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Nutrition for Sports Injuries & Healing: Part 2 of 3

Nutrition for Sports Injuries & Healing: 2 of 3

Dr. Geoff Lecovin
MS, DC, ND, L.Ac, CSCS, CISSN
Naturopathic Physician, Chiropractor, Acupuncturist, Nutritionist, & Personal Trainer

“Unleashing the Power of Food”

The key points to consider with the pyramid of nutritional

Prioritization:

  • Consume adequate calories to ensure energy balance

  • Ensure optimal intake of macronutrients (Carbohydrates, proteins and fats) for energy, repair and reducing inflammation

  • Eat enough nutrient dense foods to avoid micronutrient deficiencies (vitamins, minerals and phytonutrients)

  • Strategic timing of nutrients for energy and repair

  • Select nutrient supplementation for inflammation, muscle, tendon and bone repair

Energy

Adequate calories (energy) are essential for maintaining ideal body weight, fueling activities (e.g. rehabilitation) and promoting healing/recovery. Determining one’s energy requirements can be done using online calculators that take into account one's metabolic rate (BMR) and activity energy expenditure (i.e. rehabilitation, exercise, healing requirements and non exercise activity thermogenesis). Many individuals reduce their calorie intake during injury recovery out of fear that they will gain weight. While consuming excessive simple carbohydrates could lead to unwanted weight gain, supporting the healing process with adequate calories is essential. In addition, some weight gain may be favorable for optimal healing. Also, during recovery, the use of crutches or other ambulation aids can substantially increase one’s energy requirements.

Macronutrients

There are three macronutrients:

  1. Carbohydrates

  2. Proteins

  3. Fats

Each macronutrient plays an important role in the healing process and will be discussed in the context of the three T’s: Total, Type and Timing.

Carbohydrates

Carbohydrates include sugars (simple) and starches (complex). Their primary function is to provide energy for moderate-intense activity. They are also important in keeping the body in an anabolic state by helping to mediate cortisol levels, a main catabolic hormone. Carbohydrates also spare protein, which further aids in maintaining an anabolic state. During injury healing, one should consider meeting carbohydrate requirements for both the healing process as well as rehabilitation. This could be in the range of 3-5g/kg Body Mass, with the focus on low glycemic carbohydrates (e.g. whole grains, vegetables and fruits) as the primary sources.

Proteins

Proteins are essential for muscle growth and repair as well as keeping the body in an anabolic state. They can be categorized as:

  1. Complete - Animal sources, such as beef, poultry, pork, lamb, fish, eggs, dairy and plants such as quinoa and soy

  2. Incomplete - Plants, such as grains, legumes, nuts and vegetables

The general dose for protein to help support healing is 1.5-2.5 g/kg Body Mass. Include some protein with each meal (about 0.4 g/kg Body Mass or about 20-40g). If you are vegetarian, make sure to balance complementary protein sources throughout the day, e.g. Rice and beans, and aim for intakes towards the higher end. Protein needs can be higher in older adults as well as in disuse atrophy, where there can be anabolic resistance.

Fats

Fats and oils can be categorized according to their saturation. The degree of saturation determines the melting point and stability of a fat. Fats are important as an energy source (low intensity activity), hormone production and in controlling inflammation.

Sources of fats include:

  • Saturated fats- Animal fats and coconut Monounsaturated- Avocados, olive oil, macadamia nuts

  • Polyunsaturated:

    • Omega 6 (Proinflammatory if out of balance)- Seed and vegetable oils, e.g. canola, corn, peanut, sunflower, safflower

    • Omega 3 (anti-inflammatory)- Dark green leafy vegetables, flax/hemp seeds, walnuts, cold water fish, grass-fed beef, omega-3 eggs

In general, fats should make up anywhere from 15-20% of one’s diet, with the emphasis on omega 3 polyunsaturated fatty acids and monounsaturated sources. Diets high in saturated fats and omega 6 polyunsaturated fatty acids can put the body in a more inflammatory state.

Micronutrients

Fitness 2.jpeg

Micronutrients include vitamins, minerals and phytonutrients. They are required in small quantities to ensure normal metabolism, growth and physical well-being. They also help to reduce inflammation and support the healing process. When it comes to micronutrients, avoiding nutrient deficiencies is the key and this can be done by eating a well balanced, varied, whole foods and unprocessed diet. Supraphysiologic vitamin and mineral supplementation beyond what a balanced diet can provide, is not recommended and in the case of antioxidants (e.g. Vitamins A,C,E,Beta carotene, Zinc and Selenium) can adversely affect healing by disrupting the beneficial aspects of inflammation.


References:

  1. Areestion during prolta, J. L., Burke, L. M., Ross, M. L., Camera, D. M., West, D. W., Broad, E. M., ... & Hawley, J. A. (2013).

  2. Timing and distribution of protein ingonged recovery from resistance exercise alters myofibrillar protein synthesis. The Journal of physiology , 591 (9), 2319-2331 Louise M. Burke, John A. Hawley, Stephen H. S. Wong & Asker E. Jeukendrup (2011)

  3. Carbohydrates for training and competition, Journal of Sports Sciences, 29:sup1, S17-S27, DOI: 10.1080/02640414.2011.585473 Clifford, T., Bell, O., West, D. J., Howatson, G., & Stevenson, E. J. (2016).

  4. The effects of beetroot juice supplementation on indices of muscle damage following eccentric exercise. European journal of applied physiology , 116 (2), 353-362. Close, G. L., Sale, C., Baar, K., & Bermon, S. (2019).

  5. Nutrition for the prevention and treatment of injuries in track and field athletes. International journal of sport nutrition and exercise metabolism , 29 (2), 189-197 Currell , Kevin. Performance Nutrition . Crowood Press (April 1, 2017)

  6. Farup, J., Rahbek, S. K., Knudsen, I. S., de Paoli, F., Mackey, A. L., & Vissing, K. (2014). Whey protein supplementation accelerates satellite cell proliferation during recovery from eccentric exercise. Amino Acids , 46 (11), 2503-2516 Frankenfield, D. (2006).

  7. Energy expenditure and protein requirements after traumatic injury. Nutrition in Clinical Practice , 21 (5), 430-437 Glover, E. I., Phillips, S. M., Oates, B. R., Tang, J. E., Tarnopolsky, M. A., Selby, A., ... & Rennie, M. J. (2008).

  8. Immobilization induces anabolic resistance in human myofibrillar protein synthesis with low and high dose amino acid infusion. The Journal of physiology , 586 (24), 6049-6061 Guo, S., & Dipietro, L. A. (2010).

  9. Factors affecting wound healing. Journal of dental research , 89 (3), 219–229. https://doi.org/10.1177/0022034509359125 Juhasz, I., Kopkane, J. P., Hajdu, P., Szalay, G., Kopper, B., & Tihanyi, J. (2018).

  10. Creatine Supplementation Supports the Rehabilitation of Adolescent Fin Swimmers in Tendon Overuse Injury Cases. Journal of sports science & medicine , 17 (2), 279–288 Kelley, D. S., Adkins, Y., & Laugero, K. D. (2018).

  11. A Review of the Health Benefits of Cherries. Nutrients , 10 (3), 368. https://doi.org/10.3390/nu10030368 Kerksick, C. M., Arent, S., Schoenfeld, B. J., Stout, J. R., Campbell, B., Wilborn, C. D., Taylor, L., Kalman, D., Smith-Ryan, A. E., Kreider, R. B., Willoughby, D., Arciero, P. J., VanDusseldorp, T. A., Ormsbee, M. J., Wildman, R., Greenwood, M., Ziegenfuss, T. N., Aragon, A. A., & Antonio, J. (2017).

  12. International society of sports nutrition position stand: nutrient timing. Journal of the International Society of Sports Nutrition , 14 , 33. https://doi.org/10.1186/s12970-017-0189-4 Laumonier, T., & Menetrey, J. (2016).

  13. Muscle injuries and strategies for improving their repair. Journal of experimental orthopaedics , 3 (1), 15. https://doi.org/10.1186/s40634-016-0051-7 Logue, D. M., Madigan, S. M., Melin, A., Delahunt, E., Heinen, M., Donnell, S. M., & Corish, C. A. (2020). Low Energy Availability in Athletes 2020:

  14. An Updated Narrative Review of Prevalence, Risk, Within-Day Energy Balance, Knowledge, and Impact on Sports Performance. Nutrients , 12 (3), 835. https://doi.org/10.3390/nu12030835 Phillips, C. M., Chen, L. W., Heude, B., Bernard, J. Y., Harvey, N. C., Duijts, L., ... & Shivappa, N. (2019).

  15. Dietary inflammatory index and non-communicable disease risk: a narrative review. Nutrients , 11 (8), 1873. Maughan, R. J., Burke, L. M., Dvorak, J., Larson-Meyer, D. E., Peeling, P., Phillips, S. M., ... & Meeusen, R. (2018).

  16. IOC consensus statement: dietary supplements and the high-performance athlete. International journal of sport nutrition and exercise metabolism , 28 (2), 104-125 Myer, G. D., Kushner, A. M., Brent, J. L., Schoenfeld, B. J., Hugentobler, J., Lloyd, R. S., Vermeil, A., Chu, D. A., Harbin, J., & McGill, S. M. (2014).

  17. The back squat: A proposed assessment of functional deficits and technical factors that limit performance. Strength and conditioning journal , 36 (6), 4–27. https://doi.org/10.1519/SSC.0000000000000103 Mountjoy, M., Sundgot-Borgen, J., Burke, L., Carter, S., Constantini, N., Lebrun, C., ... & Ljungqvist, A. (2014).

  18. The IOC consensus statement: beyond the female athlete triad—Relative Energy Deficiency in Sport (RED-S). Br J Sports Med , 48 (7), 491-497 Pence, B. D., & Woods, J. A. (2014). Exercise, obesity, and cutaneous wound healing: evidence from rodent and human studies. Advances in wound care , 3 (1), 71-79. Quintero, K. J., de Sá Resende, A., Leite, G. S. F., & Junior, A. H. L. (2018).

  19. An overview of nutritional strategies for recovery process in sports-related muscle injuries. Nutrire , 43 (1), 27 Sale, C., & Elliott-Sale, K. J. (2019). Nutrition and athlete bone health. Sports Medicine , 1-13 Shaw, G., Lee-Barthel, A., Ross, M. L., Wang, B., & Baar, K. (2017).

  20. Vitamin C–enriched gelatin supplementation before intermittent activity augments collagen synthesis. The American journal of clinical nutrition , 105 (1), 136-143 Smith, Stephen, MSc, PHd, (Cand), NUTRITION FOR INJURY PREVENTION & REHABILITATION applied in an elite powerlifter.2019.

  21. IOPN Performance Nutrition DiplomaTipton, K. D. (2015).

  22. Nutritional support for exercise-induced injuries. Sports Medicine , 45 (1), 93-104 Van Vliet, S., Shy, E. L., Abou Sawan, S., Beals, J. W., West, D. W., Skinner, S. K., ... & Moore, D. R. (2017).

  23. Consumption of whole eggs promotes greater stimulation of postexercise muscle protein synthesis than consumption of isonitrogenous amounts of egg whites in young men. The American journal of clinical nutrition , 106 (6), 1401-1412 Wall, B. T., Snijders, T., Senden, J. M., Ottenbros, C. L., Gijsen, A. P., Verdijk, L. B., & van Loon, L. J. (2013). Disuse impairs the muscle protein synthetic response to protein ingestion in healthy men. The Journal of Clinical Endocrinology & Metabolism , 98 (12), 4872-4881 Yang, D. F., Shen, Y. L., Wu, C., Huang, Y. S., Lee, P. Y., Er, N.X., ... & Tung, Y. T. (2019).

  24. Sleep deprivation reduces the recovery of muscle injury induced by high-intensity exercise in a mouse model. Life sciences , 235 , 116835 Precision Nutrition, Nutrition for Injury Recovery Infographic. https://www.precisionnutrition.com/ http://www.sportsrd.org/wp-content/uploads/2016/08/Nutrition- Support-for-Inury-Recovery-Return-to-Play.pdf

Questions and Contact Info: www.drgeofflecovin.com or email: geoff@drgeofflecovin.com



Nutrition for Sports Injuries & Healing

Nutrition for Sports Injuries & Healing: 1 of 3

Dr. Geoff Lecovin
MS, DC, ND, L.Ac, CSCS, CISSN
Naturopathic Physician, Chiropractor, Acupuncturist, Nutritionist, & Personal Trainer

“Unleashing the Power of Food”

Healing after an Injury occurs in three stages

1. Inflammation - Occurs immediately and continues up to 5 days post-injury. It is the body's way of signaling the immune system to heal and repair damaged tissue, as well as defend itself against viruses and bacteria.

2. Proliferation (regeneration) - From 5 days to 3 weeks post-injury. In this phase, tissue rebuilding and repairing occurs.

3. Maturation (fibrosis) - From 3 weeks to 2 years. In this phase, remodeling of tissue structure occurs. Each stage must occur sequentially in order for optimal healing to occur. By understanding the stages of healing, one can more effectively focus specific nutrition and rehabilitation interventions. Should you use ice and/or anti-inflammatory medications after an injury?

Healing after an Injury occurs in three stages

1. Inflammation - Occurs immediately and continues up to 5 days post-injury. It is the body's way of signaling the immune system to heal and repair damaged tissue, as well as defend itself against viruses and bacteria.

2. Proliferation (regeneration) - From 5 days to 3 weeks post-injury. In this phase, tissue rebuilding and repairing occurs.

3. Maturation (fibrosis) - From 3 weeks to 2 years. In this phase, remodeling of tissue structure occurs. Each stage must occur sequentially in order for optimal healing to occur. By understanding the stages of healing, one can more effectively focus specific nutrition and rehabilitation interventions. Should you use ice and/or anti-inflammatory medications after an injury?

Fitness 2.jpeg

During the inflammatory stage, numerous chemicals are released, some of which can irritate pain receptors called nociceptors. Many people turn to Non Steroidal Anti-inflammatory Drugs, such as Ibuprofen and Naproxen, to reduce the pain. Unfortunately, while these medications can be effective at blocking pain, they can also disrupt the healing process. Fortunately, there are a number of alternative physical and nutritional interventions that can help reduce the pain associated with inflammation, while at the same time supporting the healing process.

MEAT vs RICE?

Move, Exercise, Analgesics, Treatment
Rest, Ice, Compression, Elevation
MEAT supports the healing process, whereas certain aspects of RICE may impede it, depending upon the injury. I generally recommend contrast hydrotherapy as follows: Three minutes of heat alternating with one minute cold, three times, several times throughout the day. This serves to pump nutrition into the injured area and pump waste products out. Ice is generally reserved for right after surgery or briefly after an injury, depending on the severity of the inflammation. You should consult your doctor or therapist to determine which approach best suits your injury.


References:

  1. Areestion during prolta, J. L., Burke, L. M., Ross, M. L., Camera, D. M., West, D. W., Broad, E. M., ... & Hawley, J. A. (2013).

  2. Timing and distribution of protein ingonged recovery from resistance exercise alters myofibrillar protein synthesis. The Journal of physiology , 591 (9), 2319-2331 Louise M. Burke, John A. Hawley, Stephen H. S. Wong & Asker E. Jeukendrup (2011)

  3. Carbohydrates for training and competition, Journal of Sports Sciences, 29:sup1, S17-S27, DOI: 10.1080/02640414.2011.585473 Clifford, T., Bell, O., West, D. J., Howatson, G., & Stevenson, E. J. (2016).

  4. The effects of beetroot juice supplementation on indices of muscle damage following eccentric exercise. European journal of applied physiology , 116 (2), 353-362. Close, G. L., Sale, C., Baar, K., & Bermon, S. (2019).

  5. Nutrition for the prevention and treatment of injuries in track and field athletes. International journal of sport nutrition and exercise metabolism , 29 (2), 189-197 Currell , Kevin. Performance Nutrition . Crowood Press (April 1, 2017)

  6. Farup, J., Rahbek, S. K., Knudsen, I. S., de Paoli, F., Mackey, A. L., & Vissing, K. (2014). Whey protein supplementation accelerates satellite cell proliferation during recovery from eccentric exercise. Amino Acids , 46 (11), 2503-2516 Frankenfield, D. (2006).

  7. Energy expenditure and protein requirements after traumatic injury. Nutrition in Clinical Practice , 21 (5), 430-437 Glover, E. I., Phillips, S. M., Oates, B. R., Tang, J. E., Tarnopolsky, M. A., Selby, A., ... & Rennie, M. J. (2008).

  8. Immobilization induces anabolic resistance in human myofibrillar protein synthesis with low and high dose amino acid infusion. The Journal of physiology , 586 (24), 6049-6061 Guo, S., & Dipietro, L. A. (2010).

  9. Factors affecting wound healing. Journal of dental research , 89 (3), 219–229. https://doi.org/10.1177/0022034509359125 Juhasz, I., Kopkane, J. P., Hajdu, P., Szalay, G., Kopper, B., & Tihanyi, J. (2018).

  10. Creatine Supplementation Supports the Rehabilitation of Adolescent Fin Swimmers in Tendon Overuse Injury Cases. Journal of sports science & medicine , 17 (2), 279–288 Kelley, D. S., Adkins, Y., & Laugero, K. D. (2018).

  11. A Review of the Health Benefits of Cherries. Nutrients , 10 (3), 368. https://doi.org/10.3390/nu10030368 Kerksick, C. M., Arent, S., Schoenfeld, B. J., Stout, J. R., Campbell, B., Wilborn, C. D., Taylor, L., Kalman, D., Smith-Ryan, A. E., Kreider, R. B., Willoughby, D., Arciero, P. J., VanDusseldorp, T. A., Ormsbee, M. J., Wildman, R., Greenwood, M., Ziegenfuss, T. N., Aragon, A. A., & Antonio, J. (2017).

  12. International society of sports nutrition position stand: nutrient timing. Journal of the International Society of Sports Nutrition , 14 , 33. https://doi.org/10.1186/s12970-017-0189-4 Laumonier, T., & Menetrey, J. (2016).

  13. Muscle injuries and strategies for improving their repair. Journal of experimental orthopaedics , 3 (1), 15. https://doi.org/10.1186/s40634-016-0051-7 Logue, D. M., Madigan, S. M., Melin, A., Delahunt, E., Heinen, M., Donnell, S. M., & Corish, C. A. (2020). Low Energy Availability in Athletes 2020:

  14. An Updated Narrative Review of Prevalence, Risk, Within-Day Energy Balance, Knowledge, and Impact on Sports Performance. Nutrients , 12 (3), 835. https://doi.org/10.3390/nu12030835 Phillips, C. M., Chen, L. W., Heude, B., Bernard, J. Y., Harvey, N. C., Duijts, L., ... & Shivappa, N. (2019).

  15. Dietary inflammatory index and non-communicable disease risk: a narrative review. Nutrients , 11 (8), 1873. Maughan, R. J., Burke, L. M., Dvorak, J., Larson-Meyer, D. E., Peeling, P., Phillips, S. M., ... & Meeusen, R. (2018).

  16. IOC consensus statement: dietary supplements and the high-performance athlete. International journal of sport nutrition and exercise metabolism , 28 (2), 104-125 Myer, G. D., Kushner, A. M., Brent, J. L., Schoenfeld, B. J., Hugentobler, J., Lloyd, R. S., Vermeil, A., Chu, D. A., Harbin, J., & McGill, S. M. (2014).

  17. The back squat: A proposed assessment of functional deficits and technical factors that limit performance. Strength and conditioning journal , 36 (6), 4–27. https://doi.org/10.1519/SSC.0000000000000103 Mountjoy, M., Sundgot-Borgen, J., Burke, L., Carter, S., Constantini, N., Lebrun, C., ... & Ljungqvist, A. (2014).

  18. The IOC consensus statement: beyond the female athlete triad—Relative Energy Deficiency in Sport (RED-S). Br J Sports Med , 48 (7), 491-497 Pence, B. D., & Woods, J. A. (2014). Exercise, obesity, and cutaneous wound healing: evidence from rodent and human studies. Advances in wound care , 3 (1), 71-79. Quintero, K. J., de Sá Resende, A., Leite, G. S. F., & Junior, A. H. L. (2018).

  19. An overview of nutritional strategies for recovery process in sports-related muscle injuries. Nutrire , 43 (1), 27 Sale, C., & Elliott-Sale, K. J. (2019). Nutrition and athlete bone health. Sports Medicine , 1-13 Shaw, G., Lee-Barthel, A., Ross, M. L., Wang, B., & Baar, K. (2017).

  20. Vitamin C–enriched gelatin supplementation before intermittent activity augments collagen synthesis. The American journal of clinical nutrition , 105 (1), 136-143 Smith, Stephen, MSc, PHd, (Cand), NUTRITION FOR INJURY PREVENTION & REHABILITATION applied in an elite powerlifter.2019.

  21. IOPN Performance Nutrition DiplomaTipton, K. D. (2015).

  22. Nutritional support for exercise-induced injuries. Sports Medicine , 45 (1), 93-104 Van Vliet, S., Shy, E. L., Abou Sawan, S., Beals, J. W., West, D. W., Skinner, S. K., ... & Moore, D. R. (2017).

  23. Consumption of whole eggs promotes greater stimulation of postexercise muscle protein synthesis than consumption of isonitrogenous amounts of egg whites in young men. The American journal of clinical nutrition , 106 (6), 1401-1412 Wall, B. T., Snijders, T., Senden, J. M., Ottenbros, C. L., Gijsen, A. P., Verdijk, L. B., & van Loon, L. J. (2013). Disuse impairs the muscle protein synthetic response to protein ingestion in healthy men. The Journal of Clinical Endocrinology & Metabolism , 98 (12), 4872-4881 Yang, D. F., Shen, Y. L., Wu, C., Huang, Y. S., Lee, P. Y., Er, N.X., ... & Tung, Y. T. (2019).

  24. Sleep deprivation reduces the recovery of muscle injury induced by high-intensity exercise in a mouse model. Life sciences , 235 , 116835 Precision Nutrition, Nutrition for Injury Recovery Infographic. https://www.precisionnutrition.com/ http://www.sportsrd.org/wp-content/uploads/2016/08/Nutrition- Support-for-Inury-Recovery-Return-to-Play.pdf

Questions and Contact Info: www.drgeofflecovin.com or email: geoff@drgeofflecovin.com



Blood Flow Restriction (Copy)

Blood Flow Restriction (Copy)

“Speed kills” is a phrase often heard in the athletic world to emphasize the idea that the faster the athlete is, the more successful he or she will be. As a health professional and a performance coach, it is important to teach athletes that being fast does not always have to rely on genetic background. There are plenty of specific mechanics that can turn speed into a skill.