Podcast Episode 39 Transcript – Nutrition for Injury Recovery

Aidan Muir       

Hello, and welcome back to the Ideal Nutrition Podcast. I am Aidan Muir and I’m here with my co-host Leah Higl, and this is episode 39, which we are doing on nutrition for injury recovery. So we’re going to be covering things like what to do with your calories, what to do with protein intake, and also other nutritional strategies and interventions that you can [00:00:30] use to basically more efficiently recover from injuries and get back to performing well at whatever your chosen sport or activity is.

Leah Higl          

So first place we’re going to start is talking about calories. Ideally, when you’re injured you want to be at maintenance calories. There are a lot of cons to being in a surplus and being in a deficit when you’re injured. So if you are in a calorie deficit overall, so you’re actively losing weight, or maybe by accident you’re losing weight, it’s going to lead to likely muscle [00:01:00] loss during that time, and it’s definitely going to slow down your recovery. So maintenance calories is really where it’s at. The cons of being in a surplus is that because you’re not providing that stimulus to the muscle, you’re probably going to gain a lot of body fat instead of muscle mass when in a surplus. So at the end of the day, you want to aim for maintenance calories.

The thing to consider here is that maintenance calories when you are injured probably different to the maintenance calories you have when you’re training and when [00:01:30] you’re uninjured, so there’s a couple of things that change. When you’re injured, you probably have a lower energy expenditure from the fact that you’re not training at the same capacity as you were, but depending on what injury and the severity of that injury, your calorie expenditure might increase from that regard. So depending on the individual person, the individual injury, your maintenance calories might actually be pretty different compared to when you’re uninjured. But there’s a few things that definitely go into that. [00:02:00] But broad scope, maintenance calories is definitely where you want to sit.

Aidan Muir       

Yeah, and you can see why people wouldn’t always be striving for maintenance calories. One obvious thing is like when people get injured, maybe they’re not moving as much so maybe they unintentionally go into a surplus. The other end of the spectrum is a lot of people get injured and they’re like, “I want to make progress of something.”

Leah Higl          

Yes, I see that all the time.

Like, “Oh, I might as well cut weight.”

Aidan Muir       

Yeah, might as well get lean now so I’m making progress towards something.

But just like it’s hard to recomp [00:02:30] and build muscle and lose weight at the same time, the body is also pretty good at the other end of spectrum of being like if you’re weight stable, it seems to be pretty good at holding onto muscle unless you’re immobilized. If you’re still getting some form of movement, it seems to be relatively good at holding onto muscle. Of course, if you’re injured for a long time, there’s going to be muscle loss, but if you go into a calorie deficit, it’s going to speed that up.

Leah Higl

Yeah, and I think in terms of the injury that you do have, if it’s something like you hurt your thumb.

Obviously, that’s not going to be a huge deal, you can probably do training and stuff and keep that where it is. But if you’ve got a long term severe injury that’s severely impacting your training.

Aidan Muir

Yeah, and another thing on this topic that is interesting, we can’t measure it as well, but we know very clearly rates of muscle growth when somebody is in a calorie surplus and stuff like that. But what if it’s a tendon or ligament or any kind of injury like that? It’s like the calories are still fuel for those to adapt and everything like that, [00:03:30] that is part of why it speeds up the recovery too as well. Another thing on that is it also depends on the duration of the injury too. You’d probably do very different things if it’s a short term injury, like something less than four weeks to recover from versus something like an Achilles or an ACL or something like that.

Because we’re also looking at speeding up injury recovery, but also returning to sport or activity and getting back to peak performance ideally as well as you can. And oftentimes when I work with people who have those long injuries, like ACL or Achilles, [00:04:00] we will still go through phases. We’ll be focusing on making sure calories are relatively high, focusing on recovery and stuff like that. But what if they have a phase where they do gain some body fat during the process? We might still want to have a short calorie deficit phase somewhere in there if it is necessary based on what actually happens over that six to 12 month kind of period too.

The next thing we’re going to be talking about is protein, so protein obviously becomes quite important as well while injured too, [00:04:30] just from that muscle mass perspective, that’s a big factor. We’re trying to hold onto as much muscle as we can. Typically, the range that … The current consensus on this for optimizing injury of recovery is 1.6 to 2.5 grams per kilogram per day, so it’s quite high. Typically, we’re looking at just for optimizing muscle growth, we’re looking at a slightly lower range of 1.6 to 2.2, so it’s even higher than that.

And the bottom end of that range, if it’s an injury that’s not too [00:05:00] bad, you’re still able to move around and all those kind of things, still able to train, everything like that. Towards the bottom end of that range is probably closer, but if there’s real risk of muscle loss because you either have chosen to go into a big calorie deficit or because you are immobilized. For example, you’ve had surgery. Once again, similar like ACL surgery, you are immobilized for a short period of time, muscle loss happens like crazy under immobilization situations. I’ve seen research on ACL tears where 20% loss of quad size within two weeks.

Yeah. Whereas if you’re able to get some form of movement, it just seems to stop that from having to that extreme. Of course, muscle loss is going to occur but not on that kind of level. How long does it take to gain 20% quad size? That’s a slow journey.

Leah Higl          

It would take you a really long time for 20% increase.

Aidan Muir:      

Yeah, so if we can slow down that loss and decrease that significantly, it’s going to help with that later stage rehab as well. So that’s part of why that really high amount of protein can be relevant particularly while immobilized because it could speed [00:06:00] things up down the line because you just don’t lose as much muscle to start off with.

Leah Higl

But practically thinking about getting that much protein whilst you are injured and potentially immobilized could be a bit difficult, so if you’re not very active, your appetite might have declined during that time. So just generally getting in that much protein which we know is very satiating, could in itself be a challenge. But also if your calorie budget is less, it’s going to be a greater percentage potentially of your calories [00:06:30] and maybe not again, super practical to do.

Aidan Muir

Yeah, for sure. And like some athletes don’t struggle too much with it, but there are certain athletes who are on that lower calorie budget because they’re not moving as much, they’re not as hungry, and they’re also not as hyper protein focused as some other people I might work with. And getting up to even like 1.6 is a struggle for them, let alone like 2.5. It can take a lot of work and planning and stuff like that as well. And if it’s not practically feasible, you just do the best you can. You just get as much as you can within that [00:07:00] range basically.

Leah Higl

So the next thing that we’re going to talk about is creatine, so I can’t … If we had to number how many times we’ve talked about creatine on this podcast, it would be a lot.

Aidan Muir

It’s out of hand.

Leah Higl

Probably more than anything else. That’s because we love it so much. There’s so much evidence behind it. It’s a great supplement, but basically creatine does help to build strength and muscles, so it obviously has applications for when you are rehabbing or when you are immobilized. So there is some research [00:07:30] potentially showing that it does lead to greater muscle retention and reduces the loss of strength during an injury. So there was one study where participants had one of their arms immobilized in like a full arm cast at 90 degrees. So they weren’t injured, they just had their arm immobilized kind of like they were injured, and they compared their lean mass and muscle strength pre and post having this immobilized arm. And there was one group that took creatine and one group that didn’t, [00:08:00] and that the group that took creatine did actually sustain more of their muscle mass and more of their strength after this period of time.

Aidan Muir

Yeah. Because we know creatine can potentially particularly over a duration like that, it can help you hold onto more water and that could be classified as lean mass and stuff like that, but the fact we’re actually seeing strength, that’s interesting that strength is higher.

Leah Higl

Yeah, a hundred percent. And I mean, I generally think that even if creatine didn’t help during mobilization or injury, [00:08:30] it’s still worth taking for when you get back to training.

Leah Higl

Because we know that you need to build up that saturation of creatine in the muscle. So worst case scenario, it’s probably good to maintain that so that you’re ready to go when you do hit training again.

Aidan Muir

Yeah, and we definitely see like four days longer rehab protocols, particularly when building and maintaining muscle and stuff like that are really important that having creating in your system, we know it helps with muscle growth, we know it helps with building strength. It can help with those phases of rehab as well. And the mobilization stuff is interesting [00:09:00] because there is also another study they did similar on post ACL surgery as well, from directly post ACL I’m pretty sure, and six to 12 weeks after the surgery, so still very early in the rehab, most strength markers were up by about 20%, and knee extension strength, which is pretty critical post ACL was about 47% greater. So that’s another interesting thing being like … I don’t know, there’s not much downside of creatine.

Leah Higl

I feel like there’s no downside of creatine So if there’s even the chance that it could help, [00:09:30] why not just keep it in your routine? Because if you’re an athlete, it should probably be there already anyway.

Aidan Muir

Yeah, exactly. And I’m not super high on the immobilization stuff. I’m finding that interesting and I’m like well, if there’s a percentage chance that this, exactly as you said, if there’s a percentage chance that it helps, it’s worthwhile looking into. But there is also potential … There is other studies that have been done on the immobilization stuff where it looks pretty hit and miss.

Aidan Muir

So it’s like I’m not sold on that, but it’s worth a crack because it’s pretty cheap, minimal down side. I’d definitely be looking at it, and we know for those later stages of rehab, it definitely seems [00:10:00] to help with that for sure.

Leah Higl

Yeah, definitely less set in stone than creatine use in general for training adaptations, but still worth it.

Aidan Muir

Yeah. And a lot of stuff we’ve talked about, I am pretty sold on, but the next one I’m not as sold on, so fish oil supplementation. So there’s two mechanisms as to how this can help with injury recovery. So the first one is potentially enhancing anabolic sensitivity to amino acids, and the second one is it could potentially help from an anti-inflammatory perspective. So [00:10:30] the enhancing anabolic sensitivity part, that’s where I’m most skeptical because I’m kind of like we don’t see that outside of injuries. We’re not exactly seeing all these studies on people trying to build muscle or lose fat and preserve as much muscle as possible, uninjured getting better results. That’s been studied over and over and it’s either there is no difference or maybe there’s a tiny positive difference. It doesn’t seem to be that strong.

But there is very interesting research, there’s only two studies so far that’ve been done, [00:11:00] but they’re on immobilization, once again, which we’ve talked about a little bit, and we’re probably focusing on that too much, but it is an interesting area. It’s something that I actually do care about a bit. And two studies on immobilization with fish oil basically showed that the people in the fish oil group maintained significantly more lean mass. And it’s like right now we only have two studies, but the two studies we have, have been pretty overwhelmingly positive. So even though I’m not sold on it, I’m also like if I was getting an ACL surgery, [00:11:30] I would be taking fish oil.

Leah Higl

I’d just chuck it in there.

Aidan Muir

Yeah. But on that topic, I listened to a podcast that featured the authors of those studies and I took a bunch of caffeine, got my pen and paper out, was ready to learn some stuff, and an hour of listening to that podcast, they got to the end of it and they’re like, “Yeah, even we’re not that sold on this.”

Leah Higl

And they’re doing the research.

Aidan Muir

And they’re doing the research. They’re kind of like, “We wouldn’t actually recommend taking fish all year round just in case you get injured [00:12:00] and you get in this situation.” But they did say at the ACL exam, they’re like, “If you know you’re going in for surgery and you know you’re going to be immobilized, then we would add it in for those purposes.” And the dosages they’re talking about are about two to four grams of fish oil per day.

Leah Higl

Which is a fair amount, to be fair.

Two to four grams is a fair amount. Yeah.

Aidan Muir

So it’s like they’re not looking at the year round approach, but they’re like if you’re using it … We’ll use a decent dosage.

Leah Higl

Okay, so the next thing is, again, something we’ve talked about a few times but it is collagen or gelatin. So we actually did a full episode on [00:12:30] this. It was episode 10 where I interviewed Aidan and pretty much went over this in really, really strong detail because he’s really into it. But basically, collagen may be useful for soft tissue or musculoskeletal injuries. So we know that obviously our tendons, ligaments, bones, and cartilage all contain collagen, so perhaps when we have an injury in that area that we’re looking to recover, collagen could actually be useful. And musculoskeletal injuries [00:13:00] make up about 70% of injuries amongst athletes in total, so it could be a pretty relevant supplement to a lot of injuries again, amongst athletes.

So the protocol for this is 15 to 25 grams of hydrolyzed collagen powder or gelatin about 40 to 60 minutes before your training or rehab session. So the actual timing of that is pretty important because during the rehab or training session, you are forcing kind of blood flow to that area [00:13:30] and it’s really the only way we can somewhat target that collagen towards that injury to potentially help it to recover a little bit better. So research on collagen supplementation is really in its infancy. Would you say like it’s probably not set in stone?

Aidan Muir

Yeah.

Leah Higl

But it’s one of those things that again, I mean, unless you’re vegan or something, it doesn’t have any down sides and so if you have this kind of injury, it could definitely be useful to as a protocol put it in there before training and rehab sessions.

Aidan Muir

[00:14:00] Yeah, and I was looking at your notes just before this as well about the whole like … Because with the vegan thing, it’s like well, is there an alternative for vegans? And I previously have said stuff like … I’m like well, there’s no reason why you can’t just supplement the individual amino acid because I don’t think it’s the collagen, I don’t think it’s the gelatin. I don’t think that’s a magical thing. I think it’s just the amino acids timed before the exercise about going to the injured area when they peak in the blood flow and everything like that.

I’ve taken that a step further and been like okay, how would we practically do that? And collagen is 33% [00:14:30] glycine, that amino acid, so that’s the main one. We have research on glycine in isolation helping with musculoskeletal injuries, so it’s like bare minimum that could be an option. But you could take it further and be like well it’s also high in lysine and proline. And I’m like is it easy to purchase these amino acids? That’s the question I’ve always had.

And I’ve looked into it and you can get glycine and lycine from bulk nutrients. They’re really cheap. They’re easy. A bag of glycine is like $13 or something like that. Super cheap. They don’t sell proline [00:15:00] but I didn’t have to look too hard, literally as I typed it in, bulk supplements, it’s a different thing. I think it’s American. They sell proline, so it’s like you can purchase those three amino acids. You can put them in a similar ratio or you could just do a third of each basically and put that together. And theoretically, if collagen works, I would say that those would also work as well.

Leah Higl

Well, if I ever get injured, I’ll try and let everybody know.

Aidan Muir

Yeah. You’d have to find a way to make them taste good because I don’t know if you’ve ever had unflavored amino acids.

Leah Higl

[00:15:30] That’s going to be quite the barrier for me.

Aidan Muir

But I’m sure there’s a way.

So the next one we’re going to talk about is vitamin D and calcium, so both of these are particularly relevant if there is anything related to bones, so like stress fractures, for example, is a pretty common injury. But there’s also applications for vitamin D outside of that. But starting with the stress fractures, we know from an injury prevention standpoint that just supplementing vitamin D and calcium at a population level do help with increasing bone marrow density. [00:16:00] Taking that a step further, it does seem like from the research I’ve seen that they also help improve fracture recovery. So if somebody had a stress fracture in their foot or something like that, it could shave a little bit of time off that recovery as well, which is pretty good.

The next stuff though that I found interesting is for surgeries, like if somebody was having a surgery related to injury, 84% of the studies on the topic of vitamin D status found that there was a pretty strong link between low vitamin D [00:16:30] and poor surgical outcomes. And that’s a pretty broad spectrum kind of thing, but it’s also an interesting thing because obviously you want good outcomes from your surgery, so it’s like it’s a bit of a … You would want to know, if you’re trying to optimize everything, you’d want to know your vitamin D status because that also links in with other stuff.

There’s another study I was looking at on ACL surgery showing low vitamin D status was linked with lower levels of strength, which we haven’t really seen that in athletes. I haven’t seen research on that in athletes. We’ve seen it in the elderly population. We’ve seen it in certain other areas where it’s like [00:17:00] you can almost plot vitamin D status alongside strength to a certain degree in some populations where they’re not training at higher levels. But three months post ACL surgery, you’re not exactly training at a higher level. It kind of fits into that category too, so I’m not surprised by that.

And then also the inflammation standpoint, I didn’t touch on that too much with fish oil either, but vitamin D also reduces inflammation. The reason why I don’t talk about that too much is just because it’s like we know that if you take anti-inflammatory stuff too far, maybe that has issues with injuries as well. [00:17:30] It’s a complex topic but that’s … We find that in other areas, not necessarily in nutrition that completely trying to get rid of inflammation might not be the best thing because we know inflammation is involved in injury recovery too. But it’s rare to see having a healthy diet or anything like that ever cause an issue, and I would put having good vitamin D status in the category of a healthy diet.

Leah Higl

That’s a good point.

Aidan Muir

So I don’t think it’s too risky to have good vitamin D status basically.

Leah Higl

Yeah, I guess you just can’t take anything too far because you can’t have [00:18:00] too much vitamin D but I think …

Aidan Muir

It’s hard to do, but you can.

Leah Higl

There’s so many wins from having … Like rectifying low vitamin D or vitamin D deficiency that this is just one of them, but there are a lot of win involved in that.

Aidan Muir

Exactly. Yeah.

Leah Higl

So one of the final things we’re going to touch on is a pretty basic one, but having an overall healthy diet, so with lots of fruits and veggies, making sure we get that good level of antioxidants and micronutrients just in general. So we know there’s other micronutrients that definitely [00:18:30] play a role in injury recovery, so things like magnesium, vitamin K, zinc, they all play a role. But you can get those through having a balanced diet, you don’t need to go out of your way to supplement individually with those things. So I wouldn’t focus on it too much but just kind of having that broad idea of having all your fruits and veggies, whole grains, lean proteins, and making sure you’re getting everything in that you should always be getting in is a good way to go.

Aidan Muir

Yeah, it’s [00:19:00] pretty broad. There’s so many different micronutrient and antioxidants and things like that can help, so rather than focus on everything individually, just having that broad focus on an overall healthy diet is likely to take care of that pretty comfortably.

And another thing that kind of really got me thinking heaps about how nutrition can play a role in injury recovery, or not even just nutrition, just like a broad perspective on how to manage injuries is I would listen to a certain dietician talking about his experience working with [00:19:30] the Brumbies and when people got serious injuries, what would they do? The example that he … The Brumbies Rugby Union Club to be specific, but what he was talking about is like if somebody tears an ACL, straight away they have a team around them doing stuff.

They have the dietician in who’s talking about protein, creatine, fish oil, all of those things we just talked about. They get the physios in straight away, they get multiple surgeons opinions and stuff like that, and then they also do something like electromuscular [00:20:00] stimulation. And that was the thing that really got me thinking. So I chucked out a stat earlier that was talking about this 20% reduction in quad size in one to two weeks post surgery, and in one of the studies that they did on these Brumbies players post ACL, they gained quad size postsurgery while immobilized.

Leah Higl

That blows my mind.

Aidan Muir

Yeah, and as we mentioned with creatine, maybe there’s water weight, maybe that’s one factor. I’m not going to sit here and be like yeah, [00:20:30] they’re definitely gaining size. But the electromuscular stimulation is something that can offset this muscle loss to a certain degree, and tying in the high protein intake and all those things, it can also offset it and everything like that. You end up with crazy outcomes and we’re in the power lifting space amongst other things, but our personal interest is in the power lifting space, and that’s always fascinated me because it’s like hang on, that’s the sport that has a bit of money in it.

Leah Higl

Yeah.

Aidan Muir

They have access to this kind of stuff. [00:21:00] In the power lifting world, we don’t really have that. If somebody gets a serious injury, how much of this access do they have? Do they get one opinion from a surgeon? Do they see multiple surgeons? Do they have access to electromuscular stimulation? Can they use that? Will they lose a lot of muscle function, stuff like that? Do they have someone talking to them about protein prioritizing and all of those kind of things? There are things that you can do to build a team around you, obviously, but there’s only so far you can take it. But it’s interesting to see [00:21:30] how much potential the space has for a lot of athletes.

Leah Higl

Yeah, I feel like power lifting has more of a you’ll be all right attitudes, but perhaps kind of looking at all these little different things that you could do can really assist in preventing muscle loss and strength during a time where you are injured.

This has been episode 39 of the Ideal Nutrition Podcast. If you could leave a rating and review, that would be super appreciated. But otherwise, thank you for tuning in.