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NUTRITIONAL SUPPORT FOR EXERCISE-INDUCED INJURIES PRESENTED BY PAUL K. SAKPAKU 4TH YEAR MED. STUDENT (INSTITUTE OF TRADITIONAL &NON-TRADITIONAL MEDICNE,DNEPROPERTROVSK) OUTLINE OF PRESENTATION • INTRODUCTION • COMMON EXERCISE-INDUCED INJURIES • PICTORAL EXAMPLES OF INJURIES DURING RXERCISE • STAGES OF EXERCISE-INDUCED INJURIES • NUTRITIONAL SUPPORT FOR HEALING AND RECOVERY, REHABILITATION • EATING DISORDERS INTRODUCTION • The results of an exercise-induced injury may vary widely depending on the nature of the injury and severity. Injuries typically results in cessation or reduction in participation in sports and decreased physical activity. • The overriding nutritional recommendation for injured exercise should be to consume a well-balanced diet based on whole, minimally processed foods or ingredients made from whole food. • The diet should be carefully assessed and changes considered as the injury heals and activity patterns change COMMON EXERCISE-INDUCED INJURIES • • • • • • • • ANKLE SPRAIN GROIN PULL HAMSTRING STRAIN SHIN SPLINTS KNEE INJURY;ACL TEAR KNEE INJURY;PATELLOFEMORAL SYNDROME TENNIS ELBOW FRACTURED BONE STAGES OF EXERCISE-INDUCED INJURIES • 2 MAIN STAGES: HEALING & RECOVERY PHASE *INFLAMMATION(lasts up to ̴ 4days) Body initiates response to acute injury and during this phase the aim is to control blood loss and cellular damage, remove debris and control or eliminate invading bacteria. This phase starts from the time of injury, can last for 3-4 days and is marked by vasoconstriction to stop bleeding, platelet accumulation to form clot and leukocyte migration for phagocytosis. There is pain, swelling, redness and heat at the site of injury STAGES OF EXERCISE-INDUCED INJURIES CONT’D *PROLIFERATION(from ̴4-21days) New blood vessels are formed, fibroblasts produce collagen, wound edges pull together(contracture) and the surface of the wound is covered with epithelial tissue(scar tissue) *REMODELING( ̴2-3weeks up to 2years) Collagen and other proteins become more organized in structure and type III collagen is replaced by type I which is stronger. The scar tissue which develops is 70-80% as strong as the original tissue STAGES OF EXERCISE-INDUCED INJURIES CONT’D REHABILITATION AND INCREASED ACTIVITY Full recovery may take several years, thus nutritional support may be crucial to lesson the length of time and reduce the negative aspects of reduced activity and immobilization NUTRITIONAL SUPPORT FOR HEALING AND RECOVERY PHASE • Inflammatory process is important for healing, attempting to drastically reduce inflammation may not be ideal for optimal recovery. • Dietary fat *Omega 3 fats are antiinflammatory(Mickleborough,2013) and so the ratio of omega 6(pro-inflammatory) and omega 3 should be 3:1 Sources: oily fish, linseeds, walnuts and chia seeds, olive oil, mixed nuts, avocados, flax oil, ground flax and other seeds • Dietary Herbs and Phytochemicals * Turmeric (a flowering plant in the ginger family) has an anti-inflammatory agent and in wound healing. *curry powder 400-600mg and turmeric extract 3x per day leads to reductions in inflammation *Garlic inhibit the activity of the inflammatory enzymes cyclooxygenase and lipoxygenase as well as impact macrophage function. While eating additional garlic during injury is likely a good strategy, garlic extracts may be required for more measurable antiinflammatory effects. *Bromelain is another anti-inflammatory plant extract, coming from pineapple. While best known for its digestive properties, Bromelain is an excellent anti-inflammatory and analgesic compound. Typically Bromelain is given in doses of 500-1000mg/day for the management of inflammation. • *Boswellia is a type of tree that also has antiinflammatory uses and has been shown to offer benefit through the inhibition of 5lipoxygenase and potentially other cytokines. Typically Boswellia is taken in 300mg doses 3x per day. • *flavanoids (such as those found in cocoa, tea, red wine, fruits, vegetables, and legumes) can help manage inflammation through their antioxidant actions and also by impacting cell signaling. CALORIE AND MACRONUTRIENT NEEDS DURING INJURY RECOVERY • ENERGY • Energy intake is a critical component of any nutrition plan for optimal recovery from an injury • Energy expenditure may be increased by 1550% depending the severity of injury • However, for athletes reduced physical activity and training may result in reduced energy expenditure • Additional carbohydrates should come from whole grain, minimally processed sources like whole oats, yams, beans, whole grain rice, quinoa, etc. The athlete should eat fewer starches when not training (such as during injury recovery), and more when training (unless fat loss is a goal). Although a no carbohydrate or no starch diet is unwarranted • Efforts to attain energy balance during recovery is critical • If restriction of energy intake is too severe, recovery will slow due to negative metabolic consequences • Negative energy balance will interfere with wound healing and exacerbate muscle loss since muscle protein synthesis(MPS) is an energetically expensive process • A large positive energy balance is undesirable for optimal healing and recovery; it results in increased lean body mass(BM) • Positive energy balance accelerates muscle loss during inactivity via activation of systemic inflammation • PROTEIN AND AMINO ACIDS • Decreased MPS is the major mechanism behind negative net muscle protein balance(NBAL) and muscle atrophy • Resistance of MPS to anabolic stimulation *the response of MPS to hyperaminoacidemia from amino acid infusion, essential amino acids (histidine, isoleucine, leucine, lysine, methionine, phenylalanine, threonine, tryptophan, and valine) ingestion and protein ingestion is reduced following a period of disuse *reducing muscle activity for 14 days is enough to reduce the response of MPS *possible mediators of anabolic resistance with muscle disuse include impaired protein digestion and amino acid absorption, altered microvascular perfusion and amino acid uptake into muscle and impaired intracellular molecular anabolic signaling • Muscle mitochondrial oxidative function and metabolic flexibility are impaired in muscle tissue *downregulation of mitochondrial protein transcription, decreases in translational signaling pathway in mitochondrial biogenesis and declines in mitochondrial enzyme activities all result from immobilization. • Insufficient protein intake will impede wound healing and increase inflammation *Healing processes are heavily reliant on synthesis of collagen and other proteins near the recommended dietary allowance (0.8g protein/day/kg BM) *athletes consuming relatively high protein intake ( 2 ̴ .3g protein/day/kg BM) had reduced muscle loss during periods of negative energy balance compared with athletes with lower protein intake ( ̴ 1.0g/day/kg BM) *however, during bed rest (immobilization injury) increasing protein intake to higher protein intake fail to attenuate muscle loss *response of MPS throughout the day is optimized when protein is spread equally over the day *response of MPS to protein ingestion stems from the EAA contents of protein. Thus EAA supplements are recommended for amelioration of muscle loss during disuse injury *protein with high leucine content (2.5-3g) such as lean meat, fish, poultry, eggs and dairy foods and supplements of branched-chain amino acids increase MPS in healthy humans and attenuate nitrogen loss (predominantly from the muscle during bed rest) • Arginine supplement in the range of 15-30g/day and high doses increase collagen accumulation, reduce lean BM loss, reduce nitrogen excretion and accelerate wound healing *stimulate insulin release and Insulin-like Growth Hormone Factor 1 (IGF-1) action *these powerful anabolic hormones stimulate protein synthesis and increase blood flow to the injured area as well as active macrophages for tissue clean-up *the macrophages help produce and activate growth factors, cytokines, bioactive lipids and proteolytic enzymes necessary for healing • Ornithine *ornithine is a metabolite of arginine. Ornthine is converted to amino acid proline which is essential in collagen deposition. Doses in the 20-30g/day range (10g 2-3x per day) with larger doses have the greatest effect in shortening healing time, increase healing strength and increase nitrogen retention • Glutamine *glutamine is essential for the metabolism of rapidly turning-over cells such as lymphocytes and enterocytes. During starvation, trauma and sepsis, glutamine needs drastically increase. Hence glutamine supplements should be added • HMB(β-Hydroxy β-methylbutyric acid) *HMB metabolite of leucine inhibit MPB and increase NBAL leading to potential increases in muscle mass *HMB increase collagen deposition as well as improves nitrogen balance in critically injured adult patients • Creatine *creatine supplementation counter muscle loss and enhance hypertrophy. *widely used to enhance muscle gains resistance exercise training. *but creatine supplementation did not improve muscle following total knee arthroplasty. *however, muscle atrophy in immobilized arm muscle was decreased with creatine supplement during immobilization. *during rehabilitation, after immobility, creatine supplement resulted in an increase rate of muscle growth and strength gains compared with placebo. • Vitamins *lipid soluble vitamins ‘A’ and ‘E’ and water soluble vitamins, folic acid, vitamin B6, vitamin B12 and vitamin ‘C’ are essential for normal immune function and increase resistance to infection *vitamin ‘C’ and ‘E’ are major antioxidants that are effective in scavenging reactive oxygen species in both intracellular and extracellular fluids which inhibit leukocyte apoptosis induced by oxidative stress *vitamin ‘C’ is a co-factor in the hydroxylation of proline and lysine during the formation of collagen . *sources of vitamin ‘C’: fruits and vegetables e.g. sweet peppers, brussels sprints, broccoli, watercress, tomatoes, guava, blackcurrants, kiwi, citrus fruits, strawberries, lychees and mango. • Zinc *zinc plays a role in all stages of wound healing and deficiency is associated with reduced epithelialization, decreased scar strength and collagen production *zinc is required for over 300 enzymes in the body and plays roles in DNA synthesis, cell division, and protein synthesis. These are all necessary for tissue regeneration and repair. *supplementation of 15-30mg per day is recommended, especially during the initial stages of healing. *sources of zinc include lean meat, fish, shellfish, pulses, seeds, nuts and whole grains EATING DISORDERS Mental disorders defined by abnormal eating habits that negatively affect a person’s physical or mental health *Binge eating disorder; eating a large amount in a short time *Anorexia nervosa; eat very little and thus have low body weight *Bulimia nervosa; eat a lot and then try to rid themselves of the food *Pita; eat non-food items *Ruminating disorder; regurgitate food *Avoidant/restrictive food intake disorder; lack of interest in food THANKS FOR YOUR ATTENTION