It’s not every day you get a text message from UFC champion Georges St-Pierre message asking for your help. But that’s exactly what happened one sunny afternoon in late October 2009.
“My surgery is finally scheduled. It’s in one week. What’s the best way to prepare nutritionally?”
Georges is widely regarded as one of the most committed fighters in the mixed martial arts business. So it wasn’t surprising that he was taking the role of nutrition in his recovery so seriously.
I was left wondering, however, why so many fitness and rehabilitation professionals fail to do the same.
After all, almost every movement professional I know has some inkling that nutrition can impact the injury recovery process. But that’s where most of them stop, never giving clients the tools they need to heal better and recover faster.
A quick scan of the literature shows that nutrition can play a major role in our recovery. And that, by understanding how the body repairs itself after injury and how to support it nutritionally, we can target specific systems to speed up healing.
That’s why, in this article, I’ll show you how to use food (and a few supplements) to help your injured clients return to their active lifestyles easier and faster.
Plus, I’ll share with you exactly what we did with the UFC Welterweight Champion to give him Wolverine-like powers of healing and recovery after his surgery.
Injury Recovery – Step By Step
Although injury can feel chaotic and recovery random, the physiological process is highly organized and well coordinated, with four defined phases.
Step 1: Coagulation [lasts 1 to 2 days post-injury]
Coagulation is the process by which the blood forms clots. Since injuries typically involve bleeding, the body immediately takes steps to stop this bleeding and maintain blood volume. (This is crucial as massive blood loss can result in blood pressure decreases, which can be life threatening.)
Step 2: Inflammation [lasts up to 5 days post-injury]
Another immediate response is inflammation. After damage has occurred, chemicals are drawn to the site of injury to help clean up the area. While this step kicks off the recovery process, it is unpleasant as the tissues are deprived of their normal flow of oxygen and nutrient-rich blood, resulting in pain, swelling, redness, and heat.
Step 3: Migration/Proliferation [lasts 4 to 21 days post-injury]
As noted above, inflammation kicks off the recovery process and helps attract the chemicals that remove damaged tissues. As this process proceeds and injured tissue debris is cleared, the body begins to lay down temporary scaffolding in the form of connective tissues (scar tissues). To initiate this process, new cells have to proliferate and migrate to the site of the injury. This begins the rebuilding process.
Step 4: Remodeling [lasts 5 days to 2 years post-injury]
Eventually, the temporary scar tissues that formed several days after the injury is degraded and replaced with stronger connective tissue. With appropriate movement therapy (as well as adjunct therapies, including nutrition), these new tissues can be as strong as the original ones – even stronger.
Where Nutrition Can Help
Although our ability to recuperate and heal is impacted by things beyond our control like age and genetics, the rehab we do and the adjunct therapies we employ (including nutrition) can play a major role.
Here are some key nutrition intervention points:
1. Dietary Fat
Dietary fat is very important during injury recovery, especially during the inflammation stage. We know trans-fats and omega-6 fats promote inflammation in the body, while monounsaturated fats and omega-3 fats inhibit inflammation.
So by eating fewer omega 6s and more omega 3s, excessive inflammation is dialed down and collagen production is better supported.
That’s why, during injury recovery, an ideal ratio is about two or three omega 6 fats to every omega 3 fat in the diet. But, rather than bust out the calculator to determine the ideal fatty acid balance, it’s easier to focus on specific food choices.
If you or a client is injured, start by increasing intake of the monounsaturated and omega 3 fats: olive oil, mixed nuts, avocados, flax oil, ground flax, and other seeds while supplementing with 3-9 grams (dose depends on body size) of fish oil per day.
At the same time, decrease intake of omega 6 fats: corn oil, sunflower oil, safflower oil, cottonseed oil, soybean oil, and processed, packaged foods which tend to be high in omega 6 fats or trans fats.
2. Herbs, Spices, and Flavonoids
Certain herbs can be valuable in the management of inflammation by reducing dependence on anti-inflammatory pharmaceuticals like NSAIDs (non-steroidal anti-inflammatory drugs).
While over the counter NSAIDs like Ibuprofen, naproxen sodium, and celecoxib are popular amongst the gym crowd, they might also hinder injury healing because they block the inflammation response too effectively.
The non-specific NSAIDS can also have a host of side effects such GI upset and bleeding.
That’s why NSAIDs are best reserved for the acute phase (5 days post-injury) if they’re used at all. (And the only real reason to use them is extreme pain management).
In place of NSAIDS, the following herbs are useful anti-inflammatory agents for the first few weeks post-injury:
- Curry powder/turmeric – This member of the ginger family has long been used as an anti-inflammatory and for wound healing. The active ingredient, curcumin, is likely responsible for the effects. Shoot for 1 tsp per day of the powder or 400-600mg of the supplement, 3 times per day.
- Garlic – This has been shown to inhibit inflammatory enzymes and increase macrophage function. Adding it to the diet is helpful, but a supplement might be even better. Aim for 2-4 garlic cloves each day (if you can tolerate it) or 600 to 1,200 mg of aged garlic extract.
- Boswellia – A favorite of Ayurvedic medicine, boswellia has many pharmacological uses. As an anti-inflammatory, try 300 mg 3 times per day.
- Pineapple – Bromelain, found in pineapple, is another anti-inflammatory that’s great for digestion and for inflammation/pain relief. Aim for 2 cups of pineapple per day or 500-1,000 mg in supplemental form.
During injury repair, metabolic rate can increase anywhere from 15-50% depending on the severity of the disturbance. While still lower than what’s required during sport training, this is significantly higher than during rest.
For example, a 14 year-old male athlete would require 1933 kcal per day when sedentary, but 2319 kcals per day during recovery – approximately 400 extra calories per day despite negligible differences in actual activity.
This presents a potential problem, as injury sufferers often report decreased appetite during the recovery period, and eating too few calories can prevent full and adequate healing.
That’s why it’s important to ensure your clients are practicing sound eating habits to provide enough total energy for proper repair.
During injury recovery, protein intake should be maintained in the 1g/lb range. This is a pretty standard recommendation for regular exercisers and it’s also a best practice for injury recovery.
About 1/3 of dietary fat calories should come from each type of fat (i.e. 1/3 from saturated fat, 1/3 from monounsaturated fat, and 1/3 from polyunsaturated fat).
And, although there’s no defined requirement for carbohydrate during recovery, it’s important to include enough carbohydrate to support brain function and provide adequate micronutrient intake.
Vitamins and minerals are nutrients required by the body in small amounts for a host of metabolic reactions. Since the injury recovery process relies on many metabolic reactions, in some cases additional micronutrients can speed healing.
The main players in proliferation and remodeling are:
- Vitamin A – Supports early inflammation during injury, reverses post-injury immune suppression, and assists in collagen formation. Supplement with 10,000IU daily for 3-4 weeks post-injury.
- Vitamin C – Enhances neutrophil and lymphocyte activity during phase 1 of acute injury and plays an important role in collagen synthesis. Supplement with 2000mg daily for 3-4 weeks post-injury.
- Copper – Assists in the formation of red blood cells and helps strengthen connective tissue. Supplement with 4mg daily for 3-4 weeks post-injury.
- Zinc – Plays a critical role in tissue regeneration and zinc deficiency and has been associated with poor wound healing. Supplement with 30mg daily for 3-4 weeks post-injury.
6. Recovery Nutrients
There are a number of recovery nutrients that have been shown to have excellent restorative effects during injury recovery periods.
- Arginine – Stimulates protein synthesis, collagen deposition, and wound healing. Shoot for 7g, 2 times per day.
- Glutamine – Speculated to speed up wound healing by stimulating immune cells action, gut cells turnover, and collagen synthesis. Also essential for the metabolism of cells that have rapid turnover, such as lymphocytes and enterocytes. Try 7g, 2 times per day.
- HMB – This metabolite of leucine has been shown to inhibit muscle protein breakdown and increase protein balance, leading to potential increases in muscle. HMB may also increase collagen deposition and improve nitrogen balance. Experts suggest 1.5g, 2 times per day.
Note on chronic pain: For those suffering from chronic pain (think a sore knee that never seems to get better, not tearing an ACL on the basketball court), glucosamine, chondroitin, and hyaluronic acid supplements can be effective (though not with acute injuries).
Another supplement for chronic pain called natural eggshell membrane may also be worth a try. New studies have shown significant reductions in joint pain and increased range of motion in clinical and active people. The recommended dose is 500mg daily.
Nutrition During Injury – Best Practices
To be successful with post-injury nutrition plans, it's important to focus on practical habits as opposed to impossible-to-follow mathematical calculations.
To this end, here’s a list of best practices for your injured clients and athletes.
- Eat frequently. Eat every three hours or so.
- Protein. Men: 2 palm-sized portions; Women: 1 palm-sized portion of lean protein per meal. Choose meats, dairy, eggs, beans, vegetarian proteins, or supplements.
- Vegetables. Men: 2 fist-sized portions; Women: 1 fist-sized portion per meal. Choose any vegetable or fruit you like, but focus more on veggies.
- Starches. Men: 2 golf ball-sized portions; Women 1 golf ball-sized portion of minimally processed carbs with each meal. Minimally processed sources like whole oats, whole grain rice, sprouted grain breads, and quinoa are best.
- Fats. Men: 2 thumb-sized portions; Women: 1 thumb-sized portion per meal. Choose avocado, olive oil, mixed nuts, or flax seeds with each meal. Add 3-9g of fish oil to the diet. Cut back on corn oil, sunflower oil, safflower oil, cottonseed oil, soybean oil, and highly processed, packaged foods.
- Herbs and Phytochemicals. For the first 3-4 weeks post-injury, turmeric, garlic, bromelain, and boswellia can help manage inflammation. This is where combination products come in handy, as many products on the market contain several (if not all of these ingredients).
- Vitamins and Minerals. For the first 3-4 weeks post-injury, vitamin A, vitamin C, copper, and zinc can assist in the proliferation and remodeling stages of recovery. You can either use a multi-vitamin/multi-mineral or include each separately.
- Super-Nutrients. Arginine, HMB, and glutamine, can help during the proliferation and remodeling stages. Again, there are combination products on the market that contain all 3 of these ingredients.
Note: Athletes should be mindful with all nutritional supplements to only use products that are NSF or HFL certified and guaranteed free of banned substances.
In the end, by putting these nutritional strategies to work for you and your clients, not only will you see speedier returns to function, you’ll also see more complete healing and less frequent injury recurrence.
As for my client and friend, Mr. St-Pierre? Here’s exactly what we did to prepare for and recovery from his “injury” (surgery):
Prior to surgery:
- Eat “normally” for week leading up to surgery.
- No supplements (especially fish oil) for 1 week.
- Let doctor know about prior fish oil use.
For 4 weeks post-surgery:
- Continue eating “normally”
- Quest Multivitamin - 1 cap, 2x / day (vitamins and minerals)
- Biotest Curcumin - 2 caps, 2x / day (curcumin/turmeric)
- Biotest Flameout - 3 caps, 2x / day (fish oil)
- EAS Muscle Armor -1 scoop, 2x / day (arginine, glutamine, HMB)
Note: eating normally for Georges included a menu I developed with his personal chef. The menu followed the best practices included in this article and a host of other high-performance nutrition strategies.
Also note: the idea here was to keep it as simple as possible while providing Georges with the best recovery intervention.
The results of this intervention? 11 days after his first text, GSP sent me this follow-up:
“It's only been 3 days since my surgery and my injury healed like Wolverine from the X-Men. I‘ll be back and training in no time at all. Thanks!”
Of course, you (or your clients) may not have GSP’s genetic gifts or access to the best medical teams in the world. But that doesn’t mean that these safe, effective best practices can't be put to good use.
If your clients put as much effort into recovery as they do into training with you, they can return to form quicker than ever before.