Injury Recovery: Nutrition To Speed Up Healing - Infographic

The right food and supplements to speed injury recovery

CLICK HERE to check out the corresponding 5-part series, to learn how the body repairs itself after an injury.

Click here for a fully printable version of this infographic. Share with a recently injured client or colleague, or keep handy for your own reference.

Want to know more about the science behind nutrition and injury recovery? Discover our multi-part series on the topic here.

What's Next?

Most people know that regular movement, eating well, sleep, and stress management are important for looking and feeling better. Yet they need help applying that knowledge in the context of their busy, sometimes stressful lives.

That’s why we work closely with our Nutrition & Lifestyle Coaching clients to help them lose fat, get stronger, and improve their health… no matter what challenges they’re dealing with.

Learn more @ https://www.gogoodguru.com/nutrition-coaching

Injury Recovery: Nutrition To Speed Up Healing - Part 5

The right food and supplements to speed injury recovery

Video filmed at the Fit Pro Convention in Loughborough, England. 

Wrap-up and practical implementation

In parts 1-4 of this video series, we reviewed the research on nutrition for injury recovery. We also made some practical recommendations for you and your clients.

However, taken altogether, the strategies might seem overwhelming. I can totally identify with this feeling.

I’ve sat in on hundreds of lectures. When speakers present long lists of nutrition and supplement suggestions, I usually leave baffled.

Which of the 20 or 30 supplements should I take? Which of these strategies is the most important? Do I have to take all the suggestions? Or just a few? And how do I choose?

I’d hate to have you leave this series with the same questions and anxiety. So let’s wrap this up with a few examples of just how easy the implementation can be.

To do so, I’d like to finish where we started — with Georges St. Pierre.

As discussed in part 1, GSP came to me for advice prior to a surgery in 2007. Since a surgery is essentially an injury process, the advice I gave him fits perfectly here.

GSP’s Plan – For 1 week before surgery

• Follow training-based nutrition plan leading up to surgery
• No supplements for the week before surgery (especially fish oil, as this can interfere with anti-clotting medications)
• Let doctor know about prior fish oil use

GSP’s Plan – For 4 weeks post-surgery

• Continue with training-based nutrition plan but remove 1 daily Super Shake
• Quest multi-vitamin: 1 capsule, 2x per day
• Biotest curcumin: 2 capsules, 2x per day
• Biotest Flameout: 3 capsules, 2x per day
• EAS Muscle Armor: 1 scoop, 2x per day

As you can see, we kept it very simple for Georges, making only small changes to his already well thought-out nutrition plan. And adding just 4 supplements into his regimen helped to manage the inflammation process while stimulating anabolism and tissue repair.

For a detailed explanation of why we chose these particular supplements, please see the video above.

Here’s another example. Last year, while training for the 60 m sprint race at the Indoor Canadian Masters National Championships, I injured my hamstring. This is the plan I used for 4 weeks after the injury.

JB’s Plan – For 4 weeks after hamstring injury

Copper is a mineral that assists in the formation of red blood cells and works with vitamin C to form elastin and to strengthen connective tissue. 2-4 mg/day is recommended during the first few weeks of injury repair.

• Ice, heat, elevation, 2-4x per day
• Stretching and light activation, 1x per day
• ART, 2x per week
• Doctor’s Best curcumin: 500 mg, 2x per day
• Labrada Sorenzyme: 4 capsules, 2x per day
• Fast Joint Care+: 1 capsule, 2x per day
• Optimum Nutrition vitamin: 1 tab, 2x per day
• Omega-3 fish oil: 1 tsp, 4x per day

Like Georges, my eating plan was already very good, so I didn’t really change much there. I just added a few supplements to support recovery. Again, see the video above for more.

In the end, the program worked extremely well and enabled me to compete at the National Championships, placing 3rd in my age category without any hamstring concerns.

Summary of recommendations

​In summary, injury recovery is characterized by an organized response to the acute trauma.

First, inflammation removes damaged tissues. Cells then proliferate to replace the damaged tissue. And finally, new cells replace the intermediary cells to strengthen the repair process and lead to injury resolution.

During each step of the repair process, you can use targeted nutritional strategies to support and enhance this repair process.

Ensure that injured athletes eat enough calories and protein, by using some simple strategies:

Frequency

Eat every 3-4 hours.

Protein

Each meal/snack should contain complete protein including lean meats, lean dairy, eggs, or protein supplements (if whole food is unavailable).

Vegetables & Fruit

Each meal/snack should contain 1-2 servings veggies and/or fruit (1/2 – 1 1/2 cups or 1-2 pieces) with a greater focus on veggies.

Starches

Additional carbohydrates should come from whole grain, minimally processed sources like whole oats, yams/sweet potatoes, beans and legumes, whole grain rice, quinoa, etc. The athlete should eat fewer starches when not training (such as during injury recovery), and more when training (unless they want to lose fat).

FAts

Eat at least 2-3 of these healthy fats each day: avocadoes, olive oil, mixed nuts, fatty fish (such as salmon), flax seeds, and flax oil. Add 3-9 g of fish oil to the diet.

Supplements

Although these steps above should lead to adequate micronutrition during normal conditions, during injury repair, the following vitamin and mineral supplements are useful:

• Vitamin A - 10,000 IU/day for 2-4 weeks post-injury
• Vitamin C - 1000-2000 mg/day for 2-4 weeks post-injury
• Copper - 2-4 mg/day for 2-4 weeks post-injury
• Zinc - 15-30 mg/day for 2-4 weeks post-injury

Beyond these supplements, you can also manage inflammation by:

​Balancing your fats

Increase your intake of olive oil, mixed nuts, avocados, flax oil, ground flax and other seeds, etc. Get some of each fat source each day. By eating these foods, you’ll likely balance out the saturated fats naturally present in your protein sources, leading to a healthy profile without breaking out the calculator.

Balancing your 6:3 ratio

Add 3-9 g of fish oil each day while reducing omega-6 fats like vegetable oils such as corn oil, sunflower oil, safflower oil, cottonseed oil, and soybean oil, etc. This strategy should take care of your omega 6:3 ratio.

Including anti-inflammatory foods

​These foods include curry powder/turmeric, garlic, pineapple, cocoa, tea, blueberries, and red wine (in small amounts).

Supplementing amino acids

Finally, even in well-nourished individuals, 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
  
  

Wrap-up and What's Next?

That’s it for PART 5 of our series: Injury Recovery: Nutrition To Speed Up Healing.

At this point, you might be asking: “What’s next?”

Most people know that regular movement, eating well, sleep, and stress management are important for looking and feeling better. Yet they need help applying that knowledge in the context of their busy, sometimes stressful lives.

That’s why we work closely with our Nutrition & Lifestyle Coaching clients to help them lose fat, get stronger, and improve their health… no matter what challenges they’re dealing with.

Learn more @ https://www.gogoodguru.com/nutrition-coaching

Injury Recovery: Nutrition To Speed Up Healing - Part 4

The right food and supplements to speed injury recovery

Video filmed at the Fit Pro Convention in Loughborough, England. 

Micronutrient needs during recovery

Vitamins and minerals are nutrients required in small amounts for metabolic reactions in the body. They can act as:

• catalysts that bind to enzymes to facilitate enzyme action in the body;
• coenzymes that work with other enzymes; or
• substrates that are directly metabolized themselves.

Vitamins A, B, C, and D as well as calcium, copper, iron, magnesium, manganese, and zinc are all important for injury recovery. (Interestingly, vitamin E may slow healing so avoid vitamin E supplements during injury.)

However, the role that each vitamin and mineral plays is not well understood.

Until further research confirms these roles, we don’t know whether we should simply prevent a vitamin/mineral deficiency or add supplemental vitamins/minerals for extra healing.

Rather than discussing each vitamin and mineral that may affect injury recovery, let’s discuss only those that may require additional supplementation.

Vitamin A

Vitamin A enhances and supports early inflammation during injury, reverses post-injury immune suppression, and assists in collagen formation via collagenase modulation. Studies have shown that collagen cross-linkage is stronger with vitamin A supplementation and repair is quicker.

Typically 25,000 IU daily is recommended for short periods of time surrounding serious trauma and surgery. However, we do worry about toxicity. Supplementing with 10,000 IU daily for the first 1-2 weeks post-injury is probably safer.

Vitamin C

​Vitamin C enhances neutrophil and lymphocyte activity during phase 1 of acute injury. It also plays an important role in collagen synthesis, as it helps form bonds between strands of collagen fiber. With vitamin C deficiencies, collagen fibers are formed abnormally and fibrous tissue is weak with poor adhesion.

Vitamin C is also a powerful antioxidant and immune system modulator, and research suggests that vitamin C can help people recovering from surgery, injury, and ulcers. Supplement with 1g- 2 g/day during periods of injury repair.

Copper

Copper is a mineral that assists in the formation of red blood cells and works with vitamin C to form elastin and to strengthen connective tissue. 2-4 mg/day is recommended during the first few weeks of injury repair.

Zinc

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.

Zinc deficiency has been associated with poor wound healing and, as zinc deficiency is one of the most common micronutrient deficiencies, we recommend supplementing 15-30 mg per day, especially during the initial stages of healing. (Note: Make sure to balance copper and zinc if you supplement, as an excess of one can create deficiencies of the other.)

Note: Calcium and iron deficiencies are, like zinc deficiencies, quite common. Because they’re important for bone health, athletes who are deficient in calcium and iron are more likely to suffer stress fractures.

Thus, while these two minerals may not play direct roles in injury healing, they play a large role in prevention. Get enough calcium and iron, preferably from whole foods rather than supplements.

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
• Vitamin C – 1000-2000 mg/day for 2-4 weeks post-injury
• Copper – 2-4 mg/day for 2-4 weeks post-injury
• Zinc – 15-30 mg/day for 2-4 weeks post-injury

Additional nutrients that may affect injury recovery

Supplemental amino acids powerfully affect injury healing. When the body is under stress, arginine and glutamine become conditionally essential amino acids. These two amino acids and others speed up healing.

Arginine

​​This amino acid works several ways. First, it may stimulate insulin release and IGF action. These powerful anabolic hormones can stimulate protein synthesis and collagen deposition.

Via increased nitric oxide production, arginine may increase blood flow to the injured area and activate macrophages for tissue clean-up. These macrophages also produce and activate growth factors, cytokines, bioactive lipids, and proteolytic enzymes necessary for healing.

Finally, arginine may promote the conversion of ornithine to proline.

Studies using arginine in rodents and humans have demonstrated that high dose arginine supplementation can increase collagen accumulation, reduce lean body mass loss, reduce nitrogen excretion, and accelerate wound healing. Human doses have been in the range of 15-30 g per day; higher doses having the largest effect.

ornithine
As supplemental arginine has shown benefit in wound healing and ornithine is the main metabolite of arginine, researchers have speculated that ornithine might also show similar benefits.

The mechanisms of action for ornithine in wound healing somewhat overlap those of arginine. Ornithine can be converted to the amino acid proline, which is essential in collagen deposition. Ornithine supplementation can improve protein metabolism in burn/trauma patients.

Studies using ornithine in trauma/injury situations have shown that ornithine can shorten healing time, increase healing strength, and increase nitrogen retention. Human doses in these studies have been in the 20-30 g/day range (10 g 2-3x per day) with larger doses having the greatest effect.

Glutamine

This amino acid is essential for the metabolism of rapidly turning-over cells such as lymphocytes and enterocytes.

During starvation, trauma, and sepsis, glutamine needs dramatically increase and indeed, in trauma situations, glutamine supplementation can reduce morbidity, mortality, and length of hospital stay. As a result it’s been speculated that glutamine may help speed up wound healing yet glutamine alone has not been shown to do so.

However, in one study, the combined administration of 14 g arginine, 3g HMB, 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 significantly increased collagen synthesis in adults.

HMB

HMB, a metabolite of the amino acid leucine, has been shown in numerous studies to inhibit muscle protein breakdown as well as increase net protein balance, leading to potential increases in muscle mass.

In addition, research has shown that HMB increases collagen deposition in rodents and improves nitrogen balance in critically injured adult patients.

One study showed that the combined administration of 14 g arginine, 3 g HMB, and 14 g glutamine in two divided doses (two doses of 7 g arginine, 1.5 g HMB, 7 g glutamine per day) for 14 days significantly increased collagen synthesis in adults.

Interestingly, local application of amino acids and other nutrients (directly to injured sites vs. orally) has been shown to offer unique benefits.

In one study, cylindrical sponges implanted near wound areas in rodents were regularly infused with amino acids, salts, glucose, B-vitamins, and vitamin C. The group receiving the treatment healed better than the placebo group, even though they used a lower dosage than the oral treatments.

A note on amino acids

Before loading up on amino acids, note that many of the studies discussed in this section were done on either older people or hospitalized patients. Malnourishment is common to both.

Research has shown, for example, that nearly 50% of hospitalized patients in urban areas have signs of malnutrition. One study showed that 42% of patients receiving hip replacements were malnourished. And between 40-85% of nursing home residents are malnourished.

Not only are these people deficient in micronutrients, they’re also often not eating enough protein, healthy fat, or overall calories. Thus, amino acid supplements probably eliminate relative deficiencies; adding more amino acids to an already-healthy and protein-rich diet may not be as helpful.

Of course, this point doesn’t necessarily disqualify amino acid supplementation as part of injury management. Indeed, many athletes may be poorly nourished as well, under-eating both total calories and protein. Micronutrient deficiencies have also been found in athletes.

As a result, in such cases, the first priority is to increase calorie and protein intake during recovery. In addition, nutrition coaches should encourage athletes to eat a diverse nutrient-dense diet in order to meet micronutrient needs (rather than relying on supplementation).

Yet even in well-nourished individuals, supplementing with amino acids can stimulate collagen deposition and injury healing. The combination of arginine (7 g 2x per day), HMB (1.5 g 2x per day), and glutamine (7 g 2x per day) will likely preserve lean body mass during injury recovery, while accelerating collagen synthesis and injury repair.

Glucosamine, Chondroitin, and Hyaluronic Acid

Glucosamine, Chondroitin, and Hyaluronic Acid
Three compounds — glucosamine, chondroitin, and hyaluronic acid — are showing promise for managing long-term pain and inflammation and reducing joint degeneration.

Yet much of the supportive research on glucosamine, chondroitin, and hyaluronic acid has been in the area of treating osteoarthritis. Not all researchers agree that these three compounds can be used in athletic injury treatment.

Meta-analyses in the Journal of the American Medical Association have concluded that while research suggests these agents probably offer benefit, mixed data and publication bias can lead us to overestimate the effects. (And, of course, “more research is needed…”)

These compounds probably don’t help much for acute injuries, as they take time to work — it usually takes a month or more to see marked improvement. There’s little evidence to support the claim that these compounds help with wound healing.

Therefore, it’s likely best to use these compounds in long-term degenerative conditions rather than acute injury repair.

A Note On Creatine
Some believe that creatine supplementation may cause cramping or increased risk of injury. However, the research is fairly clear: Creatine doesn’t seem to contribute to sports/exercise injury.

However, that there are a few anecdotal reports from elite athletes suggesting that in some speed/power situations, hamstring strains may occur with creatine supplementation. This is by no means common. Yet it has been reported often enough to be mentioned here.

Summary of recommendations

​In summary, injury recovery is characterized by an organized response to the acute trauma.

First, inflammation removes damaged tissues. Cells then proliferate to replace the damaged tissue. And finally, new cells replace the intermediary cells to strengthen the repair process and lead to injury resolution.

During each step of the repair process, you can use targeted nutritional strategies to support and enhance this repair process.

Ensure that injured athletes eat enough calories and protein, by using some simple strategies:

Frequency

Eat every 3-4 hours.

Protein

Each meal/snack should contain complete protein including lean meats, lean dairy, eggs, or protein supplements (if whole food is unavailable).

Vegetables & Fruit

Each meal/snack should contain 1-2 servings veggies and/or fruit (1/2 – 1 1/2 cups or 1-2 pieces) with a greater focus on veggies.

Starches

Additional carbohydrates should come from whole grain, minimally processed sources like whole oats, yams/sweet potatoes, beans and legumes, whole grain rice, quinoa, etc. The athlete should eat fewer starches when not training (such as during injury recovery), and more when training (unless they want to lose fat).

FAts

Eat at least 2-3 of these healthy fats each day: avocadoes, olive oil, mixed nuts, fatty fish (such as salmon), flax seeds, and flax oil. Add 3-9 g of fish oil to the diet.

Supplements

Although these steps above should lead to adequate micronutrition during normal conditions, during injury repair, the following vitamin and mineral supplements are useful:

• Vitamin A - 10,000 IU/day for 2-4 weeks post-injury
• Vitamin C - 1000-2000 mg/day for 2-4 weeks post-injury
• Copper - 2-4 mg/day for 2-4 weeks post-injury
• Zinc - 15-30 mg/day for 2-4 weeks post-injury

Beyond these supplements, you can also manage inflammation by:

​Balancing your fats

Increase your intake of olive oil, mixed nuts, avocados, flax oil, ground flax and other seeds, etc. Get some of each fat source each day. By eating these foods, you’ll likely balance out the saturated fats naturally present in your protein sources, leading to a healthy profile without breaking out the calculator.

Balancing your 6:3 ratio

Add 3-9 g of fish oil each day while reducing omega-6 fats like vegetable oils such as corn oil, sunflower oil, safflower oil, cottonseed oil, and soybean oil, etc. This strategy should take care of your omega 6:3 ratio.

Including anti-inflammatory foods

​These foods include curry powder/turmeric, garlic, pineapple, cocoa, tea, blueberries, and red wine (in small amounts).

Supplementing amino acids

Finally, even in well-nourished individuals, 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
  
  

Wrap-up and today's takeaways

That’s it for PART 4 of our series: Injury Recovery: Nutrition To Speed Up Healing.

For now, here are some key points.

• In addition to managing inflammation and eating enough calories, supplementing with micronutrients and amino acids may dramatically speed up the injury recovery process.
• ​Certain vitamins and minerals (A, C, copper, zinc) can help with recovery, especially when supplemented beyond normal recommended doses. So can supplementing with arginine, HMB, and glutamine.
  
• While the strategies outlined in this video series may seem complicated at times, in part 5 of the video series, we’ll break things down very simply and offer two very specific protocols for injury recovery. These are easy to implement and extremely effective.
  
  

Injury Recovery: Nutrition To Speed Up Healing - Part 3

The right food and supplements to speed injury recovery

Video filmed at the Fit Pro Convention in Loughborough, England. 

Calorie needs during recovery

In the previous video, we looked mostly at managing Stage 1 of injury recovery. Today, we’ll look at two important factors that affect Stage 2 and 3 injury recovery: adequate calorie and micronutrient intake.

Activity costs energy. Thus, we need more energy when training for sports, or following an exercise program.

Yet some athletes, especially female athletes, intentionally (to lose body weight) or unintentionally (due to improper nutrition education) under-eat.

This can lead to more repetitive stress injuries such as stress fractures or ligamentous injury. Thus, 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.

Of course, comparatively speaking, an athlete or exerciser 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, nutrition coaches must balance the increased energy and nutrient needs of injured and recovering clients with the reality of less activity.

One example of calorie needs

Let’s take the example of a young male athlete. He’s 14 years old, 5’6″ and 140 lb.

• Basal Metabolic Rate – 1611 kcal/day (mean of 3 predictive equations)
• Energy needs when sedentary – 1933 kcal/day (activity factor of 1.2)
• Energy needs with daily training/competition – 2739 kcal/day (activity factor of 1.7)
• Energy needs during recovery – 2319 kcal/day (activity factor of 1.2 and a 20% increase in metabolism due to injury)

As you can see, during injury repair, energy intake should decrease (2319 kcal) relative to training and competition (2739 kcal). However, returning to sedentary baseline (1933 kcal) will lead to underfeeding.

This is important both clinically and practically.

Less physical activity means lower appetite. If an athlete is eating based on hunger cues, s/he may under-eat during recovery. S/he might lose lean mass, heal poorly, and progress slowly.

Thus while injured athletes should eat less during periods of injury, remember: They’re still athletes, and should eat as such. This includes things like eating every few hours, getting enough protein, balancing macronutrients, and getting enough important micronutrients.

Macronutrient needs during recovery

Protein

Injury repair requires more protein. Injured athletes should aim for 1.5-2.0 g/kg, up from the usual 0.8 g/kg. Many already do this.

To ensure a quick recovery, make sure to get this higher protein intake consistently. At minimum, injured athletes should be taking in 1 g of protein per pound of body weight.

fat

​We covered dietary fat in a previous video — you’ll recall that we recommended balancing dietary fat by getting about 1/3 of total fat intake from each of the three types of fat. Most importantly, aim for more omega-3s and cut down omega-6s, to get an omega-6 to -3 ratio that’s at least 1:1 and preferably closer to 3:1.

Carbohydrate

While athletes need glucose for athletic injury healing, no specific carbohydrate recommendations have been established for injury periods. However, you should probably include enough dietary carbohydrate to ensure adequate micronutrient intake and stable insulin concentrations (which, as an anabolic hormone, may affect wound healing). In some athletes accustomed to a higher intake of carbs, not getting enough will be an additional — and unwanted — stressor.

Macronutrient needs summary

​Here’s how to implement these recommendations in treating injuries nutritionally:

Meal frequency

Eat every 3-4 hours.

​
Protein

Each meal/snack should contain complete protein including lean meats, lean dairy, eggs, or protein supplements (if whole food is unavailable).

​Vegetables and fruit

Each meal/snack should contain 1-2 servings of veggies and/or fruit (1/2 – 1 1/2 cups or 1-2 pieces) with a greater focus on veggies.

Starches

Get additional carbohydrates from whole grain, minimally processed, high-fiber sources like whole oats, yams/sweet potatoes, beans and legumes, whole grain rice, quinoa, etc. Eat fewer starches when not training (such as during injury recovery), but don’t cut them too low, especially if an athlete is not already well adapted to using fat for fuel.


Fats

Eat each of the following good fats each day — avocados, olive oil, mixed nuts, fatty fish (such as salmon), flax seeds, and flax oil. Add 3-9 grams of fish oil daily, taken in divided doses if necessary.

Wrap-up and today's takeaways

That’s it for PART 3 of our series: Injury Recovery: Nutrition To Speed Up Healing.

For now, here are some key points.

• Athletes and exercisers need to eat enough — when training and when recovering.
• When you’re injured and recovering, you should eat less than you did when you were training hard… but more than you would if you were completely sedentary.
  
• ​Eat at least 1 g of protein per pound of body weight; balance dietary fats (and get more omega-3s than -6s); get some (but not a lot of) starchy, high-fiber carbohydrates; and eat a lot of vegetables (with occasional fruit). We’ll discuss micronutrient needs in part 4 of the video series.
  
  

Injury Recovery: Nutrition To Speed Up Healing - Part 2

The right food and supplements to speed injury recovery

Video filmed at the Fit Pro Convention in Loughborough, England. 

Three physiological targets

Once we understand how healing works, we can look for different therapies to help the process along, using a three-pronged approach:

• Inflammation support (and management) through nutrition
• Immune system support through nutrition
• Regeneration and anabolic support through nutrition

Let’s start by talking about inflammation.

Inflammation

Treating acute injuries requires a tricky balance of managing inflammation while allowing it to do its important job.

Don’t try to avoid the inflammatory process in the acute phases of an injury. It’s critical for Stage 1 recovery.

But don’t make inflammation worse, either. Excessive inflammation could increase total tissue damage, slowing down the repair process.

While managing inflammation in the early stages, we want to reduce pain, as this can cause biomechanical compensations and changes that may lead to secondary injury.

However, again, strategies that eliminate pain often target inflammation. Rushing to eliminate inflammation (and pain) too soon may also reduce healing. Again, it’s a tight balancing act.

Dietary fat for inflammation control

A diet high in trans-fats, omega-6 rich vegetable oils, and saturated fat will be pro-inflammatory (in other words, it’ll worsen inflammation). A diet high in monounsaturated fats and omega-3 fats will be anti-inflammatory.

The ratio of omega-6 to omega-3 in the diet is important for overall inflammation in the body — especially during normal periods of healthy living when we definitely want to keep inflammation under control.

In these circumstances, the omega-6 to 3 ratio should be anywhere from 3:1 to 1:1, which should lead to a balanced inflammatory profile.

Of course, overall fat balance is important here. With a good balance of saturated, monounsaturated, and polyunsaturated fats (about 1/3 of total fat intake each), the body’s inflammatory profile will look pretty good.

However, purposely decrease omega-6 fats and increase omega-3s (specifically fish oil). High omega 6:3 ratios reduce collagen production while a low 3:6 ratio supports healing.

Even though relatively higher omega-3s create an anti-inflammatory response in the body, this response doesn’t interfere with repair; rather, it only helps with injury healing and collagen deposition.

Unfortunately, we haven’t yet determined the exact omega 6:3 ratio, nor the amount of fish oil supplementation required to manage inflammation during injury.

Studies with low dose fish oil (~450 mg to 1 g/day) have shown no effect on inflammatory or immune markers while other studies have shown that high dose fish oil (12-15 g/day) may reduce immune cell function in certain populations.

As a result, some authors have recommended anywhere from 3-9 grams of fish oil (salmon oil, sardine oil, menhaden oil, krill oil, etc.) per day.

In addition to the omega 6:3 ratio, research has shown that increased nut and seed consumption, as well as olive oil consumption, can mildly reduce inflammatory biomarkers.

Nuts, seeds, and olive oil likely share a common mechanism. The monounsaturated fats found in all three contain compounds that can mildly reduce COX enzyme activity (something these foods share with ibuprofen). But again, be careful. Too high a dose of any anti-inflammatory may reduce acute healing.

Thus: Improve omega 6:3 ratio while adding in healthy monounsaturated fats and balancing saturated, polyunsaturated, and monounsaturated intake. Here are some simple strategies to do this:

To balance your fats:

Increase intake of olive oil, mixed nuts, avocados, flax oil, ground flax and other seeds, etc. Get some of each fat source each day. These foods will balance out the saturated fats naturally present in your protein sources, leading to a healthy profile without needing a calculator. (Bear in mind that you may need to reduce overall portion sizes if you are inactive because of the injury.)

To balance your 6:3 ratio:

Add 3-9 grams of fish oil each day while reducing omega-6 fats like vegetable oils such as corn oil, sunflower oil, safflower oil, cottonseed oil, and soybean oil, etc. This strategy should take care of your omega 6:3 ratio.

Dietary herbs and phytochemicals for inflammation

Beyond healthy fat balance, certain dietary herbs can help manage inflammation.

Tumeric

A flowering plant in the ginger family, turmeric has long been used as an anti-inflammatory agent and in wound healing. Current research shows that the active ingredient, curcumin, is responsible for some of the benefits of turmeric. While adding turmeric to food every day is a good strategy, using 400-600 mg of supplemental turmeric extract 3x per day (or as described on the product label) is probably more manageable for most people.

​
Garlic

Garlic has been shown to inhibit the activity of the inflammatory enzymes cyclooxygenase and lipoxygenase and affect macrophage function. Again, though, 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.

​bromelain

Bromelain is another anti-inflammatory plant extract from pineapple. While best known for its digestive properties, bromelain is an excellent anti-inflammatory and analgesic compound although its mechanism of action is poorly understood. Typically bromelain is given in doses of 500-1000 mg/day for the management of inflammation.


​boswellia

A type of tree, Boswellia also has anti-inflammatory uses and has been shown to offer benefit through the inhibition of 5-lipoxygenase and potentially other cytokines. Typically supplemental Boswellia is taken in 300 mg doses 3x per day.


flavonoids
​
Found in cocoa, tea, red wine, fruits, vegetables, and legumes, flavononoids can help manage inflammation through their antioxidant actions. These powerful compounds likely act in other beneficial ways by affecting cell signaling.

It’s probably good to eat more flavonoid-rich foods in general, and during acute injuries. Yet it’s often easier to supplement with things like blueberry or grape extracts, green tea extracts, citrus extracts (hesperedin, naringin, etc), and bioflavonoid supplements containing quercetin/dihydroquercetin and rutin, which may lead to more powerful anti-inflammatory effects.

Again, with all of these nutrients, use caution. During acute phases of injury we don’t want to completely suppress the inflammatory response. Don’t stop inflammation from happening; just keep it under control.

And don’t load up on all of these anti-inflammatory supplements at once. Rather, focus on foods rich in natural inflammation-modulating agents such as these:

• Curry powder/turmeric
• Garlic
• Pineapple
• Cocoa
• Tea
• Blueberries

Only supplement if inflammation becomes a major/chronic problem. This would likely be discussed with your physician first.

What about NSAIDs?

In sport, it’s very common to use non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen sodium, celecoxib, etc. as the first line of defense against acute injury, pain, and inflammation. They come over the counter, docs prescribe them readily, and they reduce pain.

Yet new research suggests in some cases, NSAIDs might actually hinder injury healing in the mid-term. Celebrex, for example, reduced ligament strength in rats recovering from injury by about 32%. In another study, the same thing happened with both Celebrex and Indocin.

Not all studies show these effects, but enough of them do to cause some concern. That’s why we recommend moderating NSAID use in acute injury or muscle pain.

Beyond interfering with ligament healing, NSAIDs also may interfere with muscle strain healing, weight training adaptation, and bone healing in the mid-term. Of course, there are also the side effects (such as GI bleeding with many types of NSAIDs). Again, the data are mixed, but suggest that NSAIDs should be used sparingly.

Use caution when taking NSAIDs or any other anti-inflammatories for pain management during acute injury. In some cases the risks (GI problems, reduced healing rates, incomplete healing prognosis) may outweigh the benefits (pain management).

Inflammatory questions

This discussion of the cost/benefit ratio of NSAIDs raises the question of whether any inflammation strategy is beneficial during acute injury. After all, we want the inflammation process to occur. And NSAIDs may negatively impact healing because they block an important step in the recovery process.

So why even use NSAIDs, fish oil, turmeric, garlic, and other anti-inflammatory nutrients? Well, for starters, if used in moderation at the right time, they get results. These compounds help reduce pain, reduce excessive inflammation (which can damage local, non injured tissues), and help with later stages of injury repair.

As discussed above, we want to manage inflammation during injury, not eliminate it. That’s why we recommend moderate use of NSAIDs (if at all) and healthy use of nutraceuticals.

Remember from ​part 1 that inflammation and healing proceed on a timeline.

Following a soft tissue and/or bone injury, the acute phase of inflammation can last from the time of injury to 4 days (soft tissue) or 14-21 days (bone). During this time, we expect and want inflammation.

More aggressive anti-inflammatory strategies are best reserved for after the acute inflammatory phase. During the proliferative and maturation stages, these agents may help keep excessive, chronic inflammation at bay, speeding up the healing process.

Wrap-up and today's takeaways

That’s it for PART 2 of our series: Injury Recovery: Nutrition To Speed Up Healing.

For now, here are some key points.

• There are three nutritional targets for injury recovery: inflammation management, immune support, and anabolic support.
• Inflammation is a critical step in the injury recovery process. But it must be managed. Supplementing with omega-3 fats, reducing omega-6 fats, and balancing out saturated, monounsaturated, and polyunsaturated fat intake is a key strategy.
  
• As we’ll show you in the next few videos, other foods and nutraceuticals may also help with inflammation management. For now, on to part 3, calorie and macronutrient needs during recovery.