eating to win: diet & nutrition for athletic injury prevention & treatment ·...

1©2008 BAUMAN COLLEGE Holistic Nutrition and Culinary Arts 800-987-7530 • www.baumancollege.org

Eating to Win: Diet &Nutrition for AthleticInjury Prevention & Treatmentby Jodi Friedlander, M.S., N.C. and Ed Bauman, M.Ed., Ph.D.

While watching the 2008 Olympics recently, didyou wonder what those world-class athletes

were eating? How many of them had nutrition consult-ants advising them on calories, macronutrients, micro-nutrients, and — most importantly — phytonutrients tohelp them recover from the strenuous training and theall-out effort they put in day after day? Furthermore,how will the young athletes who are not savvy aboutnutrition age? Will they fall prey to premature burnout,which is common in competitive sports? Will they resortto performance-enhancing drugs rather than stabilizingand tonifying nutrients in order to stay in the game?

Just as top-tier athletes need trainers, coaches, psy-chologists, and health advisors, so too does the weekendathlete, who trains intermittently and may be unawareof the toll that strenuous exercise can cause when thediet is poor or erratic. Clinical nutrition consultants arevery much in demand to provide nutrition services tothese ordinary athletes, evaluating their unique nutri-tion and metabolic status to see if they are receiving the optimal diet, booster foods, beverages, and supplemen-

tal nutrients that will help them perform at their bestand prevent minor or major injuries and endocrineexhaustion due to inadequate or excessive calories andnutrients.

Most people are by now familiar with the increas-ing levels of overweight, obesity, and degenerative con-ditions we face in this country. The rapid rise of theseconditions is a topic that has received much attentionand a lot of research dollars. The conclusions drawn incountless studies lay the blame on the over-consump-tion of nutrient-depleted junk foods and our increas-ingly sedentary lifestyles, mostly spent in our cars or infront of computer or television screens.

Eating to Win: Diet & Nutrition for Athletic Injury Prevention & Treatment

2©2008 BAUMAN COLLEGE Holistic Nutrition and Culinary Arts

www.baumancollege.org • 800-987-7530

Most people understand that regular, almost dailyexercise is a vital component of good health in generaland crucial for any successful weight loss program. Avery recent study (Jakicic et al., 2008) found that peo-ple who were able to maintain a weight loss of 10%over the course of two years exercised at least an houra day, five days a week, in addition to restricting caloricintake. Combining modest calorie restriction with aero-bics, flexibility exercises, and strength training is nowconsidered the most efficient way to lose fat — not justweight — and keep it off. Another study that looked atlifelong runners (Chakravarty et al., 2008) found thatpeople who practice long-term aerobic exercise experi-ence fewer disabilities, a longer span of active life, anda smaller chance of dying an early death than the gen-eral population. In other words, people who exercise arehealthier than those who do not.

The human body is designed to move and operatesmuch more efficiently when given a regular opportunity

to do so. Exercise boosts our metabolic rates, helps ourbodies excrete toxins, is beneficial to all of our organsand blood vessels, and improves immune function.Furthermore, it benefits our minds and our moods, and— if done correctly – makes us glow from the inside out.

Moving Right AlongThe human musculo-skeletal system is a compilation oforgans that allows us to move. It is comprised of bones,joints, muscles, tendons, and other connective tissues(including ligaments, collagen, and glycosaminoglycans[proteoglycans]), all of which are either positively oradversely affected during exercise.

As any athletic person knows, one bad injury can ruinmore than just a whole day. It can seriously disrupt a ben-eficial workout program for weeks or months, and some-times much longer. For the nutrition consultant, then, theissue becomes how to provide newly active clients withthe proper diet and lifestyle recommendations to help



them prevent injuries, thereby encouraging them to makefrequent exercise a regular part of their health-promot-ing routines, and how to help already active clientsremain so. The key factor is prevention. While the bodyhas an enormous capacity for healing, injuries are oftenthe “gifts that keep on giving.” It is rare, following injury,for the body to fully regain its pre-injury status.

If injuries do occur, our understanding of howproper nutrition can provide excellent natural symptomrelief and help rebuild tissue becomes invaluable.Remember, nutrition can be used effectively in conjunc-tion with standard therapies, which generally consist ofRICE (Rest, Ice, Compression, Elevation), non-steroidalanti-inflammatory drugs (NSAIDs), and corticosteroiddrugs. While such drugs can be damaging and oftenactually impede the healing process, diet and supple-mental nutrients can speed the healing process despitethese hindrances (Bucci, 1995).

It is naive to assume that supplemental nutrients canreturn injured tissues to normal function, or beyond, assome would hope. Though many nutrients play a role inboth injury prevention and treatment, to throw pills andpotions at injuries without considering diet is to miss thebig picture. It is also a waste of money. Added vitamins,minerals, and other nutrients are simply not particularlyeffective in the face of inadequate overall nutrition.

Nutrition for Injury Prevention and HealingAthletic injury prevention depends on many factors.Genetics plays a role, as do training frequency andintensity, proper body mechanics, cross-training toavoid repetitive-use injuries, and adequate rest andrelaxation. But the musculoskeletal system’s tissues arealso profoundly affected by what we eat — including themacronutrients (protein, fats, and carbohydrates) andmicronutrients (vitamins, minerals, phyto (plant) nutri-ents). Our dietary habits over the course of a lifetimecontribute greatly to the body’s ability to perform well.Clearly, optimal nutrition takes its place among all ofthese variables as a vital component for both prevent-ing and resolving athletic injuries.

The basic approach to optimal sports nutrition is toprovide a wide array of nutrient-dense whole foods tosupport musculoskeletal health (see Eating For Health™chart on page 4), including:

. Adequate protein intake for muscle mainte-nance, growth and repair, good immune func-tion, and hormone production;

. High-quality fats for energy and reduction ofinflammation;

. Good quality carbohydrates for immediateenergy, stable blood sugar and insulin levels,and to aid with the protein synthesis recoveryprocess (Virgin, 2006);

. High levels of antioxidant nutrients to help pre-vent lipid peroxidation and muscular damagefrom free-radical activity generated by exercise;

. Adequate hydration with pure filtered waterand diluted fresh juices; and

. A whole foods powder such as BaumanNutrition’s Vital Scoop™ (whey, flax, greens,and fruit extract) in smoothies as a meal orsnack, or combined with honey, royal jelly, andadaptogenic herbs as a calorie and energybooster when on the go.

When healing from musculoskeletal injuries, it isimportant to consider additional factors:

. Maintaining caloric intake — approximately 35kcal/kg/day (Bucci, 1995, p. 216) — dependingon age and level of activity (while caloricdepletion can be a detriment to healing, noextra calories beyond those in the normal dietare needed unless an injury is serious enoughto cause hospitalization [Bucci, 1995, p. 26]);

. Increasing nutrient density even furtherbecause athletic injuries increase requirementsfor various nutrients; and

. Adding specific foods, herbs, and supplementsthat can address the symptoms and underlyingconditions associated with injuries.



LEAFY CRUNCHY UNREFINED SEASONAL BOOSTERSEEDS/OILS PROTEIN VEGETABLES VEGETABLES STARCHES FRUIT FOODS

Daily Servings 2-3 2-4 1-3 1-3 2-4 2-4 2-4

Serving Size 1 Tbsp. oil 3 oz. animal 1 cup 1/2 cup 1/2 cup root 1/2 cup or 1 tsp. to2 Tbsp. seeds 6 oz. vegetable vegetable, 1 med. piece 1 Tbsp.

grains, bread.

Examples Flax, sunflower, Poultry, fish, Salad mix, kale, Broccoli, string Yams, winter Berries, apple, Nuts, yeast,sesame, and eggs, milk, and and spinach. beans, cukes, squash, corn, grape, and seaweed,almonds. beans. onions, celery. millet, rice. citrus. algae, spices.




Dietary Recommendations for Musculo-Skeletal Health and Injury Prevention:

General:

. Eat 3 meals and 0-2 snacks each day, ensuringthat you eat every 4-6 hours (Virgin, 2006) toensure stable blood sugar and insulin levels.This will also help keep cortisol levels regu-lated, which is crucial, since chronic high cor-tisol will cause the breakdown of muscletissue and can lead to adrenal fatigue, a con-dition that can lead to heightened susceptibil-ity to musculoskeletal injury and a decreasedability to heal (Barker, 2006).

. Keep well-hydrated overall with plenty of fil-tered water (about 64 oz. daily). When exercis-ing, extra hydration is important. Both fluid andfuel needs spike 30-40 minutes into a strenu-ous workout, and the best way to satisfy theserequirements is to provide your body with car-bohydrates and protein in a liquid form (Barker,2006). Drinking 8 ounces of water mixed with 1 1/2 to 2 ounces of orange juice plus one serv-ing of a high-quality whey, rice, or hemp pro-tein powder, will provide the recommended6-8% carbohydrates and one serving of protein.Commercial sports drinks contain the right per-centage of carbohydrate, but they also containrefined sugars and other additives and repre-sent a less-than-optimal choice.

. Protein: Eat the following amounts of high-quality proteins, such as cold-water fish,organic poultry, grass-fed meats, organic soyproducts such as tempeh and tofu, and high-quality whey protein powder:

• 1.0–1.5 g/kg/day (70–100 gm protein dailyfor a 70-kg. (150-lb.) person) (Bucci, 1995,p. 216).

• Divide this protein between all meals andsnacks to ensure optimal assimilation(Virgin, 2006).

. Good fats, such as those found in cold-waterfish; nuts and seeds such as walnuts, flax, andpumpkin seeds (which also provide some pro-tein); avocado and coconut; extra virgin oliveoil; and small amounts of organic butter.

. Fresh organic vegetables and fruits; eat atleast 5 servings daily, preferably more.

. Whole grains, beans, and legumes

. Antioxidants: Studies concur that exerciseproduces reactive oxygen species, leading tofree radical activity and possible damage tolipids and muscles (Clarkson et al., 2000; Senet al., 2000; Evans, 2000). This effect is mostpronounced in people who do little training, orin older people and those with impairedantioxidant status (Evans, 2000). Though regu-lar exercise reduces this problem, extra antiox-idant protection is an important dietarycomponent for the health of connective tissue.Research into antioxidant supplementationhas shown inconsistent, sometimes disap-pointing, results (Clarkson et al., 2000;Hamilton, n.d.), possibly because studies havefocused on the effects of single nutrient sup-plementation, usually with vitamins C and E,selenium, and lipoic acid, along with measure-ments of glutathione activity. Eating foodshigh in antioxidants skirts the issues associ-ated with supplements.

Antioxidant-rich fruits and vegetables alsocontain good amounts of carotenoids andbioflavonoids. Carotenoids are precursors ofvitamin A, which is critical for bone and connective tissue health, fast wound healing,and good immune function (Bucci, 1995, pp.64-65). They are most abundant in red, yellow,and orange fruits and vegetables and in leafygreens. Bioflavonoids protect connective tissueand reduce the production of enzymes thatpromote inflammation (Percival, 2002).




Carotenoid Foods. Apricot

. Limes

. Yams

. Cantaloupe

. Lemons

. Winter squash

. Oranges

. Carrots

. Sweet potato

. Tomato

. Kale

. Spinach

Bioflavonoid Foods. Citrus (lemons, grapefruits, oranges)

. Apricots

. Cherries

. Berries of all types, especially dark ones

. Green tea

. Tomatoes

. Buckwheat

. Green peppers

. Greens

. Cherries

. Red grapes (and wine)

. Broccoli

If the message is not already abundantly clear, thenthe advice of naturopath and sports medicine specialistDr. Jason E. Barker should make it so: Consume an anti-inflammatory diet. Eat more plants.

. Iron-rich foods if ferritin (the storage form ofiron) levels are low. It is somewhat ironic thatwhile excess iron can cause oxidative damage— rust — in the body, low iron stores appear tobe related to an increased incidence of athleticinjuries (Bledsoe, n.d.). Considering that iron isa key component of hemoglobin, which carriesoxygen in the blood, and of myoglobin, whichcarries oxygen in the muscles, it makes sensethat low levels could lead to injury. Butbecause iron supplementation can lead tooverload, it may be wiser to eat more iron-containing foods, such as:

• Spinach

• Chard

• Cooked dried beans

• Parsley

• Thyme

• Fish

• Poultry

• Eggs

• Muscle meats

• Calf’s liver

Antioxidant Foods (from www.whfoods.com)

VITAMIN C FOODS VITAMIN E FOODS LIPOIC ACID FOODS GLUTATHIONE-GENERATING FOODS

Papaya, red bell peppers, Nuts and seeds (esp. Green plants, esp. Cysteine-containing foods: poultry, Brussels sprouts, straw- sunflower seeds and leafy greens; muscle yogurt, egg yolks, red peppers, garlic, berries, oranges, canta- almonds), mustard and organ meats. onions, broccoli, Brussels sprouts, oats, loupe, kiwi, cauliflower, greens, turnip greens, (Lipoic acid regen- and wheat germkale chard erates vitamins C Selenium-containing foods: Brazil nuts,

and E and raises crimini mushrooms, fish (cod, halibut, glutathione levels.) snapper, tuna, salmon); high-quality

whey protein


. Booster Foods:• Sea vegetables and algae

• Whey protein powder

• Flax seed

• Nutritional yeast, a good source of B vita-mins, vital to injury recovery

• Herbs and spices, both fresh and dried,many of which have anti-inflammatoryproperties

A diet supporting musculo-skeletal health mini-mizes the following foods:

. Excess caffeine;

. Refined carbohydrates such as white flourproducts; sugar- and fructose-sweetened foods;

. Artificial sweeteners;

. Fried foods, greasy foods; and bad fats —including margarine, partially hydrogenatedfats, large amounts of vegetable oils, andexcess fat in general;

. Processed foods and snacks of all kinds,including luncheon meats, chips, cookies,crackers, cereals, and pastries;

. Smoking;

. Alcoholic drinks; and

. Over-the-counter drugs.

Athletic InjuriesThe musculo-skeletal system can sustain injury in sev-eral ways:

. Sprains and strains are some of the mostcommonly seen athletic injuries. Sprains resultfrom an injury to a ligament, the connectivetissue that links bones together at joints.

They most often occur in the ankle, knee,elbow, or wrist. Strains occur from tears inmuscle tissue and are often seen in the mus-cles that support the neck, thigh, groin, andankle. They are most likely to occur whenmuscles are asked to both stretch and bearweight simultaneously, with the weakest partof the muscle not having the strength to bearthe load (OneMedicine, 2001).

Symptoms include pain and swelling, with apossibility of joint instability if the injury isvery severe.

. Tendinitis and Bursitis can be very painfulinjuries that limit activity for long periods oftime. Muscles are attached to bones by connec-tive tissue known as tendons. When a tendon isinflamed from repetitive or excessive exercise,or from an acute injury, tendonitis results. Itoccurs most commonly around the shoulders,elbows, wrists, and heels. Bursitis occurs for thesame reasons and most commonly in the sameplaces, but it is an inflammation of bursae,small fluid-filled sacs that cushion pressurepoints between the bones as well as the tendons and muscles near the joints.





Symptoms of both include pain — sharp or dull— and tenderness around affected joints,worsening with use or movement. Warmth andswelling may be apparent. Tendonitis can alsocause numbness or tingling (HerbalRemedies,2007; MayoClinic, 2008).

. Broken Bones

. Bruises

HealingThe healing of athletic injuries is divided into the fol-lowing three phases, each of them dependent on theinteractions of all of the body’s systems — nervous,immune, endocrine, cardiovascular, visceral, and muscle(from Bucci, 1995, pp. 15–16):

. The inflammatory phase, which generally last7 days, though individual cases vary. Its classicsigns include localized redness, swelling, pain,and heat. Loss of function sometimes occurs.Inflammatory chemicals called eicosanoidscontribute to the initiation and progress ofinflammation, while other chemicals andprocesses work to limit it.

. The repair phase begins approximately 48hours after the initial injury. It is characterizedby cell growth and the production of extracel-lular matrix, which includes collagen and pro-teoglycans (protein/sugar chains, a majorcomponent of connective tissue). This phasegenerally lasts 6–8 weeks but can take muchlonger in serious injuries.

. The remodeling phase is initiated approximately14 days after injury. The functions that makerepair possible begin to decline, collagen syn-thesis and function return to near normal, andscar tissue is formed, which is usually not asstrong as the original tissue. Remodeling cantake up to a year or longer to be completed.

The goals for diet and nutrient supplementation forathletic injuries include relieving pain and modulatinginflammation (hopefully sufficiently to reduce use ofprescription or over-the-counter (OTC) drugs) and pro-viding the nutrients necessary for connective tissuehealing. Reducing inflammation can help preventinjuries from becoming chronic, can get people up andmoving more quickly, and is thought to help speed thehealing process (Barker, d, 2006; Bucci, 1995, p. 17).However, some amount of inflammation is required topromote the repair stage of inflammation, so removingit from the equation entirely can delay the healingprocess (Bucci, 1995, p. 17).

Virtually all of the nutrients we derive from foodplay a role in musculoskeletal health and to list everynutrient and its effect is beyond the scope of this arti-cle. However, research and clinical experience point tosuperior results for several foods, nutrients, and herbsthat can relieve pain and inflammation and help thehealing process. Those that have proven themselvesmost effective will be discussed here.

As mentioned previously, acute and chronic connec-tive tissue injuries increase the need for various nutri-ents, with specifics varying by individual. Therefore, inaddition to a healthful diet, many practitioners advo-cate the use of a high-quality multiple vitamin and min-eral supplement, additional Omega 3 fats, and asynergistic antioxidant complex (Virgin, 2006; Barker,interview, Aug. 2008; Bucci, 1995, p. 218) during thehealing process.

Test, Don’t Guess: Laboratory AssessmentsAll dosage recommendations are suggestions rather thanprescriptions, as individual needs vary. It is strongly rec-ommended that clients with chronic pain and inflamma-tion, such as arthritis, bursitis, tendonitis, etc., completethe following assessments to identify their unique areasof nutritional insufficiency. This allows the practitionerto create a baseline of analysis and work up a targetedprogram of support. Useful laboratory tests include:



. A Complete Blood Chemistry (CBC) Panel thatincludes tests for magnesium, vitamin D, vita-min B-12, folic acid, and homocysteine (a keycardiovascular risk factor).

. Functional Intracellular Analysis (by SpectraCell Labs) to test vitamin A, B complex, D,minerals, calcium, magnesium, zinc, chromium,and copper; antioxidants such as coenzyme Q-10; and cardiovascular protective factors notincluded in a CBC.

. Organic Acid Panel to identify metabolites thatindicate an insufficiency of vitamins, minerals,and amino acids needed for cellular energyproduction, proper neurotransmitter balance,proper pH, and gastrointestinal health. A com-prehensive metabolic profile would add fattyacid and food sensitivity testing to the organicacids to provide more data on energy-deplet-ing foods or the need for modifying theamount and ratio of anti-inflammatory essen-tial fatty acids

. Hormone Assessment to evaluate adrenal, thy-roid, pancreas, and pituitary status. Athletestypically show adrenal stress, leading tofatigue that lowers thyroid function and leadsto blood sugar imbalances that create carbo-hydrate cravings, slow recovery from exercise,and delay wound healing.

Modulating Inflammation, Reducing Pain,and Promoting Healing

. According to Dr. Barker, proteolytic enzymes(proteases) are the tools of choice for combat-ing acute inflammation from injuries andbruises and for sore muscles (interview, Aug.2008). They are beneficial for sprains, strains,and fractures and may also work well onchronic conditions, such as tendonitis, bursitis,and chronic joint conditions.

Proteolytic enzymes digest proteins. Whentaken 30 minutes before meals, they go towork on the protein-containing chemicals ofinflammation. They both substitute for andactivate endogenous proteases. Bromelain,obtained from pineapple stems, is probably themost-studied of these enzymes and may be aseffective as NSAIDs for easing pain andinflammation (DeBusk, et al., 2002). Otherwidely-used proteases include papain, trypsin,chymotrypsin, and pancreatin. Alone or incombination, these enzymes appear to speedrecovery, sometimes by as much as twofold(Percival, 2002). Proteolytic enzymes are mosteffective when supplementation begins imme-diately after injury (Bucci, 1995, p. 179), andthey can even be taken prophylactically anhour or two before an activity that may causeinjury (Bucci, 1995, p. 174).

Animal research has indicated that combina-tions of enzymes are more effective than theuse of a single protease, and using plantenzymes in conjunction with those of animalorigin may provide a wider spectrum of action(Bucci, 1995, p. 174). Plant enzyme combina-tions alone are fine for those who are opposedto using animal products.

Dosage recommendations with proteases canbe confusing, since individual enzyme meas-urements are reported in several differenttypes of digestive units. Having a practitionertranspose these units into milligrams (mg) ofpurified enzyme, or working with a practi-tioner who uses products with known efficacywould be helpful for most people. Bucci (1995,p. 218) recommends proteases in these doses:




ENZYME TOTAL DAILY DOSE (MG)

Pancreatin 1000–4000

Trypsin/Chymotrypsin 500–1000

Bromelain 500–2000

Papain 500–1000

Jason E. Barker, N.D. continues usage untilsymptoms disappear (interview, Aug. 2008),though other researchers’ (DeBusk et al., 2002;Bucci, 1995, p. 218) recommendations rangefrom 3 days to no longer than 10 days in a row.

Possible side effects from bromelain include nau-sea, vomiting, diarrhea, and excessive menstrualbleeding (DeBusk et al., 2002), though mostpeople will only experience a warm sensation intheir stomachs, if anything (Barker, d., 2006).

. Magnesium is a good muscle relaxant andpain killer. According to Dr. Jason Barker, mag-nesium can provide wonderful relief in just afew days for people with tight, stiff, or spas-ming muscles (June, 2008). He says that all ofhis athletic patients eventually take somemagnesium, primarily because the medical andnatural foods industries have promoted cal-cium supplementation so energetically for solong that almost everyone is magnesium defi-cient (June, 2008; interview, Aug. 2008).Couple this with the multiple mineral deficien-cies in commercial farmland and it’s easy tobelieve that most of us are low in magnesium.However, as with most minerals, testing fordeficiencies is difficult, so perhaps the bestmeans for determination is by doing a courseof supplementation and noting any beneficialresults.

Dr. Barker’s recommendations are for 800 mgdaily of magnesium, in the glycinate form topromote assimilation and prevent diarrhea, individed doses (interview, Aug. 2008). Bathing inEpsom salts (magnesium sulfate) may also

prove helpful. It may be best to consider high-dose supplementation as a short-term (lessthan one year) program, as there is speculationthat high levels of one nutrient can produceimbalances in others.

. Protein/Amino Acids* — Adequate protein isvital to the healing process. More than thebasic recommendations, however, is not better,as extra protein has not been shown toenhance healing (Bucci, 1995, p. 30). Certainindividual amino acids, though, have beenshown to positively impact recovery. Notableamong them are:

• L-Glutamine, found in abundance in low-temperature processed whey protein pow-ders or capsules, helps repair connectivetissue and is essential for synthesis of cellcomponents such as proteins, proteogly-cans, DNA, RNA, and other amino acids. Itprevents immunosuppression after stressor surgery; increases the removal ofammonia waste from the body; preventsor reduces metabolic catabolism after



physiological stress; and enhances proteinsynthesis and nitrogen retention afterstress (Bucci, 1995, p. 38). The recom-mended effective dose is 1.5 gm/day.

• Tryptophan/5-Hydroxytryptophan (5HTP)reduces musculoskeletal pain andincreases the pain threshold by buildingserotonin levels. Increased brain levels ofthis neurotransmitter are associated withan analgesic effect (Bucci, 1995, p.44–45). Because there have been problemsassociated with tryptophan, making it lessavailable today, only dosing parameters forits metabolite, 5-HTP, will be given:

• 300–600 mg daily, in three divideddoses (Bucci, 1995, p. 45)

• D-Phenylalanine helps relieve chronic painfrom musculoskeletal conditions, such asdegenerative joint issues, or from injuries.Bucci (1995, p. 47) recommends 1500 mgdaily in three divided doses.

• Arginine (as L-arginine hydrochloride orarginine aspartate) appears to enhancehealing by increasing vasodilation andoxygen and nutrient supply at the sites ofinjuries and wounds (Bucci, 1995, p. 36).Alone, or in conjunction with either L-lysine or L-ornithine, it releases anabolichormones, including insulin, that speedhealing and reduce body fat (Bucci, 1995,p. 36). It has been shown to boost colla-gen deposition and to increase proteinsynthesis, both markers of improved heal-ing status (Bledsoe, n.d.).

Bucci’s dosage recommendations are10–30 gm daily of either form in 3–4divided doses (1995, p. 47).

• Sulfhydryl Amino Acids (methionine, cys-teine and others) provide a source of sul-phur for the body that is necessary for

synthesis of glycosaminoglycans and col-lagen, as well as for optimal detoxificationcapability. Cysteine is a direct precursor toglutathione, the antioxidant in greatestquantity in the body; all sulphur-contain-ing amino acids have antioxidant proper-ties. For the purposes of athletic injuries,three forms of sulphur-aminos are used:

• S-adenosyl methionine (SAMe), whichhas been shown to have both anti-inflammatory and analgesic properties(Bucci, 1995, p. 41). Human researchtrials have focused on its use forosteoarthritis, which has shown ananalgesic effect equal to NSAIDswithout the gastric side effects.

SAMe is synthesized in the body frommethionine, with help from folate andvitamin B12, and diets with adequateprotein should provide enough sulphursubstrate. However, supplementaldoses of up to 400 mg, twice daily, for30 days have been very beneficial forosteoarthritis sufferers (Bucci, 1995,p.41). SAMe is recommended for usein chronic injuries, such as bursitisand tendonitis, and also possibly forsprains and tendon and ligamentrepair, in doses ranging from1200–2400 mg daily in 3 divideddoses (Bucci, 1995, p. 47).

• Dimethyl sulfoxide (DMSO) is used topicallyin cream form as an analgesic for bursitis,tendonitis, and sprains and has beenwidely touted as being effective. However,some of the positive research studies on itare not considered to have been rigorousand other studies have contradicted theirfindings (DeBusk et al., 2002).




• Methylsulfonylmethane (MSM) is ametabolite of DMSO and its oral counter-part. At doses of 100–750 mg/day, it hasbeen shown to have benefit for inflamma-tory conditions, but whether it aids con-nective tissue healing is uncertain (Bucci,1995, p. 42). Ameye et al. (2006) havefound moderate evidence of efficacy forMSM, and studies have shown MSM andDMSO to soften collagen. MSM has alsobeen shown to provide pain relief, dilateblood vessels, increase blood flow, reducemuscle spasms, and promote normalimmune function.

Obtaining sufficient sulphur from foodrather than supplements is highly recom-mended. Good sources include eggs, meat,fish, poultry, and legumes, as well as gar-lic, onions, Brussels sprouts, asparagus,kale, and wheat germ.

Recommended doses of supplements are:

• 500–1000 mg MSM daily (Hahn,2005), or topical doses of 60-90%DMSO applied 1-3 times per day(DeBusk et al., 2002).

*Because branched-chain amino acidsare heavily promoted, it bears men-tioning here that their effect on heal-ing connective tissue injuries isequivocal at best (Bledsoe, n.d.), sotheir use is not recommended (Bucci,1995, p. 41).

. Essential Fats, the Omega 3s — alpha-linolenic acid (ALA), docosahexanoic acid(DHA), and eicosapentanoic acid (EPA) —and the anti-inflammatory Omega 6,gamma-linolenic acid (GLA), are essentialfor the formation of anti-inflammatoryeicosanoids. Addition of these at the timeof acute injury, however, is not effective,

since they require some time to takeeffect. They are very useful, though, forchronic injuries, such as bursitis and ten-donitis (Bucci, 1995, p. 59; Percival, 2002).

Bucci (1995, p. 60) recommends 3-18 gmof supplemented fish oils, in addition todietary Omega-3s, along with additionalGLA.

. Glycosaminoglycans (glucosamine and chon-droitin sulfates) have been much studied andamply written about in the medical literature.Glucosamine is an amino sugar found in con-nective tissue that appears to help repair andform cartilage. Chondroitin is derived from thecartilage of various animals, often sharks, andis part of the molecule that gives cartilage itselasticity.

According to Bucci (1995, p. 201), glucosaminesalts, which are mostly used to treatosteoarthritis (OA), are the most effective of allthe nutrients used for musculoskeletal health.Most of the research, then, has focused on OA,but because numerous studies have shown it tobe as effective for pain and inflammation asibuprofen (Sutter, 2000; Bland, 2004), it is log-ical to extend its use to other conditions ofdegenerative joints, such as bursitis and ten-donitis. It is also possible that it will be effec-tive for tendon and ligament tears and sprains(Bucci, 1995, p. 203). As well as being an effec-tive anti-inflammatory, it has been shown tohelp replenish and repair the proteoglycansthat are necessary for joint lubrication andmovement (Hahn, 2005). Its sulfur componentis an essential part of cartilage.

Side effects include gastrointestinal distur-bances and the possibility of increased insulinresistance in susceptible individuals (Hahn,2005), so its use with diabetic clients should becarefully monitored.

• 1500 mg daily, preferably on an emptystomach. Effects may not be noted for upto six weeks but will be maintained 4–8weeks after cessation of treatment.

. Chondroitin sulfates, often used with glu-cosamine, have a similar but larger molecularstructure. They inhibit degradable enzymes andstimulate the synthesis of glycosaminoglycansand proteoglycans in connective tissue cells(Bucci, 1995, p. 184). Chondroitin is generallyincluded in glucosamine supplements but isconsidered less effective, possibly due toabsorption difficulties caused by the size ofthe molecules. (Hahn, 2005).

• 400 mg 2X/day

. Antioxidants, despite their spotty researchrecord, do appear to reduce levels of DNA oxida-tion, oxidized glutathione, and other parametersof oxidative damage. The research is particularlypositive for the benefits of vitamin C (Hamilton,n.d.), which is vital for connective tissue repair.Antioxidants work much better in synergisticcombinations and are best obtained from food,except in cases where needs are greater thanusual, such as in endurance athletes, the aged,and the nutritionally compromised.

Where the research becomes more certain is inthe reduction of post-workout muscle sore-ness.

An optimally functioning antioxidant systemseems to minimize free-radical damage tomuscle cells, thus reducing muscle soreness,and also appears to enhance post-workoutmuscle damage repair (at least where researchexists, which is for older runners) (Hamilton,n.d.). Once again, though, there is contradic-tory evidence in the research for antioxidantsupplements. There is no argument, however,about the need for antioxidant foods, so againthe emphasis should be on these.

. Anti-inflammatory Herbs:

• Curcumin, the yellow pigment and themain curcuminoid in the herb turmeric,has a long history of use in Ayurvedicmedicine and has been well-studied for itsbeneficial properties. Arora et al., in 1971,found curcumin (as well as anotherunnamed compound in turmeric) to haveas much anti-inflammatory activity ashydrocortisone. It has also been shown tobe an antioxidant, both directly andthrough the synthesis of glutathione, and






to inhibit several substances responsiblefor inflammation (Higdon, 2005). Takenorally, its bioavailability is low, so doses of

3.6 gm or higher are recommended.

According to Dr. Barker (d, 2006), cur-cumin also stimulates tissue repair, mainlythe regeneration of muscle tissue, so thisagent is particularly useful for injuriesinvolving muscles.

Side effects appear to be rare.

• Ginger (Zingiber officinale), a medicinalherb used for thousands of years in Indiaand China and a relative of turmeric, isrecognized as a potent anti-inflammatoryand antioxidant. Two meta-analyses foundmoderate evidence for its use in degenera-tive joint conditions (Sodhi, 2007). Gingeralso has analgesic, antihistaminic, andanti-toxicity properties and contains aproteolytic enzyme (Sodhi, 2007), all ofwhich may be useful for athletic injuryrelief and repair.

According to Sodhi (2007), effective studydoses (for arthritis) were 500 – 1000 mgdaily, taken for 3 months to 2 1/2 years

• Cayenne Pepper (Capsicum annum), whosemain component is capsaicin, may helpprevent inflammatory eicosanoid produc-tion and may deplete a neuropeptide nec-essary for transmitting pain signals to thecentral nervous system (Percival, 2002).

• Boswellia is a gum resin from the Boswelliaserrata tree. It is used traditionally inAyurvedic medicine as an anti-inflamma-tory agent. The main active constituents,boswellic acids, have been shown to inhibitinflammation and may also inhibit a part ofthe immune system whose sustained acti-vation is believed to create ongoing inflam-mation (Percival, 2002).

• Stinging Nettles (Urtica dioica) also have along history of usage, mainly for disordersof the joints. Recent studies have shown itto relieve pain and to have a mild anti-inflammatory effect (Grauds et al., 2002).It can be taken as a tea, fluid extract, ortincture, and it can be used topically incream form for joint pain, sprains andstrains, and tendonitis.

Side effects are rare but may include mildstomach upset, fluid retention, and some-times hives when used topically. It shouldnot be used by pregnant women (Grauds etal., 2002).

• Devils Claw (Harpagophytum procumbensDC) is a plant found in the Kalahari andSavannah desert regions of South andSoutheast Africa. Its dried roots are usedmedicinally. An extensive body of researchdoes not exist for it, but traditional use,along with what research there is, suggestthat it is most effective for short-term reliefof inflammation in the joints. Traditionalusage also indicates it has antioxidant prop-erties and is effective for knee pain andtendonitis (MedLine Plus, 2008).

MedLine (2008) indicates that potential sideeffects include gastrointestinal disturbance,low blood pressure, and abnormal heartrhythms, and that it is contraindicated foruse with blood thinning medications.

• 670 mg–2 gm of powder daily, with>50 mg daily of the active ingredient,harpagoside, has been shown to beeffective for inflammation (Ameye etal., 2006)



• Other herbs that have either been shownto have anti-inflammatory properties orhave been used traditionally for this pur-pose (and haven’t already been mentionedin this article) include:

• Ashwagandha

• Feverfew

• Guggul

• Holy basil

• Hops

• Oregano

• Rosemary

• White willow bark

It is not known whether any of thesewould be effective for athletic injuries.

• Adaptogenic Herbs are used to balance thebody’s response to stressors. Because theycan be used to improve endurance duringexercise (Bone, 2008) and to help thebody adapt to stress, they can provide asecond line of defense against athleticinjuries. Anything that strengthens thebody and helps with physical performanceand recovery will help prevent it from get-ting hurt. Some of the best adaptogens forathletic purposes are:

• Rhodiola rosea (Barker, June 2008);

• Asian or Korean ginseng (Panax gin-seng) (Bone, 2008); and

• Schisandra (Schisandra chinensis),though to date this effect has onlybeen tested in horses (Bone, 2008).

CONCLUSIONPhysical activity is such an important aspect of ahealthy lifestyle that preventing injuries and maintain-ing the health of the musculoskeletal system are essen-tial. If these aspects of health are neglected, chronicpain and inflammation may result. A nutrient-densewhole food diet that covers every component of theEating For Health™ model, supplemented with boosterfoods and herbs, is a first-line defense against injury.Lifestyle factors such as proper training, good sleep,adequate hydration, and stress reduction are likewisekeys to high performance and longevity. Minor injuries,at least, are likely to occur with the repeated stress andstrain on bones, joints, muscles, and tendons that comesfrom regular athletic activity. It is reassuring to knowthat there are safe and effective natural means to easesymptoms and allow the healing process to ensue. Usingproteolytic enzymes, zinc, vitamin C, and bioflavanoidsrather than over-the-counter pain relievers can preventserious degeneration. Even when short-term drug treat-ment is utilized, specialized nutrients support recoveryin all musculoskeletal conditions. Let’s remind ourfriends, family members, and clients to eat for health sothey can continue to perform at a high level well intoadvanced age.

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