Muscle soreness is a limiting factor in gymnast performance, and inflammation is a pre-courser/indirect cause. Hard training sessions, overdone conditioning sessions, or just general wear & tear will slow down a gymnasts’ progress.
As a result, the sports supplement industry is a multi-billion dollar industry full of promises of cures to all the athlete’s aches and pains. Some of these are proven and effective, others are not, and this article is going to give you the overview of the most important and often recommended.
Proper nutrition is paramount before considering additional supplements. An athlete must be consuming adequate energy (calories), adequate carbohydrate and protein, applying proper Performance Nutrition, hydration, and getting adequate sleep + recovery from rest days and proper training programming. Check out this blog on the Top 4 Reasons Your Gymnast is Always Tired to start.
It’s also essential to note that supplements are not regulated by the Food and Drug Administration (FDA) like pharmaceuticals. You must ensure you’re taking a product that has been third-party tested by an independent lab like Consumer Lab, NSF Certified for Sport, or the United States Pharmacopeia. Without this certification, you have no idea about the purity of the supplement you’re taking and can jeopardize NCAA eligibility if you take something that tests positive for a banned substance on a random drug screening. Read more here.
Before we dive in, we have to understand what we’re looking at in terms of effects. A whole other blog could be dedicated to muscle growth and performance, this article will cover what’s called “exercise induced muscle damage” and inflammation as a result of training.
Defining Muscle Soreness and Inflammation
Exercise Induced Muscle Damage (EIMD) is an indirect result of exercise induced inflammation. This can cause feelings of soreness that make it difficult to perform optimally in subsequent training sessions.
Chronic inflammation (like in type 2 diabetes, autoimmune conditions, etc) vs acute inflammation (bone break, sprain/strain) are different that exercise induced inflammation though a lot of the same inflammatory markers and effects are involved.
Vitamin D, bone health, and inflammation
Vitamin D plays an essential role in bone health and also helps regulate the inflammatory response. I’ve written about this one before in regards to bone health and specific situations that would for sure warrant testing. There is no clear evidence supporting vitamin D helping with EIMD, but it’s known benefits with skeletal health and inflammation make it prudent that athletes aim for 30-50 ng/dL as previously mentioned. It is near impossible to meet daily vitamin D needs through food sources and Vitamin D3 (cholecalciferol) is the preferred form.
Athlete may need anywhere from 1000-4000 IU a day to reach at least 30 ng/dL, but let’s “test, not guess”. A blood level of less than 30 ng/dL 25-OHD is considered insufficient, less than 20 ng/dL is deficient. Both need to be treated and rechecked within 6-8 weeks.
Omega 3 Fatty Acids are an anti-inflammatory powerhouse
Omega 3 fatty acids (specifically eicosapentanoic acid and docosahexaenoic acid, EPA and DHA) can be effective in blunting delayed onset muscle soreness, about 48 hours after the exercise. Should you choose fish or a daily supplement? Ideally, you’ll obtain nutrients from whole foods sources when able to maximize your nutrition. A 3-4 oz serving of salmon has ~ 1.2 mg of omega 3 (EPA, DHA). Studies report anywhere from ~1.8-3+ g per day supplementation of EPA/DHA, though you’d have to look at the studies to see if the dose was 1.8-3 g of combined EPA/DHA. When you look at omega 3 supplements, you want to be sure that the EPA/DHA content is about 80-100% of what the label claims. If the label advertises 1280 mg of Omega 3’s and there is 1100 mg of combined EPA/DHA, that’s a quality supplement and you can take what dose is suggested based on the serving size or whatever your goal is.
Creatine monohydrate is well known for it’s improvements in exercise power, aerobic and anerobic performance, body composition (increases in lean mass), and strength. There are other forms of creatine available, but there are not studies supporting the use of other formulations over creatine monohydrate.
Some studies support that creatine can also help reduce muscle damage or enhance recovery following intense exercise, including lowering inflammatory markers. Studies show mixed results, but it may be beneficial.
There are a lot of fears and misinformation surrounding the use of creatine, but it’s currently a legal and effective ergogenic aid (energizing) that also can help with repair and recovery in addition to proper sports nutrition and programming.
We make about 1 gram of creatine per day and if you consume animal proteins you will consume about 1 g per day through food. Vegetarians and vegans have reduced creatine levels so they may very well respond to supplementation.
As an ergogenic aid (energizing) creatine gives the muscles more fuel so you can accomplish more in the weight room, at practice, etc.
Research supports two methods of taking creatine. The “loading method” involves taking 0.3 g/kg/day for 5-7 days (split into 3-4 doses a day as some athletes may experience gastrointestinal distress otherwise) and then 3-5 g/day thereafter. Other methods involve cycling the creatine by taking 3-5 g a day for 4-6 weeks at a time which provides a more gradual increase in muscle creatinine and not as quick of an effect as using the loading protocol follow by a maintenance dose.
In terms of young high level gymnasts, I’d not jump to creatine supplementation until the “big rocks” of sports nutrition were in place- adequate overall energy, adequate protein, adequate carbohydrate for fueling, hydration, sleep, and proper rest/recovery. Then I’d consider other ergogenic aids and supplements to help reach the last 2-3%.
The International Society of Sports Nutrition (ISSN) recommends the following guidelines when deciding on supplementing with creatine in young athletes, and I agree:
- The athlete is past puberty and is involved in serious/competitive training that may benefit from creatine supplementation;
- The athlete is eating a well-balanced, performance enhancing diet;
- The athlete and his/her parents understand the truth concerning the effects of creatine supplementation;
- The athlete’s parents approve that their child takes supplemental creatine;
- Creatine supplementation can be supervised by the athletes parents, trainers, coaches, and/or physician;
- Quality supplements are used; and,
- The athlete does not exceed recommended dosages.
Tart Cherry Juice as a strategy to reduce muscle soreness and inflammation
Tart cherry juice (Prunus cerasus) has been touted as “amazing” for post-workout recovery and soreness prevention in the past couple years. This juice, alike pomegranate and blueberries, has a high percentage of phytochemicals such as flavonoids, anthocyanins, and other phenolic compounds. These phenolic compounds have been shown to reduce inflammation in the same mechanism as non-steroidal anti-inflammatory medications like Aspirin.
As recent review on nutritional strategies to reduce the signs and symptoms of exercise-induced muscle soreness has shown tart cherry juice to benefit maintenance of muscle strength and reduce muscle pain by helping reduce inflammation and oxidative stress, but this is not consistent throughout the literature.
Many studies have shown that 30mL of tart cherry juice concentrate or 250-355 mL of tart cherry juice have benefit with reducing exercise induced muscle soreness and inflammation. Some studies show no result, but a study done in female dancers with 30 mL tart cherry juice before/after workouts showed faster muscle recovery and less delayed onset soreness after an intense related sprint exercise protocol which shows promise for gymnasts.
CherriBundi is a popular brand, commonly used withing NCAA sports nutrition programs as on option for post-workout recovery nutrition along with a source of high quality protein.
You should note the difference between tart cherry juice vs concentrate. Check out this free guide to see some brands and amounts. A young high level gymnast may not need 1-1.5 cups of juice twice a day from a nutritional standpoint although it wouldn’t hurt the high level gymnast who’s working out 5+ hours a day as the carbohydrate content can help replace muscle glycogen.
I’d personally opt for the 30 mL (1 oz) tart cherry juice concentrate pre/post workout which still contains 14-15 g carbohydrate per oz and can be used towards Performance Nutrition and Recovery.
It’s important to note that tart cherry juice is pretty sour and may be best used in a smoothie or alongside another food, especially for young athletes who are more sensitive to flavors.
While adequate protein is essential for muscle recovery and adaptation, studies have not consistently shown protein attenuating muscle soreness. Thus, there’s no need to go above and beyond daily protein needs (1.5-2g/kg) in effort to attenuate soreness.
Bedtime casein protein
Cow’s milk has two main proteins: Whey and Casein. It’s commonly thought that whey is a “fast” protein because it’s easily broken down in the stomach and digested. Casein is considered a “slower” protein as it takes longer to break down so it’s that that this factor is beneficial in prolonging the availability of amino acids (building blocks of protein) overnight while the body repairs and recovers. Casein makes up a large proportion of the protein in milk, cheeses, and yogurts. Current studies show that about 40-48g of casein within 30 minutes of sleep at bedtime can help with post-exercise recovery and positively help muscle protein synthesis, aside from adequate protein throughout the day. The two mechanisms through which this can help with muscle soreness and inflammation is a) providing a prolonged increase in amino acids to support a positive protein balance via muscle protein synthesis overnight and b) decreasing the post-exercise inflammatory mechanism which in turn could reduce muscle soreness.
Pomegranate juice (Punica granatum L.) is rich in polyphenols has shown some potential ability to reduce EIMD. Studies have examined 250-480 mL of juice or 30 mL of concentrate. Recent evidence suggested that pomegranate juice showed promise as a strategy to improve muscle recovery and reduce indirect biomarkers of exercise-induced muscle damage.
Magnesium is an essential mineral in the body that is involved in hundreds of chemical reactions in the body. Magnesium helps w/ blood glucose regulation, lowers lactate production during exercise, helps with Vitamin D absorption in those with deficiency, and is often low in conditionals like type 2 diabetes, metabolism syndrome, etc. Magnesium is also supplemented at times in individuals experiencing migraines.
A few studies have looked at Mg on muscle soreness and recovery. Years ago a study was published on a high level tennis player (6 hr practices) that was having muscle cramps and found to be deficient in Mg. She was supplemented appropriately and the cramps resolved, but this was an n=1 study. Another study looked at marathoners that were not deficient in Magnesium, and supplementing them with Mg prior to the race did not improve performance though it did decrease soreness 24 hours post-marathon.
A recent 2020 study looked at supplementing 350 mg Magnesium for 10 days prior to a bench press 1RM (rep max) and showed a significant decrease in post-exercise muscle soreness. Improvements in performance trended towards significance in those who were supplemented.
Studies have shown that Magnesium (Mg) status is lower in athletes w/ Achilles or patella tendon pain. Studies also show that athletes are more likely to be deficient in Mg because of inadequate dietary intake or losses through sweat and urine. We know that 60% of individuals are not meeting the recommended dietary allowance (RDA) for Mg, and this would include athletes as well. The RDA for children 9-13 is 240 mg per day, for adolescents 14-18 it’s 360-410 mg (females vs males), and for 19-70 years it’s 320 to 420 mg per day (females vs males).
Before supplementing Mg, I’d evaluate the diet of an athlete since much of the literature shows a benefit from supplementation in athletes that are not meeting the RDA or have excessive losses through sweat/urine which is detected via serum Magnesium levels. We cannot equivocally say whether Mg supplementing will or won’t benefit an athletes, but it’s prudent to get more specific about the athlete’s individual dietary intake before blinding supplementing.
Dietary sources- leafy greens (frozen spinach, ½ cup = 78 mg), nuts (1 oz brazil nuts = 107 mg; 1 oz almond = 77 mg), wholegrains (oat bran, ½ cup = 96 mg), brown rice (1 cup cooked= 86 mg), 1% cow’s milk (1 cup = 39 mg)
It’s important to note that some Calcium supplements and Multivitamins will contain vitamin D and magnesium, so it’s important to know how much you’re getting. If you choose to supplement magnesium, Magnesium Citrate is a more bioavailable (better absorbed) form than Magnesium Oxide. Magnesium citrate has a natural laxative effect, so do not take in excessive amounts. Magnesium Glycinate is also highly bioavailable (second to Magnesium Citrate).
Bottom Line- Aim for increasing dietary sources of Mg before considering supplementation. MagCalm is a product I see athletes use and it generally contains 290 mg of Magnesium (magnesium carbonate) per 2 tsp. This product is advertised for helping “relax” as they claim that stress is from too much calcium out of balance from magnesium. From my perspective, it’s more important that athletes get adequate amounts of both calcium and magnesium as they are involved in so many essential processes in the body. First from food, then from supplements. It’s important to note that excess magnesium can cause GI distress (diarrhea), so more is not better.
Many gymnasts I work with take vitamin C. I think some of the motivation is it’s touted benefit in helping fight the common cold and others have heard of it’s benefit with soft tissue injuries.
In terms of the current literature, vitamin C is highlighted in reference to collagen supplementation due to it’s involvement with the amino acid proline in collagen synthesis.
Vitamin C also helps with plant-based forms of iron (non-heme) absorption so it’s often suggested to take iron with a vitamin C supplement.
Vitamin C is also involved in hormone synthesis, specifically norepinephrine and corticoid hormones which are involved with stress.
Vitamin C is often used in wound healing. During my training as a dietitian at Duke, we had a specific wound healing protocol that had high dose vitamin C, vitamin A, zinc, and a multivitamin for major surgical wounds and burns. Vitamin C would be something to supplement after a surgery.
In terms of high doses of vitamin C (>500 mg) used to help with EIMD, there needs to be more research.
It’s not “harmful” to take 1000 mg of Vitamin C as this is a water-soluble vitamin that can be excreted if in excess, but I’d prefer athletes focus on the food sources to get all the tertiary benefits. For example, an orange has high in vitamin C and the pith (white part of the orange segments once peeled) has anti-cancer compounds that are often lost in the juicing process and certainly as a vitamin C supplement that’s just ascorbic acid.
It is true that a deficiency of vitamin C will hurt performance, but very few individuals are deficient. Specific diets, specifically low carbohydrate, ketogenic, or restrictive eating disorders could set an individual up for a clinical deficiency. Outside of those diets, it’s very easy to meet the RDA for Vitamin C which is 45-65 mg per day for 13-18 years old and 75-90 mg per day for adults (female and male). For context, a cup of strawberries has 85 mg, ½ cup cooked broccoli has 51 mg, and 1 medium orange has 65 mg.
Bottom line-You’ll likely get vitamin C from a multivitamin, I would for sure take it if supplementing with collagen for an acute injury, and taking 1000 mg per day during cold/flu season isn’t going to hurt since this is a water-soluble vitamin (but may not help either). As always, food first.
Curcumin is a natural phenolic compound found in turmeric (makes up 2-5%) that has been well studied for it’s potential anti-inflammatory effects and ability to reduce EIMD. One of the biggest issues with curcumin is it’s bioavailability or ability to be absorbed in the body because of it’s structure. Importantly, curcumin has poor aqueous solubility, has low absorption volume from the gut, is rapidly metabolized and is excreted quickly. Studies have used “novel” drug delivery vehicles in effort to maximize absorption.
Importantly, curcumin, like many other polyphenols, has poor bioavailability that can be improved with piperine co-ingestion or a lipid preparation (fat). Piperine is the major component of black and long peppers and has been shown to inhibit enzymatic conjugation of curcumin allowing greater levels of unconjugated curcumin to be absorbed into blood (Shoba et al. 1998) and increase curcumin tissue retention time. Lipid formulations like BCM-5 and Meriva dosed are 200-500 mg twice a day are used.
Literature supports doses of 1,000 – 1,500 mg of curcumin daily can help decrease inflammation, stiffness and pain due to cartilage wear and tear (osteoarthritis), along with muscle damage and perceived soreness. Low does curcumin does not seem to decrease muscle pain from exercise / training.
Curcumin works by modifying NF-κB signaling, proinflammatory cytokines such as interleukin production and phospholipase A2, COX-2, and 5-LOX activities.
Notwithstanding, it appears that curcumin has good potential as an intervention to attenuate EIMD, particularly if metabolites are bio-available in a 24-h window.
Do not take curcumin supplements if you are taking a blood thinning medication as it may increase bleeding. If you are on medications, talk to your pharmacist first before taking curcumin. Give them the specific supplement you want to take as the piperine in some curcumin supplements might increase drug absorption.
Ground turmeric has also been known to have lead contamination.
Bottom line– Turmeric (curcumin specifically) is a supplement I’d focus on after the “big rocks” are in place and Vitamin D, Magnesium, and Iron status have been checked. Just increasing the amount of turmeric in your meals is not going to be sufficient to see a potential beneficial anti-inflammatory effect, though it likely won’t hurt.
Red beetroot (Beta vulgaris rubra) has shown some potential to reduce EIMD and soreness, but the benefits appear small and what’s consider “perceptual”, meaning difficult to measure as research study participants report their perceived “pain” or “soreness” which is subjective. High nitrate foods like beets, celery, leafy greens, beets, etc provide nitrates which are converted to nitric oxide in the body.
Nitric oxide may help increase blood flow and thus potentially reduce inflammation and enhance recovery. Authors in this review conclude that thought the benefits appear small, if you can tolerate the taste of beetroot juice it isn’t going to harm.
Bottom Line– I would not necessarily add this supplement until the big rocks of nutrition are in place and other more proven interventions are tried like omega 3’s or tart cherry juice.
When evaluating a gymnast’s diet and need for supplementation to help with muscle soreness and inflammation, I’d first ensure the “big rocks” of nutrition are in place. I’d then ask 1) Where can foods be added in the diet to provide some of these beneficial nutrients in fighting muscle soreness and inflammation (fatty fish for omega 3’s, leafy greens for magnesium, etc) and 2) How much does this specific gymnast need in addition to her optimized diet in terms of supplements.
Remember that “more is not better” when it comes to nutrition, and you don’t want to just blindly start supplementing as this can throw off the balance of vitamins/minerals in the body or cause an unintended effect.
As always, feel free to contact me if you have specific questions or concerns for yourself or your athlete.