Athletes, Injuries and Nutrition
By Nancy Clark, RD
Athletes get injured. It’s part of the deal. Be it a torn ACL, Achilles tendonitis, or a pulled muscle, the questions arise: What can I eat to recover faster? Would more vitamins be helpful? What about collagen supplements? At this year’s virtual Food and Nutrition Conference and Expo (FNCE) of the Academy of Nutrition and Dietetics (AND, the nation’s largest group of nutrition professionals), several presentations offered updates on nutrition for injuries.
Pre-injury diet. You never know when you will break a bone that requires a surgical fix, get hurt in a car accident, or end up with COVID. That’s why you want to prepare your body for the worst by eating wisely on a daily basis. While you need not eat a “perfect diet,” you certainly want your meals and snacks to include at least 90% quality calories. Ten-percent fun foods are allowed!
If you know you’ll be having surgery for, let’s say, a rotator cuff injury, you certainly want to enter into the surgery being well nourished, with your liver stockpiled with the vitamins and minerals needed for healing. (A well-nourished person’s liver stores enough vitamin C to last for about six weeks.) Well-nourished patients have shorter hospital stays and faster recoveries. A light-weight rower who restricts food intake or a runner with anorexia could easily be under-nourished. Be proactive; eat well every day. Pre-habilitation makes (unexpected) rehabilitation easier!
By focusing two-thirds of your plate on wholesome grains, fruits and vegetables, you’ll not only optimize your intake of vitamins and minerals, but also fiber. Fiber feeds the microbes in your gut. These microbes influence the strength of your immune system. Other foods that boost health of the microbiome include yogurt, kefir, blue and other “moldy” cheeses. In contrast, low-fiber ultra-processed foods do little to enhance gut health and immune power. Keto-athletes, take note: some (but not all) studies suggest low fiber keto diets may be detrimental to the microbiome.
Post-injury diet. Injured athletes may be tempted to over-restrict calories, believing they “don’t deserve to eat” because they are not exercising. Wrong. Even when you are on bedrest, your body burns about 10 calories per pound of body weight just for your resting metabolic rate (energy used to fuel organs such as heart, lungs, liver, brain—and just be alive). That means, if you weigh 150 pounds, you likely need about 1,500 calories for your resting metabolic rate + more fuel for your (limited) daily activity (brushing teeth, getting dressed, etc.) + 10% to 20% additional calories for healing the injury. When healing injuries, you do not want to severely restrict your intake of valuable nutrients!
On the other hand, you don’t want to over-indulge and smother your injury-related grief and/or boredom with ice cream. Rather, add structure to your day with scheduled meals and snacks. A sports dietitian (RD CSSD) can offer a nutrition rehab plan that identifies the amount of protein needed to prevent loss of lean muscle, an appropriate calorie intake to optimize healing without gaining undesired body fat, offer suggestions for ways to boost your intake of iron and zinc (to optimize healing), and identify anti-inflammatory foods such as berries, leafy greens (spinach, arugula, kale), cruciferous vegetables (Brussel sprouts, broccoli), and anti-inflammatory fats (extra virgin olive oil, salmon, nuts).
Ruptured tendons, torn ligaments, and muscle pulls. So called “soft tissue injuries” such as ruptured tendons, torn ligaments, and muscle pulls (muscle torn off tendons) can be season-ending injuries. Preventing them from happening in the first place could save a lot of angst. Research suggests strength training (more so than stretching) reduces the incidence of these injuries.
Speaking at FNCE, Keith Barr PhD, a researcher at University of California at Davis, explained tendons and ligaments have a collagen-filled matrix. To heal tendon and ligament injuries, Baar reports loading (stressing) them helps to increase collagen synthesis and make them stronger. For example, the anterior cruciate ligament (ACL) gets thicker (i.e., stronger) during a training season.
Unlike muscles, your tendons and ligaments get nourished with little blood flow to provide nutrients. Rather, fluid in connective tissue gets squeezed out when the muscle stretches during exercise; nourishing fluid then gets sucked in when the muscle relaxes. Consuming a collagen supplement 30 to 60 minutes before exercise assures having collagen-building amino acids circulating around the damaged tissue. This has been shown to enhance healing.
To create tissues that are more injury-resistant, athletes in sports that include explosive movements (basketball, track and field, soccer) might want to take collagen supplements prophylactically. Doing so may also enhance their performance. One study suggested hydrolyzed collagen during training also improved explosive performance compared to a placebo.
While research is limited (and commercial collagen products are exploding), hydro-lyzed collagen, collagen peptides, and yes, Knox gelatin all offer the amino acid glycine, needed to heal these tissues. Dana Lis PhD RD, researcher with Baar at UC-Davis, reports not all collagen supplements are created equal. Bone broth, for example, has low levels of glycine. Hydrolyzed collagen seems to be absorbed better than gelatin and tends to be more palatable.
Lis notes vitamin C is a co-factor needed to repair damaged tissue, so athletes should consume 50 mg vitamin C (for example, the amount in 4-oz. orange juice or ½ cup of cooked broccoli) along with the collagen supplement. To date, research has not been done to determine if glycine-rich foods (meat, fish, and poultry, or lessor amounts in soy, nuts and plant-proteins) are as effective as supplements. Would eating pre-exercise chicken + orange juice do the same job? Stay tuned.
The bottom line: Don’t underestimate the power of nutrition in preventing and healing injuries!
Sports Nutritionist Nancy Clark, MS, RD is a frequent contributor to the PBSCCS website. For more information on sports nutrition, check out the 6th edition of Sports Nutrition Guidebook at NancyClarkRD.com