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
