Nutrition for the Injured Athlete

We talk all the time about nutrition for performance and nutrition for recovery but there is not much talk about nutrition for injury. Is there even a specific regimen for the injured athlete?!
Unfortunately, there is not much research out there on the injured athlete so we don't have a specific regimen, however, we do have some knowledge and recommendations to help heal faster and get back in the game sooner.

Injury has 3 healing phases:

1. Inflammation - occurs immediately up to 2-5 days post injury
2. Proliferation -  occurs 5 days - 3 weeks post. During this phase there is rebuilding and repairing 
3. Maturation - occurs 3 weeks - 2 years (depending on severity of injury). During this phase there is remodeling to a stronger structure

If the injury is serious we may not be able to immobilize which in turn will cause less muscle building, muscle loss, decrease in strength and of course decrease in performance.  

Nutritionally, we divide recommendations to 2 phases: 

1. Injury and immobilization - during this phase most of the muscle loss occurs
2. Rehabilitation - during this phase exercise is re-introduced in the form of therapy and advanced to full practice when able

Nutrition recommendations during Injury and immobilization (= inflammation and proliferation phase of healing):

• Energy (kcal) - demands of energy are slightly higher in order to assist with the healing processes. If injury is severe, energy expenditure can go up by 20%. If on crutches, energy expenditure can be 2-3 times higher than walking. Sometimes, a small weight gain is beneficial because with out enough calories we can prevent muscle protein synthesis (building muscle)
• Protein - During the immobilization phase we lose muscle which then causes us to lose strength. Protein helps us build and repair, therefore, are needs for protein are higher. Although we do not have an exact number of grams/lb we need per day, we assume its more than the DRI (dietary reference intake) which is 0.8 grams/kg (0.35 grams/lb). Some research suggests we need close to 1-1.2 grams/kg/day (0.45-0.55 grams/lb/day). Since the majority of us eat more protein than we need this should not be an issue
• Carbohydrates - When we exercise, carbohydrates are our main source of energy. However, when injured, we don't need as much, therefore, we may decrease carbohydrates slightly to prevent excessive weight gain. Sports beverages, gels, sodas and concentrated sweets are highly discouraged during this time
• Fats - very essential for healing. What type of fats is most important. Omega 3s (found in fatty fish as well as certain seeds/nuts) have been found to possibly help increase muscle protein synthesis (building muscle) as well as help with recovery and decreasing inflammation
• Vitamins and minerals:
             * Vitamin C - Helps with wound healing, tissue repair and increased immune function. Foods rich in vitamin C include: citrus fruit, strawberries, red bell peppers, watermelon, etc.
             * Vitamin A - Helps with cell growth and development as well as immune function. Foods high in vitamin A include: sweet potatoes, tomatoes, carrots, papaya (orange/red fruits and vegetables)
             * Zinc - Helps with wound healing, protein synthesis and immune function. Foods rich with zinc include: beef, almonds, seeds (sunflower, flax, pumpkin, etc.) and seafood
             * Vitamin D - Important for bone health and immune function. The sun vitamin - get 5-30 minutes of sun between 10 AM - 3 PM (time is based on skin color, the darker the skin the more time you need) or it can be found in dairy products, fatty fish or fortified foods

                      

• Fluids - fluids are needed in order to deliver the different nutrients to the different organs and tissues. Moreover, its needed to support joints and soft tissues. Roughly, you should be drinking half your weight in ounces, preferably water. 

Nutrition during rehabilitation phase

We treat this phase as we were to treat someone who does strength and conditioning. We put emphasis on enough energy and protein as well as healthy fats and plenty of vegetables and fruits. More on strength and conditioning nutrition in a future blog.

There are also foods/beverages that can prevent us from healing optimally, which we should avoid:

• Fried fatty foods (example: pizza, fried chicken, french fries, etc.)
• Added sugars and concentrated sweets (soda, candy, ice-cream, etc.)
• Being malnourished (more common in elderly but applies to people that restrict eating a lot)
• Less than optimal sleep (athletes should sleep 8-10 hours/day)
• Alcohol - it inhibits muscle protein synthesis and increases muscle loss 

So, if you or any of your friends get injured, remember to also focus on nutrition to help speed your healing and recovery! Food always comes first and if need be, consult a sports RD or a sports MD for supplement recommendations.

Gastrointestinal Issues in Runners and Strategies to Overcome Them

Bill Rogers, a famous American runner that won four times the Boston and NYC marathon's between 1975-1980 and a 2000 USA Track & Field Hall of Famer stated, "more marathons are won or lost in the portable toilets than at the dinner table". Obviously, he was well aware of the gastrointestinal (GI) issues runners face.
GI issues have a variety of symptoms including: diarrhea, nausea, vomiting, bloating, belching, cramps heartburn and bloody stools. Symptoms are more common in women, younger athletes, elite athletes and people with a history of GI issues. It is estimated to occur in 30-90% of distance runners during and/or after exercise. Complaints of GI issues differ in severity and they may cause a decline in performance and recovery.

                           

There are three main reasons for GI problems:

• Physiological - When we exercise, depending on the intensity, blood supply to the gut may decrease by up to 80% in order to transfer more blood to the working muscles, skin and heart. This in turn may cause diarrhea, nausea, vomiting and stomach pain.
• Mechanical -   Running is a high impact sport with continuous pounding. This pounding also influences the GI tract which in turn can cause GI symptoms. Therefore, runners have a tendency to have more problems than bikers. 
• Nutritional - The meal timing before exercise as well as beverage and food choices may cause GI symptoms. A meal shortly before running, rich with fiber, fat and protein will cause GI symptoms because these nutrients have a slow emptying rate in the stomach. Drinking a concentrated carbohydrate beverage during or slightly before a race will cause GI symptoms. Moreover, dehydration intensifies GI symptoms. As discussed in the previous blog on alcohol and performance, drinking the night before a run several drinks can cause GI symptoms probably due to its diuretic effect. 
• Note; Certain people may have a medical condition such as: celiac disease, lactose/fructose mal-absorption and irritable bowel syndrome to name a few, that makes them more susceptible to GI symptoms

Since this blog is a nutrition blog, lets talk about some nutrition strategies to prevent GI symptoms:

• Hydration, hydration, hydration - before a run, make sure you are hydrated. Focus on hydrating well throughout the day. 
• Avoid beverages during or slightly before a run rich with fructose such as juice. Prefer water or if running long distance, a sports beverage with 6-8% carbohydrates such as Gatorade or Powerade.
• Avoid high fiber foods 1-2 hours pre-exercise as well as the day before a big race. 
• Avoid high fat and high protein foods 1-2 hours pre-exercise
• "Train the gut" - the gut is very adaptable, therefore, train your gut by eating during your training as well as before (if activity is lower than 60-90 minutes there is no need to eat anything during and water should suffice). Experiment with foods before a training session to check what works and what doesn't.
• Avoid using non-selective, non steroidal anti-inflammatory drugs (NSAIDs) such as Aspirin and Ibuprofen as they tend to increase GI symptoms.
• Avoid lactose containing milk products if you think or know that you are lactose intolerant. 
• Avoid or limit alcohol drinking before a morning run or a big race

It is very important that if you have severe GI symptoms such as bloody stools, you consult with a medical professional.

For specific guidance and assistance if you suffer from the symptoms noted above, consider consulting with a sports dietitian to help you with strategies to prevent any GI symptoms.

Sleep, an Essential Component

There are 4 main components that are essential for any athlete: training, recovery, nutrition and sleep.
We tend to talk a lot about the first 3 components but not much on the last one.
The recommendations for sleep duration are as follows:
Children - 10-11 hours/day
Teens - 8.5-9.5 hours/day
Adults - 7-9 hours/day

Lack of sleep has been shown to: impair cognitive performance and mood, disturb glucose metabolism and appetite regulation which in turn can cause higher weight, decrease immune function and decrease production of hormones such as testosterone and growth hormone (these hormones assist with building and repairing muscle). 

When it comes to physical activity, sleep deprivation has been noted to cause: slower reaction times, slower sprint times, decreased aerobic performance, decreased cognitive processes (visual tracking, focus, mood, determination) and higher odds for injury.

Although there are not many studies out there, the University of Stanford has done several studies on swimmers, tennis players and basketball players. They tried to see what happens if you extend sleep time to 10 hours/day. College students had their baseline (performance and psychological tests) measured while sleeping regularly for several weeks (typical sleep day ranged 6-9 hours) and then got them to sleep at least 10 hours a day for several weeks. If they could not sleep the whole time at night, they were encouraged to take naps throughout the day. Interestingly enough the results showed they all had faster sprint times and they all had increased mood and decreased day time fatigue. 

Each sport also had specific improvements:

1. Tennis - Had about 24% better accuracy in hitting as well as 42% better hitting depth.
2. Basketball - Had improved shooting accuracy by 9% in both free throw as well as 3 point field goals. They also had a better reaction time
3. Swimming - Had faster reaction times, total faster times and 25% more kicks 

Are you ready to go to sleep yet? If you are, here are some things you can do to get a better sleep:

1. Sleep on a comfortable mattress with comfortable pillows
2. Finish eating about 2 hours before you go to sleep
3. Schedule time for sleep. If need be, set an alarm
4. Avoid caffeine or energy drinks close to bed-time
5. Dim the lights in your room and when its time to go to bed make sure your room is dark as possible
6. Turn off all screens at least an hour before bed: TV, laptop, computer, Ipad, cell phone, X-box, etc. If you feel you must text or email before bed make sure you use the light dimming apps 

Athletes should make sure they are not only training, eating and recovering right but also sleeping enough!

Good Night

Alcohol and Performance

Alcohol is the most abused recreational drug in society and is the one most used by athletes. It is well known to cause poor judgement, decreased reaction time and decreased fine motor skills which is why we don't drink and drive. In addition, it effects our heart function, our ability to regulate body temperature and it can cause hypoglycemia (low blood sugar).

Research states that 88% of intercollegiate American athletes use alcohol. Moreover, collegiate athletes are much more likely to binge drink compared with non-athlete students. It's speculated that maybe the competitive behavior of athletes is not just on the court or field but also in social activities, such as drinking.

So, what can alcohol do to performance? Lets go over some facts:

• Athletes that drink alcohol once per week have been shown to have twice the risk for injury. 
• Moderate alcohol consumption has been shown to lower force production.
• Chronic alcohol use can cause substantial weight gain. Which in turn can slow you down.
• Alcohol use can decrease aerobic ability as well as decrease sustained power output. In fact, one study showed that drinking 24 hours before an event caused 11% decrease in performance which could be the difference between being first and last.
• Alcohol hurts recovery by interfering with muscle protein synthesis (building and repairing muscle) as well as glycogen re-synthesis (restoring our glycogen stores so that we have stored fuel for exercise). One study showed that even if you consumed alcohol with protein after exercise you would still have lower rate of muscle protein synthesis.
• Alcohol can interfere with our ability to regulate core temperature, therefore, lowering our ability to tolerate training no matter what the temperature is (even in an air-conditioned facility).
• Alcohol influences our psycho-motor skills which means it can decrease balance, reaction time, visual search and recognition, memory as well as accuracy of fine motor skills. Now imagine a quarterback that has all these problems.
• Alcohol shortens our time in deep sleep (REM). Lack of deep sleep causes a decrease in performance as well as a decrease in human growth hormone (HGH) secretion. HGH helps us build and repair muscle. (Stay tuned for a blog on how sleep effects performance in the near future).
• Alcohol is a diuretic (promotes production of urine) which means it can cause dehydration. Dehydration in turn can cause a decrease in performance.
• Alcohol may continue to effect your performance 2-5 days after you drink, depending on how much you drank.

If you're an athlete that wants to improve PR, excel and/or win, you must think about what you are willing or not willing to do. Make sure you fuel right for performance and limit or avoid alcohol. Since social interaction with friends many times includes alcohol, be smart about it and consider following the American College of Sports Medicine (ACSM) guidelines:
"Pre-event - Avoid alcohol beyond low-amount social drinking for 48 hours.   

Post exercise - Re-hydrate first and consume food to retard any alcohol absorption"

Cheers! 

Sleep and Athletic Performance

A recent study by Stanford University of their varsity men's basketball team showed that getting more sleep improved athletic performance. This is probably something that you believed to be true already, but now here is the proof. The researchers recorded their averages of sprint speed, shooting accuracy, 3-point percentage, and free-throw percentage. Then they asked the basketball players to get a minimum of 10 hours of sleep per night - how many of you get that? 

After a 5-7 week period of more sleep at night, the players improved! They were running faster, shooting better, and reported an improvement in mental health. Their free-throw percentage increased an average of 9% and their 3-point field goal percentage increased by 9.2%!

As a college athlete, you are given a few obstacles that may interfere with your sleep. Studying, training, and traveling to competitions certainly takes up a lot of your time. It can be easy to put less emphasis on sleep when your to-do list is long. But it is important to realize that creating a sleep deficit DOES make a difference in how well you perform, not only in your sport but in school.  

You can read the full manuscript here:
The Effects of Sleep Extension on the Athletic Performance of Collegiate Basketball Players by Cheri D. Mah, MS, Kenneth E. Mah, MD, MS, Eric J. Kezirian, MD, MPH, and William C. Dement, MD, PhD