Updated: Mar 4, 2020
As a nutritionist, it is essential my nutritional interventions with athletes are primarily underpinned by established scientific literature. However, in the context of the injured athlete, this is very difficult since there are no published research studies in this population as it’s very unlikely you would be able to injure an athlete in the name of science – and who would volunteer!? Instead, you have to consider the consequences of an injury and devise nutritional interventions to address these. One of these consequences is a loss of muscle mass and in this first instalment of articles addressing nutrition for injury, I’ll discuss how you can offset these losses.
Throughout the day you are in a constant state of protein balance, either positive or negative, where muscle protein synthesis or degradation i.e. the making or breaking down of protein within the body. When you eat or drink some protein, muscle protein synthesis increases, putting you into positive balance, after a few hours once you are back in a ‘fasted’ condition, protein synthesis declines and you go into negative protein balance. In the injured athlete you often see a loss of muscle mass (I’m sure you’ve seen in comparison photos of somebody recovering from a leg injury), which is due to a reduction in weight bearing or muscle contraction and also due to the inflammatory response from the injury. The biggest loss of muscle tends to be in the first two weeks following injury, so this is the key time to prioritise nutritional interventions to try to offset these negative consequences. With this loss of muscle mass, we also see a decline in functional strength and even some local fat deposition.
'injury is a key time to prioritise nutritional interventions'
Another unfortunate consequence of reduced mobilisation is that the muscle develops a state of ‘anabolic resistance’. What this means is that you don’t get the same response in protein synthesis that you do when you are healthy. So, if you consider the rehabilitation period may over many weeks, for every meal you eat you are getting an impaired protein response.
What can you do?
The best strategy to offset some of the muscle mass loss is to simply eat more protein. When working with an athlete I like to teach the 3Ts: Timing, Total, Type. In this case, the Type is protein, but what’s important is the Timing and Total. Most people ingest protein three to four times per day i.e. breakfast, lunch, dinner and maybe a snack. However, in this case I would recommend increasing this to 5-6 servings per day such as the example below:
2 whole eggs plus 2 egg whites made into an omelette, with mushrooms and spinach
2 scoops whey (40g protein) and a banana
1 large chicken breast with side salad
150g low fat yoghurt with mixed berries
200g salmon fillet, jacket potato, mixed green vegetables
500ml milk or 40g casein protein
Another common factor I see when analysing an athlete’s diet is an uneven distribution of protein through the day (Timing). We often see a small serving of protein at breakfast, a slightly larger one at with lunch, then the greatest intake at dinner. Instead, I aim for a consistent dose of protein, aiming for approximately 40 grams of protein in each meal and snack, or between 2.0 – 2.3 grams per kilo for your daily total. This might seem excessive and far beyond what you may normally eat, but this increase in protein can help offset some of the anabolic resistance of the muscle. The source of protein needs to be high in the amino acid leucine, the key regulator of protein synthesis which is found in high amounts in poultry, eggs, beef, fish, dairy and whey protein.
Take Home Message
Periods of immobilisation following injury cause a loss of muscle mass through a reduction in muscle contraction and the development of ‘anabolic resistance.’ In order to offset some of these consequences, you should aim to increase your intake of protein, aiming for a 40g serving in each main meal and snack. In addition to increasing the total amount of protein, it is important to aim for a consistent distribution throughout the day.
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