Jan 29, 2015Balancing Act
When an athlete is injured, revising his or her dietary plan is critical. That means balancing nutrients, calorie intake, healthy fats–and sometimes the actual food itself.
By Ingrid Skoog
Ingrid Skoog, MS, RD, CSSD, is a sports dietitian in Eugene, Ore., specializing in performance nutrition for collegiate and elite athletes. She is a faculty member in Oregon State University’s Nutrition and Exercise Sciences Department and also provides nutrition advice to OSU athletes. She can be reached at: [email protected].
Ashley knew what had happened even before the athletic trainer uttered the words “ACL tear.” She knew she would likely need to have surgery and complete a long rehab. All she could think about was not being able to play the sport she loved.
But she began to feel better after a long talk with the athletic trainer at her school who explained that they would work together to rehabilitate her knee and she would be back in time for next season. Her fears lessened even more when she learned that in addition to an aggressive rehab plan, she had another important tool in her back pocket: A well-constructed nutritional intake program that could help speed up her recovery.
Just as nutrition plays a supporting role in on-field performance, it can also play a role during recovery from injury. The evidence that says dietary intake–or lack thereof–can impact both the rate and “completeness” of recovery is piling up. Proper nutrition will fuel an injured athlete’s body both during rehab sessions and while they are in rest mode. The right intake can put the athlete on the road to a speedy recovery while lessening the risk of repeated injury.
To understand the role of nutrition in injury recovery, athletes need to understand the body’s typical physiological response to injury. The body goes through a natural process that includes inflammation and tissue repair and growth. Therefore, foods consumed post-injury need to provide the nutrients required for an adequate and appropriate response to inflammation. Additional key nutrients are used to repair damaged tissues and build new tissues. When talking about how nutrition aids the recovery process, injuries can be separated into four major categories.
Injuries that require surgery: Nutrition has the biggest impact on the most serious injuries. Post-surgery, athletes will need to focus on nutrient-dense foods. Don’t assume that weight gain will be an immediate outcome just because the athlete is unable to participate in much activity directly following surgery. Under-fueling during the immediate recovery process can delay repair, so this is not the time to put an athlete on a diet.
Immobilizing injuries: When an athlete is immobile, they must change the way that they obtain, prepare, and sometimes even consume foods. They will need to identify quick or already prepared options that provide quality nutrients without unwanted fat, sugar, and sodium. Consuming a high-quality diet while immobile should shorten the time the athlete will need to remain immobile, allowing them to start their rehab program sooner.
Fractures: Because bone fractures in the lower body often require weeks, if not months, of being in a cast or using crutches and/or a walking boot, athletes’ energy and nutrient needs will remain elevated for a longer period of time. Due to the length of recovery time required for these injuries, athletes are likely to experience more muscle atrophy and body composition changes. In addition, if an athlete broke a bone due to poor nutrition, they should be evaluated by a physician or registered dietitian to determine if they need to change or supplement their diet with added calcium, vitamin D, and magnesium.
Strains and pulls: Because these injuries are less severe, damaged muscles may not require the same calorie intake as the injuries previously mentioned. However, recovery can still be positively impacted with improved nutrition, especially intake prior to, during, and for the first several hours after training and treatment sessions. Recurring and nagging aches and pains can also be put into this injury category.
A high quality diet of wholesome, nutritious foods is required when any athlete suffers an injury. The following specific nutritional strategies will aid the body’s physiological response to injury throughout the healing process:
Consume adequate calories. Acute injuries and the early phases of recovery (first one to two weeks, depending on severity) can result in an elevated metabolic rate, which means a higher energy expenditure than expected. As mentioned earlier, there is a common misconception that because an injured athlete isn’t as active as they were pre-injury, they should cut back their calorie intake. But under-eating during this time can actually prolong inflammatory response and slow down immune function. After the first few weeks of recovery, athletes can then assess the quantity of food they are consuming relative to changes in their body weight and composition.
This is an especially important point for female athletes who tend to worry about their weight and body image more than males. Female athletes need to be sure they don’t enter into an unhealthy pattern of under-consuming foods and nutrients.
And for athletes on crutches, they shouldn’t underestimate the energy they use in a day. They may not be running drills or lifting weights, but hauling themselves up a flight of stairs and getting around on crutches is hard work and burns plenty of calories.
Consume healthy fats. Omega-3 fatty acids contain natural anti-inflammatory properties that help control inflammation while providing a valuable source of essential fatty acids. Injured athletes should consider adding canned tuna or salmon, which both have high levels of omega-3, to their diets.
In addition to lowering LDL cholesterol, monounsaturated fats can displace more saturated and trans fats, which is a positive thing for the athlete worried about weight gain while they are injured. Foods high in monounsaturated fatty acids include canola oil, walnuts, almonds, avocado, and seeds, including sunflower, sesame, and pumpkin.
Avoid bad fats. Athletes should limit foods that are high in saturated fats like cheese, red meat, and bacon, while altogether skipping any foods with trans fats like crackers, cookies, chips, and other foods made with hydrogenated or partially hydrogenated oils if they are concerned about gaining weight while immobile or exercising at a considerably reduced rate.
Saturated fats have some role in diet, but tend toward excessive intake when individuals choose more fast food or convenience foods or eat a high animal product diet that includes whole milk, cheeses, creamy salad dressings, mayonnaise, fried foods, and processed chips and cookies. Trans fats are atherogenic and can increase risk for cardiovascular disease. Everyone, athletes included, should keep their trans fat intake as low as possible. Both saturated and trans fats can contribute to inflammation, which for injured athletes, is detrimental to their recovery.
Weight gain is not a given with injury recovery, but the fast food drive-through trap is likely to result in unwanted body fat gains. For athletes with mobility issues, it’s certainly an easy option, but one that should be avoided if possible since the menus are generally loaded with poor choices. The athlete ends up getting less of what they need and more of what they don’t.
If the drive-through is the only option, athletes should look for places that offer chicken sandwiches, turkey burgers, burritos made with chicken, beans, and rice, and made-to-order deli sandwiches. By passing on the cheese, mayo, and sour cream, these foods are reasonable options. In addition, if an athlete needs to have surgery that will result in immobilization, they should get organized beforehand and stock their kitchen with healthy foods like turkey and bean chili, spaghetti sauce, burrito fillings, frozen veggies, canned fruits, and grilled chicken breast.
Consume a variety of foods. A great rule of thumb is that “color is good.” Colorful foods like tomatoes, broccoli, oranges, red grapes, carrots, and peppers are high in antioxidants, phytochemicals, fiber, and essential vitamins and minerals. In addition, as the weeks of recovery go by and energy expenditure decreases as the body gets used to using crutches or sitting around for longer, these foods often provide strong satiety or fullness signals to naturally reduce overconsumption.
Take a good multivitamin. Though nutrients in pill form cannot replace the strength of whole foods in the recovery process, they do provide a little back up and insurance that an injured body is getting the micronutrients it needs. Choose one that includes no more than 100 percent of each daily nutrient requirement. Look for a well-known brand or one that has a United States Pharmacopeia (USP) endorsement to limit the possibility of consuming a banned substance.
Look into additional vitamins and minerals. In addition to a multivitamin, zinc, calcium, vitamin D, and vitamin C may aid injury recovery. Many athletes’ diets are already too low in zinc, and this nutrient is especially important for the wound healing process. Athletes can fuel up on yogurt, beans, lean meats, hummus, almonds, and fortified breakfast cereals to get the proper amount of zinc.
For athletes who have suffered a broken bone, calcium and vitamins D and C are excellent for bone building. Vitamin D can be found in fortified cow’s, rice, or soy milk. Vitamin C is plentiful in citrus fruits, potatoes, broccoli, and tomatoes. And calcium can be found in low-fat dairy or dairy alternative products, fortified juices and cereals, tofu, and greens. However, ignoring food and relying on supplements is a sure way to delay or derail recovery. Always think food first!
Stay hydrated: Injured athletes’ fluid needs will likely decrease since they won’t be sweating as much during their recovery, but that doesn’t mean that hydration should be put on the back burner. Athletes should drink water during the day and not ignore feelings of thirst. Though drinking more water is preferable, lower calorie drinks like skim or one-percent milk or diluted fruit juices are options and provide extra nutrients. The general recommendation when not exercising is to consume three liters of fluid per day for men and two liters of fluid per day for women.
To best illustrate how to put this advice into practice, let’s revisit Ashley’s injury and a hypothetical diet for her to follow throughout the rehab process. Ashley had reconstructive surgery, so this diet could work for any athlete who undergoes a similar procedure and is about 5-foot-7 and weighs between 145 and 175 pounds.
For the first one to two days following surgery, liquids may be better tolerated than solids due to pain medications the athlete is taking. Pain meds can often irritate the gastrointestinal (GI) tract, and solid foods that are hard to break down can pose a problem in terms of GI tract function.
After the athlete is relying less on pain medications, hydration, nutrient density, and ease of preparation are important meal considerations. Athletes should try to spread their intake out over the course of the day. Here are some easy-to-prepare healthy meal and snack options:
Breakfast suggestions: • Large smoothie made with low-fat yogurt, one to two teaspoons of oil or one to two tablespoons of peanut butter, apple juice, frozen berries, and banana • Oatmeal with low-fat milk and added nuts, raisins or craisins, cinnamon, sugar, and fruit • Peanut butter and jelly on wheat bread with fruit and low-fat milk or fruit juice Lunch suggestions: • Turkey, cheese, and veggie sandwich with potato chips and fruit juice or lemonade • Bean, chicken, and rice burrito with veggies, salsa, guacamole, sour cream, or cheese and fruit juice • Turkey chili with saltines, carrot sticks, and one piece of fruit and fruit juice or low-fat milk
Dinner suggestions: • Chicken stir fry with lots of colorful vegetables and white or brown rice • Spaghetti and extra lean ground beef meatballs with marinara sauce • Chicken and veggie lasagna or meat ravioli with sauce • Grilled chicken, rice, and steamed veggies • Tuna sandwich on wheat bread with tortilla chips and salsa
Snack suggestions: • Saltine crackers with peanut butter and fruit juice • Low-fat yogurt with one piece of fruit • Carrot sticks and hummus • Handful of almonds • Grapes and yogurt • Hot cocoa • Bowl of low-sugar cereal with low-fat milk
You’ll recognize a lot of the foods detailed here are also good choices for healthy athletes. That’s because nutrition while recovering is based on the important principles found in any high-quality training diet. The main concepts of healthy eating don’t change when an athlete goes down with an injury.
It’s important to note that a great recovery diet will set the athlete up to prevent another injury. What they say about sport proves true for nutrition as well: The best defense is a good offense. Improving daily intake to support high quality training and adaptation means stronger immune function and decreased injury risk.
Sidebar: WEIGHT GAIN & LOSS
Many injured athletes worry that inactivity will cause them to either gain or lose too much weight. The reality is that this happens quite often. Some athletes gain weight because of lack of exercise while others lose muscle mass because of it.
The first question that needs to be asked is if the weight gain or loss is inappropriate. It is natural for athletes who are no longer exercising to gain a couple of pounds, but is the extra weight gain excessive due to poor dietary choices? It’s also normal for muscle atrophy to occur as a result of inactivity, but is the loss exacerbated by inadequate calorie intake? A three- to five-pound fluctuation in either direction isn’t cause for concern, but more than that should be addressed.
It might be a good idea to perform a baseline body composition assessment upon injury. The assessment should be done by an experienced, well-trained professional. The athlete and athletic department dietitian, athletic trainer, or coach can then consider follow-up assessments every four to six weeks throughout the recovery process.
It is important that athletes accept small changes as normal weight fluctuations. If you are worried that an athlete will drastically (and unhealthily) change their behavior upon hearing the results of an assessment, resist supplying them with the results unless an obvious trend signaling poor diet emerges.
Sidebar: BEST & WORST
Sometimes injured athletes are looking for “super foods” that will aid their recovery, while wanting to avoid foods that might derail or slow down their recovery. The following lists apply whether an athlete is injured or not, but become even more important when an athlete is working to get back into the game.
Best Salmon (wild instead of farm raised if possible) and flaxseed contain omega-3 fatty acids. Flaxseed is commonly found in oil and is also available in ground or whole versions, which can be added to foods like oatmeal, smoothies, or spaghetti sauce.
Almonds and walnuts (a small handful or quarter to half cup a day) contain omega-3 and monounsaturated fatty acids, selenium, and protein, which helps with satiety.
Olive and safflower oil (used for cooking) are full of omega-3 and -6 fatty acids.
Broccoli, tomatoes, and sweet potatoes all have lots of fiber, antioxidants, and phytochemicals.
Low-fat dairy contains probiotics and phytochemcials. Athletes should look for yogurts with probiotics in them.
Garlic and other colorful spices contain phytochemicals, specifically carotenoids and flavinoids.
Colorful fruits (berries, watermelon, mangos, red grapes, and apples) contain lots of antioxidants.
Lean meats are protein-rich and also contain zinc, B vitamins, and iron.
Beans (black, kidney, pinto, and garbanzo beans, and hummus) are great lean proteins, high in fiber, nutrient-dense, and contain prebiotics and iron.
Worst Energy drinks with caffeine, excess B vitamins, and other ingredients do nothing to help recovery and can decrease compliance with activity limitations and displace nutrient intake.
Alcohol has extra calories that offer no nutrients for healing and consumption can slow down recovery if consumed in excess. Alcohol also has a diuretic effect, which promotes dehydration.
High-fat meals crowd out room for the nutrients required for recovery.
If eaten in excess, foods high in sodium, trans fat, and saturated fat can lead to trading one problem (the injury) for another, such as hypertension, cardiovascular disease, and inflammation.
Very low-fat diets undermine the intake of essential fatty acids and some fat-soluble vitamins that are needed for repair and recovery. This is especially evident in female athletes.