7 nonnegotiable ingredients for women's peak performance

Doctor Sue unveils the top immutable nutrients female athletes need to achieve peak performance, from protein to vitamin D and the 3 Cs — calcium, creatine and choline. Plus two other essentials.

Sue Kleiner, Owner

May 15, 2024

5 Min Read

At a Glance

  • Studies on women pales in comparison to male-centric ones.
  • Data is lacking on life cycle and menstrual cycle.
  • After taking care of immunity and iron, here's the list.

[Editor's note: This story is part of the new Natural Products Insider digital magazine, "What women want." Download it for free here. It contains a wealth of features guaranteed to make you smarter in your business, whether you're in marketing, research or running the business. Topics include perimenopause, postmenopause, five multitasking ingredients, optimizing health of women over age 40, and the provocative concept known as the microgenderome.]

Coaches must have certain unfailing strategies that athletes can rely on as effective. While coaches must always be prepared with alternate strategies (or multiple tools in the toolkit), science often can dictate at least a few non-negotiables. In the case of nutrition — of course unless the consumer is allergic or these make her sick — my list is negotiable. But short of that, frankly, I’m pretty firm on my selections. 

Supporting female health and performance (without health, a person doesn’t get much performance), these are my top seven nonnegotiable ingredients. Side note: We’re talking ingredients here. Otherwise, energy would be at the top of the list. Also, iron supplementation is commonly needed in menstruating females but is not recommended without an understanding of iron status. For this reason, it is not a nonnegotiable supplement. 

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Protein: While the number of studies on females pales in comparison to male-centric studies, protein is undeniably a key requirement for physiological adaptations to exercise. In other words, when it comes to enhancing performance — without enough protein, people are wasting their time in the gym. 

We lack the kind of data that would give females a more personalized approach to dietary intakes based on life cycle and menstrual cycle, hormonal contraceptive use or those with perturbations of the menstrual cycle. 

What we can say with confidence, though, is that healthy, eumenorrheic, recreationally active females should consume at least 0.8 grams of protein per pound of body weight daily. If a woman is restricting calories, she should move up to at least 1 g per pound of body weight daily. High-quality protein should be consumed as soon as possible after exercise; and if she is low in protein and/or energy for the day, she may benefit from a small dose of protein before sleep. 

Creatine: The benefits for creatine supplementation in females range enhancements in strength, hypertrophy, exercise performance, energy, cognition, mood, memory, bone health and even fertility. According to a position paper on female athletes from the International Society of Sports Nutrition (ISSN), “Compared to men, females exhibit 70-80% lower endogenous intramuscular phosphocreatine stores and consume considerably lower amounts of dietary creatine.” Current evidence supports consistent recommended dosage amounts for males and females. 

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Vitamin D: During winter months, vitamin D concentrations in athletes are commonly low in a wide range of sports, as they are year-round for indoor sport athletes. Achieving peak bone mass in younger athletes and maintaining bone mineral density in all female athletes is a concern, along with low energy availability; low carbohydrate and protein intake; and low intakes of vitamin D, calcium and other bone-building nutrients. 

Since female athletes commonly have low vitamin D intakes, supplementing is key not only for bone health, but vitamin D is also associated with higher muscle strength, reduced injury rates and better sports performance. In addition, vitamin D plays an active role in immune function, protein synthesis, muscle function, cardiovascular function, inflammatory response, cell growth and musculoskeletal regulation. 

Calcium: Similar to vitamin D, calcium consumption is low in female athletes, and dermal losses can be significant in endurance athletes. Low vitamin D and calcium, along with low energy availability and low protein, have been associated with increasing risk for stress fractures. Studies suggest that the prevalence of stress fractures decreased when athletes were supplemented daily with 800 IU 25(OH)D and 2,000 mg calcium. 

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Citicoline: Choline is an often-ignored B vitamin. Citicoline is a form of choline that is easily taken up by the body and rapidly converted to phosphatidylcholine (PC), a critical component of brain health. Citicoline also supplies choline (half of the most abundant neurotransmitter in the body) with acetylcholine, which works every time a person thinks and moves, 24/7. Suboptimal intakes of choline are present across many gender and life-stage subpopulations, as well as in pregnant women in the U.S. 

The main source of choline in the diet is from egg yolks, and it is very difficult to consume adequate choline without consuming multiple eggs daily and supplementation. Daily citicoline supplementation has been shown to enhance attention, focus, cognition, mood and memory. 

To read up on the final two of the seven magnificent essentials, download the free Natural Products Insider digital magazine here.

About the Author(s)

Sue Kleiner

Owner, High Performance Nutrition

Susan M. Kleiner, Ph.D., RD, CNS-E, FACN, FISSN, is owner of High Performance Nutrition LLC, a consulting firm in Mercer Island, Washington. A trailblazer and internationally recognized expert on nutrition for peak performance, Kleiner is a communicator and consultant, educator and coach, co-founder of the International Society of Sports Nutrition (ISSN) and the author of 10 books, including the bestselling books The New Power Eating, The Good Mood Diet, and Powerfood Nutrition.

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