- Annie Bothma, IOPN Sports Performance Nutritionist (EQF Level 7. Masters), Running Coach and Elite Marathon Runner
Welcome to a special blog series on supplements for athletes. In this third blog post in the series we will focus out attention to supplements for injuries. Injuries, whether from sports, accidents, or everyday activities, can be setbacks that disrupt our daily routines and long-term health goals.
However, advances in nutritional science have shown that certain supplements can significantly aid in the recovery process, helping to reduce pain, improve function, and accelerate healing. In this series, we will explore the latest research on various supplements and their roles in injury recovery. I will aim to highlight how these supplements work at a cellular level to support tissue repair and improve recovery outcomes.
Whether you're an athlete, a fitness enthusiast, or someone recovering from an injury, this series will provide valuable insights into how supplements can be integrated into your recovery plan. Join me as we explore the potent combination of science and nutrition in enhancing injury recovery.
COLLAGEN
BENEFITS
Collagen is the protein that is made up of the amino acids glycine, proline and hydroxyproline - that triggers your muscle to respond to an anabolic process, whereby new muscle tissue is being generated and exciting ones grow. It is the fibrous protein found in connective tissues of the body, e.g. tendons, ligaments, cartilage, bones, teeth.
Muscles tear as you stress them through exercise, so it is crucial that new ones are created and existing ones are required to make sure you are ready to work hard the next time. Collagen is also a component of cartilage, the tissue that cushions and supports your joints.
Therefore, collagen is effective to help support joint health and may help with connective tissue repair, wound healing and scar tissue formation.
BONUS BENEFITS
Type I & III collagen acts as a scaffolding for your skin, making up 75% of the cells within the dermis. Studies suggest that after the age of 25, natural production reduces by 1.5% per year, so a supplement may help keep your skin frim.
RECOMMENDED DOSE
Take 15 g collagen 45-60 minutes prior to doing your rehab exercises with a source of vitamin C, like a glass of orange juice, for the maximum benefit.
MOST EFFECTIVE FORM
Type II, but there are may others. However, Type II collagen main purpose is the treatment of joint pain and arthritic conditions.
FOOD-FIRST APPROACH
Chicken
egg whites
citrus foods
fish
POTENTIAL SIDE-EFFECTS
Feelings of fullness or constipation. Both can be caused by the body breaking down a lot of protein (collagen) at once, without sufficient fluid and fibre to aid digestion. Staying hydrated and including plenty of fruits and veggies in your diet can help avoid this. Alternatively, consider splitting or halving the dose.
NOTE
Vitamin C plays a major role in tissue growth and repair, wound healing and bone maintenance and repair. It also plays a crucial role in collagen production, which is essential for tissue repair. Therefore, it is important to make sure you have adequate vitamin C alongside collagen supplementation to optimize the benefits of this supplement.
PROTEIN POWDER
BENEFITS
Protein is a key nutrient for bone health, providing the building blocks for bone tissue.
Immobilization decreases the ability of myofibrils proteins to respond to amino acid stimuli. This phenomenon is called anabolic resistance, which makes the muscle building process more difficult. In order to overcome this, researchers have established higher protein recommendations (1.6-2.5 g/kg/d) and emphasize consuming leucine-rich foods.
The amino acid leucine has been named “the anabolic trigger” as it has the power to stimulate muscle protein synthesis faster than other amino acids. For best results, consume 20 to 35 grams of leucine-rich protein every three hours during the day and before bed.
Leucine from food sources may have the ability to aid in injury recovery. Leucine rich foods include cheese, meat, fish, as well as some nuts and seeds and tempeh.
Casein-rich foods (milk and dairy products) before bed provide a competitive healing edge as they take longer to digest and are slowly released into the blood stream. This provides a slow and steady supply of amino acids that can be used to build muscle while catching some Zzzs.
BONUS BENEFITS
Muscle Growth and Repair: Essential for muscle building, especially after exercise. Helps in muscle repair and growth.
Weight Management: Protein can increase satiety, helping with weight management or loss.
Convenience: Protein powder offers a quick and easy way to increase protein intake, especially for those with busy lifestyles.
Versatility: Protein powder can be added to various foods and drinks, like smoothies, oatmeal, and baked goods.
RECOMMENDED DOSE
The recommended daily protein intake for athletes is 1.4-2.0 g/kg body weight per day, depending on the type and intensity of the sport.
A protein serving of 0.3g/kg of body weight or roughly 20-40 g of protein is recommended after exercise to optimize muscle protein synthesis and promote recovery.
As explained above, a higher protein intake consisting of a protein sources rich in leucine during injury may be beneficial to optimize muscle protein syntheses.
MOST EFFECTIVE FORM
Whey Protein
Derived from milk, whey protein is a complete protein containing all essential amino acids. It's rapidly absorbed, making it ideal for post-workout recovery.
Types: Concentrate (lower in fat and carbs, higher in lactose), Isolate (higher in protein, lower in fat and lactose), and Hydrolysate (pre-digested, fastest absorption).
Casein Protein
Also derived from milk, it's absorbed more slowly, providing a steady release of amino acids. Ideal for taking before bed to aid muscle recovery overnight.
Plant-Based Proteins
Options like pea, rice, hemp, and soy protein are great for vegetarians and vegans. Often combined to ensure a complete amino acid profile. Alternatively, look for an isolate version like pea protein or soy protein isolate.
Egg White Protein
A lactose-free alternative, high in quality protein, though less common than whey or plant-based options.
FOOD-FIRST APPROACH
Protein powders should supplement, not replace, whole food sources. Foods like meat, fish, dairy, legumes, and nuts offer additional nutrients not found in supplements.
Emphasize a balanced diet rich in whole foods to ensure a comprehensive nutrient intake.Use protein powders to fill gaps in your diet, especially on busy days or after workouts.
POTENTIAL SIDE-EFFECTS
Digestive Issues
Some people may experience bloating, gas, or diarrhea, particularly with high intakes or lactose intolerance (in the case of whey and casein).
Nutritional Imbalance
Over-reliance on protein powder can lead to a lack of variety in the diet, potentially leading to deficiencies in other nutrients.
Quality Concerns
Some protein powders may contain additives, artificial sweeteners, or contaminants. Choosing a high-quality, third-party tested product is important.
CREATINE
BENEFITS
Muscle Atrophy Prevention: Creatine may be beneficial in reducing muscle atrophy, especially during periods of immobilization, which is a common concern for injured athletes. This is particularly noted in the case of immobilized arm muscles.
Rehabilitation Phase: During the rehabilitation period following immobility, creatine supplementation has been shown to increase the rate of muscle growth and strength gains compared to a placebo. This could potentially aid in faster recovery for athletes.
Impact on Muscle Strength: The effectiveness of creatine in improving muscle strength post-injury, such as after knee surgery, is not clear-cut. Therefore, relying solely on creatine for strength gains might not be advisable.
Oxidative Impairments: Creatine may have a positive impact on muscle oxidative impairments observed during muscle disuse. This could be beneficial for maintaining muscle function during periods when an athlete is unable to train fully.
RECOMMENDED DOSE
You can take it any time of day, just be consistent. I always choose to take it after a training session because that’s when muscles are most ready to take in protein and carbs for recovery.
Another interesting thing to consider is supplementing creatine monohydrate alongside carbohydrates. Studies have shown that ingesting creatine with protein and/or carbs may shorten the loading phase by increasing creatine absorption.
The recommended maintenance dose is 3-5 g of creatine daily.
MOST EFFECTIVE FORM
The most common type of creatine and the one most studied is creatine monohydrate. That’s the type you want to look for in any supplement you choose. It is also the most affordable. Pill or powder form both works fine.
FOOD-FIRST APPROACH
Creatine is formed from three amino acids; arginine, glycine and methionine. In your kidneys and liver, it's put together in a two-step process and it forms creatine. That's one way that we can actually get creatine is by our bodies actually producing creatine. We can also get creatine from our diet as well. Things like meat, for example, fish, poultry, they all contain creatine. We can also get it through food sources, but we can also get it through dietary supplements. Those are the three ways that we can get creatine.
However, it's typically present in much lower concentrations in foods compared to the levels used in creatine supplementation. To get an adequate amount of creatine from food alone, you would need to consume substantial quantities of these sources, which can be impractical and may not be suitable for everyone's dietary preferences or restrictions.
Like mentioned, creatine is a naturally occurring compound found in small amounts in animal-based foods, particularly in red meat, fish, and poultry. Vegetarians and vegans may have a harder time obtaining creatine from their diets, as plant-based foods contain minimal to no creatine. So, for individuals who choose not to consume animal products, it can be especially challenging to get enough creatine solely from food. However, it has also been shown that plant-based athletes may gain a bigger advantage from creatine supplementation than those who eat meat or on a regular basis.
POTENTIAL SIDE-EFFECTS
Initially, if you do a loading phase creatine supplementation may cause weight gain due to increased water retention in the muscles. This is why I suggest athletes go straight into a maintenance phase of 3-5 g of creatine per day. Although it may take longer (up to 20-30 days) to fully saturate your creatine stores, it is easier for most people to adhere to this protocol. It also won’t cause excess water retention or bloating that is typically associated with doing a loading-phase of 4 x 5 g creatine for 5 days.
OMEGA-3 FATTY ACIDS
BENEFITS
With omega-3 it is the eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) that you are after. These can help reduce inflammation and aid recovery. They also have Immune-modulatory properties that is important for keeping your immune system strong and healthy.
Omega-3 has been reported to help: reduce muscle soreness, improve oxygen & nutrient delivery, increase muscle synthesis and help reduce inflammation.
BONUS BENEFITS
DHA has been shown to help improve concentration, since it is the main fatty acid found in your brain and is responsible for blood flow and improving the efficacy of all the cells in the brain. Cognitive tasks are much harder without it.
RECOMMENDED DOSE
1000-2000 mg per day.
MOST EFFECTIVE FORM
Look for a supplement with a higher ratio of EPA to DHA, as EPA is far more effective in delivering physical benefits, like reducing pain, aches and swelling.
Algal oil is derived from micro-algae and is a vegan source of both EPA and DHA, the long-chain omega-3 fatty acids. It's often available in supplement form and can be a reliable way to ensure you're getting EPA and DHA in your diet.
FOOD-FIRST APPROACH
Animal-based:
Mackerel
tuna
salmon
trout
Plant-based:
Walnuts
brussel sprouts
avocado
seaweed
Seeds like flaxseeds, chia seeds, hemp seeds
POTENTIAL SIDE-EFFECTS
An unpleasant aftertaste in your mouth or slightly fishy-smelling breath - but these both should be very mild.
CALCIUM
BENEFITS
Bone Health: Calcium is the most abundant mineral in the body. It is essential for bone health and growth, and can help reduce the risk of stress fractures, since it is required to form and maintain bone tissue.
BONUS BENEFITS
It also plays a role in muscle contraction, nerve function, and blood clotting.
RECOMMENDED DOSE
Adults' recommended daily calcium intake is 1000-1200 mg daily, depending on age and gender.
The body can only absorb a limited amount of calcium at a time, usually around 500-600 mg. Therefore, it's more effective to take smaller doses throughout the day rather than a single large dose.
MOST EFFECTIVE FORM
The two main forms of calcium supplements are calcium carbonate and calcium citrate:
Calcium Carbonate: This is the most common and inexpensive form. It contains a high amount of calcium but requires stomach acid for absorption, so it's best taken with food. It's not suitable for people who take acid blockers or who have reduced stomach acid.
Calcium Citrate: This form is more expensive but can be absorbed well with or without food, making it a good choice for older adults or those with reduced stomach acid. It's also a good choice for individuals taking acid blockers.
FOOD-FIRST APPROACH
Good dietary sources of calcium include:
dairy products
leafy green vegetables
nuts
fortified foods.
POTENTIAL SIDE-EFFECTS
Excessive calcium intake can lead to kidney stones and may interfere with the absorption of other minerals. It's important not to exceed the recommended dosage.
VITAMIN D
BENEFITS
Bone Health: Vitamin D is crucial for calcium absorption in the gut, which is essential for maintaining bone strength and health. Therefore, adequate Vitamin D levels can decrease the risk of bone fractures by enhancing bone mineral density.
Muscle Function: It plays a role in muscle function and strength, potentially reducing the risk of falls and related injuries, especially in older adults. Improved muscle function from sufficient Vitamin D levels can reduce the risk of falls
BONUS BENEFITS
Immune System: Vitamin D influences the immune system, which can impact healing processes and the body's response to injury.
RECOMMENDED DOSE
Adults' recommended daily vitamin D intake is 600-800 IU per day.
The right dosage varies depending on age, skin color, latitude, season, and current vitamin D levels. A blood test can help determine deficiency and necessary dosage.
Vitamin D is fat-soluble, so taking it with a meal containing fats can improve absorption.
MOST EFFECTIVE FORM
Vitamin D3 (Cholecalciferol):
This is the most effective form of Vitamin D supplementation. It's the same type of Vitamin D that your body produces naturally when exposed to sunlight.
Better at raising and maintaining vitamin D levels in the blood compared to Vitamin D2 (ergocalciferol), which is the plant-derived form.
Supplemental Forms:
Available in tablets, capsules, and liquid forms. The choice of form depends on individual preference and absorption efficiency.
Some people may prefer sublingual drops or sprays for better absorption.
FOOD-FIRST APPROACH
Vitamin D is produced in the skin when exposed to sunlight.
It can also be obtained from dietary sources such as:
fatty fish
egg yolks
fortified foods
dairy products
JUST A AN EXTRA NOTE ON BONE HEALTH
Three other nutrients that are important for bone health include, phosphorus, vitamin K and magnesium.
Phosphorus
This nutrient is important for bone health, as it is a major component of bone tissue.
Good dietary sources of phosphorus include dairy products, meat, fish, and whole grains.
The recommended daily intake of phosphorus for adults is 700 mg.
Vitamin K
This nutrient is important for bone health as it helps activate proteins involved in bone mineralization.
Good dietary sources of vitamin K include leafy green vegetables, broccoli, and Brussels sprouts.
Adults' recommended vitamin K intake is 90-120 mcg daily, depending on age and gender.
Magnesium
This nutrient is required to form and maintain bone tissue and plays a role in muscle and nerve function.
Good dietary sources of magnesium include nuts, seeds, whole grains and leafy green vegetables.
Adults' recommended daily magnesium intake is 310-420 mg, depending on age and gender.
TURMERIC & CURCUMIN
BENEFITS
Turmeric, known for its active compound curcumin, offers a variety of health benefits.
Anti-inflammatory: Helps reduce inflammation in the body, beneficial for conditions like arthritis.
BONUS BENEFITS
Antioxidant: Protects against cellular damage from free radicals.
Brain health: May improve memory and brain function, and lower the risk of brain diseases.
Heart health: Contributes to improved heart health by enhancing the function of the endothelium (lining of blood vessels).
Digestive Health: Can soothe the digestive system, reducing symptoms of bloating and gas.
Skin Health: Its anti-inflammatory and antibacterial properties may improve skin health.
RECOMMENDED DOSE
The recommended dosage can vary, but typically, 500–2,000 mg of turmeric per day, with at least 70–95% curcuminoids, is considered effective. However, always consult with a healthcare provider before starting any supplement regimen.
MOST EFFECTIVE FORM
Capsules with black pepper (piperine) are considered more effective, since black pepper significantly enhances the absorption of turmeric.
The key compound in black pepper responsible for this effect is piperine. Curcumin, the active ingredient in turmeric, has a low bioavailability on its own, which means that it's not easily absorbed by the body. Piperine increases the bioavailability of curcumin by inhibiting certain intestinal enzymes that would otherwise metabolize (break down) curcumin too quickly, allowing more of it to enter the bloodstream.
FOOD-FIRST APPROACH
Including turmeric in your diet: Add it to curries, smoothies, or teas. The absorption of curcumin is improved when consumed with fat or black pepper.
POTENTIAL SIDE-EFFECTS
Generally safe when consumed in food amounts. In supplement form, high doses or long-term use may cause gastrointestinal issues, allergic reactions, or interact with certain medications. It's important to discuss with a healthcare provider, especially for those with gallbladder disease, as curcumin can worsen gallbladder problems.
GLUCOSAMINE & CHONDROITIN
BENEFITS
Glucosamine:
Supports joint health and may help alleviate symptoms of osteoarthritis, such as joint pain, stiffness, and reduced mobility.
Believed to promote cartilage formation and repair, contributing to joint cushioning.
Chondroitin:
Supports joint health and may help reduce joint pain and improve joint function in osteoarthritis patients.
It is thought to protect and maintain cartilage integrity.
BONUS BENEFITS
Glucosamine:
Some studies suggest that glucosamine may have anti-inflammatory properties.
There is some evidence to suggest it may benefit individuals with temporomandibular joint (TMJ) disorders.
Chondroitin:
Chondroitin may have anti-inflammatory properties.
Some studies suggest it may help with eye health and reducing the risk of age-related macular degeneration (AMD).
RECOMMENDED DOSE
Glucosamine:
Typical doses range from 500mg to 1500mg per day, divided into two or three doses.
Dosage may vary based on the specific form (glucosamine sulfate or glucosamine hydrochloride) and the product's formulation, so follow the instructions on the supplement label or consult a healthcare professional.
Chondroitin:
Typical doses range from 800mg to 1200mg per day, divided into two or three doses.
Dosage may vary based on the specific product, so follow the instructions on the supplement label or consult a healthcare professional.
MOST EFFECTIVE FORM
Glucosamine:
Glucosamine sulfate is the most studied and commonly recommended form.
Chondroitin:
Chondroitin sulfate is the most commonly used and studied form in supplements.
People often use glucosamine and chondroitin supplements together because they are believed to have a synergistic effect in promoting joint health. These supplements are available over-the-counter in various forms, including capsules, tablets, and powders.
FOOD-FIRST APPROACH
Glucosamine
Glucosamine is naturally present in the body and can be obtained from dietary sources. It is found in the shells of shellfish and can also be found in bone broth.
Chondroitin
Chondroitin is not readily available in dietary sources, so a food-first approach is not applicable in this case.
POTENTIAL SIDE-EFFECTS
Glucosamine:
Generally, glucosamine is considered safe for most people when taken at recommended doses.
Common side effects may include digestive issues like nausea, diarrhea, and stomach upset.
People with shellfish allergies should avoid glucosamine supplements made from shellfish shells.
It may interact with blood-thinning medications like warfarin, so consult a healthcare professional if you are taking such medications.
Chondroitin:
Chondroitin is generally considered safe for most people when taken at recommended doses.
Common side effects may include mild stomach upset, diarrhea, and headaches.
It's advisable to consult a healthcare professional if you are pregnant, nursing, have bleeding disorders, or are taking blood-thinning medications, as chondroitin might interact with them.
JUST NOTE
It's essential to note that while many people report relief from joint pain and improved joint function when using glucosamine and chondroitin, scientific evidence supporting their effectiveness is mixed. Some studies have shown positive results, while others have found no significant benefit. Results may vary from person to person, and these supplements may not work for everyone.
CONCLUSION
In conclusion, this blog series offers a comprehensive look into how various supplements can aid in the recovery process for athletes. It covers the unique benefits of supplements like collagen, omega-3 fatty acids, protein powders, and others, highlighting their roles in tissue repair, inflammation reduction, and muscle recovery.
The series emphasizes the importance of a food-first approach, addresses potential side effects, and underscores the need for a balanced, informed approach to supplementation. The best recommendation would be to adopt a ‘first, do no harm’ approach. The use and amount of each nutrient should be considered in the context of a risk/benefit ratio. Even if the benefit is uncertain, it may be worth trying if no risks can be identified. Otherwise, if there is a risk of doing harm with use of a particular nutrient, then perhaps that nutrient should be avoided. As always, the basis of nutritional strategy for an injured athletes should be a well- balanced diet based on a diet of whole foods from nature (or foods made from ingredients from those foods) that are minimally processed.
It's essential to research the quality and safety of the supplements you choose, as the market can be filled with products of varying quality. Read my previous blog post for tips and considerations when buying supplements: SPORT NUTRITION SUPPLEMENT SERIES: Introduction
Check out the two post in the sports nutrition supplement series:
If you would like to work with me one on one to nail down your nutrition as an endurance athlete or you need a running coach to help you prepare for your upcoming race, please click on the link below to learn more about the services I offer.
Contact me at anniesathletes@gmail.com to set up a consultation today.
RESOURCES
Asker Jeukendrup, Micheal Gleeson, Sport Nutrition, Third Edition, 2019
Craig Sale, Kirsty Jayne Elliott-Sale, "Nutrition and Athlete Bone Health," Journal of Sports Medicine, 2017
Graeme L. Close, Craig Sale, Keith Baar, Stephane Bermon, Nutrition for the Prevention and Treatment of Injuries in Track and Field Athletes, International Journal of Sport Nutrition and Exercise Metabolism, 2019
Keith Baar, Minimizing Injury and Maximizing Return to Play: Lessons from Engineered Ligaments, Sports Med, 2017
Benjamin T. Walla, James P. Morton, & Luc J. C. van Loona, Strategies to maintain skeletal muscle mass in the injured athlete: Nutritional considerations and exercise mimetics, European Journal of Sport Science, 2014
Ronald J Maughan, Louise M Burke, Jiri Dvorak, IOC consensus statement: dietary supplements and the high-performance athlete, Consensus statement, 2018