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  • Annie Bothma

NUTRITIONAL SUPPLEMENTS STRATEGIES THAT CAN HELP SUPPORT ATHLETES BONE HEALTH

Updated: 7 days ago

- By Annie Bothma, January 2023

What nutritional supplement strategies both during the peri-exercise window and daily could athletes implement to help facilitate them repair bone tissue and prevent the recurrence of bone-related injuries in the future?


This post outlines some practical nutritional supplement strategies athletes can implement to help protect their bones. Alongside each strategy, I will specify how much is needed to get the desired effect and how athletes can implement it into their daily routine. Lastly, I will provide a rational why this strategy is important.


STRATEGY #1 - FUEL FOR THE WORK REQUIRED

Athletes should prioritize nutritional intake prior- and post-exercise; as well as during prolonged exercise sessions. Athletes should avoid fasted exercise sessions, since it has been shown to be extremely harmful for bone metabolism. Furthermore, doing fasted training sessions on a regular basis may influence an athlete's hormonal profile, which may especially be detrimental in the long-term for female athletes.


Amount:

Nutritional intake will depend on the metabolic requirements for the exercise session; therefore, athletes should take a periodized nutrition approach to fuelling before, during and after their exercise sessions.


Example of implementation:

  • Meal or snack rich in carbohydrates with a small amount of protein to help stabilize blood sugar levels. The snack or meal should be low in fiber and fat to avoid gastrointestinal upset before or during exercise.

  • Carbohydrates drinks or gels during intense or long exercise sessions. Electrolyte drinks containing sodium are suitable during low-intensity shorter exercise sessions.

  • A protein and carbohydrate drink immediately post-exercise is a practical way to kickstart the recovery and repair process after training.


Rationale:

Nutrient ingestion around acute exercise can alter the bone resorption marker response to that exercise bout. Many athletes exercise in the morning after an overnight fast, which has the potential to promote an increase in bone turnover. Carbohydrate feeding attenuated bone resorption (β-CTX) and formation (P1NP) in the hours, but not days following exercise, indicating an acute effect of carbohydrate feeding on bone turnover. When carbohydrate plus protein was ingested immediately post-exercise, there was a suppression of the exercise-induced bone resorption (β-CTX) response when compared to the control trial, along with a smaller increase in the bone formation (P1NP) response 3–4 h post-exercise. It would seem clear that feeding around exercise can moderate the bone metabolic response to an exercise bout, with the post-exercise period being perhaps the most useful timeframe for refueling.


STRATEGY #2 - OPTIMIZE VITAMIN D STATUS

Amount:

2,000–4,000 IU D3 daily


Example of implementation:

Taken daily with a meal.


Rationale:

It is well established that many athletes are Vitamin D deficient due to a lack of sunlight exposure. There is a direct relationship between serum vitamin D levels and musculoskeletal outcomes and it makes sense given the important role for vitamin D in calcium and phosphorus metabolism. Research suggests that vitamin D deficiencies

can impair muscle regeneration following damaging exercise both in vitro and in vivo.

Given that there is a well-identified link between low vitamin D levels (serum 25-hydroxy vitamin D [25OHD] levels below 25 nmol/L and bone, it is highly likely that athletes who are deficient in vitamin D would be at a greater risk of low bone mass and bone injuries, such as stress fractures.


Whilst the causes of vitamin D deficiency in the general population are clearly multifactorial, it is most likely that the main cause in the athletic population is a reduction of ultraviolet B radiation absorption into the skin, which is the major source of vitamin D. Whilst this seems fairly obvious in relation to those athletes who largely train and compete indoors and those who live and train in latitudes farthest from the equator, it might also be of relevance to those who train and compete outside, but also for those who wear a significant amount of equipment or those who choose to use high sun-protection-factor sunscreen or sunblock to protect their skin


Improving Vitamin D status through supplementation has been shown to reduce the risk

of developing a stress fracture and would therefore be a beneficial strategy to help

facilitate the repair of bone tissue and prevent the recurrence of bone-related injuries in

the future. The athlete should take 2,000–4,000 IU D3 daily, especially during the winter

months, to ensure serum 25(OH)D is greater than 75 nmol/L.


STRATEGY #3 - CALCIUM SUPPLEMENTATION

Amount:

1000 mg


Example of implementation:

Taken 20-minutes before exercise sessions


Rationale:

Similarly to Vitamin D, there appears to be a link between calcium intake and both bone mineral density and stress fracture risk in athletes. A consideration that might need to be made with regard to the calcium intake of endurance athletes is the amount of dermal calcium loss over time. Although the amount of dermal calcium lost with short-term exercise is unlikely to be that important, in some endurance athletes performing prolonged exercise bouts or multiple sessions per day, this could become an issue. Under these circumstances, athletes should consider either a high-calcium pre-exercise meal containing ∼1 300 mg of calcium or a 1 000 mg calcium supplement, both of which have been shown to limit disturbances to calcium homeostasis and, potentially, the bone metabolic response to subsequent exercise.


If athletes train indoors in a gym they may be sweating more than when training outdoors. Air flow helps sweat evaporate, which is an essential step in the cooling process. Inside, this air flow is greatly reduced or is completely nonexistent, so the sweat often just hangs on the skin, reducing the cooling effect. This then prompts the body to sweat even more. Therefore, adding a pre-exercise meal or supplement containing calcium could help minimize dermal calcium losses over time and may serve as a protective strategy to help prevent the recurrence of bone-related injuries in the future.


STRATEGY #4 - REPLACE DERMAL SODIUM LOSSES

Amount:

250-500 mg sodium tablets dissolved 500 ml water bottle


Example of implementation:

Added to an athlete’s water bottle during exercise sessions.


Rationale:

In line with replacing dermal calcium losses from sweat, there is also the possibility that the challenge to fluid and sodium homeostasis that would occur under these circumstances might influence bone metabolism and health. This relationship has not been as well-studied in relation to the athlete, but there is some suggestion from the osteoporosis focussed literature suggesting that bone might be negatively affected by hyponatremia. Verbalis et al. examined the effects of using a syndrome of inappropriate antidiuretic hormone secretion rodent model to show that 3 months of hyponatremia (~30% compared with normonatremic controls) significantly reduced the BMD of excised femurs and reduced both trabecular and cortical bone, purportedly via an increase in bone resorption and a decrease in bone formation.


The same paper also reported on a cross-sectional analysis of human adults from the Third National Health and Nutrition Examination Survey, showing that mild hyponatremia was associated with significantly increased odds of osteoporosis, in line with the rodent data presented. This might be explained by novel sodium signaling mechanisms in osteoclasts resulting in the release of sodium from bone stores during prolonged hyponatremia.


Therefore, it may be beneficial for athletes to include an electrolyte drink containing sodium while he is exercising to help replace some of the dermal sodium losses. Aside from helping to prevent hyponatremia or low serum sodium concentration, sodium containing drinks also help increase palatability; maintain thirst (and therefore promote drinking); increase the rate of water uptake; and Increase the retention of fluid.


STRATEGY #5 - GELATIN/HYDROLYZED COLLAGEN SUPPLEMENTATION

Amount:

15 g Gelatin/Hydrolyzed Collagen


Example of implementation:

15 g of gelatin taken with Vitamin C 1 hour before rehab-exercise session.


Rationale:

Gelatin or hydrolyzed collagen is another rich amino acid source that may

facilitate healing in the injured athlete. Gelatin is created by boiling the skin, bones,

tendons, and ligaments of cattle, pigs, and fish. Boiling releases large molecular weight

proteins that show limited solubility in water and form a gel after heating. The chemical

or enzymatic hydrolysis of gelatin breaks the protein into smaller peptides that are

soluble in water and no longer form a gel. Because both gelatin and hydrolyzed

collagen are derived from collagen, they are rich in glycine, proline, hydroxylysine, and

hydroxyproline.


In a randomized, double-blinded, placebo-controlled, crossover-designed study, subjects who consumed 15 g of gelatin showed twice the collagen synthesis, measured through serum propeptide levels, as either a placebo or a 5 g group. When serum from subjects fed either gelatin or collagen is added to engineered ligaments, the engineered ligaments demonstrate more than two-fold greater mechanics and collagen content. This data suggests that consuming gelatin or hydrolyzed collagen may increase collagen synthesis and potentially decrease injury rate in athletes.


Vitamin C is important for collagen synthesis and is also a known antioxidant, which

might explain both direct and indirect effects on the bone.


CONCLUSION

Don’t neglect your bones. Avoid things that are known to be detrimental for your bones like smoking and excessive alcohol intake. Soft drinks and excessive caffeine intake can also be problematic, so moderation or avoidance is a better choice. Instead, prioritize foods that will help build your bone density like calcium, vitamin D, vitamin K, and magnesium. Consider making using of these supplemental strategies to support a balanced diet to optimize your bone health as an athlete. Good nutrition practices can help repair bone tissue, prevent bone-related injuries and development osteoporosis, osteopenia in the future.

 

RESOURCES:

Craig Sale1, Kirsty Jayne Elliott-Sale2, "Nutrition and Athlete Bone Health," Journal of Sports Medicine, 2017, available online at https://pubmed.ncbi.nlm.nih.gov/31696454/

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