Physiology and Nutrition: Strategies for Acute Recovery (Part 1)

crashRight next door to my office a new niche recovery lounge has opened up (RechargeSportSF.com) attending to the most under-emphasized aspect of training: Recovery. There are several types of recovery: the acute phase (the minutes to hours after training or racing), the day to day/week to week recovery, and, as we saw in the TdF, the recovery from traumatic crashes and broken bodies offered up by the precariousness of the peloton. In this article, I will focus on the acute recovery from a crash or surgery and exercise-induced muscle damage. (Part 2 will explore different modalities and optimal timing).

One of the biggest risks of our sport is crashing; the injuries ensuing -from broken collarbones to muscle crush injuries- are coupled with a long, arduous recovery process. It is well known (and most of us have experienced, at some point in our cycling careers) that the first week or two post injury is the hardest, with regard to regaining range of motion/movement and regaining muscle strength-firing patterns.

Injuries and consequent surgery are associated with hormonal and inflammatory stress responses that trigger a rapid muscle loss. In the first two weeks of disuse from injury, 150-400g of muscle mass can be lost from a single immobilized limb; coupled with metabolic changes that reduce the body’s ability to build muscle. Of additional concern is the functional strength loss from disuse; in general, this strength decline is approximately three times the rate of muscle mass loss. This functional strength loss is attributed to alterations in motor unit recruitment and the loss of skeletal calcium and magnesium stores (necessary for muscle contractions).

In the first week of immobilization, the general thought is the muscle mass loss is due to disuse. However, it is more an impairment in muscle-protein synthesis coupled with an increase in protein turnover that results in the muscle mass loss. As with most injuries, there comes a decrease in overall physical activity and a reduced energy intake. The reduced energy intake is a key point here: when trying to minimize muscle loss, inadequate protein intake accelerates muscle loss during disuse. By manipulating the diet to maintain adequate protein intake (~1.6 to 1.8g per kg body weight), the rate of muscle mass loss will slow, but will not be alleviated completely (due to a hormonal change that decreases the body’s ability to build muscle-aka anabolic resistance).

How to overcome Anabolic Resistance?

It is more than just “eat more protein”. Recent research has been investigating dosage as well as type of protein to garner the biggest anabolic response. What has been found is the anabolic response to a dose of protein increases in a dose-response manner. In healthy, young men, a 20-25g dose elicits maximal protein synthesis rates but in healthy older (>65y) men who have an anabolic resistance to dietary protein intake, this dose increases to 35-40g to maximize protein synthesis rates. Comparing healthy to injured young men, the dose response for the injured is akin to the dose needed in older men (35-40g). In the scheme of things, a frequent dose of 35-40g of protein can be difficult to consume (especially with reduced energy requirements). This is where the specific anabolic properties of protein come into play. The two critical properties are the digestion-absorption kinetics and the overall amino acid profile. For example, whey protein, which is more rapidly digested and absorbed than soy or casein has been shown to be more anabolic. However, when the soy or casein has been treated to have similar digestion and absorption rates to whey, they still do not exhibit the same anabolic responses. This is where the amino acid profile plays an important role: the greater the leucine content, the greater the stimulus for muscle protein synthesis.

Why Leucine? High stress exercise, injury, and post-exercise recovery all change amino acid and protein metabolism in skeletal muscle, with an increase in the metabolism of leucine. Specifically, the damage in the muscle tissue stimulates the breakdown of branched chain amino acids (coupled with total muscle cell breakdown) and in the recovery state, tissue levels of leucine must be increased in order to shut down the breakdown signals. The greater dietary intake of leucine, the faster the tissue levels rise which hastens the signaling of muscle synthesis. (Within the 35-40g of whole protein, the leucine content should be 2.5-3 grams.) Of particular interest is the recent research in the co-ingestion of protein and carbohydrate to elicit muscle synthesis. The current thought is that with carbohydrate, there is an increase in insulin release, which works with leucine to improve muscle cell synthesis. In states of anabolic resistance (injury, stress, age), co-ingestion of carbohydrate with protein slows the rate at which the protein is digested and absorbed and does not improve the rate of muscle synthesis. Thus, a 4:1 ratio of carbohydrate to protein will not improve muscle synthesis over dosages of 20-40g protein alone.

To further enhance muscle repair and to slow down muscle loss, fish oil (omega-3 fatty acids) supplementation has been making a mark. Specifically, long term supplementation (4g per day) has been shown to boost the anabolic sensitivity to amino acids. The omega-3 supplementation effect is not from dampening inflammation, but apparently sensitizing molecular pathways responsible for muscle cell synthesis.

What does all this mean? And how to put it all together?

If you are in a high stress state and/or are injured, with the potential of muscle mass loss (or lack of being able to put muscle on due to high stress and training loads), dosage of high quality (high leucine content) protein, timing of ingestion, and use of omega 3 fatty acids will help preserve and build muscle. Let’s use a hypothetical 160lb guy who has a major crash and ends up with a broken collarbone and a significant quadriceps crush injury. To reduce muscle mass loss and preserve strength during recovery, the ideal recommended daily protein intake is 116-130g of protein, ideally spread across four main meals (30-32g per meal with 2-3g of leucine). This amount counteracts the anabolic resistance caused by injury and with the timing, this equal spread keeps muscle synthesis rates elevated over a 24 hour period. In addition to the evenly spaced protein doses, a split supplementation of 4g omega-3 fatty acids (2g in the morning, 2g before bed) will maintain the upturn of muscle synthesis signaling.

Injury, crashes, and high stress are unfortunately unavoidable in our sport, but knowing how to manipulate the body’s responses to minimize muscle and strength loss will shorten the recovery time and get you back on your bike!

(Part 2: Modalities: compression, cooling, neuromuscular electrical stim, massage, and timing. Note- if there are other modalities you are interested in, drop a note and I’ll cover it!)


Dr Stacy Sims cofounder of OSMO and Bikerumor contributorStacy Sims, MSc, PhD, served as an exercise physiologist and nutrition scientist at Stanford University specializing in recovery and nutritional adaptations for health, body composition, and maximizing performance. During the past decade she has worked as an environmental physiologist and nutrition specialist for top professional cyclists and triathletes, ultra-endurance athletes, the Garmin/Slipstream Pro Cycling Team, USA Cycling Olympic Team (BMX and women’s track cycling), Team Tibco, Flying Lizard Motorsports, and Team Leopard-Trek, among others. She competes as a Cat 1 road cyclist and elite XTerra triathlete and is co-founder of OSMO Nutrition.

Suggested Reading:

  1. Wall BT, Morton JP, and van Loon, LJC. Strategies to maintain skeletal muscle mass in the injured athlete: Nutritional considerations and exercise mimetics. Eur J Sport Sciences; Jul 2014.
  2. Gorissen S, Burd N, Hm H, Gijsen A et al. Carbohydrate co-ingestion delays dietary protein digestion and absorption but does not modulate postprandial muscle protein accretion. J Clinical Endo Metabol, 2014; 99(6): 2250-2258.
  3. Hamer H., Wall B., Kiskini A, de Lange A., et al. Carbohydrate co-ingestion with protein does not further augment post-prandial muscle protein accretion in older men. Nutr Metabol, 2013; 10(1): 10-15.
  4. Sousa M, Teixeira VH., and Soares J. Dietary strategies to recover from exercise-induced muscle damage. Int J Food Sci Nutr, 2014; 65(2):151-163.

Comments

steve - 08/08/14 - 1:03pm

i understand gels are good for recovery

Dominic Giampaolo - 08/08/14 - 3:14pm

So a couple of eggs/egg-whites in the morning, a tuna-fish sandwich for lunch and some grass-feed beef for dinner and you’re golden, right?

stacy - 08/08/14 - 4:16pm

@Dominic yep, that’s about right!

purito - 08/08/14 - 6:55pm

I hear that Skratch Labs is coming out with a new crash recovery blend. Stay tuned!

Fleche1454 - 08/08/14 - 8:13pm

This article is exactly why I can’t come to grabs with local racing anymore. Someone gets a little to in the zone at the end of the race and you cross wheels and you are in the hospital and your bike is broken and it messes with your work. Racing karts if you crash you can fix damage which is mostly tires whch you replace and your ribs get bruised if you have an impact.

A - 08/08/14 - 8:30pm

I would be wary of this article. Eating 100+ grams of protein is extremely unnatural.

carbon12 - 08/08/14 - 9:42pm

100+ grams, unnatural? Seriously? You must be a vegetarian with an iron deficiency. Protein builds and repairs muscle. When you’re and athlete, you should be consuming at least that, preferably more.

B - 08/09/14 - 11:03am

A – you apparently haven’t bro’d down with your local bros at the gym.

kurti_sc - 08/11/14 - 1:14pm

According to Wiki, a 10oz Ribeye has about 69g of protein. I can’t really eat a full 10oz, I mean I can, but i’m usually pretty full about 2/3rds of they way through (add in the other side items, too!).
Other sites claim that active people should be in the 60 – 100g of protein per day, too. So the advice above doesn’t seem to be out of the ordinary. I just wouldn’t do it all in one sitting with red meat every day… and most of us wouldn’t.
Thanks BR for the insight here. I hope I won’t need this type of recovery (crash – broken bones) any time soon.
@Purito. I surely hope you are in jest there. I chuckled out loud.

AJ - 08/11/14 - 3:28pm

Solid article, as always. One question/clarification:

You note that co-ingestion of carbs with protein typically encourages muscle syn; however, if in states of anabolic resistance, co-ingestion does NOT encourage muscle syn. Does these “states of anabolic resistance” include DOMS from ‘overtraining’? [Because, wow, isn't this very frequent for any serious athlete?]
Are common muscle-crush injuries included there as well?

Also, I assume that you’re referencing Burd et al with the abovementioned carb/protein note; can you recommend other studies on this?

Thanks again.

stacy - 08/11/14 - 7:34pm

@AJ
The DOMs is not part of this intensive anabolic resistance as it isn’t a severe trauma like a crush injury or other that causes a complete immune response.
The Gorrissen et al as well as the Hamer et al are two of the most recent studies looking at dose depend actions of protein with and without carbohydrate.
Wall, Morton & vanLoon “Strategies to maintain skeletal muscle mass in the injured athlete: Nutritional considerations and exercise mimetics” Euro J Sports Sci, 2014 Jul 16: 1-10. is also a good review.

Durianrider - 08/11/14 - 8:42pm

This is laughable. You have pro cyclists that abuse corticosteroids so they can LOSE muscle mass and then you have someone who works for a supplement company promoting high whey protein intake to PRESERVE muscle mass.

Look at Nibali, Wiggins, Contador and Froome. NONE of them have ANY real strength but they can all push 6.5w/kg for at least 30mins end of a 5 hr stage in the sun.

Anyone reading this can push that wattage quite easily but only for a few minutes or 30 seconds. Most people here could bench press or squat as much as a pro tour GC rider. Why do we need more muscle mass? This is cycling, not NFL. Even the steroid cycles pro riders do is a LOT less so they don’t bulk up too much.

#smellslikesnakeoil

AJ - 08/12/14 - 9:21am

@Durianrider
With respect to your comment, you seem to have assumed a thesis other than what Sims is positing. She’s merely pointing out that injuries cause a loss of muscle mass, and offering a synthesis of research findings on how to prevent said loss.

Now: Could cyclists gain more w/kg by loosing some weight? Most likely. That’s just not her point.

As far as you and other folks calling BS on Sims, I understand the knee-jerk skepticism. But if you actually read the research, and if you read her prior writing/comments in other articles, it’s not “snake oil.” In fact, one thing that has led me to trust her is one article she wrote about hydration and blood osmolality. Though she obviously has a special commercial interest in this subject (OSMO), she clearly stated that you could effectively hydrate with a home-made concoction of salt and sugars. She wasn’t just pushing her product. The same goes for her stance on gels. She’s offering solutions you can DIY, so long as you approach the valid problems with awareness instead of rote cynicism.

Jose D - 08/14/14 - 1:52pm

Stacy, thank you for another great read! Would Leucine supplementation be useful in a heavy training load week(s) and/or a heavy racing month? If so, how would that work if one is also using OSMO Acute Recovery Post-training/racing? Is the supplement best pre/post training or should it be with meals or between meals or at bedtime? Finally, is there any specific brand or formulation that you recommend to your athletes? Powders taste terrible and then they mix them with a bunch of chemicals and artificial sweeteners, which is worrisome and then if you go the capsule route one needs to ingest 6-9 capsules/tablets at once multiple times per day! Thanks!

Post a comment:

Comment sections can be a beautiful source of knowledge, conversation and comedy. They can also get pretty ugly, which is why we've updated our Comments Policy. If your comment isn't showing up or suddenly disappears, you might want to check it out.