Nutrition and Injury Recovery

I'm currently typing this one-handed, sitting banged up at home with my first serious injury in about 4 years. I dislocated my elbow at the start of the week and will be spending the foreseeable future in the world's least stylish full-arm cast and not lifting anything heavier than a teacup. Awesome. So it seems as good a time as any to discuss options for injury rehab, recovery nutrition and finding some way to not just bow down and give up for several weeks.

Not a good look.

Injuries are a nightmare, aside from the pain and the damage you've caused yourself, they stop you doing what you love, and usually a big part of the depression people encounter post-injury is from a feeling of helplessness. The bottom line is you need to let your body heal, it might take a week, or it might take a year, but your body needs to have time to do its job. There are things you can do however to help your body along, and optimise conditions for it to heal itself, as well as maintaining your fitness levels, avoiding weight gain or loss and minimising the decline in your physical strength and well-being.

Nutrition for Injury Recovery
I first started looking into nutrition and injuries years ago following a knee injury and being desperate to do something, anything, to encourage my body to heal. It was something none of my doctors discussed with me, but when I started looking into it there was a substantial catalogue of research on the subject. Just as nutrition plays a major role in contributing to your general health and physical performance, it can make a significant difference to how well and how quickly your body repairs itself following injury.

Calorie Intake
Depending on the individual and the sport or activity involved, a major concern of injury will be the prospect of unwanted weight-gain or weight-loss. First off, remember your injury is temporary, so changes to your body will not be permanent, it can all be reversed. If you are immobilised in a cast, particularly lower limb, you may lose weight due to a loss of muscle mass. Unfortunately not a huge amount can be done when you are unable to move a limb, however adequate calorie intake and adequate protein intake will slow the degree of muscle wastage.

Carbohydrate requirements are lowered when activity levels decrease as you will not be depleting your body's glycogen stores. Instead focus on quality protein sources, dietary fats rich in omega 3's and nutrient dense fruits and vegetables.

When your body is repairing itself, basal metabolic rate can increase by 15-20%. In cases of major surgery this can go up to as much as 50% - so don't starve your body or you won't provide it with the energy it requires to heal itself. Be aware however that if you are unable to exercise, or are greatly having to reduce your physical activity, you will be burning less calories than when training at full health.

If your calorie requirements when training are 2800/day, and without training 2000/day, factor in a 20% rise above your sedentary needs to account for the rise in basal metabolic rate, and your calorie requirements are 2400/day. If you know your calorie requirements when training, it shouldn't be difficult to work out requirements when injured. If you can't work out your specific requirements keep weighing yourself, and if you are losing or gaining more than usual adjust your intake accordingly.

Inflammation
Regardless of what type of injury you sustain, the immediate result will be inflammation. Inflammation is typically characterised by pain, swelling and heat and is usually the point that your injury feels most severe, the acute phase over the first 5 or so days. Your body uses inflammation as a means of repair - clearing out dead and damaged cells and producing new ones, and as such, inflammation is a necessary part of the healing process. That said, excess inflammation is damaging and should be controlled. Inflammation following injury is typically controlled by NSAIDs (Non-steroid anti-inflammatory drugs such as ibuprofen), however it can be more effective to manage inflammation through nutrition.

Dietary fats
Dietary fats are a means of managing inflammation post-injury. Omega 3's and mono-unsaturated fats will help reduce inflammation, while Omega 6's and saturated fats will exacerbate it. In practical terms then you want to increase your intake of "good" fats, and decrease your intake of "bad" fats.

• Take 3-9g fish oil daily
• Eat nuts, seeds, avocado and olive oil (use it as dressing, not for cooking) daily

As well as fats there are numerous other nutrients shown to be effective in managing inflammation.

Bromelain
Bromelain is a protein digestive enzyme found in pineapple that has been shown to have incredibly potent anti-inflammatory properties. Benefits have been seen from as little as 200mg/day, however supplementation of between 500-1000mg/day is considered optimal for inflammation control. Unless you intend to eat vast quantities of pineapple (including the stem) each day, it is easier to meet bromelain requirements through dietary supplements.

Tumeric
A staple ingredient of curry, the spice tumeric, or to be more specific curcumin which is found in tumeric has a well documented track record for controlling inflammation. 1200-1800mg/day is recommended for effective control of inflammation. Again, unless you eat a lot of curry with a lot of tumeric in it, dietary supplements are the easiest way to achieve recommended intake.

Garlic
Garlic extract is known for a range of health benefits, not least it's anti-inflammatory properties. Again this is an easy and effective means of assisting your body in the inflammation stage. To get enough to have a significant effect, eating 2-4 cloves of garlic, or supplementing with 600-1000mg of AGE (aged garlic extract).

Vitamin A
As stated above, inflammation is a necessary part of recovery, and during the acute phase, vitamin A can support the cellular regeneration work by supporting inflammatory response. Vitamin A also supports collagen repair and so is crucial in repair of soft tissue injury. 10,000 IU/day is adequate for the acute phase (up to 4 weeks).

Remodelling
So after the inflammation stage, your body still has a whole lot of work to do and a long way to go in repairing and rebuilding tissue around the site of injury. Whether you've damaged bone and sustained a fracture or caused trauma to soft tissue, your body needs to repair, remodel and rebuild through production of new tissue.

Protein
Protein provides the building blocks for tissue repair. While protein intake is important for athletes during normal training it is even more important during injury recovery. At a minimum you should be taking 1g protein per kg bodyweight daily, ideally up to 2g/kg. If you can't make this quota through dietary sources use protein supplementation. Even without exercise, daily whey protein (one of the 2 milk proteins) consumption has been shown to stimulate muscle protein synthesis.

Vitamin C
Vitamin C plays an important role in collagen synthesis, and can help minimise muscle inflammation and damage. It is also important for modulating the immune system and as such can help individuals recovering from surgery and injuries. Aim for 1g- 2 g/day when injured.

Copper and Zinc
Copper helps with the formation of red blood cells, contributes to formation of elastin and can strengthen connective tissue.  In the more acute stages of injury - up to 4 weeks - 2-4mg/day is recommended. Zinc is necessary for cell division and protein synthesis. It plays an important role in immune function and is important for wound repair and infection prevention.15mg/day zinc is recommended if your activity levels have reduced to sedentary through injury, 30mg/day if you are continuing to exercise.

High ingestion of either mineral may cause a deficiency in the other, so to ensure the body is provided with adequate provision of both, supplementation of both minerals is recommended.

Summary

Stay hydrated - your body needs fluids to transport nutrients so don't fall at the first hurdle. Don't be tempted to starve yourself to avoid weight-gain, your body requires energy to heal, however energy intake should be reduced slightly from training intakes. Initial priority is management of inflammation, followed by providing your body the required nutrients to remodel the site of injury.

Inflammation

• Take 3-9g fish oil daily
• Eat nuts, seeds, avocado and olive oil (use it as dressing, not for cooking) daily
• Bromelain 500-1000mg daily
• Tumeric/Curcumin 5-8mg/day
• Aged Garlic Extract 600-1000mg
• Vitamin A 10,000 IU/day for up to 4 weeks

Remodelling

• Increase protein intake up to 2g/kg body weight daily. Eat lean protein with every meal.
• Vitamin C - supplement to 1/2g daily
• Copper 2-4mg/daily
• Zinc 15-30mg/daily

References

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Walker AF, Bundy R, Hicks SM, Middleton RW. (2002) Bromelain reduces mild acute knee pain and improves well-being in a dose-dependent fashion in an open study of otherwise healthy adults. Phytomedicine, 9(8).