Latest / The ACL Athlete Podcast / 071 | Nutrition + ACL Rehab with Emily Barnhart, Sports RD - Part 1

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071 | Nutrition + ACL Rehab with Emily Barnhart, Sports RD - Part 1 · The ACL Athlete Podcast

0:19
SPEAKER_01: Welcome everyone to the ACL Athlete Podcast.
0:23
SPEAKER_01: This is the podcast where we talk about everything related to the ACL, whether that's the injury itself, the rehab process, return to sport, and more.
0:33
SPEAKER_01: I'm your host, Dr.
0:34
SPEAKER_01: Robbie Patel, performance physical therapist and coach.
0:38
SPEAKER_01: Between myself and fellow guests and experts, you'll learn through the lens of the patient, the healthcare professional, and the coach.
0:46
SPEAKER_01: The goal of this podcast is to equip you, the athlete, with the education to make the best informed decision about your care and your ACL journey.
0:57
SPEAKER_01: Thanks for joining.
0:58
SPEAKER_01: Now let's dive into today's episode.
1:03
SPEAKER_01: Welcome back, everyone, to the ACL Athlete Podcast.
1:07
SPEAKER_01: This is your host, Robbie Patel, and today I'm so pumped and excited.
1:12
SPEAKER_01: We have Emily Barnhart on the podcast today.
1:16
SPEAKER_01: Emily, how are you?
1:17
SPEAKER_00: I'm good.
1:18
SPEAKER_00: Thanks for having me, Robbie.
1:19
SPEAKER_01: Of course.
1:20
SPEAKER_01: Emily is a registered dietitian that runs her own practice specializing in nutrition for injuries and rehab called the injury RD.
1:30
SPEAKER_01: Prior to that, she worked in collegiate and professional athletics, most recently with the Texas Rangers, and is currently a consultant with uh USA volleyball.
1:40
SPEAKER_01: Emily, thank you so much for being here and welcome to the show.
1:44
SPEAKER_00: Yeah, again, I'm excited to be on here and have this chat.
1:48
SPEAKER_01: So give us a little bit about your background.
1:51
SPEAKER_01: You know, we talked a little bit about uh, you know, registered dietitian and some of your history, but talk about your background, what got you to this point you're at right now?
2:00
SPEAKER_00: Yeah, so actually my undergrad and master's degree are both in exercise physiology.
2:06
SPEAKER_00: I originally wanted to be a strength coach and then did an internship with a football team and learned very quickly that I am not the right personality to be a strength coach.
2:15
SPEAKER_00: Yeah.
2:15
SPEAKER_00: But long story short, um, during my master's, I learned that sports nutrition existed and felt very strongly that my athletic career would have looked a little bit different if I had known some of this information then.
2:29
SPEAKER_00: So swerved and yeah, now I'm a registered dietitian and I love it.
2:36
SPEAKER_00: I love it every day.
2:37
SPEAKER_01: That's awesome.
2:38
SPEAKER_01: Yeah, I think it's very unique.
2:40
SPEAKER_01: You have a special background, especially when you come into performance as a strength conditioning coach.
2:46
SPEAKER_01: And it's always cool, like, you know, you get to dive into these different realms of performance, um, whether it's weight training or especially nutrition, and they go hand in hand.
2:55
SPEAKER_01: So it's cool that you kind of pivoted towards that.
2:58
SPEAKER_01: And I think it's a very much needed area, especially when it comes to injuries, which is your specialty, right?
3:06
SPEAKER_00: Yeah, yeah.
3:07
SPEAKER_00: When I was working in Pro Ball, obviously we had a lot of Tommy John injuries, which is uh an elbow injury that pitchers will get.
3:14
SPEAKER_00: And if you know anything about it, it's a very long rehab process.
3:19
SPEAKER_00: So getting to see intimately what their rehab looked like and the group that they put together to support that athlete.
3:26
SPEAKER_00: And um yeah, some of the struggles they were going through, I was just like, wow, we need to do a better job of supporting these guys.
3:36
SPEAKER_00: Um, so I took that and ran with it.
3:39
SPEAKER_01: Yeah, it's it's one of those things that especially during rehab, and obviously we're focused mostly on ACL injuries, but it's not like nutrition isolates and focuses just on one injury in terms of what you take into your body.
3:54
SPEAKER_01: So Tommy John is actually a good kind of parallel to ACL injuries because of the length of a recovery.
4:01
SPEAKER_01: And the only other one I can really think of is maybe an Achilles tendon, um, where someone recovers from that.
4:07
SPEAKER_01: There's they're so unique, they're such a long process.
4:11
SPEAKER_01: And so what can easily get missed is the nutrition piece.
4:16
SPEAKER_01: There's so many athletes I talk to where they uh they might be crushing it on the rehab side, but then they're might be making not as not as good a progress as they hope to be.
4:27
SPEAKER_01: And when we ask about the nutrition side, uh they they're not really checking the boxes on the things they need to be working on, right?
4:35
SPEAKER_01: And so that's one of the things today that I want to talk about is essentially when we talk about, so let's take a step back and let's talk about the macronutrients, just nutrition, the big umbrella.
4:49
SPEAKER_01: Give us a very simple breakdown of those uh macronutrients or macros that we say.
4:56
SPEAKER_00: Yeah.
4:56
SPEAKER_00: So obviously there are three macronutrients, technically four, but we don't talk about alcohol.
5:01
SPEAKER_00: You know, you can do that on your own time.
5:03
SPEAKER_00: Right.
5:03
SPEAKER_00: But carbs, protein, and fat.
5:06
SPEAKER_00: Carbs are hopefully being used for energy.
5:09
SPEAKER_00: And when it comes to rehab athletes, they tend to give us a lot of the nutrients that we're looking for.
5:15
SPEAKER_00: So I see a lot of rehabbers try to automatically cut out carbs, and I will fight that till my dying day.
5:21
SPEAKER_00: You still need some carbs.
5:23
SPEAKER_00: Right.
5:23
SPEAKER_00: Fat is our other form of energy.
5:26
SPEAKER_00: So we're getting energy from carbs and fat.
5:28
SPEAKER_00: Fat is also helpful for hormones.
5:32
SPEAKER_00: And then protein, of course, hopefully is not being used as an energy source.
5:37
SPEAKER_00: It's metabolically kind of difficult to use protein, and it's hopefully only being used as a building block.
5:43
SPEAKER_00: So your tissues are always breaking down.
5:45
SPEAKER_00: Protein is what we need to continue to repair that.
5:48
SPEAKER_00: And obviously, during rehab, that is super important.
5:52
SPEAKER_01: Right.
5:52
SPEAKER_01: And then what about you'll hear the term called micronutrients thrown around as well.
5:57
SPEAKER_01: What are those in uh kind of a nutshell?
6:00
SPEAKER_00: Yeah, micronutrients are your vitamins and minerals.
6:03
SPEAKER_00: Um, and there's some specific micronutrients that uh I pay attention to with all the rehabbers that I work with, uh, which we can get into if you want.
6:12
SPEAKER_01: Yeah, so that leads perfectly into preparing for ACL surgery.
6:18
SPEAKER_01: So I get this question all the time.
6:20
SPEAKER_01: It's, you know, how is nutrition different for someone who is going through this process?
6:27
SPEAKER_01: So, what I'd like to do is kind of focus on the before during after for ACL surgery.
6:34
SPEAKER_01: So if you want to kind of walk us through that and what is your approach to that?
6:39
SPEAKER_00: Yeah, the way that I think about before, during, after in general is you can break rehab down into parts.
6:47
SPEAKER_00: And then I always think of nutrition as how can we support what PT is trying to work on or what you're trying to work on in the weight room.
6:56
SPEAKER_00: So you're putting the external work there.
6:58
SPEAKER_00: How can we support that from the inside out?
7:00
SPEAKER_00: And obviously, Ravi, connect, correct me if I'm wrong, but prior to surgery, our main goals are range of motion, which nutrition can't really affect.
7:09
SPEAKER_00: Right.
7:09
SPEAKER_00: But also we're working on building, you know, integrity within that muscle and getting as strong as possible heading into surgery, right?
7:17
SPEAKER_01: Yeah.
7:17
SPEAKER_01: Okay.
7:18
SPEAKER_01: Yeah.
7:18
SPEAKER_01: Oh, absolutely.
7:19
SPEAKER_01: One of the biggest things is making sure we minimize atrophy.
7:22
SPEAKER_01: So make sure the muscle doesn't get small, but also can we still maximize the hypertrophy?
7:27
SPEAKER_01: Can we get it bigger and get it ready for surgery?
7:30
SPEAKER_00: Correct.
7:30
SPEAKER_00: Obviously, nutrition can play a role in that one.
7:33
SPEAKER_00: Um, and there's really two things that it comes down to.
7:36
SPEAKER_00: One, are you eating enough?
7:38
SPEAKER_00: Because anytime you're not getting enough calories, things are breaking down, including that muscle.
7:43
SPEAKER_01: Yeah, yeah, absolutely.
7:45
SPEAKER_00: And two, are you getting enough protein?
7:47
SPEAKER_00: And protein is a huge topic that we're gonna talk about.
7:49
SPEAKER_00: And I'm probably gonna start sounding like I'm repeating myself, but it's it's easier said than done.
7:56
SPEAKER_00: You know, ideally in a perfect world, we're getting 20 to 30 grams of protein every three to four hours.
8:05
SPEAKER_00: And that is the best that we know to continuously signal to that muscle, like, hey, we still need you.
8:11
SPEAKER_00: We want you to continuously build up.
8:14
SPEAKER_00: Versus we actually know that that 20 to 30 grams every three to four hours is better at that signal than 10 grams every two hours or 60 grams every six hours.
8:26
SPEAKER_00: So the biggest thing that I'm working on at all times with my athletes is that pattern.
8:32
SPEAKER_00: Are you eating breakfast?
8:33
SPEAKER_00: Are you eating lunch?
8:34
SPEAKER_00: Are you eating dinner?
8:35
SPEAKER_00: Are you eating snacks?
8:36
SPEAKER_00: And nine times out of 10, that is the first place we're starting because we all know plenty of people that skip breakfast or just have a coffee for breakfast.
8:45
SPEAKER_00: They skip lunch and then they're starving at night and they have a huge dinner.
8:49
SPEAKER_00: That's kind of one of the worst things you can do from a muscle standpoint and a protein standpoint.
8:55
SPEAKER_01: Yeah.
8:55
SPEAKER_01: So what you're saying here is making sure that there's a consistent pattern of getting protein into your system in order to make sure we're facilitating that, that way there's not too many highs and lows.
9:08
SPEAKER_01: And obviously there's a big piece to this of the amount that you're getting as well.
9:13
SPEAKER_00: Yeah.
9:13
SPEAKER_00: Yeah.
9:14
SPEAKER_00: And if we want to talk numbers on the amount of protein before, during, after surgery, it's all going to be the same.
9:21
SPEAKER_00: We are aiming for your body weight and protein, basically.
9:25
SPEAKER_00: So if I'm 150 pounds, I'm looking for 150 grams of protein a day.
9:31
SPEAKER_00: It can get a little bit higher if you're a vegetarian and getting mostly plant-based sources of protein, you know, just for availability reasons.
9:41
SPEAKER_00: But for the most part, we're looking for body weight and protein.
9:44
SPEAKER_00: So again, that's for most people 20 to 40 grams at every meal, trying to include at least 10 grams in every snack.
9:52
SPEAKER_00: Or an even easier way to think about it is at every meal, do you have a hand-sized portion of protein on your plate?
10:00
SPEAKER_00: So that's palm plus fingers laying flat in front of you.
10:03
SPEAKER_00: That's what your piece of chicken should look like.
10:06
SPEAKER_01: Okay.
10:07
SPEAKER_01: Yeah, that's great.
10:08
SPEAKER_01: And so essentially what you're saying is one gram per pound body weight is roughly a good rule of thumb in terms of trying to get the amount of protein per day in.
10:19
SPEAKER_00: Yep.
10:19
SPEAKER_00: Yep.
10:19
SPEAKER_00: That's usually the starting point.
10:21
SPEAKER_00: And then obviously, like I said before, carbs and fats and other things are important too.
10:26
SPEAKER_00: Um, and I usually build those around the protein.
10:29
SPEAKER_01: Gotcha.
10:30
SPEAKER_01: So how does that differ?
10:32
SPEAKER_01: And I know a lot of this comes back to activity and people's daily lifestyles.
10:37
SPEAKER_01: I know that has to be factored in in order to kind of give a good breakdown of what people need.
10:42
SPEAKER_01: But how do the other pieces?
10:44
SPEAKER_01: So let's talk about carbs and fats, how does that play into the before, during, or after?
10:50
SPEAKER_01: Do you change anything up with those?
10:52
SPEAKER_00: Yeah.
10:53
SPEAKER_00: I think a lot of athletes like to think in extremes.
10:57
SPEAKER_00: And we don't have to do that here.
10:59
SPEAKER_00: We can operate in a gray area.
11:01
SPEAKER_00: So yeah, just including those regularly throughout your day too.
11:05
SPEAKER_00: If we want to talk about portions, most people need a spoon or two of fat at every meal, or you can use your thumb if we want to go with our hand measurements again, and about a fist or two of carbs at every meal.
11:20
SPEAKER_00: So again, if you're spooning rice onto your plate, does that pile of rice look about the size of your fist?
11:26
SPEAKER_00: Or actually for most athletes, it's two, sometimes even three fists.
11:31
SPEAKER_01: Gotcha.
11:32
SPEAKER_01: Okay.
11:33
SPEAKER_01: And so what about uh protein shakes?
11:36
SPEAKER_01: I'm sure you get a lot of questions about this, but how do you fit this in in terms of you'll hear some people say, oh, well, it's not a natural source versus, you know, if we're trying to get 150 grams of protein, you're not gonna eat seven chicken breasts in a day.
11:51
SPEAKER_01: Yeah.
11:51
SPEAKER_01: So, you know, so question is, you know, with protein shakes, how do you incorporate those?
11:57
SPEAKER_00: Yeah.
11:57
SPEAKER_00: Yeah.
11:57
SPEAKER_00: I mean, there's definitely a way to do it through food, especially if you're eating meat and dairy.
12:02
SPEAKER_00: But a protein shake can be very helpful.
12:05
SPEAKER_00: And I'm totally fine with that, especially in the morning.
12:08
SPEAKER_00: A lot of people find a protein shake or smoothie easier to get down if they're not big breakfast eaters, but we're working on being better.
12:16
SPEAKER_00: Um, but notice that I said a protein shake.
12:20
SPEAKER_00: Yeah.
12:20
SPEAKER_00: I think uh sometimes the issue comes when, you know, at the end of the day, you're you've done six scoops of protein powder.
12:29
SPEAKER_00: One, you're missing out on other things if you're going for it that much.
12:33
SPEAKER_00: And two, that normally doesn't sit well in people's stomach.
12:36
SPEAKER_00: So then they come to me and they're like, yeah, and you know, we don't have to get into the visuals of all the stomach problems that I hear about day after day, but one scoop, maybe two to help you hit that goal, but you don't need a protein shake at every meal, or you shouldn't.
12:51
SPEAKER_00: Um, and if you're struggling, then talk to a dietitian and we'll help you figure out something that's gonna work for you.
12:57
SPEAKER_01: Right.
12:57
SPEAKER_01: So with protein and those values, is there any time?
13:03
SPEAKER_01: So I know you mentioned if you're plant-based, you might increase the number.
13:06
SPEAKER_01: Is there any other time during around an injury or a surgery that you will potentially increase the values of the protein that you're looking for the athlete?
13:17
SPEAKER_00: Not really.
13:18
SPEAKER_00: Protein is pretty stable.
13:20
SPEAKER_00: I mean, uh, you know, a lot of people think of protein as we need it as a post-workout.
13:26
SPEAKER_00: One, your workouts, especially in the beginning stages of rehab, aren't super intense.
13:30
SPEAKER_00: Uh and two, again, that pattern is more important than you know, our pre and post workout timing right now.
13:39
SPEAKER_00: So, again, really, really focusing on getting high quality, even distributions of protein throughout the day.
13:45
SPEAKER_01: Gotcha.
13:46
SPEAKER_01: And so then when we're talking about protein sources, what are your go-to that you typically tell your athletes?
13:55
SPEAKER_01: Maybe some easy strategies or just go-tos that you give to your athletes.
14:01
SPEAKER_00: Yes, I think uh, I mean, anytime we're talking about sources, uh, it's hard to give general recommendations because I always want to consider what are people's budgets, what do people like, what you know, what do people feel comfortable cooking, that kind of stuff.
14:15
SPEAKER_00: Uh, but there are a lot of kind of easy hacks out there.
14:18
SPEAKER_00: So you can always find protein waffles and um there's higher protein cereal options like Kashi is a good one, or Special K has one that's more than 10 grams.
14:27
SPEAKER_00: Um, there's higher protein milk options.
14:29
SPEAKER_00: Dairy itself is a great way to get some protein in.
14:33
SPEAKER_00: I feel like we have a big fear of dairy in this country right now.
14:37
SPEAKER_00: Um so even if you're not drinking milk, a lot of the milk alternatives make sure they have at least eight grams of protein per cup.
14:44
SPEAKER_00: And then there's some tricks.
14:45
SPEAKER_00: Like if you're someone that loves to eat chips, if we can find a way to pair that snack with a protein.
14:53
SPEAKER_00: So chips and salsa, you can listen.
14:56
SPEAKER_00: This sounds weird.
14:57
SPEAKER_00: I learned about this like two months ago.
14:59
SPEAKER_00: Don't knock it till you tried it.
15:01
SPEAKER_00: Mix your salsa with some cottage cheese.
15:04
SPEAKER_01: And oh, interesting.
15:06
SPEAKER_00: And dip your chips in it, and you are getting a more balanced snack and you're sneaking in some extra protein in there.
15:11
SPEAKER_00: Same thing if you love ruffles, they sell ranch dressing and packets.
15:16
SPEAKER_00: You can mix that in some plain Greek yogurt.
15:18
SPEAKER_00: And again, you're making um a snack that a lot of us would classify as unhealthy into a more balanced option.
15:26
SPEAKER_00: And that's always the way that I operate.
15:28
SPEAKER_00: I'm never gonna take away the things that you love.
15:30
SPEAKER_00: I mean, I've had athletes that love Doritos, and we do the ranch and Greek yogurt option, and I let them eat their Doritos and they love that.
15:37
SPEAKER_00: We just make it more balanced.
15:39
SPEAKER_01: Yeah, that's brilliant.
15:40
SPEAKER_01: That's I love finding ways that you can take the athlete or their lifestyle and be able to implement different strategies to make sure you guys are kind of getting both of what you want.
15:53
SPEAKER_01: They're hitting the protein numbers and they're also getting their Doritos, right?
15:56
SPEAKER_01: Like that's a really cool way to look at it.
15:58
SPEAKER_01: And then being able to sneak it in.
16:00
SPEAKER_01: And I think one thing that's easy uh for people to sometimes look at nutrition, especially protein, is like I got to either have a shake or a protein or a chicken breast or something kind of like black and white when there's different ways, like you had mentioned, whether it's the cereal or protein waffles.
16:18
SPEAKER_01: So think about maybe what you're eating now and what is it that you can kind of sneak in to be able to try and hit those numbers that you had mentioned every few hours, but also total in the day.
16:30
SPEAKER_00: Yeah.
16:30
SPEAKER_00: And I think you know, you kind of touched on this too.
16:33
SPEAKER_00: People assume if I'm trying to eat 150 grams of protein, I need eight chicken breasts every day.
16:39
SPEAKER_00: Right.
16:39
SPEAKER_00: Keep in mind that your carbohydr most of your carbohydrate sources also have a few grams of protein in there.
16:45
SPEAKER_00: Right.
16:46
SPEAKER_00: And again, if you're including that at every meal, you're including some whole grains at breakfast, you're including some beans at lunch and things like that.
16:53
SPEAKER_00: That kind of adds up too.
16:55
SPEAKER_00: So it hopefully doesn't feel as daunting to see those numbers when you actually kind of do the math and see, oh, you are sneaking some in some places.
17:06
SPEAKER_01: Yeah.
17:07
SPEAKER_01: And so uh one thing I want to make sure we address before we move forward is eating too much protein.
17:15
SPEAKER_01: This is the classic question I will get.
17:17
SPEAKER_01: I know any of my dietitian friends, uh, we talk about this, but you know, what happens to your kidneys?
17:23
SPEAKER_01: The myth of like too much protein is bad.
17:26
SPEAKER_01: Uh, so let's talk about this.
19:33
SPEAKER_00: Yeah, yeah, this is a very nuanced question.
19:35
SPEAKER_00: So if you have kidney problems, there is such a thing as too much protein.
19:43
SPEAKER_00: If you don't have kidney problems, there's really not.
19:47
SPEAKER_00: However, if you remember what we talked about in the beginning with macros, we don't really want our energy to come from protein.
19:55
SPEAKER_00: We want it to come from carbs and fat.
19:57
SPEAKER_00: So if you're looking at your macro breakdown and your protein intake is 40%, sometimes even 30% or higher, you're going to run into that metabolism and issue where you're making your body work harder for its energy.
20:16
SPEAKER_00: And there are certain cases where that's helpful, like weight loss, but right now we're focused on healing and and we can still achieve weight loss without, if that's the goal, without going super, super high on protein.
20:30
SPEAKER_00: The other thing is when your protein is that high, again, we're typically looking at some stomach issues.
20:35
SPEAKER_00: Constipation is a big one.
20:37
SPEAKER_00: Uh, if you are getting too much protein in.
20:41
SPEAKER_00: Um and yeah, uh, are you potentially missing out on the other nutrients that we're getting from carbs and fat if you if you're focusing too much on protein?
20:51
SPEAKER_01: Got it.
20:52
SPEAKER_01: Okay.
20:53
SPEAKER_01: And so uh this is actually a funny kind of segue, but uh a lot of people post-surgery, especially after ACL, will deal with constipation.
21:03
SPEAKER_01: Yeah.
21:04
SPEAKER_01: So talk talk to me a little bit how we can help our ACL athletes out with feeling better.
21:09
SPEAKER_01: And I know that has to do with the medication they're taking as well as the mobilization and things like that.
21:15
SPEAKER_01: But talk to us about a better route to tackle the constipation.
21:18
SPEAKER_00: Yeah, yeah.
21:19
SPEAKER_00: The big three that I see post-surgery are constipation, diarrhea, and nausea or just like no appetite.
21:26
SPEAKER_00: So if we're talking about constipation, one, if it's been more than three or four days, it's time to call your doctor.
21:33
SPEAKER_00: Food can only do so much, right?
21:35
SPEAKER_00: But if you are struggling with it, try to slowly increase your fiber every day.
21:41
SPEAKER_00: Like an extra five grams a day.
21:44
SPEAKER_00: If you add too much too quickly, you can actually contribute to the problem.
21:48
SPEAKER_00: So an extra five grams would be eat your normal diet, but add in a piece of fruit or swap out your white bread for a whole grain bread on your lunch sandwich that day.
22:00
SPEAKER_00: And just slowly add five grams for three to four days and see if that makes a difference.
22:05
SPEAKER_00: Hydration also plays a big role in this.
22:08
SPEAKER_00: So make sure you're drinking plenty of water and getting electrolytes too.
22:12
SPEAKER_00: And then the other one is magnesium.
22:14
SPEAKER_00: So magnesium is uh a main ingredient for a lot of laxatives and magnesium in high uh amounts, so roughly like 400 milligrams for most people, is gonna send things right through.
22:30
SPEAKER_00: So you can either try a magnesium supplement by itself, or there's magnesium in most multivitamins.
22:37
SPEAKER_00: Uh, and I would recommend a multi to most people post-surgery, anyways.
22:42
SPEAKER_00: So you can um pop a couple multivitamins.
22:46
SPEAKER_00: Or there's there's magnesium and a lot of things that have fiber.
22:49
SPEAKER_00: So those whole grains, beans, uh, nuts and seeds and all that kind of stuff, um, trying to increase some of that intake can be helpful for constipation.
23:00
SPEAKER_01: Yeah, that that's really helpful.
23:02
SPEAKER_01: And hopefully you guys can take away some information from that, but slowly increasing the fiber and then magnesium uh seems to be very helpful.
23:11
SPEAKER_01: And then, you know, whenever you're potentially in pain or like struggling, like there's no harm in reaching out to your doc to make sure that you can get things taken care of.
23:21
SPEAKER_00: Yeah, take the medicine, it will help you.
23:23
SPEAKER_00: It's so funny that you bring this up.
23:25
SPEAKER_00: I mean, this week I had an athlete that was five days post op and hadn't pooped yet, and she was crying to me on the phone, and I was like, you need to call your doctor.
23:35
SPEAKER_00: Yeah, yeah.
23:36
SPEAKER_01: Yeah, and it's it's one of those where you can be as prepared as possible.
23:40
SPEAKER_01: You can't control your body and the way it reacts sometimes.
23:42
SPEAKER_01: So, anyways, you guys, it it's way more common.
23:46
SPEAKER_01: So if you're here thinking like, oh, that was me, it's way more common than we think.
23:50
SPEAKER_01: So uh these are some good strategies to implement uh regarding this.
23:55
SPEAKER_00: And and if I can while we're on this topic, the other really, really common thing is just feeling nauseous and having no appetite.
24:04
SPEAKER_00: And again, we've talked about how right after surgery your muscle wants to waste away and it's getting bombarded with signals.
24:11
SPEAKER_00: So those first couple days, it's actually so important that you eat.
24:15
SPEAKER_00: But unfortunately, most people feel really, really nauseous.
24:18
SPEAKER_00: So if you are struggling with that, try to focus on small meals throughout the day.
24:24
SPEAKER_00: Try to focus on bland, plain room temperature flavors and go slowly.
24:32
SPEAKER_00: A couple bites is better than nothing.
24:34
SPEAKER_00: And a lot of times I'll also say a lot of us kind of revert back to our childhood favorites.
24:41
SPEAKER_00: And if you're feeling that, I don't care how unhealthy you perceive that to be, eating it is better than nothing.
24:48
SPEAKER_00: So if you got to reach for, I don't know, the bagel bites or whatever you had that you loved when you were eight years old, and that's gonna help you get something in, go for it, please.
24:59
SPEAKER_00: Guilt-free, go for it.
25:01
SPEAKER_01: Yeah, I love I love that uh recommendation.
25:04
SPEAKER_01: Also, bagel bites are the bomb.
25:07
SPEAKER_00: Bagel bites are always my example because I lived on bagel bites and chicken nuggets from age like five to ten.
25:13
SPEAKER_01: Oh, they're amazing.
25:14
SPEAKER_01: And so yeah, I remember it's interesting you bring this up.
25:17
SPEAKER_01: And when I reflect back on my two ACL, like the surgeries around that time, especially my first one, it wasn't like I was so dialed into nutrition as a high school athlete.
25:28
SPEAKER_01: But I do remember the appetite was not very much there for the first few days.
25:34
SPEAKER_01: And as you had mentioned, that and when we see uh muscle atrophy, it's the biggest in those first few days.
25:42
SPEAKER_00: Yeah.
25:43
SPEAKER_00: There's a crazy, there's a crazy stat, and I can try to find this paper to cite it for you.
25:48
SPEAKER_00: Um, it's something like 60% of total muscle atrophy happens in the first five or six days.
25:55
SPEAKER_00: Yeah.
25:55
SPEAKER_00: And really the only fight we have against that in those first couple of days is nutrition.
26:00
SPEAKER_00: Because it's not like you're gonna be doing a lift, obviously, right?
26:04
SPEAKER_00: Um, nutrition and getting enough calories and getting protein in.
26:08
SPEAKER_01: Right.
26:09
SPEAKER_01: So uh that's one thing to make sure you guys focus on is being able to get your protein in immediately after surgery.
26:16
SPEAKER_01: So then that way you have your body is equipped to maximize uh your protein as well as the muscle building process and to minimize what we call uh catabolism, where it starts to break things down and making sure that we are able to minimize the muscle atrophy, right?
26:35
SPEAKER_00: Yeah.
26:36
SPEAKER_00: There's also an interesting theory that we can try to look at surgery like an athletic event.
26:41
SPEAKER_00: So there's some people that think we could potentially carb load heading into a surgery.
26:48
SPEAKER_00: I wouldn't go that far, but I do think there's some metabolic um value there uh without getting into too much of the science.
26:58
SPEAKER_00: Make sure that the night before your dinner has carbs in it.
27:02
SPEAKER_00: And then the morning of, even if you're on a liquid diet, usually you can do juice without pulp or you can do um like Gatorade, real Gatorade that includes sugar.
27:11
SPEAKER_01: Yeah.
27:12
SPEAKER_00: And then afterwards, yeah, getting your protein in, but getting your carbs in too.
27:15
SPEAKER_00: And I actually have a free handout on my website.
27:19
SPEAKER_00: It's linked from my Instagram that goes into a schedule of what should you be doing leading up to surgery right before, right after.
27:28
SPEAKER_00: And then, you know, some of those foods that you can focus on.
27:31
SPEAKER_01: That's perfect.
27:32
SPEAKER_01: We'll make sure we'll link that in the show notes.
27:34
SPEAKER_01: That way people can download that if they want to gain access to it.
27:38
SPEAKER_01: So in terms of healing, I want to make sure that we kind of tackle this subject.
27:44
SPEAKER_01: And I know we've been talking about it, but setting up the environment, setting up the knee and the body to facilitate the best healing process.
27:53
SPEAKER_01: So we talked about the macronutrients.
27:55
SPEAKER_01: So we talked about the protein and the carbs and the fats and how protein is super vital in this process.
28:02
SPEAKER_01: Are there any other things that you recommend as we're approaching surgery, but especially the days after that stick out in your mind?
28:12
SPEAKER_00: Yeah.
28:13
SPEAKER_00: Approaching surgery a little bit, yeah.
28:16
SPEAKER_00: After surgery for sure.
28:18
SPEAKER_00: There is nothing that can make healing faster.
28:21
SPEAKER_00: And if people are telling you that, run, right?
28:24
SPEAKER_01: Right.
28:25
SPEAKER_00: But nutritionally, there is one specific micronutrient that can slow you down if you are deficient.
28:32
SPEAKER_00: So before I even say this, keep in mind if you are deficient, that doesn't mean that you need to mega dose with this.
28:40
SPEAKER_00: That's actually not helpful.
28:41
SPEAKER_00: It just means that you need to get enough.
28:44
SPEAKER_00: Okay.
28:44
SPEAKER_00: And that micronutrient is zinc.
28:46
SPEAKER_00: So that's a big reason that I recommend a multivitamin for most athletes.
28:51
SPEAKER_00: It's just a really easy safety net to get it in.
28:54
SPEAKER_00: We're looking, depending on if you're a man or woman, we're looking for nine to 11 milligrams a day.
28:58
SPEAKER_00: And that's what pretty much every multivitamin that I've seen will have those.
29:04
SPEAKER_00: I'm not connected to this label in any shape or form, but Nature Made is a good one that I like that you can find at most grocery stores and targets.
29:13
SPEAKER_00: So that's a solid multivitamin.
29:14
SPEAKER_00: You can also get zinc from most cereals are fortified with zinc.
29:19
SPEAKER_00: So again, another argument for why you should be including carbs.
29:22
SPEAKER_00: Right.
29:23
SPEAKER_00: Oysters, surprisingly, are really good.
29:25
SPEAKER_00: I don't know people that are out there eating oysters every day, but if you have access to that, but red meat, chicken, and nuts are also really good sources of zinc.
29:33
SPEAKER_00: And then the other one is magnesium.
29:37
SPEAKER_00: So again, remember when we were talking about uh constipation, keep in mind if you are mega dosing on magnesium, you're gonna have some diarrhea issues.
29:45
SPEAKER_00: But if you are getting enough, which is usually around that 300 milligram point, yeah.
29:54
SPEAKER_00: Magnesium is involved in like 300 reactions in your body, one of which is protein synthesis.
30:00
SPEAKER_00: And it's an ingredient that most people, or it's a not an ingredient, but it's a micronutrient that most people are not getting enough of in their average diet.
30:13
SPEAKER_00: So again, magnesium is in most multivitamins.
30:17
SPEAKER_00: It's also in things like peanuts, pumpkin seeds, beans, lentils, and then there's a little bit in milk and yogurt and stuff like that.
30:25
SPEAKER_00: So again, those are all carbs.
30:27
SPEAKER_00: Well, I guess I mean peanuts are a fat, but yeah, you know, again, that's why we can't just focus on protein.
30:34
SPEAKER_00: You have to have a balance of all three macronutrients well to make sure you're getting those micronutrients.
30:41
SPEAKER_01: Yeah, and it's so important.
30:42
SPEAKER_01: And, you know, we we kind of look at the big pictures of the macros.
30:46
SPEAKER_01: You know, you talk about the proteins, carbs and fats, and making sure that sure protein is important and we have emphasized that, but it's also a part of the pie, if you will, and protein or sorry, carbs and fats will be such an important piece of that.
31:03
SPEAKER_01: And these all these macronutrients play off each other.
31:06
SPEAKER_01: It's not like they operate in silos.
31:08
SPEAKER_01: And when you think about your human body, sure you have your immune system, you have your reproductive, your muscular, but at the end of the day, these all work together, and these macronutrients are the ones that help to facilitate energy, healing, building, breaking down of all these different areas.
31:25
SPEAKER_01: And so that's gonna be super key to make sure as you're approaching this process, that's not just protein or fat, it's looking at the whole picture of what this is.
31:34
SPEAKER_00: Yeah, you also kind of led me into a perfect segue of something I want to make sure we definitely hit on.
31:41
SPEAKER_00: Um, and that's just total calories.
31:43
SPEAKER_00: So 99 people out of a hundred will feel like they don't need that much food because they're not doing anything.
31:51
SPEAKER_00: And people equate exercise to needing calories, but you just listed off a bunch of things that require calories.
31:58
SPEAKER_00: Your immune system, your brain takes a ton, your heart has to continuously beat, obviously.
32:04
SPEAKER_00: And then that big, giant, gaping knee that you have after surgery is taking a ton of your calories.
32:10
SPEAKER_00: So people think that there's a huge difference between pre-surgery or pre-injury calorie needs and post-injury calorie needs, and it's not as big as you think.
32:21
SPEAKER_00: So, again, you know, athletes are usually super dedicated and they like to operate in extremes.
32:27
SPEAKER_00: And we are operating in a gray area here.
32:30
SPEAKER_00: You do not have to for most people, obviously, every person is different, depends on your sport and all that kind of stuff.
32:36
SPEAKER_00: But for the most part, you don't have to drop your calories as low as you think you do.
32:44
SPEAKER_01: Yeah.
32:45
SPEAKER_01: And that's that's really good to know because I think naturally most people will want to start not eat as much, and it depends on your background, who you are as a person, maybe the sport or activity.
32:57
SPEAKER_01: But naturally, we want to be like, okay, well, we're not gonna be moving as much, so we should eat less.
33:03
SPEAKER_01: And that logically it makes sense, but in reality, when you're thinking about what your body still needs as well as the things that are playing against it, you need to make sure.
33:12
SPEAKER_01: Essentially, the way that I view nutrition is essentially fuel.
33:16
SPEAKER_01: How is it going to fuel your body for that day and for what you're working towards?
33:21
SPEAKER_01: And you're trying to fuel your body to be able to rebuild and to heal and to make sure that you are not in this caloric deficit during this time.
33:31
SPEAKER_00: Yeah.
33:32
SPEAKER_00: Yeah.
33:32
SPEAKER_00: And most people don't necessarily love to hear this, but I would much, much rather see you, you know, accidentally gain five to ten pounds in this process than lose it.
33:44
SPEAKER_00: Again, for that muscle integrity.
33:46
SPEAKER_00: Because if you're losing 10 pounds um right after your surgery, the majority of it is coming from, you know, your quad muscle.
33:54
SPEAKER_01: Yeah.
33:55
SPEAKER_01: So which we do not, we do not want.
33:57
SPEAKER_01: Correct.
33:58
SPEAKER_01: We do not want that.
33:59
SPEAKER_01: Um, so one thing that I want to make sure we talk about is the lovely topic of supplements.
34:06
SPEAKER_01: And I know you have touched on this some, uh, but we know that some supplements can be beneficial, some are not worth our time.
34:15
SPEAKER_01: Obviously, there's a financial investment into these.
34:18
SPEAKER_01: So curious as you are in this process, um, let's talk about, especially around the injury and surgery.
34:27
SPEAKER_01: Um, what is worth spending your money and potentially your time on to help use it for your recovery and healing?
34:35
SPEAKER_00: Yeah, I think um really the only one, um, and I'm gonna talk about three others that you can decide if you want to use or not, but the only one that I pretty much automatically recommend to everybody is a multivitamin and an actual pill, not a gummy multivitamin, because the gummies tend to not have as much of what we're looking for.
34:59
SPEAKER_00: It's just hard to kind of pack that into a gummy form.
35:02
SPEAKER_00: So a pill multivitamin.
35:05
SPEAKER_00: And then we can also look at supplements in supporting stages of recovery.
35:10
SPEAKER_00: So omega-3s are an anti-inflammatory that could be beneficial.
35:15
SPEAKER_00: However, I say that with a big, huge, giant asterisk because please refer to your surgeon on their opinion on omega-3s.
35:23
SPEAKER_00: Uh, I think it's kind of an old school way of thinking, but there are some surgeons that will say absolutely no omega-3s before or after surgery because um they are potentially a blood thinner and we don't want to go into any problems.
35:37
SPEAKER_00: There are other surgeons that don't care about it.
35:40
SPEAKER_00: That obviously is not my area, so I'm always going to refer to what the surgeon tells you to do about your omega-3.
35:47
SPEAKER_00: That being said, typically six weeks after surgery, around that mark, is when they stop caring about it.
35:53
SPEAKER_00: So then I can recommend an omega-3, just in general, it's an anti-inflammatory, it's good for your brain, it's good for your heart, it's good for your muscle.
35:59
SPEAKER_00: Most people aren't getting enough.
36:02
SPEAKER_00: The other ones that you can think about are potentially creatine.
36:06
SPEAKER_00: So if you are already taking creatine when your injury happens, I would encourage you to continue taking it.
36:13
SPEAKER_00: Again, focusing on that muscle integrity prior to surgery.
36:16
SPEAKER_00: Taking it post can also help too.
36:18
SPEAKER_00: If you want to add it in, that's totally up to you.
36:22
SPEAKER_00: If your, you know, protein and that meal pattern that we've talked about are already on check and you just want to add one more thing to top off that pyramid, that's potentially okay.
36:33
SPEAKER_00: And then the last one that you hear a lot about is collagen.
36:37
SPEAKER_00: And collagen can potentially be helpful, but we're not a hundred percent sure yet.
36:46
SPEAKER_00: It's definitely not going to hurt you.
36:47
SPEAKER_00: So if you want to invest in it, go for it.
36:49
SPEAKER_00: However, I would say most people take it incorrectly.
36:53
SPEAKER_00: So I don't really think you need to invest or start in collagen until you are really getting into your physical therapy phase because tendons and ligaments are so difficult to heal because they don't get a lot of blood flow to them, right?
37:09
SPEAKER_00: And all the nutrients they need for healing are in blood flow.
37:11
SPEAKER_00: I like to think of it as like, remember that show from a decade ago, ice road truckers.
37:16
SPEAKER_00: Um, and when the ice, oh, you don't know that one?
37:18
SPEAKER_01: Okay, well, see that.
37:20
SPEAKER_01: No.
37:20
SPEAKER_00: Basically, there's an ice road, and when it exists, truckers can transport stuff and when it melts, it melts and it doesn't exist anymore.
37:29
SPEAKER_00: So blood flow to your ACL is kind of like that.
37:34
SPEAKER_00: Um, and that ice road exists when you are exercising.
37:38
SPEAKER_00: So we want the collagen to be available when the blood is flowing to that ACL.
37:43
SPEAKER_00: So taking your 15 to 20 grams about an hour before physical therapy, or if you're in the lifting phase, so an hour before your lift is kind of the only time that it's going to be useful for you.
37:56
SPEAKER_00: Otherwise, we don't have the ice road available or the blood flow available to send that collagen to where we want it to be.
38:03
SPEAKER_00: So you're just wasting your money.
38:08
SPEAKER_01: All right, team.
38:09
SPEAKER_01: This is part one of part two of the series with Emily, where we're talking about all things related to nutrition and ATL rehab.
38:17
SPEAKER_01: So stay tuned for next week as we release part two and making sure that we are answering all of your questions as well as a lot of different pieces that we did not touch on today.
38:27
SPEAKER_01: So stay tuned for that.
38:29
SPEAKER_01: As always, thank you so much for listening.
38:31
SPEAKER_01: This is your host, Robbie Patel, signing off.