Sporting injuries and resulting surgeries are caused by a whole multitude of factors.
Injuries and surgery can often be a chaotic experience. No one likes them and they can be a huge setback for any athlete. The inflammation that results from injuries and surgery (i.e. incision and anaesthetic effects on the body) is often painful, uncomfortable and sometimes extremely debilitating.
In my experience as a Naturopath, I have found that in the recovery/rehab process, little emphasis is put on diet and lifestyle modification, and how it can help or even hinder recovery. It is usually based around pain and anti-inflammatory medications, as well as physical rehab (depending on the type of injury or surgery).
After an injury or surgery, every athlete wants to resume normalcy in their lives as soon as possible and get back to competing. The good news is that implementing certain nutritional strategies, lifestyle interventions, as well as evidence based herbal and nutritional supplementation, can help speed up the recovery process and decrease the risk of a repeated injury.
Note: The general principles in this post can also be applied to the general lay person in order to optimize recovery from both injuries and surgeries.
Nutritional strategies for recovery.
When addressing optimal nutrition for injuries, it is important to first look at a person’s caloric intake. Too few calories when healthy can lead to injury; too few calories during recovery can prevent an athlete from getting healthy.
Energy needs increase during acute injury repair. In fact, basal metabolic rate (BMR)* may increase by 15 to 50% based on the severity of the trauma. For example, sports injury and minor surgery may increase BMR by 15-20%, while major surgery and burn injury may lead to a 50% increase in BMR.
*BMR is the minimum amount of calories to support the energy needs of a person. It depends on age, sex, height and activity levels.
Obviously an athlete will have to eat less during injury recovery than during training and competition. Yet if they return to baseline intake, they may be under-eating. Thus, it is important to eat enough calories to support healing, while not eating too much leading to weight gain.
If a person is eating based on hunger cues, they may under-eat during recovery. They might lose lean mass, heal poorly, and progress slowly. Therefore, an athlete should try to eat before they feel hungry and make sure the quantity is slightly less than what they would normally eat.
Meals should ideally be separated by around 3-4 hours. While it is important to eat enough calories to support energy needs, it is also important as to what types of foods these calories are coming from.
Ideally, an individual should try to eat more whole, unprocessed foods such as lean meats, fish, eggs, dairy, seafood, nuts, seeds, beans, legumes, whole grains, fruit, vegetables and healthy fats like coconut oil/milk/yoghurt/cream, butter, animals fats, avocado, olive oil and nut/seed oils. These foods contain many beneficial nutrients that can help control inflammation and support healing/recovery. Eating lots of processed and refined food may exacerbate inflammation and decrease healing/recovery.
Furthermore, whole foods are nutrient dense, providing lots of important nutrients to support healing and recovery. The nutrient density of whole foods will also help an athlete feel fuller for longer, so they don’t overshoot their caloric intake, leading to weight gain.
Injury repair requires more protein. Injured athletes should aim for 2-2.5 g of protein to per kg of body weight. A lay person should aim for 1.5-2g/kg.
To ensure a quick recovery, it is important to get this higher protein intake consistently. At the minimum, injured athletes should be taking in 1.5g of protein per kg of body weight. Protein is extremely important for tissue repair and injury healing. Adequate protein intake after an injury or surgery has been shown to increase collagen deposition and improve recovery.
Protein is also important to ensure a person maintains their muscle mass while they are injured or recovering from surgery because muscle loss is a serious issue problem due to the under use of muscles. When the body doesn’t need something, it gets rid of it, unless adequate nutrients are provided to maintain that tissue. Furthermore, lean protein sources such as meat, fish, eggs, whey protein powder and seafood have many other beneficial nutrients that can helps support healing and recovery.
Sometimes, people can find it hard to consume enough protein from whole foods due to how filling high protein meals are. Also, due to time constraints, they may not be able to always sit down and eat a large protein meal. This is where protein powder and protein shakes can become very useful.
You can add a protein shake in between your meals (or in place of meals like breakfast, perhaps) to boost your overall protein intake.
Protein shakes should consist of what a balanced meal should look like. It should consist of a protein, carb and fat source, as well as some veggies. Here is a good example of a recipe:
- 1 scoop of a high quality whey, egg or beef protein powder. Animal proteins are more bioavailable and better absorbed than plant proteins. Make sure to find a protein powder without carbs.
- 2 fists of spinach (vegetable).
- A healthy fat source like coconut oil OR coconut cream/milk/yoghurt OR avocado OR nuts OR pure nut butter (fat).
- Frozen berries, banana or any frozen fruit of your choice (carbs).
- cinnamon and vanilla extract for taste
- water OR milk as a liquid
(try different ingredients to see what suits your taste buds, just as long as it has a vegetable source, protein source, fat source and carb source)
Protein shakes can be a source of additional calories if you’re trying to aid recovery, or a means of boosting protein without adding calories.
To get a rough idea of protein amounts in food, 1 palm of meat or fish tends to contain roughly 30-60g of protein. Also, one egg contains 6g of protein.
Eating healthy fats from foods and oils like coconut oil, coconut cream/yoghurt/milk, olive oil, nut/seed oils, butter, avocado, fish, nuts, nut butters and seeds can help control inflammation due to the important anti-inflammatory nutrients that these foods contain. Fish is a great source of protein, vitamins and minerals. It is also the best food source of omega 3 fatty acids, which are very important in modulating inflammation. When injured or recovering from surgery, an athlete should aim to eat fish 2-3 times a week. This is a healthy habit even if one is not injured.
When an athlete is injured or recovering from a surgery, because they are more sedentary than usual and their energy needs decrease, they may want to reduce their carb intake slightly. The carbs that an individual does consume should be from whole-food sources like rice, whole grains, fruits, beans and legumes, wholegrain bread, sweet potato, potato and pumpkin, as these are also packed with beneficial nutrients to support healing and recovery.
Obviously carb intake would become higher once the athlete gets back into training, as this is the most important fuel source for athletes who engage in long bouts of moderate to high intensity work, like footballers. Eating low carb while training hard can lead to fatigue, poor performance, delayed recovery and many other negative health impacts.
Fruits and vegetables:
Fruits and vegetables are packed with plant chemicals called phytonutrients, which can help manage inflammation that results from injuries or surgery, due their anti-oxidant and anti-inflammatory actions. They can also help maintain the health of the connective tissues that the body makes to repair the damaged tissue from an injury or a surgery. Therefore, at each meal, it is important for an athlete to eat a vast array of fruits and vegetables, which they should be doing even if they are not inured, as we all know that these are good for our health and performance.
Ideally, every meals should consist of a protein source, vegetable source, healthy carbohydrates and fat source.
When cooking meals, ideally we want athletes to cook using healthy fats (e.g. olive oil, coconut oil, butter), using olive oil and vinegar for salad dressings and flavouring their foods with salt, pepper, herbs and spices rather than with sauces like tomato, BBQ, sweet chilli etc. This is because processed sauces contain oils and sugar that may increase inflammation in the body.
All meals should ideally be home cooked, however if the athlete does decide to eat a meal out, they should try to pick healthy options with a good source of protein and vegetables.
The protein and vegetable source should not be in a burger, on pizza, in a pasta, deep fried and in a pie, with lots of sauce and oils.
Supplementation strategies recovery.
Vitamin A helps to decrease post-injury immune suppression, and assists in collagen formation. Collagen is the main protein that makes up our bones, ligaments, tendons and muscles. Studies have shown that collagen cross-linkage is stronger with vitamin A supplementation and repair is quicker.
Supplementing with 10,000 IU daily for the first 1-2 weeks post-injury is probably ideal. Some people are concerned about possible vitamin A toxicity with supplementation. However, toxicity only occurs in the backdrop of a vitamin D deficiency. Therefore, supplementing with 3-4,000 IU would be ideal.
Also, Vitamin A is hard to get from the diet as it only really exists in significant amounts within liver, therefore eating liver twice a week would decrease the need for supplementation.
Vitamin C is essential in the production of collagen. Vitamin C is also a powerful antioxidant and immune system modulator, and research suggests that vitamin C can help people recovering from surgery and injury. Supplement with 1g- 2 g/day during periods of injury repair. Vitamin C supplements can be bought from your local health food store.
Zinc is required for over 300 enzymes in the body and plays roles in DNA synthesis, cell division, and protein synthesis — all necessary for tissue regeneration and repair after injury.
Zinc deficiency is common in athletes and has been associated with poor wound healing, therefore it would be a good idea to supplement with 15-30 mg per day, especially during the initial stages of healing. Zinc supplements can easily be bought from your local health food store.
Here’s a brief list of the vitamin and mineral supplements that help with acute injury recovery:
- Vitamin A – 10,000 IU/day for 2-4 weeks post-injury (with 3-4,000 IU vitamin D)
- Vitamin C – 1000-2000 mg/day for 2-4 weeks post-injury
- Zinc – 15-30 mg/day for 2-4 weeks post-injury
Nutrient deficiencies: It may also be important to screen for common nutrient deficiencies such as iron, which can be commonly low in females due to their periods, poor absorption and potentially low intake via their diet. Iron is easily tested on a blood test and is vital for wound healing due to its function in carrying oxygen to tissues on red blood cells.
Curcumin is the active ingredient of turmeric (spice). It is a potent anti-inflammatory and has been shown to decrease inflammation associated with injuries/surgery.
Curcumin has a poor oral bioavailability when consumed in tumeric and thus should be enhanced with other agents such as black pepper extract, called piperine. This is unless you want the curcumin in the colon (as it is a colon anti-inflammatory and can help with digestion), in which case you wouldn’t pair it with an enhancement.
Doses up to 8g curcuminoids in humans have been shown to not be associated with much adverse effects at all, and in vitro tests suggest curcumin has quite a large safety threshold.
For any systemic purpose (requiring absorption from the intestines into the blood), then an oral supplementation of curcumin in the range of 80mg-2g would be required assuming an enhancement. 1-2g until the individual is fully recovered is recommend for injury/surgery repair. Curcumin is poorly absorbed inherently, and one of the following is mandatory to enhance absorption into the intestines:
- Pairing curcumin with black pepper (piperine)
- Curcumin phytosomes complexed with phosphatidylcholine (Meriva or BCM-95)
- Curcumin nanoparticles (THERACURMIN)
Garlic has been shown to inhibit the activity of the inflammatory enzymes. While eating additional garlic is likely a good strategy, garlic extracts may be required for more measurable anti-inflammatory effects. Typically recommended dosing is 2-4 g of whole garlic clove each day (each clove is 1 g) or 600-1200 mg of supplemental aged garlic extract. Supplemental garlic is readily available from health food stores.
Supplementing with the following amino acids can stimulate collagen deposition and injury healing.
Arginine: 7 g, 2x per day
HMB: 1.5 g, 2x per day
Glutamine: 7 g, 2x per day
Combined administration of 14 g arginine, 3g HMB (a metabolite of leucine), and 14 g glutamine in two divided doses (two doses of 7 g arginine, 1.5 g HMB, and 7 g glutamine per day) for 14 days has been shown to significantly increase collagen synthesis and decrease muscle loss in adults. These amino acids typically come in supplemental formulas together.
What about NSAID’s?
After an injury or surgery, it’s very common to use non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen sodium, celecoxib, etc. This is in order to reduce pain and inflammation. However, some research suggests that in some cases, NSAIDs might hinder injury healing. NSAID’s may impair the healing of ligament injuries, muscle strains and even bone injuries in the mid-term.
In the acute phases following an injury we don’t want to completely suppress inflammation, as it is a very important part of the healing process. This means that NSAID’s may not be ideal. We want to modulate inflammation, because excess inflammation is also not good. Modulating inflammation can be done using the nutritional and supplemental strategies listed above, as these foods/nutrients that have anti-inflammatory properties are not nearly as powerful as a pharmaceutical drugs.
NSAID’s may become helpful a few weeks after surgery or an injury, in order to manage pain when the individual begins rehab. This is so it is possible to take a joint, muscle or bone through its normal range of motion so the scar tissue deposits properly.
Injuries and surgery can be a bit chaotic at times, however trying to implement these strategies will go a long way in improving healing and recovery. Apart from nutrition, it is also extremely important that athletes get enough sleep (7-9 hours), abstain from alcohol and manage their stress levels (decreased sleep, alcohol and increased stress can increase inflammation in the body and delay healing, as well sleep is a time of regeneration for the body). Some athletes may have certain habits around smoking or drinking alcohol, which must be kept to as little as possible because these factors can increase inflammation, impair immune function and impair healing. Any factors that increases inflammation in the body and impairs immune function will ultimately decrease healing of the body.
It also goes without saying that the athlete should engage in some form of physical rehab (e.g. physio, exersize physiologist, strength coach etc). There are many physical rehab processes available to athletes in order for them to get back to their sport and it is usually the fist port of call during injury recovery with little emphasis on diet, supplementation, sleep and stress. However it is important to note physical rehab will be greatly enhanced in terms of its positive outcomes, if the athlete is getting adequate/restful sleep, managing their stress and having a solid diet and supplement regime. Injury recovery requires a multi-faceted approach for the best outcomes, faster recovery and decreased risk of re-injury.