Injury Rehab – Why Is Nutrition Ignored?

Each sport has its own list of the most common strains, tears, dislocations, fractures, and overuse injuries. The common first aid protocol of rest, ice, compression, and elevation with the use of anti-inflammatory medications is the usual approach to an injury. Nutritional protocol often calls for a reduction in caloric intake, especially if the athlete is unable to train. However, nutrition plays a vital role in injury rehabilitation, from limiting the damage caused by chronic inflammation to actively promoting tissue healing and improving recovery times. As such, can any athlete ignore the role that nutrition could play in their injury rehabilitation?

Inflammation and NSAIDs

Anti-inflammatory medication is often used to treat swelling caused by injury. However, NSAIDs do have side effects, especially with long-term use. These are regularly used by athletes, including adolescent athletes, and most of these users do not recognize the potential toxicity or adverse effects of these drugs, especially in athletes undergoing intermittent dehydration. Considering the documented harmful side effects of NSAIDs, the use of enzymes and diet could be viable alternatives.

inflammation and enzymes

Enzymes have been reported to moderate the inflammatory cycle and regulate the healing process. Its use is suggested for bruises, sprains, strains, fractures, low back pain, dental surgery, arthritis and post-surgical trauma and recovery. The anti-inflammatory action of these enzymes, which is believed to inhibit the arachidonic cascade, is also associated with increased tissue permeability, facilitating resorption of edema and accelerated restructuring of damaged tissue.

Enzymes are protein compounds capable of accelerating a change in their substrate by catalytic action. Proteolytic enzymes catalyze the hydrolysis of proteins and various protein end products. For proteolytic enzymes to work, they must be actively absorbed from the gastrointestinal tract. However, the intestinal absorption of enzymes has been a matter of scientific controversy for many years, since enzymes are proteins, it is believed that if taken orally they are denatured by hydrochloric acid in the stomach.

Intestinal absorption of undegraded proteins, particularly proteolytic enzymes, has been observed for many years with research dating back to the 1960s. More recent studies have shown that intestinal transport of undenatured and undegraded proteins (often coated enteric) may occur to a small but significant extent and that these enzymes may decrease recovery time from injury. Furthermore, it has been suggested that because different enzymes have different targets of activity, different modes of action, and different rates of absorption, use of a combination of enzymes is believed to be more effective than use individually.

Also, proteolytic enzymes appear to be safe at high doses and when taken long-term. However, for best results they must be adhered to as they need to be taken 2-4 times a day on an empty stomach. The only known contraindications are for those taking anticoagulant medications and allergies to the compounds in the enzyme combination preparation.

Inflammation and Diet: Fatty Acids

Proinflammatory signals are mediated by metabolites of arachidonic acid (AA), an omega-6 polyunsaturated fatty acid (PUFA). Mitigating inflammation through dietary intervention requires a reduction in AA and increased intake of eicosapentaenoic acid (EPA), an omega-3 PUFA.

Several studies on the effects of a low-AA diet in conjunction with fish oil supplementation have been shown to improve clinical signs of various inflammatory and autoimmune diseases in humans, and in particular rheumatoid arthritis. The beneficial effect of EPA, the active ingredient in fish oil, was found to increase with reduced dietary intake of AA. The EPA and DHA in fish oil are believed to be biologically more potent than the omega-3s in flaxseed oil.

Inflammation and Diet: Vitamins and Minerals

Numerous vitamins and minerals are involved in wound healing, only a few of which will be reviewed.

Vitamin A plays a role in every stage of wound healing. It enhances the early inflammation phase, increasing the number of monocytes and macrophages.

Vitamin C is necessary for the hydroxylation of proline and, consequently, the synthesis of strong collagen. Vitamin C also participates as an antioxidant in the elimination of free radicals and improves the absorption of iron.

Vitamin E, as a fat-soluble vitamin, accumulates in cell membranes where it protects polyunsaturated fatty acids from peroxidation by free radicals. Vitamin E has an anti-inflammatory action by inhibiting the activity of phospholipase-A2 and, consequently, the production of prostaglandins, which are chemical mediators of the inflammatory response.

Marginal zinc deficiencies are common because our soil is depleted. Furthermore, there is increasing evidence that zinc deficiency occurs even when micronutrient intake appears to be adequate. Zinc deficiency results in delayed wound closure, decreased collagen tensile strength, and increased susceptibility to recurrent infections. Zinc deficiency also decreases the acuity of taste, which can lead to decreased food intake. There is an apparent decrease in serum zinc during wound healing with a higher concentration in wound tissue, in surgical patients.

conclusion

The body’s metabolic rate increases during times of repair: the increases correlate with the severity of the injury. As such, the nutritional protocol during injury should be to increase, not decrease, caloric intake. If the activity level has decreased considerably due to the injury, the increase in BMR due to the injury is often canceled out by the decreased activity level. Therefore, caloric intake should remain more or less the same as when you are active. The USRDA for protein is increased from 0.8 g/kg to 2 – 4 g/kg to support wound healing. However, the increased caloric requirement is not simply because of the quantity but because of a particular quality of nutrients that assist and promote repair and recovery. To ensure optimal repair and reduced recovery time, please adhere to the following:

1. eat regularly; especially if the injury is severe, the basal metabolic rate can increase by up to 20%
2. eliminate all junk food
3. eliminate all refined and processed foods and especially all refined sugar
4. Avoid all saturated fats, ie pro-inflammatory foods, found in pork products (ham, bacon, salami, sausage, pate) and fatty red meats like lamb.
5. Eat fish, chicken (without skin), and extra-lean cuts of red meat instead (limit red meat to twice a week)
6. increase the intake of fruits, vegetables, vegetables and legumes
7. use an omega-3 oil (never heat the oil as it is prone to oxidation)
8. ensure protein intake is kept high i.e. 1.0 – 1.5g/kg
9. The use of proteolytic enzymes is best administered under the supervision of a qualified nutritionist.

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