The Nutrition Nerd’s Guide to Eating While Injured, Part One

If you exercise, there’s a good chance you’re going to get hurt at some point. Injuries are one of the few downsides to living an active lifestyle. But honestly, it’s kind of a small downside. After all, wouldn’t you rather twist an ankle instead of catching a bad case of obesity, heart disease, diabetes, or osteoporosis?

And unlike all those inactivity-related illnesses, sport-related injuries tend to heal. If you’re smart about, they heal quickly. Conventional wisdom tells us that RICE (rest, ice, compression, elevation) and maybe a little ibuprofen are the best way to deal with most injuries. But the truth is that you have another incredibly powerful tool in your healing arsenal: your mouth.

Well, not so much your mouth per se, but rather what you put into it. Over the next two posts, let’s take a look at how proper nutrition and a solid supplement regime can get you off the couch and back into your groove in no time. 

Anatomy of an injury

The human body can be injured in all kinds of funky ways.  Sprains, strains, cuts, bruises, tears, and burns all present in different ways and symptomology varies wildly. That said, there are some basic commonalities when it comes to the way we heal. Injuries tend to be put into two groups: mild and severe. Mild ranges from a twisted ankle to elective surgery. Severe injuries include major surgery and severe burns. I’m going to talk mostly about the mild stuff.

Wound healing can be broken down into five stages. To explain them, I’m going to throw down some hardcore anatomy and some serious 25¢ words. If that’s not your trip, it’s all good. Just skip down to the “eating thing” part below.

Hemostasis: First, bleeding is stopped and the wound is isolated thanks to constricting blood vessels (vascoconstriction), clotting, and a scab. These barriers prevent infection and supply structure for the next stages.

Inflammation: Prostaglandins and other inflammatory buddies promote the opening up of blood vessels (vasodilation), allowing enzymes, antibodies, and nutrients to enter the wound. White blood cells also head on in, fighting infection and removing debris and bacteria. (Although inflammation is a dirty word in many circles, it’s actually quite a useful stage in healing. It’s only problematic when it goes on for too long, but we'll talk about that another time.)

Proliferation: Once the body has managed the injury, this is where the healing truly begins. Collagen-building cells called fibroblasts and blood vessel-building cells called endothelial cells travel to the wound in order to put Humpty Dumpty back together again. (BTW, collagen is the connective tissue surrounding our cells that holds us together. Remember that. There might be a quiz.)

Contraction: This is when the wound starts shrinking. Cells called myofibroblasts are in charge of pulling the wound together. (At this point, you’re probably noticing that every stage of healing includes some sort of energy expenditure. That's another potential quiz question.)

Remodeling: At this point, you’re basically healed. Collagen isn’t being built as much as it’s being reworked and strengthened. This phase can take years.

Now, about the eating thing

First, let’s get one thing straight. This is not hippy advice. I understand that the hippies tend to think the right foods can cure anything. That’s not what I’m about to recommend. This nutritional advice is grounded in hard science—and little bit o’ love.

Calories: Especially among us fitness and weight-conscious types, there’s a perception that you should greatly decrease calories during a healing cycle because you aren’t expending calories working out. The clinical term for this kind of thinking is “stupid.” In fact, the opposite is true.

Healing takes a tremendous amount of energy—so much so, in fact, that it causes hypermetabolism, meaning you burn extra calories without even working out. (Score!) And because the body views all injuries as life-threatening, your system makes healing its priority, so if you’re not eating sufficient calories, your body will resort to “autocannibalism,” which is every bit as grizzly as it sounds. In other words, if you don’t eat enough, your body will break down amino acids—typically muscle and, in severe cases, also skin collagen and bone--in order to heal.

How many calories you need depends on the severity of the wound, but for the type of injury we’re discussing here (mild), the lamely-named journal Eplasty recommends the following:

Basal Metabolic Rate x 1.2 (injury-induced stress factor) x activity factor=

recommended caloric intake

(Activity factor is 1.2 if you’re not exercising. It’s 1.5 or up if you’re remaining active.)

For those of you not into math, that means you should continue to eat at a weight-maintaining level, but don’t be afraid to add an extra portion or two or an extra snack to your eating plan to allot for increased nutritional needs.

Protein, carbohydrates, and fat:  All of the macronutrients play important roles in the healing process. (Duh.) Carbs matter because glucose (blood sugar) provides energy for healing cells. They also serve several other functions, including playing a key factor in a number of wound-healing enzymes. 

Fat also works as an energy source and is vital for the creations of inflammatory mediators such as prostaglandins. Furthermore, it’s an important ingredient in the creation of new cells, given cell membranes are made of fat.

While these two macronutrients are important, the Grand Poobah here is protein. As I stated earlier, protein is comprised of amino acids, the building block in wound healing. Given all the cells you're tearing down and building up, along with increased enzymatic activity, it’s important to increase protein intake during healing phases. A good number to shoot for is between 1.5 and 2 grams per kilogram of body weight.

And if you really want to get fancy about it, there are two amino acids to seek out in particular. Arginine helps with vascodialation (blood flow) and can be found in soy, sesame seeds, gelatin, turkey, and crab meat. Glutamine serves a number of roles in the body, including helping immune cell function. It’s been shown to reduce hospital stay lengths in injured patients. You’ll find glutamine in meat, fish, eggs, cabbage, and beets—although it’s tough to process from vegetable sources unless it’s fermented.

Let’s stop here for today. Tomorrow, we’ll look at micronutrients and supplementation.