Injury recovery is an uphill battle. You’re burdened by pain, isolated from training partners, inundated with appointments and rehab, worried about your diagnosis (or lack thereof), and sidelined from a sport that you love. On top of all that, you might feel the need to rethink the way you eat, since your level of activity is lower than normal.
There are conflicting schools of thought when it comes to how to best fuel up while you’re in recovery mode. If you’re training less, it might seem logical that you should be eating less. On the other hand, maybe you’ve heard that you should err on the side of more calories, since even a small nutrient deficit can impede your healing. Research suggests that the sweet spot lies somewhere in the middle. Below, three registered dietitian-athletes share the latest findings in injury nutrition, plus actionable advice, so that food can be an asset and a source of pleasure—rather than a source of stress—during an already trying time.
Respect the energy demands of healing. You may be moving less than normal, but the body immediately gets to work after trauma, explains Claire Fudge, an Ironman triathlete, a registered dietitian, and the founder of 4th Discipline Triathlon Nutrition in Birmingham, England. If you’re dealing with an acute injury, your heart rate speeds up in response to tissue damage, pain, and anxiety (which is an immediate psychological response to injury). The site of your injury swells as your blood flow increases and your body ramps up the production of cytokines, a type of protein that helps mediate inflammation. To keep up with all this extra work, your metabolism increases, too.
“Metabolism can increase 15 to 20 percent with trauma, minor surgery, and the use of crutches,” says Catherine Kruppa, a masters marathoner and registered dietitian who owns Advice for Eating, in Houston. Major surgery spikes it even more. Exact caloric demands depend on the type of trauma and your position in the chain of healing events, but the bottom line is that your body is under stress, and your energy needs likely increased at the onset of injury. Your priority should be getting enough calories to support healing—not limiting your intake because you’re moving less.
Gaining weight is a common fear among sidelined athletes, but do your best to put that aside. It’s true that eating exactly as you did pre-injury may lead to a change in body composition. In some sports, that could result in a competitive disadvantage upon your return. The natural conclusion for most athletes, then, is to decrease food intake to prevent increased body fat and total mass. But a fixation on weight or leanness can muddy the ultimate goal of healing quickly and completely. As Kelsey Beckmann, an Olympic Trials marathoner and a registered dietitian in Jacksonville, Florida, puts it: “We’re faster when we’re a few pounds heavier than we are when we’re injured.”
Beckmann encourages injured athletes to keep in mind that marginal differences in body weight are typical across a season for most people, and similar to a postseason break, your body will normalize once you’ve returned to full training. “The single most important nutritional consideration during reduced muscle activity and/or immobility is to avoid nutrient deficiencies,” a 2015 study published in Sports Medicine concluded.
Change Is Good
Just as elite runners eat differently during 100-mile weeks than during taper weeks, your nutritional needs will change throughout a season of injury. There are three widely accepted phases of healing: inflammation, in which your immune system is activated and damage-control cells rush to the injured site; proliferation, which is when your body builds new tissue, restores blood vessels, and covers the surface of any exposed wounds; and remodeling, the period in which the traumatized area matures and regains strength, often leaving a scar in its wake.
As your body’s natural inflammatory response goes to work during the first few days post-injury, Kruppa suggests eating balanced meals with plenty of whole foods, especially as many fresh fruits and veggies as you can get your hands on. Purported anti-inflammatory foods like turmeric get a lot of buzz, but the bottom line is that a healthy, well-rounded diet is the best culinary defense against inflammation, rather than one specific ingredient. However, there are certain ingredients that promote inflammation. If it doesn’t create too much stress, try to moderate your intake of refined carbs, simple sugars, trans fats, and alcohol.
During proliferation and remodeling, which start around day four and last as long as your injury does, your body is busy replacing damaged tissues with new, healthy ones. Kruppa explains that your goal during this time should still be balanced nutrition, and she emphasizes how crucial it is that you get adequate calories in the form of ample protein, complex carbohydrates, and healthy fats.
Don’t Skimp on Protein
Of the three macronutrients—carbs, fat, and protein—research best supports the role of protein during injury recovery. Whenever a body experiences a health disturbance, such as sickness or inflammation, extra protein is required to maximize muscle protein synthesis. Consume too little of it and your healing will lag, inflammation will increase, and muscle loss may follow.
Beckmann recommends aiming for one gram of protein per pound of body weight per day while recovering from an injury, so 140 grams for a 140-pound person. Spreading that intake throughout the day is helpful, too—try and sneak a little protein into each meal and snack, and get a final hit at bedtime. A 2016 study published in the journal Nutrients found that eating protein immediately before sleep can stimulate muscle protein synthesis as well as adaptation from that day’s training. Seek out a variety of protein sources, such as ethically sourced meats, dairy products, eggs, beans, tofu, and tempeh. All of these high-protein options are also rich in leucine, an essential amino acid involved in the growth and repair of muscle, skin, and bone.
Carbs and Fat Are Your Friends, Too
The body’s primary fuel source is glucose, one of the simplest types of carbohydrates. Anytime you eat a carb—whether that’s from fruit, bread, or potatoes—your body breaks it down into glucose and either uses it immediately for energy or stores it as glycogen. It’s a critical part of cellular health: glucose gives our cells the chemical energy and heat they need to function, which means it’s also a major player when it comes to recovery. “Not eating enough carbohydrates could prompt us to mobilize our lean body mass—muscle—as fuel,” Beckmann warns. We’re extra vulnerable to losing muscle when we’re injured, so it’s even more important not to skimp.
Her recommendation is to eat a minimum of 1.4 grams of carbohydrates per pound of body weight per day, and aim to get about 40 percent of your total daily calories from carbohydrates. Because you don’t need quick-digesting carbs like bagels and sports drinks to fuel your training, it’s a good time to load up on complex ones like sweet potatoes and whole grains. These offer more nutrients, ample fiber, and longer-lasting energy. And don’t stress too much about a sugar craving. “At the end of the day, our bodies are going to break either type of carbohydrate down to energy, as molecules of glucose,” Beckmann says.
Beckmann endorses a deliberate approach to fat intake while you’re out of commission. “Trans fats, omega-6 fats, and saturated fats are considered pro-inflammatory,” she says. Adding to your body’s natural inflammatory response may be counterproductive—especially in the early stages of healing. But research shows that a diet high in monounsaturated fats and omega-3’s aids with collagen deposition, a key part of the rebuilding process in which tissues gain the strength and structure necessary to absorb impact and force again. Avocados, nuts, seeds, olive oil, and fatty fish are some of Beckmann’s favorite choices for athletes on the mend.
Whole Foods Are Better Than Supplements
A supplement, by definition, is supposed to be an add-on, not the main ingredient. “If you are eating a balanced diet full of lean protein, healthy fats, dairy, whole grains, and fruits and vegetables, you will be ahead of the game and likely won’t need supplements,” Kruppa says. She recommends leaning on real foods containing the following micronutrients: vitamin A, vitamin C, vitamin D, calcium, magnesium, zinc, and copper. These are largely found in colorful fruits and vegetables as well as in dairy products, nuts, and seeds. Mushrooms, for example, are great sources of copper, which assists with red-blood-cell formation, immune function, and bone health. Legumes contain high levels of magnesium, which plays a role in protein synthesis, circulation, and the absorption and metabolism of calcium and vitamin D.
That said, it’s not always possible to meet your nutritional needs through food alone. With a bone fracture, for instance, Kruppa says that your calcium needs increase to 1,500 milligrams per day, which may necessitate supplementation. For context, a single serving of cow’s milk has 305 milligrams of calcium. In addition, many healthy and injured athletes alike supplement their iron, an essential mineral that helps transport oxygen from your lungs to your muscles and an easy one to run low on—especially if you’re a female endurance athlete. If you think you might be deficient—common symptoms include dizziness, fatigue, and weakness—consult with a doctor and get a blood test before supplementing iron.
Fudge and Kruppa agree that it’s also worth considering supplemental protein, amino acids, and collagen. Leucine, a branched-chain amino acid, stimulates muscle protein synthesis faster than other amino acids. Casein, a milk protein that comes in powdered form and many dairy products, contains all the amino acids your body needs to build and repair muscle. Creatine, an amino acid, may help prevent muscle loss, especially while a limb is immobilized. Whey protein may boost ligament, tendon, and muscle healing when consumed within an hour after exercise or rehabilitation. And collagen, when ingested before exercise with vitamin C, may help with the recovery of ligament and tendon injuries. Consult with your doctor or a nutritionist first to ensure a supplement makes sense for you.
As with most nutritional questions, there is no one-size-fits-all answer. The keys to a good recovery diet are simple: pay attention to what your body needs and wants, make sure you’re getting enough nutrients and calories, and don’t sweat the small stuff. You’ll be back in the saddle before you know it.