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

Welcome back to my two-parter on how to eat when you're recovering from an injury. Last week, we discussed how we heal; how many calories we should eat while we heal; and how protein, carbs, and fat should be treated while we heal. Today, we're going to dig into the nitty gritty and look at vitamins and minerals, as well as supplements, foods, and other cool junk. Ready for some edumacatin'? Let's roll.

Micronutrients

As anyone who’s ever had a boo-boo knows, wounds are stressful. With this in mind, antioxidants are a good idea when you’re injured to help fight oxidation brought on by inflammation. However, three antioxidants in particular are especially useful: zinc, vitamin A, and vitamin C.

Zinc is a trace mineral that plays an important role is DNA and protein synthesis, as well as cell division—three crucial processes for tissue regeneration. Impaired wound healing due to a zinc deficiency is well documented, so make a point of getting at least 15-30mg daily particularly during the early inflammation stage. Good sources of zinc include calf’s liver, spinach, crimini and shiitaki mushrooms, as well as pumpkin and sesame seeds.

Vitamin A plays an important role in immune function and has been shown to improve wound breaking strength by helping you build a stronger collagen matrix. (Refresher: collagen is the stuff that holds your cell together.) It also plays an important role during the inflammation phase by increasing inflammation, which sounds bad, but is actually a good thing because, as you recall, inflammation in the early stages of an injury is important for protecting the area. So you’ll want to supplement this earlier in the healing process.

Vitamin A toxicity can happen but 25,000mg on a short-term cycle appears to be okay in most non-pregnant adults. (Although if you're a pregnant man, you might be in trouble regardless of vitamin A consumption.) Vitamin A-rich foods include sweet potato, carrots, and most leafy greens (especially spinach).

Vitamin C—or ascorbic acid--is an important cofactor in collagen synthesis, meaning it helps the enzymes that rebuild a wounded area. It can also boost immunity. Considering we don’t store ascorbic acid, it’s important to keep the stuff coming when you’re injured. Up to 1-2g daily should do the trick. 

B complex vitamins play all kinds of roles in wound healing. They act as coenzymes during the inflammation stage and they aid in the removal of dead tissue and bacteria. They aid in the building of collagen, wound constriction, and scar support. The amount you need depends on which B vitamin you’re talking about, but a varied, healthy diet should cover you. Foods rich in the B complex include potatoes, bananas, garbanzo beans, chicken, oatmeal, fish, and sunflower seeds. Keep in mind that vitamin B12 comes from animal sources, so if you’re a vegan, it’s an especially good idea to supplement during wound healing.

Supplements

For most of us, wound healing is a time for desperate measures--or so it feels. So, as is typical of these situations, the supplement industry offers no shortage of Hail Mary pass-type pills and potions you can pop. Luckily, some of them actually stand up to scrutiny—and happen to be inexpensive and non-proprietary.

Glucosamine sulfate is mainly recommended as a treatment for osteoarthritis because it stimulates the manufacture of key structural components of cartilage. It is my opinion that it can also benefit joint-related injuries in the same way. Some experts also suggest that glucosamine is important for the synthesis of hyaluronic acid, a key player in tissue repair. Try 1500mg daily during the proliferation stage.

If you want to know more about glucosamine, here’s something I did a few months ago about it.

Bromelain is made up of proteolytic enzymes (enzymes that breakdown protein) derived from the pineapple plant. (Who knew?) It’s been shown to have an anti-inflammatory effect on injuries, most likely because it eats up protein-based waste in the wound and inhibits synthesis of pro-inflammatory prostaglandins. At the same time, it promotes the production of fibrin, the stuff that blocks off the wound to protect it during the inflammatory stage. It’s useful in the early stages of an injury in order to prevent inflammation from going on too long.

 

There is no shortage of studies showing the efficacy of bromelain in sports-related wound healing, but by far the coolest is a 1960 study where boxers supplementing bromelain were shown to heal bruisessignificantly faster than non-supplementing boxers . Typical dosage is between 125g and 500g, three times a day. Make sure to take it on an empty stomach or the enzymes will work on the protein in your food instead of on your wound.

Anti-inflammatory foods

There are a number of helpful foods in addition to the ones mentioned above when managing an injury--and they primarily focus on inflammation. Foods rich in proteolytic enzymes (including pineapple, papaya, and cheese) and bioflavanoids and antioxidants (both from fresh fruits and veggies) can help, as can anti-inflammatory herbs such as ginger and turmeric.

Omega-3 fatty acids, which you’ll find in seafood, flax, chia, and walnuts, are needed for the production of anti-inflammatory eicosanoids. Personally, I’ve had good results combating inflammation by supplementing fish oil at 8000mg a day. (It also cleared up my skin and made it extremely supple, but that’s a topic for a different blog post--maybe even a different blog entirely.)

On the other hand, arachidonic acid is a precursor to several pro-inflammatory substances, so if inflammation is in an issue, you might want to pull back on animal products in general, but particularly beef, eggs, and dairy. That said, if you are going to eat meat, pasture-raised animals tend to have a higher amount of omega-3 fatty acids. I recommend this given the anti-inflammatory nature of omega-3s might offset the arachidonic acid.

Some experts express concern over linoleic acid, which you’ll find in vegetables and seeds, due to the fact that is can be converted to arachidonic acid. As long as the foods you’re eating are fresh and raw (if possible), I don’t think this is worth worrying about. The benefits of veggies and seeds, where you’ll find linoleic acid,  far outweigh this concern, especially considering the body converts very little linoleic acid to arachidonic acid.

Beyond nutrition

Obviously, there are a number of therapies that can aid wound healing. These include chiropractic, acupuncture, therapeutic massage, and active release therapy—a relatively new practice involving the breaking down of scar tissue to promote healing.

If your injury includes some type of open wound, the topical application of Aloe vera has been show to stimulate both collagen and fibroblast synthesis.

Another things you can do is avoid stress. There are several reasons for this, but in my opinion, the most compelling one is that stress elevates cortisol levels. Cortisol is a hormone that, among other things, increases the breakdown of protein into glucose. As I mentioned earlier, protein is crucial to wound healing, so trying to heal in a stressed state basically pulls your body’s proteins in two different directions.

Finally, don’t be a hero. The best thing for any injury is rest. I know you want to keep moving. I know you don’t want to lose all the fitness gains you’ve made, but if you push an injury too hard, it’ll only get worse. You run the risk of turning a one-month annoyance into a lifetime source of chronic pain.

Eating after you’ve healed

Just because you feel 100%, it doesn’t mean everything is perfect. In fact, the remodeling stage can take up to two years. The bulk of the healing is done, though, so it’s safe to return to your exercise-based nutrition routine, just being mindful of protein intake (at least .8g for each kg of body weight), given protein deficiency does inhibit wound healing in the remodeling stage.

Parting thoughts

I know this seems like a lot to absorb, but truly it’s not. I can sum 99% of it up for you in 5 quick points:

1. Don’t skimp on calories or protein.

2. Take a solid multivitamin to meet increased micronutrient needs.

3. Eat plenty of antioxidant-rich, fresh fruits and veggies.

4. Bromelain and glucosamine sulfate are a couple of solid, reputable supplements to consider.

5. Take it easy on your injury and stop stressing.

And that’s it. Now, go get better!