sutherland, who takes us through these questions and more. She discusses the lack of research surrounding women in sports, the challenges surrounding completing research in this area, and some of the treatment approaches she uses in her own clinic to differentiate between the needs of male and female athletes.

Covered in this episode

[01:00] Welcoming back Kira Sutherland
[01:55] Discussing the lack of research in women’s sport
[04:02] Conducting research in conjunction with the menstrual cycle
[07:14] Rejecting women as a “special population” in sports nutrition
[10:45] Do carbohydrate requirements vary between the sexes?
[15:21] Should female athletes use the OCP to control their hormones? 
[21:46] Training in a fasted state
[24:14] Eating disorders and Relative energy deficiency in sport (RED-S)
[26:37] Gut microbiota in athletes
[30:13] Choosing the right sport for body type
[33:01] Body fat and amenorrhoea 
[35:35] Fuelling before, during and after training
[39:53] Timing fluid and food intake during endurance events
[42:38] Thanking Kira and closing remarks


Andrew: This is FX Medicine. I'm Andrew Whitfield-Cook. Joining us on the line again today is Kira Sutherland, who's an Australian naturopath and sports nutritionist with more than 20 years in clinical practice. She is the current sports performance nutritionist for the Sydney Marathon and Running Festival.

Kira divides her time between clinical practice, lecturing at the undergraduate level, and mentoring practitioners of complementary medicine in the application of holistic sports nutrition. As a keen endurance athlete herself, Kira has participated in many Ironman distance events and marathons and is an avid cross-country and downhill skier, thus providing her with a solid foundation of practical experience to add to her academic and clinical background. 

And I warmly welcome you back to FX Medicine, Kira Sutherland. How are you, Kira?

Kira: Oh, I'm really good. I'm excited to be back.

Andrew: Thank you so much for joining us today. We're going to be talking about women’s sport and what we don't know. So let's start with women in sports research. Is there a lack of research, and why?

Kira: So is there a lack of research? In the past, there's been a huge gap in the research. The last kind of 5 to 7 years, there's a much bigger push. There's a lot more funding to know more about women, especially in sports nutrition. So it's a blossoming area but, yes, there is a great lack of actually knowing the difference between how a female body versus a male body responds under certain sporting conditions. Absolutely.

Andrew: Now, you're saying only in the last 5 to 7 years so that's a lack of longevity there. 

Kira: Yeah.

Andrew: We don't know long-term effects apart from what we haven't looked at. So, I guess where I'm going here is I made a comment to somebody once about the lack of research and they said, "No, there is research." So what's the state of play here? Is there actually misinformation out there about the research?

Kira: Well, there is research but then there's also just a lot of gaps that we don't know where we've taken men and women, and we've clumped us together within clinical trials, and we've not teased out the information between the sexes. I'm not saying that there's no research because there's some amazing researchers that have been going for years looking at women.

But overall in sports nutrition, a good 60% to 65% of clinical research is done on men, often college-age guys that are 70 to 80 kilos, because those are the easy people to test. And so we don't have a grand depth of how women respond differently, and there is now a big push to actually figure this out.

Andrew: So there's a whole gold standard there that's totally incorrect.

Kira: Yeah. Well, we don't know what we don't know. Testing women... And I get why we haven't tested women in the past. Getting funding for research is always difficult. And then if you have women in a clinical trial for something like sports nutrition, depending on what the parameters of what you're testing are, you've got this dynamic person who has their follicular phase, their luteal phase, their ovulation. And we are hormonally and biochemically quite different in our response to different stimuli at different phases of the cycle.

So you either need three times as much time to do some of the testing, or you need to flatline everybody with an oral contraceptive pill. And then the question is: are you actually testing a female body and how they respond? Or are you testing a female body on the pill?

Andrew: You made a very interesting point there about the time to conduct a research. In the newer research, is there an elongated amount of time for recruitment and testing to allow for say... I don't know if I'm saying the correct thing here. Do I say staggering the research start point...

Kira: Yes.

Andrew: ...to a period? Is that right?

Kira: Yes. I mean there's people... There's a lot going on at the moment in Australia. There's a couple researches happening in Queensland actually looking at how do you test women. There's actually a new... I'll send you the paper that just came out—it's not Australian actually—about how we should go about testing women in sports nutrition and exercise physiology. So there is a new paper on it. I don't have it sitting in front of me, but I will get you the link.

We now have parameters on how we should be doing this because the follicular phase is a very different response to... I mean very different. I should be careful with my adjectives. We can potentially respond differently to stimuli when we're in what you would call our low hormone phase versus post-ovulation which is a much higher hormone phase. And it might not be grand differences but it's enough that we need to understand it.

Andrew: Have these parameters been set out by knowledgeable women? 

Kira: Yes.

Andrew: Or have they been set out by men?

Kira: Both. We have both researchers looking at this. And, yeah, both sexes are looking at this research. There's an amazing PhD, Dr Kirsty Elliott-Sale up in the UK, who's really leading the charge on a lot of this and looking at women and health and periods and sports science. So she's doing wonderful things. Dr Stacy Sims out of Otago is doing amazing things.

So there is a drive for it and there are some male researchers on that forefront of women's research as well. We're not being sexist in who's researching.

Andrew: No, but I guess my comment was also almost, sorry, reverse sexism against males, as well. Okay, so misinformation. Is there any misinformation?

Kira: Misinformation or missing. We could even say missing information, but again it's that we don't know what we don't know.

Andrew: Right.

Kira: If we look at... You know, I've been doing sports nutrition for over 20 years. And when I studied post-grad, you're given sports nutrition and then there was... And a lot of sports nutrition books are like this as well, you have a chapter on "special populations" and you have teenagers, you know, disabled athletes, eating disorders, and then you also have females as a special population.

And I get what they were doing, and they weren't trying to do it incorrectly, but we're not a special population. We're 51%...

Andrew: That's right.

Kira: ...51% of the population. And a lot of people will defend and say, "Hey, but there's a lot more men in professional sport," although that is now changing...

Andrew: Changing, yeah.

Kira: ...as well. If you look within Australia, the number one growing sport for women is AFL. 

Andrew: Yes.

Kira: And we had half a million females sign up to play AFL last year. That's pretty good for a 25-million population country.

Andrew: That's incredible.

Kira: Yeah. So yes, we're not as... You know, there's a lot more male professional sport, but that doesn't mean we're not trying to be there playing sport, whether it's professional or amateur or just grassroots sports.

Andrew: Okay. So as a female athlete, have you seen/heard/dialogued about, "Oh, yeah, you know, they say to do this but that's rubbish. We all do this"? Like, have you worked out what to do over a period of years anyway?

Kira: Yeah. But you don't always realise or I didn't always realise it might have been a male/female difference. And it might not be. There's beautiful research about gut absorption and carbohydrates, this is mainly endurance events and what the maximum absorption is of glucose or multiple transportable carbohydrates, so adding in more than just glucose.

And there's research and meta-analysis kind of saying “it doesn't matter if you're male or female or how big you are. We all kind of have about the same intestinal ability. You just have to figure out what you need individually.” And I get that, and it's strong research, it's a meta-analysis. But then you kind of go, over the last 20-25 years, I will often go to the bottom or just below the recommended volumes with women. Or you end up there just because that's where they feel the best.

Andrew: Right.

Kira: So it's a long answer to the question but, yeah, the guidelines are guidelines. They're not rules and I think that's where people get it wrong in sports nutrition and they try to stick to those guidelines like that's the only thing you can do. But it's all about flexibility of what each individual can handle. And in hindsight, I've often had women on that very lower end of the guidelines, if not just off the bottom, depending on what they're doing.

Andrew: Okay, so I guess the questions's got to be asked here. If everybody experiments and find their own natural set point, is there research showing that there is vast differences between the ranges of let's say normal intake of carbs, throughout various parts of a circadian cycle?

Kira: Yeah, that's interesting. Is it a vast difference? I don't think...

Andrew: Between males and females, sorry, I should say.

Kira: Yeah, I think saying vast is probably... I would go for the word subtle. I think there are subtle differences, but those differences can make or break in the athlete when they're out there trying to run a marathon or do an Ironman. 

Andrew: Got you.

Kira: As a clinician, I'm working with really high-level athletes but I'm also working…probably 80% of my athletes are age-group athletes, right? The elite of the elite are working with the Australian Institute of Sports and places like that.

So a lot of my bread and butter athletes are age-groupers trying to figure it out for themselves as well. And they're not going as fast or as hard as some of the elite athletes that some of the clinical research has been done on. So I think there is a big difference for everybody, not just between men and women.

Andrew: I take the point that, when you're talking at, especially the elite level but also competitive levels, 3% to 4% difference in performances is massive.

Kira: It's everything. It's qualifying for your world championship you're trying to go to or ending up in 10th place, you know? So there is a difference.

And I was actually listening to a podcast the other day by this genius researcher down in Melbourne. Ricardo de Costa is this amazing Australian researcher looking at gut integrity in health and sports. And he said in his podcast, and I don't think the research was published yet, he was finding... He was taking women down by 20% versus men.

Andrew: In carbs you're talking about?

Kira: In volume of carbohydrates. He was talking about endurance events. And so, say, you gave a male 1 gram per kilogram of bodyweight. You had a 70-kilogram male, and that's what you kind of had worked out works best for them. 

He was suggesting women might do better on 0.8 grams times their bodyweight in kilos and just that we maybe don't need as much whether it's also that we carry a higher fat percentage, so we also have other stores to use, or that we weren't as efficient at using larger volumes of carbohydrates.

I can't remember exactly what he said, but it was the first time I'd heard a researcher really pull that number down. And I loved it because that's often what I have found clinically, even though I can't always show you the research on it.

Andrew: Okay, so that's counterintuitive to what I've learnt previously…

Kira: What do you mean?

Andrew: ...in that women do require larger amounts of carbs.

Kira: We're talking now in motion while racing.

Andrew: Ah, right, right.

Kira: Yeah, I'm not talking about daily carb intake. I'm talking about ingestion of carbohydrates per hour, say, while you're doing a, you know...

Andrew: During.

Kira: ...7-hour bike ride...

Andrew: Got you.

Kira: ...or a marathon or something like that. He was suggesting that they might actually do better on slightly less.

Andrew: So there's a whole conundrum in itself, the preparation versus racing intake.

Kira: Yes, absolutely. It’s how we need to fuel in the week before an event or if you do abbreviated carb loading. A lot of that's changed over the last decade as well, versus what you actually ingest during racing, but that's getting down to kind of that nitty-gritty of how you apply sports nutrition. 

But to bring it back to women versus men, they're starting to also look at the way we carb-load. Women don't get such a great glycogen volume versus men when they carb-load. We're just finding these subtle differences between men and women, and then we need to look at the research and then how to apply it clinically. Is it actually going to make a difference if we change our suggestions for women or not?

Andrew: I mean there's also that issue of how do women prepare hormonally before sports events? I mean do elite athletes commonly, as you said, use OCP to flatline in a prior month to a big event. Let's say the Olympics, let's say a triathlon or a marathon.

Kira: Yes, often it happens. Often people are put on whatever form of hormone works for them so that they're not having their period during really big events. But now we're starting to question, in some circles, should we be doing this or not or...? 

Andrew: Yeah.

Kira: You know, there's a little bit of research saying being on the pill potentially doesn't allow for as good muscle gain as people not on the pill. There's research showing both ways and not very deep research, I'm going to say that right now.

Andrew: But then there's also the issue of the timing of between events. I mean events aren't necessarily every month. 

Kira: No.

Andrew: Even on the OCP, you're standardising for a cycle.

Kira: And what we're finding is, if you're on the OCP, you're kind of flatlining your body's own hormones and potentially you're missing out on some great benefit. 

Andrew: Yes.

Kira: So if you take the follicular phase, so the first two weeks of the cycle starting with the period, this is where we're lower hormone. This is where we're more similar to men, and there is some research showing that this is where we have our best gains in strength and power, or we have just enhanced gains, I should say. I need to be careful with my wording there. 

This is where we feel great. We recover more quickly. We utilise carbohydrates really well. And we're such a dynamic...we're such a flux, you know, animal in some ways. I don't know if I should say that.

Andrew: Organism, yeah.

Kira: But we're not playing to our potential strengths if we're flatlining. And we're missing out on some hormone...you know, the little testosterone and ovulation and all that kind of stuff. Why are we not utilising our body's natural rhythms rather than just going, "Oh, my God, I don't want to have my period during my race"? Whereas potentially you could feel better if you did.

Andrew: Yeah. So this goes back to my early question about, you know, you're seeing good research in the last 5-7 years. We haven't seen this longevity in the research with regards to bone health, heart health, skin health, fertility, all of these sorts of issues. So are they experienced by female athletes?

Kira: Well, we just don't know, right? 

Andrew: Again.

Kira: We’re such an experiment of our own. You know, women have only been on the pill since, what, the late '60s, early '70s. When have we been testing women and athletes, you know? We don't know the difference of how we're responding.

There is research that's come out recently about being on the pill, being protective for connective tissue and not having... I can't remember if it was ACL injury or meniscus... You know, it was knee injury. But potentially there's a lower rate of injury for women on the pill rather than women in their natural cycles because there is a period of the cycle where everything's more loose and you're more liable to injury.

And, yeah, that sounds great, selling the pill to soccer players so they don't have ACL injury. But what about all the cascade of other implications of being on the pill. We’re not just two knees, right? There's so much else that can go right or wrong for women on the pill.

Andrew: And so team sports. Is it seen? Is it common for practice for the whole team to be on the OCP to basically control the hormones as a baseline, if you like, from a point from a date in time?

Kira: That's a great question, but I don't have an answer for you on that one. I don't tend to work with a lot of team sports so I don't actually know what people are doing in that regard. Although I do know there's so much awareness happening. 

We're on that groundswell of women not wanting to be on the pill and wanting to have their cycles and be empowered with how they feel in the different parts of the month. So I don't actually have an answer for you on that one, Andrew.

Andrew: There's another podcast and certainly other research.

Kira: Yeah, absolutely. Yeah, so women, we're just in this really interesting phase where we don't... Like we keep saying, we don't know what we don't know. Women could be performing better potentially, allowing their cycles to happen, but again it's about having that research done and having the stats on women and what the differences are.

In Canada, they've recently come out with a ruling, that unless there's a very specific region to only have one sex within a clinical trial, that they must include both men and women. 

Andrew: Right.

Kira: They’re the first country to kind of lay that down and we're hoping other countries really follow suit.

Andrew: Okay, and just to continue on that end, in the female cohort, they're going to be staggering the research so that they start from a point in time which is considered day one.

Kira: Well, you would have to or... It depends. I'm not sure the ruling went down that far, but it was just the inclusion of women. I think probably that next step is: are you actually looking at women as a dynamic, fluctuating being because we are very different?

But I know, when I was looking at doing research, I was talking to my supervisor and it was going to take three times as long to put women into the trial if they weren't on the pill because you do need to stagger it and know where they are. I know there's people in Queensland looking at how to do salivary testing of hormones to make it easier to know where people are.

Andrew: Got you. Right. So at least there's some movement towards that.

Kira: Oh, yeah.

Andrew: Yeah.

Kira: Yeah, there's beautiful movement. And, you know, we're getting there. It's just going to take time.

Andrew: Okay, so strict dietary adherence is obviously a given for the elite athlete. Then you've intermittent fasting, keto, nutrition, body shape, and all of those dietary uses for body shape, not just talking about running but let's say, powerlifting or team sports. We've mentioned those. 

Kira: Yes.

Andrew: What’s happening in that sort of world? What do we need to be aware of?

Kira: Well, my gosh, it's an interesting area, right? Because keto is so huge at the moment, and it does have incredible benefits in some realms of clinical practice. But again there's two camps or two opinions on where and when it should be applied, there's great research on training fasted, when training fasted actually creates further adaptations for the body. 

But the problem is people take that research and then go, "Oh, my gosh, well, I'll apply fasted training to all my sessions so I have more what's termed, ‘anabolic flexibility,’" or, "I'm better at burning fats," but they don't understand that the research was looking at doing it at two or three specific times a week, where you then had more of a recovery session for your next training session because you're doing it in a low glycogen state.

So it's not so much any one style is a problem, it's how the general public then perceives it and takes it into an extreme state which isn't where it was originally tested. Does that make sense?

Andrew: Well, there's a lot to learn.

Kira: Yeah. I mean I find... I get these people that, yeah, two or three sessions a week training fasted can be fantastic training in a low glycogen state. We know it has a lot of adaptation. I'm not coming up with the right word there. 

But it has some benefits. But again you're not supposed to be doing your hardest session of the week in a fasted state potentially because you're not going to feel as good. You're not going to train as hard. But, yeah, we take things and we just take it to the nth degree and then wonder why we're not feeling so good.

Andrew: What about the pressures on women with regards to body shape? I mean we're seeing so many eating disorders, and I should say the pressures aren't necessarily in the shape. 

How do you cope here with the strict parameters of diet and adhering to a diet and performance? How do you overcome these sort of issues in women, particularly with eating disorders or at a risk of developing an eating disorder?

Kira: So I mean there is a high prevalence in athletes or people that are very sports focused. I know I just saw a research yesterday or the day before I was reading research on how there's a linking of eating disorders to exercise addiction. And they often go hand in hand. So whether we're even talking about the elite athletes, we're talking about everybody.

Prevalence of eating disorders is high, and it's not just in women. There's also lots of issues with men. What we used to call the female athlete triad, which had undereating or eating issues involved in it and amenorrhoea and problems with bone health, that's now been renamed over the last few years RED-S, relative energy deficiency. And that was to be inclusive of men as well as women. 

And it's really being looked at at this big dynamic, hormonal, all-encompassing, and not just hormonal but affecting every system of the body; this overexercising and under-eating for your volume of exercise.

Andrew: Wow, that's such a big issue then.

Kira: Yeah, it's a massive issue. And not just with elite athletes. But to get back to your actual question, if somebody shows up and it's got all the signals of issues around food intake or borderline eating issues, my first port of call is make sure they have the psychological support with sports doctors, sports psychologists.

I will work with somebody holistically but I will stay in my lane and refer those people on to work in tandem with me, because there's so much in a situation where you've got eating disorders going on.

Andrew: I want to get on to a question later about how do you start changing the mindset of, not just women but also I guess men, as well. But I want to go back to something you said earlier. And was it one of the researches? Was it Ricardo da Costa looking at gut integrity?

Kira: Yeah. He's looking at absorption and gut health during endurance sports. Ricardo da Costa.

Andrew: Okay. Are there any researchers looking at the changes in the gut microbiota over in women during a menstrual cycle? And I guess men as well. Where I'm going here is you're talking about gut integrity, and I'm thinking of, you know, the diarrhoea with endurance athletes, usually marathoners. We see it usually in marathoners with regards to stress, the heat shock proteins, isn't it? Is that right?

Kira: Yeah, yes, yes. So he's doing a lot of research. I don't actually know specifically. He's doing a lot of stuff on microbiome but I don't know specifically, I’d have to go back and look at the suite of publications he's been coming out with.

We know the microbiome is enhanced with sport. There is research, although I'm thinking of research that's done on male rugby players at this point, about athletes tend to have a bigger biodiversity of microbiome, which is great.

Andrew: Well, this is the good work that exercise helps your bugs.

Kira: Yeah, absolutely and bigger diversity of bugs.

Andrew: Yeah.

Kira: So we do know that from preliminary trials on men. I haven't seen if he's pulling stuff apart between men and women. I have to be honest with that one. 

Andrew: Right.

Kira: But, yeah, he's definitely heavily looking at endurance sport. And I think he himself is also very involved in endurance sports.

Andrew: Got you. I remember some earlier work. We're talking about a decade ago by Dr Cecilia Shing of University of Tasmania looking at heat shock proteins, elite athletes, and I think it was fire personnel.

Kira: Yeah, yeah.

Andrew: And they were using a probiotic to avert issues with that, but I don't know if there's any work on elite athletes and preventing that diarrhoea or helping maintain the gut integrity.

Kira: Yeah, but I'm not sure. I do know a lot of what we considered to be sports nutrition research actually also happens on our Armed Forces. 

Andrew: Ah, okay.

Kira: I know this more from Canada and America. There's huge budget for research looking at Armed Forces, and heat and cold exposure, and what that's doing to the body, and then how to prevent it or support a body under those extreme conditions.

So that's actually where quite a lot of our research comes from there as well. Although again, that would probably be heavily male-dominated because...

Andrew: Yeah.

Kira: ...we're a very small percentage, although women would be included but yeah. So it's interesting where that research comes from.

And just also to make another point, in sports nutrition, often our clinical trials aren't super... What's the word? Deep is probably not right, but you'll often read clinical papers in sports nutrition and there are only 20, 30 participants because it’s...

Andrew: Underpowered.

Kira: …such extreme... Very underpowered. Thank you. I couldn't think of that word. You'll often read things that are 8, 15 participants, 20 participants, and that's very standard in sports nutrition.

Andrew: Okay, so to go onto my question about changing the mindset of women in sport, how do you get them to start thinking, or to realise that they're different? They're a dynamic being that has particular needs. How do you get them to start realising this?

Kira: That's a good question. You know, I think the last decade and especially last two or three years, there is that big empowerment for women around lifting heavy or being happy with, you know... How do we get a movement for women to be happy with their bodies? Wow, that's like...

Andrew: Whoa, there's a big one.

Kira: You know? It's that: what is the ideal female body? I think it's really about... One of the ways I go about this, I guess, if you're asking me personally is I talk to a lot of my clients about what their body type is, height, muscle mass, the whole thing, and what does their ideal body type look like? Not what does Vogue and society's body type look like.

You know, like, if you don't... I mean, you know me but, for listeners, I'm almost 5'10". I'm built like my Viking/Scottish ancestry. I would have been a great shield-maiden, you know?

Andrew: You're intimidating as hell.

Kira: Why didn't they hire me for that Vikings show? So I'm not going to be this super petite... I never should do gymnastics. I mean there's doing sport that you love just for the love of it, but there's also finding sports that suit your body type. You're going to excel in those sports and it's going to feel good. And then, in turn, there's the self-acceptance when you feel like you're doing something great with your body. 

Andrew: Right.

Kira: Did that make any sense?

Andrew: Yes, absolutely.

Kira: Like, I have an almost 14-year-old girl, right? I've been a practitioner the whole time she's been around, and I have that fear, as every mom or dad does-especially if it’s a daughter-around the body. I mean, don't get me talking about social media. 

And we're often talking about "this is your body shape” versus “that is somebody else's natural body shape" and steering her towards sports where her body shape is an asset rather than an issue. Because it scares me when women do sports, or girls do sports, when their body shape isn't quite the best body shape for that sport. Those are the people probably at risk first.

Andrew: If we could just take a few little snippets of what you've done clinically, let's say in the last three cases, the last three patients that have you've helped. What sort of things are common? What sort of things do you commonly come up against to have to change, or to initiate in people?

Kira: Oh, my gosh. What a question. What are the things? One of my last clients had hypothalamic amenorrhoea. So she at some point while doing a strength sport lost body fat and she got below 17% body fat.

Now, for a lot of women, 17% body fat is like that threshold where a lot of women will go amenorrhoeic underneath it. She's not an elite, elite athlete but a very strong athlete. Although everybody's different. Some women will lose their period at 19%, others can be done at 14% and still be having a beautiful cycle. But this athlete lost her period after going on a really strict diet. I wasn't involved in that.

And so we've been working to get her cycle back, and it was a point of looking at bloods and actually going, "I think you're still under-eating for the volume of exercise you're doing." And so it's around the mindset of not being scared to eat.

Andrew: Yes.

Kira: So many women, everyone has carb phobia and I would probably say the biggest thing I have to work on with everybody, male and female, is carb phobia. We are so scared of it. Yes, there's a place for low carb. Yes, there's a place for keto. But there's also a beautiful place for healthy carbohydrates especially if you're doing a bunch of sport, right?

Andrew: Yeah, yeah.

Kira: And so it's retraining that mindset that it's safe to eat, and it's safe to eat carbohydrates. And some people may or may not agree with this, but I spend my life trying to teach people, especially around exercise, that's your safest time to eat your bigger volume carb because your body wants to turn it into glycogen and trying to get them to let go of their fear around eating enough. That's probably my number one thing, but that was maybe two things.

Andrew: That's one case. Let's go to two more cases. What sort of things...?

Kira: Oh, my gosh. Oh, I've just been on holidays. You're hitting me hard. What else? I can't think of another thing right now. 

I think that's my biggest thing is carb phobia, eating after training. If I could teach every athlete one thing, it's about fuelling properly after training. Is this my wish list of what I want people to know?

Andrew: Yes, so refuelling. Let's talk about refuelling after training or after an event.

Kira: Yeah. Actually, could we talk about... I'm jumping to my other one. Fuelling before training. Not every session needs to be fasted. You will often train better if you have a small snack before training. And so many people wake up in the morning and train fasted in the hopes of more fat burning. Yet, then they peter out and they're exhausted by the end of their session.

And we're not asking people to have a lot of food before training but just 10, 15, 20 grams of carbohydrates or a little hit of protein, just something little to fuel their body through a hard session. They will often feel so much better.

And Dr Stacy Sims, who's over in New Zealand, is a big advocate of this, of saying women shouldn't be fasted training. Get them eating. And it's really liberating for women to go back to that...

Andrew: Great.

Kira: ...after thinking they may have to fasted train.

Andrew: What about intra-event, especially endurance events? What about nutrition during that event?

Kira: Oh, my gosh, yes. So there's different amounts that are suggested during events. If your event is an hour or shorter, you don't really need to be eating anything, especially if you've had something before. There is research on mouth rinsing with sports drink just for a little hit, but I don't tend to do that with a lot of people. Up to a two-hour event, the average suggestion is 30 grams an hour of carbohydrates per hour. But again, if your body doesn't feel like it needs that much, go down a little bit. If you get really hungry, go up a little bit. It's allowed to fluctuate. 

Endurance events, which are really considered stop over an hour and a half to two hours, it depends on how hard you're going. But you need to be fuelling every hour of the event, not waiting till the end of the event.

Andrew: Yeah. What about protein?

Kira: During events?

Andrew: Yeah.

Kira: It's so individual. Most of the research says carbohydrates is king during events, but you can depending... The longer the event, the more I'll bring in a little bit of protein and a little bit of fat for satiety so they don't feel as hungry, for great stabilisation of blood sugar levels, but it's not a large amount. The highest I bring in is like a 4:1 ratio of carb to protein during an event and not all the time. But again, it's individual and you have to play with it.

It's like solid food in an event. If it's a 5-hour event, a lot of people don't want solids. But the minute you get above 5 or 6 hours, I found people really need solid food at a couple points during an event.

Andrew: I mean it's so interesting with regards to mouthfeel, thirst-quenching, and also digestive processes during a stressful event. There's so much that goes into that...

Kira: Oh, yeah.

Andrew: ...how much do they actually assimilate. Any research on this sort of stuff?

Kira: Oh, my gosh. There's massive. There's deep, massive research on what to ingest or how to ingest during endurance events. And, you know, the research is because of so many great, big endurance events, and ultra events are kind of the new goal I think for middle-aged people, which I'm one of. 

There's a lot of different options and a lot of different suggestions around what to ingest. There's guidelines but the way I go at it with clients is you really just have to experiment with yourself. But the biggest thing I probably spend my time... 

So this is number three. I'm going back to your question. One of the biggest things that I end up undoing is people's incorrect ingestion of fluid and foods during endurance events. 

Andrew: Right.

Kira: And it's often that they're not having the wrong thing. They're having it at the wrong time. Timing is everything so that they're not overloading their digestive system and causing a stomach plug, which in the end then causes either vomiting or diarrhoea.

Andrew: Yes.

Kira: So I spend my time, you know, changing around literally the timing of how they do it, more so even than the volume.

Andrew: Now, you mention that 4:1 carb to protein ratio with solid food in extended events. You said there's oodles of research. Has that research been done on women?

Kira: I don't know if... I'm going to say I don't know. I can go back and have a look now.

Andrew: I bet you any money it hasn't.

Kira: Well, or a lot of research has been done on men and women combined, but we've never pulled out the difference between the two. And I hope that research is being done now and I'm sorry I'm not further... My brain has been on holidays for almost two months. That's what I would love to see.

Andrew: See, that would be a really interesting thing to look at about...

Kira: Oh, my God. It would be incredible.

Andrew: ...the specific needs of women with regards to assimilation of these nutrients and their bodily requirements during an event.

Kira: Absolutely. And, you know, as far as endurance events goes, when we get to ultra-endurance events, we're starting now to see women winning ultra-endurance events overall because our bodies are actually built for endurance. 

Andrew: Yes.

Kira: And the longer the event, the more likelihood is a female can actually excel even over some of the men. I mean, it depends on the event and it's not about that but it's about the fact that we need the research for the women.

So I'm sure it is being done at the moment. I'm going to be really positive in that statement. And, yeah, now I've got to have to go look for the rest of the day so I can send you some links.

Andrew: I'd love to say that my body type is more suited for power, but I think it's more suited for slumber.

Kira: Well, it's like me. I love running but I'm a really slow runner, right? I do triathlons and the swim and the bike is great, and then it's just... I'm a little bit of a plodder of a run, but it doesn't stop me from doing it, you know?

Andrew: Yeah. Kira, there's so much more that has to come out from this. I look forward to the day when you and I can have a chat and go, "We have these results." That would be an amazing podcast.

Kira: Oh, my God, that's exciting.

Andrew: So we'll have you back on the show in the future when we have some more information to go on. But in the meantime, I love the work you're doing, and the questions that you're asking, and the people that you're helping with regards to their sports and helping them to achieve their goals. Well done.

Kira: Absolutely. Thank you. Thank you for having me. And it's exciting where it's all going for women. It's going to be slow but we're going to get there. And, in the end, we might find it doesn't matter that much between the sexes for some stuff, and other stuff it does. So it's an exciting area that we're getting into.

Andrew: Well-said.

Kira: Yeah, thanks for having me.

Andrew: This is FX Medicine. I'm Andrew Whitfield-Cook.


Other podcasts with Kira include


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Kira Sutherland

Kira Sutherland is an Australian Naturopath and Sports Nutritionist with more than 20 years in clinical practice. She is the 2019 winner of the BioCeuticals Integrative Medicine Award for Excellence in practice (Nutrition/Dietetics) and is the current performance nutritionist for the Sydney Marathon and running festival (IAAF Gold Label event).

Kira divides her time between clinical practice, lecturing at the undergraduate level, and mentoring practitioners of complementary medicine in the application of holistic sports nutrition. As a keen endurance athlete herself, Kira has participated in many Ironman distance events and marathons and is an avid cross country and downhill skier, thus providing her with a solid foundation of practical experience to add to her academic and clinical background.