Nourishing the De c re a se in stre ng th o De c re a se in musc - PDF document

1/9/2014 Injury Considerations I mmo b iliza tio n • L o ss o f musc le ma ss o Nourishing the De c re a se in stre ng th o De c re a se in musc le func tio n o Me ta b o lic impa c t o f immo b iliza tio n • Injured Athlete Ne g a tive ne t musc le pro te in b a la nc e o Ana b o lic re sista nc e o Amino a c ids • De c re a se in insulin se nsitivity • Bo ne c o lla g e n synthe sis do e s re spo nd to inc re a se d a mino a c id le ve ls o De c re a se in a c tivity Ma ure e n Na mko o ng , MS, RD • Dire c to r, Nutritio n a nd F itne ss E ve ryda y He a lth Inc . E AT A Ja nua ry 2014 Considerations During Overview Rehabilitation Hig h-le ve l re vie w o f the he a ling pro c e ss • Co nside ra tio ns during he a ling a nd re ha b ilita tio n • Ana b o lic sta te • Nutritio na l ma na g e me nt o f the injure d a thle te • I nc re a se musc le o I nc re a se stre ng th Spe c ific nutrie nts o f inte re st o • I nc re a sing a c tivity • F o o ds to disc o ura g e during injury • E me rg ing a re a s • F ina l ta ke a wa y re c o mme nda tio ns • Process of Healing I nfla mma tio n • I nitiatio n o f the he a ling pro c e ss o Cle a r the site o f b a c te ria a nd c e llula r de b ris o The Impact from a Ang io g e ne sis o Pro life ra tio n • Nutrition Perspective De po sitio n o f the fib ro b la st a nd c o lla g e n ma trix o Oste o b la st fo rma tio n a nd c a rtila g ino us c a llus o Gro wth o f ne w c a pilla ry ne two rks o Re mo de ling • Cyc le o f b re a king do wn, re b uilding , a nd o rg a niza tio n o Oste o b la st/ o ste o c la st a c tivity o Simulta ne o us pro te in synthe sis a nd de g ra da tio n o Ne t re sult – hype rme ta b o lic sta te & pro te in ne e ds • 1

1/9/2014 Comparison of Nutritional Consideration Recommendations Inc re a se d b a sa l me ta b o lic ra te • Healthy State Injur ed State All pha se s o f he a ling re q uire e ne rg y o 15-25% inc re a se o E ne rg y Ne e ds E ne rg y Ne e ds • • De pe nds o n the se ve rity o f the injury o 1.0 – 1.2 Mino r surg e ry 1.8 mo de ra te a c tivity o Cha ng e s in a c tivity o • 1.1 – 1.3 Ma jo r surg e ry 2.3 ve ry he a vy physic a l a c tivity o o Immo b ilize d limb o 1.25 – 1.3 L o ng -b o ne fra c ture o 30 kc a l/ kg F F M No t pa rtic ipa ting in spo rt o o 30 – 35 kc a l/ kg o E ne rg y ne e ds will de pe nd o n a c tivity le ve l o f the a thle te Pro te in Ne e ds • • Pro te in Ne e ds • ME T va lue o f c rutc h wa lking = 5.0 1.2 -1.4 g / kg fo r e ndura nc e o o 1.0 – 1.5 g / kg initia l injury o ME T va lue o f wa lking fo r ple a sure = 3.5 o 1.2 -1.7 g / kg fo r stre ng th o 1.2 -1.7 g / kg re ha b o Sta g e o f re ha b ilita tio n o F a t • F a t • Inc re a se d re q uire me nt fo r pro te in • 20 – 35% c a lo rie s 20 - 30% c a lo rie s o o Mic ro nutrie nts • Ca rb o hydra te s Ca rb o hydra te s • • Go a ls o f re ha b ilita tio n • 7 – 8 g / kg 7 – 8 g / kg o o Nutrition Management Female 5’6”, 135 lb, 20 y/o Minimize c a ta b o lism • Healthy State Injur ed State Me e t pro te in ne e ds • Ca lo rie s Ca lo rie s • • Me e t e ne rg y ne e ds • 2600 - 3350 2450 - 3050 o o Ba la nc ing a c t o Pro te in Pro te in • • I ndividua lize d o 74 – 105 g ra ms 74 – 105 g ra ms o o K e e p pro te in fro m b e ing use d a s e ne rg y o E nsure mic ro nutrie nts a re a de q ua te • Co nside r who is a t hig he st risk • Ma lnutritio n will impe de the he a ling pro c e ss • How to Calculate Calories Male 6’0”, 190 lb, 20 y/o He a lthy I njure d Healthy State Injur ed State Ca lo rie s Ca lo rie s • • Basal Basal Metabolic Rate Metabolic Rate 3750 - 5000 3500 - 4300 o o Pro te in Pro te in • • 104 - 147 104 – 147 Activity Factor o o Activity Factor Stress (injury) Factor Total Energy Expenditure Total Energy Expenditure 2

1/9/2014 What to Avoid During Injury L o w-de nsity fo o ds • Hig h-sug a r • Hig h-fa t Specific Nutrients • Alc o ho l • Ho w so me mine ra ls, vita mins, a nd a mino a c id s pla y a ro le in he a ling May be helpful in healing Zinc pla ys a ro le in immune func tio n, pro te in, a nd c o lla g e n • synthe sis, c e llula r pro life ra tio n, a nd wo und he a ling Vitamin C func tio ns in the synthe sis o f c o lla g e n c o nne c tive • tissue pro te in, a c ts o n fib ro b la st pro life ra tio n, c a pilla ry How does all of this fo rma tio n, a nd ne utro phil a c tivity Vitamin A stimulate s the immune syste m, e nha nc e s wo und • translate? he a ling b y stimula ting e pithe lia liza tio n, a nd inc re a se s c o lla g e n d e po sitio n b y fib ro b la sts Glutamine c ritic a l fo r the synthe sis o f fib ro b la sts, e pithe lia l c e lls, • a nd ma c ro pha g e s, e sse ntia l fo r g luc o ne o g e ne sis, a nd A d a y in the life thro ug h fo o d impo rta nt in stimula ting the infla mma to ry re spo nse Ar ginine sub stra te fo r pro te in synthe sis, c o lla g e n de po sitio n, • a nd c e llula r g ro wth Calc ium e sse ntia l fo r no rma l b o ne struc ture • Vitamin D fa c ilita te s the a b so rptio n o f c a lc ium • Food Sources Typical Intake ‐ Female Bre a kfa st • Zinc – me a t, live r, e g g s, a nd se a fo o d • Who le whe a t b a g e l, c re a m c he e se , yo g urt & fruit smo o thie with spina c h o Vita min C – c itrus fruit, g re e n ve g e ta b le s, to ma to e s, a nd o ra ng e juic e • Sna c k • a nd po ta to e s Apple , a lmo nds, c ra c ke rs o Vita min A – live r, ye llo w ve g e ta b le s, g re e n le a fy L unc h • • T urke y sa ndwic h with le ttuc e a nd to ma to , c a rro t stic ks, o ra ng e , pre tze l o ve g e ta b le s, e g g s, a nd milk pro duc ts ro d, a nd spo rts drink Sna c k Ca lc ium – milk, yo g urt, a nd c he e se • • Hummus, ve g g ie stic ks, a nd a pita o Vita min D – sun e xpo sure , fo rtifie d fo o ds – milk a nd Dinne r • • Sa lmo n, spina c h, winte r sq ua sh, b ro wn ric e , a nd milk c e re a ls o Sna c k • Gra ha m c ra c ke rs, pe a nut b utte r, stra wb e rrie s o T o ta ls • 2800 c a lo rie s, 435 g CHO, 112 g Pro o 3

1/9/2014 Oral creatine supplementation facilitates the Typical Intake ‐ Male rehabilitation of disuse atrophy and alters the expression of muscle myogenic factors in humans Bre a kfa st He spe l, e t a l. • • Who le whe a t b a g e l, c re a m c he e se , ha rd b o ile d e g g , yo g urt a nd fruit o Do ub le -b lind tria l smo o thie with spina c h, pe a nut b utte r a nd o ra ng e juic e • Sna c k • Me tho ds • Cle me ntine , a lmo nd s, c ra c ke rs o 22 yo ung he a lthy vo lunte e rs o L unc h • Ca st wa s use d to immo b ilize the rig ht le g fo r two we e ks o T urke y sa ndwic h with le ttuc e , to ma to , a nd c he e se , c a rro t stic ks, a pple , pre tze l o Ha lf the sub je c ts re c e ive d c re a tine mo no hydra te – 20 g do wn to 5g da ily ro d, a nd spo rts drink o Sub je c ts pa rtic ipa te d in a kne e -e xte nsio n re ha b ilita tio n pro g ra m Sna c k o • Me a sure d the c ro ss-se c tio na l a re a o f the q ua dric e p with NMR ima g ing o Yo g urt, g ra no la , a nd spo rts drink o Me a sure d ma xima l kne e e xte nsio n po we r with iso kine tic dyna mo me te r o Dinne r • Ne e dle b io psy ta ke n fro m the va stus la te ra lis we re e xa mine d fo r o Chic ke n b re a st, who le whe a t pa sta with re d sa uc e , b ro c c o li, winte r sq ua sh, o myo g e nic re g ula to ry fa c to rs a nd sa la d with dre ssing Re sults Sna c k • • Ce re a l, milk, a nd pe a r Ora l c re a tine supple me nta tio n stimula te s musc le hype rtro phy during o o re ha b ilita tio n stre ng th tra ining T o ta ls • 3900 c a lo rie s, 600 g CHO, 172 g Pro o Jo urna l o f Physio lo g y (2001) 536.2 The Effect of Creatine Supplementation on Strength Recovery After ACL Reconstruction T yle r, e t a l. • Do ub le -b lind, pro spe c tive , a nd ra ndo mize d c linic a l • tria l What Are We Still Me tho ds • Learning? 60 pa tie nts we re ra ndo mize d into pla c e b o a nd c re a tine o 20 g / da y fo r the first 7 da ys the n do sa g e wa s re duc e d to 5g / da y o F o rma l re ha b ilita tio n b e g a n a t 1 we e k o Qua dric e ps a nd ha mstring stre ng th a nd po we r we re me a sure d o So me E me rg ing T o pic s iso kine tic a lly. Hip fle xo r, a b duc to r, a nd a dduc to r we re me a sure d with a ha ndhe ld dyna mo me te r prio r to surg e ry, a t 6 wks, 12 wks, o r 6 mo nths a fte r surg e ry. Re sults • Pa tie nts do no t b e ne fit fro m c re a tine supple me nta tio n during the first 12 o we e ks o f re ha b ilita tio n a fte r ACL re c o nstruc tio n AJSM, Vo l 32 No .2 2004 Emerging Information Take Away Supple me nta tio n with immo b iliza tio n E nc o ura g e a thle te s to c o ntinue the ir no rma l inta ke • • Pro te in supple me nta tio n o Hig h q ua lity pro te in, who le g ra ins, fruits, & ve g g ie s • Bra nc he d-c ha in a mino a c ids • Ca re fully wa tc h tho se a t mo st risk L e uc ine • • Ome g a -3 I f yo u ha ve c o nc e rns spe a k with yo ur te a m die titia n o • Cre a tine o a nd/ o r do c to r 4