Nagging gymnastics injuries and nutrition.

It’s that time of year!

February means we’re starting to look towards National and Elite competitions, but many athletes may not quite be “there” yet. Even worse, for some, nagging aches and pains are starting to threaten injury.

Nutrition is an often-over-looked aspect to a gymnast’s training, and there is no more important time to ensure adequacy than in light of impending or active injury.

Here are 6 tips to help your athletes utilize nutrition to prevent and manage injury:

1. Adequate Nutrition- Calories matter. I am not advocating your gymnasts track their daily calories as this can, but not always, lead to disordered eating. Mathematically speaking, an athlete must consume enough food to meet their baseline energy needs along with training expenditures to facilitate training adaptation and recovery. Adequate nutrition starts with 3 balanced meals per day that include lean protein, veggies/fruits, whole grains, and healthy fats along with at least 1-2 snacks. Unfortunately, gymnasts often under eat for a variety of reasons: aesthetic pressures, busy schedules, following misguided advice, and should be encouraged to appropriately fuel their bodies. Not only do young athletes expend a great deal of energy during training, but many are also in times of peak growth and development, which requires extra energy.

During injury, the initial response of most athletes is to lower energy intake. But, during the healing process, energy expenditure may be increased up to 15-50% depending on the type and severity of injury (Tipton, 2015). Although overall physical activity and training may be reduced, the reduction in energy expenditure may be less than what would appear intuitive. Additionally, the energy expended while ambulating with crutches can increase energy expenditure two-to-threefold. Therefore, if the restriction of energy intake is too severe, recovery will be slowed due to impaired wound healing and exacerbated muscle loss. A large energy excess is also not ideal. If your athlete is struggling with nutrition and/or body image while injured they should work with a sports dietitian who can guide them in fueling their body.

Sometimes injuries that cause big disruptions to training can trigger disordered eating behaviors due to fear of weight gain. If you notice your injured athlete eating less, skipping meals/snacks, or obsessively “body checking” in the mirror, a sports dietitian should be quickly involved. Depending on the extent of the issue, consult a medical doctor or therapist.

If you have a female athlete that is plagued by overuse injuries, they should be monitored for RED-S (Relative Energy Deficit in Sport) which is like the Female Athlete Triad and is largely caused by inadequate fueling. RED-S can occur with or without the presence of disordered eating, but can impair bone mineralization and suppress immune function.

2. Adequate Protein- Often health professionals and coaches look to protein for injury repair and prevention. But, without adequate fuel (food), protein will be utilized as energy and not for muscular and soft tissue repair needed to keep your athlete healthy. Athletes need anywhere from 1.2-2 g of protein per kg per day, which works out to about 20-35 g protein per meal and 10-20 g per snack. Protein should be consumed 3-5 times per day within a meal or snack to maximize muscle protein synthesis and repair (Tipton, 2015). Lean animal protein should be encouraged as it is the most bioavailable (compared to plant protein) to the body and maximizes absorption (Berrazaga, 2019).

3. Manage Inflammation- Inflammation is part of the body’s natural healing process and helps shift the body’s focus to resolving the injury (Tipton, 2015). Excessive inflammation is counterproductive to healing, but some is needed for wound healing. Therefore, the aim is not to “eliminate all inflammation”. These days, you’ll hear “nix sugar” as a strategy to manage inflammation. Research has associated a high sugar intake with increased rates of obesity, heart disease, and cancer (Sulaiman, 2014; West, 2001; Saris, 2000). This information then gets portrayed as “avoid sugar for optimal body composition, i.e. “Eat Clean” which is arbitrary and can lead to disordered eating and body image distortion (Linardon, 2017). Avoiding all sugar may seem logical at first, but you must ask “is it the sugar that is causing the damage, or the excess calories from too much sugar?”. Several cans of soda, juice, or flavored milk per day could provide a massive excess of sugar (calories) which could negatively affect the athlete’s body composition and could cause increases in inflammatory markers (Aberlie, 2011). Studies have shown that when diets are equal in calories, protein, and fiber yet differ in sugar content (high vs low), there is no difference in body composition (Saris). Aside from body composition, other studies have shown that when sugar is incorporated in moderate amounts, there were no differences in blood pressure changes, blood lipids, blood glucose, insulin, thyroid hormone, or markers of inflammation (West, 2011; Saris, 2000; Raatz, 2005; Surwit, 1997). Though added sugar should be minimized to less than 10% of the diet, it does not need to be demonized or completely avoided in light of injury.

4. Omega 3s-This is another important nutrient to think about in an effort to reduce inflammation through the diet. These fatty acids, primarily eicosapentaenoic and docosahexaenoic acids (EPA/DHA), are found in fatty fish like salmon or sardines, which also provide high quality protein. You should be weary of supplements as their contents are not regulated by the US Food and Drug Administration. An omega 3 supplement may claim to have 1000 mg “omega 3s” per capsule, but when you look at the Supplement Facts label you’ll often find that what matters (combined dose EPA/DHA) only comprises 30% of the supplement (300 mg instead of 1000 mg). So, instead of taking 1-2 capsules per day to reach 1000-2000 mg of omega 3s, you’d actually have to take 3-7 capsules since they are “diluted” with “other omega 3s” which are not of benefit towards mitigating inflammation. It is more important to focus on overall dietary patterns than trying to address inflammation with one specific nutrient.

5. Iron Status: Female athletes, especially those who have begun menstruating, notoriously struggle with iron deficiency anemia which impairs injury recovery. The athlete should have their physician check iron status labs and prescribe a supplement if needed. Iron is best absorbed with a source of vitamin C and can cause some GI issues (constipation), so monitoring by a dietitian or physician is recommended to maximize compliance.

6.  Maximize Nutrition-When counseling athletes, I support the “90/10” practice. Ninety percent of the time the athlete should be consuming lean proteins, veggies/fruits, healthy fats, and whole grains; the other 10% is allotted to “fun foods” which works out to 1-2 items (servings) per day of sugary items, desserts, fried foods, dinners out with family and friends, special occasions, etc. The quantity of these “fun foods” varies between athlete (gender, age), but it is reasonable to start with a serving.  For a young female gymnast, this may look like a cookie in their lunch (a normal sized cookie, not the coffee shop XXL cookie) or going out to dinner after practice. The important take-away is that one meal or snack is not going to ruin performance or body composition, but they should aim to incorporate nutrient dense foods most of the time. A lot of athletes struggle with snacking on less nutrient dense foods because they are actually HUNGRY, which is the body’s way of telling the brain “need more food”.  I encourage athletes to pack nutritious snacks that combine a protein and carbohydrate (apple + string cheese, peanut butter + whole grain crackers, etc.) instead of snacking on a bag of sour candy all day, which provides minimal nutrition.

 

References

Aeberli, I., Gerber, P. A., Hochuli, M., Kohler, S., Haile, S. R., Gouni-Berthold, I., … & Berneis, K. (2011). Low to moderate sugar-sweetened beverage consumption impairs glucose and lipid metabolism and promotes inflammation in healthy young men: a randomized controlled trial. The American journal of clinical nutrition94(2), 479-485.

Berrazaga, I., Micard, V., Gueugneau, M., & Walrand, S. (2019). The role of the anabolic properties of plant-versus animal-based protein sources in supporting muscle mass maintenance: A critical review. Nutrients11(8), 1825.

Linardon, J., & Mitchell, S. (2017). Rigid dietary control, flexible dietary control, and intuitive eating: Evidence for their differential relationship to disordered eating and body image concerns. Eating behaviors26, 16-22.

Raatz, S. K., Torkelson, C. J., Redmon, J. B., Reck, K. P., Kwong, C. A., Swanson, J. E., … & Bantle, J. P. (2005). Reduced glycemic index and glycemic load diets do not increase the effects of energy restriction on weight loss and insulin sensitivity in obese men and women. The Journal of nutrition, 135(10), 2387-2391.

Saris, W. H. M., Astrup, A., Prentice, A. M., Zunft, H. J. F., Formiguera, X., Verboeket-Van De Venne, W. P. H. G., … & Vasilaras, T. H. (2000). Randomized controlled trial of changes in dietary carbohydrate/fat ratio and simple vs complex carbohydrates on body weight and blood lipids: the CARMEN study. International journal of obesity24(10), 1310-1318.

Stanhope, K. L. (2016). Sugar consumption, metabolic disease and obesity: The state of the controversy. Critical reviews in clinical laboratory sciences53(1), 52-67.

Sulaiman, S., Shahril, M. R., Wafa, S. W., Shaharudin, S. H., & Hussin, S. N. (2014). Dietary carbohydrate, fiber and sugar and risk of breast cancer according to menopausal status in Malaysia. Asian Pac J Cancer Prev15(14), 5959-64.

Surwit, R. S., Feinglos, M. N., McCaskill, C. C., Clay, S. L., Babyak, M. A., Brownlow, B. S., … & Lin, P. H. (1997). Metabolic and behavioral effects of a high-sucrose diet during weight loss. The American journal of clinical nutrition65(4), 908-915.

Tipton, K. D. (2015). Nutritional support for exercise-induced injuries. Sports Medicine45(1), 93-104.

Yudkin, J., & Watson, R. H. (1969). Sugar and ischemic heart disease. British medical journal4(5675), 110.

West, J. A., & De Looy, A. E. (2001). Weight loss in overweight subjects following low-sucrose or sucrose-containing diets. International journal of obesity25(8), 1122-1128.