Download nutritional support for exercise-induced injuries

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
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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