Aug 7, 2021Information on Inflammation
Recovery is an important aspect when it comes to athletic development. The ability to efficiently recover directly impacts an athlete’s ability to perform, adapt, and grow. The term inflammation is frequently thrown around in the sports world in regards to recovery, often in a negative light and with little context. Anti-inflammatory diets and supplements are all the craze for supporting recovery and enhancing performance. However, there are misconceptions regarding the role of inflammation and athletic performance. While chronic inflammation can be problematic and hinder performance and recovery, is inflammation always bad? If not, how can we reap the benefits without experiencing chronic inflammation and performance decrements?
What is Inflammation?
To provide context, inflammation can be defined as the clinical, physiological, cellular, and molecular processes that drive the repair of damaged tissues (Scott et al., 2004). Inflammation can be divided into two general phases: initiation and resolution (Sansbury et al., 2017). At the initiation of inflammation, pro-inflammatory pathways and mediators such as leukotrienes and prostaglandins are released at the site of damage to begin the process. Think pain, heat, swelling. This does not just happen with an obvious injury, it also happens in response to muscle damage following exercise. Within two hours of resistance training inflammatory markers in muscle are elevated (Vella et al. 2019), and Neubauer et al. (2008) showed after an Ironman triathlon parts of the inflammatory response may persist for five days.
Once inflammation is initiated there become two possible outcomes: the resolution or progression of the inflammatory process. Interestingly, the presence of inflammation triggers the active process of resolution. Here, immune cells switch to produce pro-resolving mediators from the families of lipoxins, resolvins, and protectins that begin clearing debris and healing tissue back to its normal structure. An uncoordinated response can result in the transition from acute to chronic inflammation, placing athletes at risk for further injury and performance impairments (Hannoodee et al., 2021).
Essentially, in an acute setting (i.e. after exercise-induced muscle damage), inflammation is a normal response that is needed for the repair and growth of tissue. To put it simply, we need acute inflammation in order to recover and adapt!
What is Anti-Inflammation?
Anti-inflammation refers to the process of inhibiting pro-inflammatory mediators and therefore disrupting, or pushing back, the inflammatory process. It is important to note that anti-inflammation is not synonymous with pro-resolution. Certain anti-inflammatory approaches can in fact prolong the inflammatory process and delay resolution (Serhan, 2007). For example, chronic use of non-steroidal anti-inflammatory drugs (NSAIDs) can promote chronic inflammation and potentially impair muscle and bone development, in addition to possibly causing other gastrointestinal, renal, and cardiovascular adverse events (Doux et al., 2005).
As you can see, the inflammation versus anti-inflammation battle isn’t all that simple. In order to grow, adapt, and perform we need both inflammation and resolution to promote tissue regeneration. Imagine this process as a seesaw, we don’t want it to be too tilted one way or the other. Rather, we ideally want a dynamic seesaw that is able to teeter around the middle providing inflammatory and resolving processes when necessary.
Nutritional Considerations in Balancing Your Inflammatory Process
Nutrition plays an integral role in the resolution of acute inflammation and the prevention of chronic inflammation. There are dietary approaches that can be taken to help prioritize recovery and minimize any damaging effects of long-term inflammation.
- Increase consumption of omega 3 fatty acids
Omega 3 fatty acids (O3FA) are essential fatty acids, meaning our body cannot synthesize them, and therefore, we need to obtain them from our diet. There are three types of O3FA: alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA). EPA and DHA have inflammation-resolving properties because end products of their metabolism result in pro-resolving mediators (Figure 1). Research has shown a positive association between supplementation of fish oil with active EPA and DHA on skeletal muscle recovery, muscle protein synthesis, and inflammatory markers (Ritz et al., 2021). The potential to supplement bioactive derivatives of EPA and DHA that are steps closer to pro-resolving mediators is of emerging interest.
A study assessing the O3FA status of NCAA Division I collegiate athletes found that both male and female athletes did not meet current dietary recommendations for O3FA intake (Ritz et al., 2020). Recent work by Davis et al. (2021) showed a similar trend in professional basketball athletes, where only 2 out of 119 athletes had an optimal or low-risk omega-3 index, a measured marker of intake and status. Foods high in O3FA include fatty fish like salmon, mackerel, anchovies, and sardines. The American Heart Association recommends consuming fatty fish at least 2 times per week (Kris-Etherton et al., 2003). Supplementation may be beneficial for athletes with a low intake of seafood, a high intake of omega 6 fatty acids, a history of concussions, and those undergoing surgery (Anzalone et al 2019). Supplement dosages will vary on the individual and purpose, but general recommendations to support the inflammatory-limiting effect of O3FA range from 1-4 grams/day (Rangel-Huerta et al., 2012).
- Balance consumption of omega 6 fatty acids
Omega 6 fatty acids (O6FA) are also essential fatty acids that must be obtained from one’s diet. There are two types of O6FA: linoleic acid (LA) and arachidonic acid (AA). As indicated in Figure 1, the metabolism of O6FA results in the production of pro-inflammatory mediators. However, they are also an example of how complex nutrition can be because they are also precursors to pro-resolving mediators from lipoxins. In addition, the metabolism of both O3FA and O6FA compete for the same enzymes, indicating that consuming a balance of both fatty acids is required to help manage the inflammatory process – think seesaw analogy (Saini et al., 2018).
The main concern is that the typical Western diet tends to be excessively high in O6FA and deficient in O3FA (Simopoulos et al., 2002). Foods high in O6FA mainly include beef, pork, eggs, dairy, and vegetable oils like soybean, sunflower, corn, and safflower oil, which are commonly used in ultra-processed and fried foods. A lower ratio of O6FA:O3FA is recommended for managing inflammation and overall metabolic health (McGlory et al., 2019).
- Increase consumption of antioxidant-rich foods
Prioritizing the addition of antioxidant-rich foods to one’s diet will also aid in balancing the inflammatory seesaw. Exercise-induced muscle damage increases the release of reactive oxygen species (ROS), which can lead to further inflammation, damage, and injury (Slattery et al., 2015). Antioxidants can help fight against the increased levels of ROS and therefore help to manage the inflammatory process. Consider increasing the consumption of antioxidant-rich foods such as tart cherry juice, berries (blueberries, blackberries, strawberries, etc.), bell peppers, beets, kiwi, kale, brussels sprouts. This may be as simple as boosting awareness of and intent toward regularly eating a wide variety of fruits and vegetables.
Many athletes are consuming diets that are higher in O6FA and deficient in O3FA. This imbalance may impact their inflammatory processes and therefore, their ability to recover, adapt, and perform.
- Increasing consumption of seafood and decreasing consumption of fried/fast foods is one way to improve the O6FA:O3FA.
- Supplementation may be beneficial and necessary for certain individuals who struggle to consume adequate O3FA, have a history of concussions, or are undergoing surgery. Consider the total amount of EPA and DHA, not just the total amount of fish oil.
- Including antioxidant-rich foods in one’s diet will also assist in balancing the inflammatory seesaw.
- Don’t forget the big picture – an overall adequate diet, sleep, management of training loads and rest are key components in addressing inflammation and recovery.
» ALSO SEE: Assessing Proper Hydration in Athletes
So, is inflammation always bad? No! Inflammation is a necessary component of the healing and recovery process. Managing these pathways is important for athletic development and growth. Addressing nutritional considerations that will help promote resolution is one way to reap the benefits of inflammation without experiencing chronic, damaging inflammation. O3FA and O6FA are two nutritional factors that play an important role in inflammation and should be considered if looking to better manage these processes.
Written by a Collegiate and Professional Sports Dietitians Association Registered Dietitian (RD). To learn more about sports nutrition and CPSDA, go to www.sportsrd.org