Latest / The ACL Athlete Podcast / 269 | Feed the Rebuild: What ACL Athletes Get Wrong About Nutrition

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269 | Feed the Rebuild: What ACL Athletes Get Wrong About Nutrition · The ACL Athlete Podcast

• 0:18
  SPEAKER_00: Welcome everyone to the ACL Athlete Podcast.
• 0:22
  SPEAKER_00: 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.
• 0:31
  SPEAKER_00: I'm your host, Dr.
• 0:32
  SPEAKER_00: Robbie Patel, performance physical therapist and coach.
• 0:36
  SPEAKER_00: Between myself and fellow guests and experts, you'll learn through the lens of the patient, the healthcare professional, and the coach.
• 0:43
  SPEAKER_00: 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.
• 0:54
  SPEAKER_00: Thanks for joining.
• 0:55
  SPEAKER_00: Now let's dive into today's episode.
• 1:00
  SPEAKER_00: What is up, team, and welcome back to another episode on the ACL Athlete podcast.
• 1:08
  SPEAKER_00: So my voice is off again.
• 1:10
  SPEAKER_00: I'm pretty sure I recorded an episode two or three weeks ago where I was off.
• 1:16
  SPEAKER_00: Maybe it was last week.
• 1:17
  SPEAKER_00: I honestly lose track.
• 1:19
  SPEAKER_00: But my kids got sick, mostly my toddler Asher always brings stuff home from preschool.
• 1:26
  SPEAKER_00: And so here I am getting sick again.
• 1:28
  SPEAKER_00: And so my voice is just trying to survive.
• 1:32
  SPEAKER_00: So here we go.
• 1:33
  SPEAKER_00: We're doing this again.
• 1:35
  SPEAKER_00: Hopefully we have the spring and summer to look forward to.
• 1:39
  SPEAKER_00: So there's less sickness around the Patel house.
• 1:42
  SPEAKER_00: But let's talk today about nutrition.
• 1:46
  SPEAKER_00: Specifically, what happens to your body when you undereat after surgery and why that instinct to potentially cut calories might be one of the most costly mistakes you could make in your ACL recovery.
• 2:01
  SPEAKER_00: So let's get into it.
• 2:02
  SPEAKER_00: And the first thing I want to say is I am not a registered dietitian and I am not going to claim to be.
• 2:08
  SPEAKER_00: So if we're talking about specific macros or specific recommendations about someone, what they should eat day in and day out, the carbohydrates, the fats, the proteins, the specifics, I am not here to say that.
• 2:30
  SPEAKER_00: Being a medical professional, being also someone who is in the health and performance space.
• 2:37
  SPEAKER_00: But if you need something that is more specific to you, then I recommend reaching out to a registered dietitian.
• 2:44
  SPEAKER_00: Yeah, people that we love and we recommend.
• 2:47
  SPEAKER_00: I have also done podcast episodes with registered dietitians.
• 2:52
  SPEAKER_00: So this is something that I would say reach out to if you need it.
• 2:56
  SPEAKER_00: But today I want to get into this topic specifically.
• 3:00
  SPEAKER_00: And here's the thought process I hear all the time from athletes, especially right after surgery, or maybe it's early in rehab.
• 3:07
  SPEAKER_00: Maybe it's in the prehab process.
• 3:09
  SPEAKER_00: I'm not doing anything.
• 3:10
  SPEAKER_00: I'm on the couch.
• 3:11
  SPEAKER_00: I'm not training as much as I was.
• 3:13
  SPEAKER_00: I'm not as active.
• 3:14
  SPEAKER_00: I don't need to eat as much.
• 3:16
  SPEAKER_00: And I definitely don't want to gain weight.
• 3:18
  SPEAKER_00: And this is especially sensitive for my athletes who are maybe not the leanest of athletes.
• 3:24
  SPEAKER_00: And we know we have a spectrum of different body types.
• 3:28
  SPEAKER_00: And this is not something I want to necessarily dig into in terms of this episode.
• 3:33
  SPEAKER_00: But the goal here is to understand everyone's in their own situations.
• 3:37
  SPEAKER_00: And so, with that said, even for my own personal experience, I have grown up a heavyweight kid.
• 3:44
  SPEAKER_00: And so then when I had my first ACL surgery, I was nervous about that.
• 3:48
  SPEAKER_00: And even in my second surgery, it's just something that comes to mind when I dealt with weight-related issues growing up.
• 3:55
  SPEAKER_00: And so I know that this is something on the minds of athletes we work with, and so many of you potentially listening, right?
• 4:02
  SPEAKER_00: And some of you, it may not even come into the mind at all.
• 4:06
  SPEAKER_00: But with many athletes we work with, we work with so many female athletes, which obviously we know that this can be related to, but it can kind of run the spectrum regardless of gender, if you will.
• 4:19
  SPEAKER_00: And this is something that even happened recently to one of my male athletes who he was discussing I should cut my macros, especially after the surgery, because I'm not moving as much.
• 4:30
  SPEAKER_00: He's been on the heavier side, and so he wants to lose some weight.
• 4:33
  SPEAKER_00: And so we actually had a discussion about this because he was going into surgery and the surgeon actually said, Yeah, you should cut your macros.
• 4:40
  SPEAKER_00: And I actually disagreed because the surgeon wasn't kind of thinking about the rebuilding process, and he also is very much in his own little world of nutrition.
• 4:52
  SPEAKER_00: And so this was something that I had a conversation with that I've also had talked with other registered dietitians about in terms of what's important in the post op process or even in this certain process where maybe athletes are trying to retain muscle mass, also trying to make sure that they're getting the adequate nutrition to heal and to be able to build forward, right?
• 5:16
  SPEAKER_00: But a lot of times athletes will say, I definitely don't want to gain weight.
• 5:20
  SPEAKER_00: And whether it's outwardly said, or maybe it's maybe internally.
• 5:23
  SPEAKER_00: And I get it.
• 5:24
  SPEAKER_00: It's logical on the surface, but here's what's actually happening inside your body while you're sitting on that couch, for example.
• 5:31
  SPEAKER_00: Your body is working harder than you think and is managing an inflammatory process, it's healing a surgical site post op.
• 5:39
  SPEAKER_00: It's trying to integrate a graft into your bone, and it's all doing all of that while fighting to hold on to muscle mass that is actively being lost at a rate that would shock most people.
• 5:51
  SPEAKER_00: And I've talked about this before, but I'm gonna break that down today as well.
• 5:54
  SPEAKER_00: But that process requires fuel, and that's the way I want you to reframe food, and that's how I think it's important.
• 6:02
  SPEAKER_00: My wife and I have even talked about this before.
• 6:05
  SPEAKER_00: She didn't necessarily have as much exposure to like education on the nutrition side.
• 6:11
  SPEAKER_00: And so as we got together and we talked about food and, you know, the influences of things, we started to view it more as fuel.
• 6:19
  SPEAKER_00: It's important for us to think of it that way versus, you know, there could be a lot of negative, positive connotations with food.
• 6:26
  SPEAKER_00: And instead, we think about we use our bodies for many different things: performance, for work, for school.
• 6:32
  SPEAKER_00: There's obviously the mental side, emotional side of things, lots of things that we want to balance.
• 6:37
  SPEAKER_00: And so it's fuel to our body to perform appropriately.
• 6:41
  SPEAKER_00: The thing is, when you cut the fuel off, you're not necessarily staying neutral, you're actively working against your own recovery.
• 6:48
  SPEAKER_00: And so there's a specific mechanism worth understanding here because once you see it, the instinct to eat less makes even less sense.
• 6:57
  SPEAKER_00: After surgery, your body goes through what researchers call a surgical stress cascade.
• 7:03
  SPEAKER_00: Cortisol spikes, glucagon spikes, your body upregulates catabolism, meaning it starts to break things down, catabolic, to fuel wound healing, immune function, and to keep blood glucose stable.
• 7:19
  SPEAKER_00: And one of the primary sources it pulls from to do all that is skeletal muscle.
• 7:25
  SPEAKER_00: At the same time, insulin sensitivity drops.
• 7:29
  SPEAKER_00: And insulin is one of the primary drivers of muscle protein synthesis.
• 7:34
  SPEAKER_00: It's one of the main signals telling your body to build and retain muscle.
• 7:40
  SPEAKER_00: So you've got breakdown going up and building going down simultaneously.
• 7:46
  SPEAKER_00: That's what a catabolic state actually means in practice.
• 7:49
  SPEAKER_00: And that's exactly where your body lands in the days following surgery, whether you like it or not.
• 7:56
  SPEAKER_00: Now, here's where the numbers get sobering.
• 7:59
  SPEAKER_00: A 2021 review published in the journal Nutrients, looking specifically at orthopedic surgery outcomes, found that in healthy young men, total thigh muscle volume dropped by around 1.7% after just two days of disuse and 5.5% after seven days, with the greatest loss happening in the quads.
• 8:24
  SPEAKER_00: I know it's so sad, y'all.
• 8:26
  SPEAKER_00: Tell me about it.
• 8:27
  SPEAKER_00: Seven days, that's your first week post-op.
• 8:31
  SPEAKER_00: And for most ACL athletes, that's exactly the window where they start resting, icing, elevating, doing all the rehab stuff they can do in that window and eating less because they feel like they're not doing anything productive.
• 8:43
  SPEAKER_00: They're not moving as much, burning as much calories.
• 8:46
  SPEAKER_00: The reality is that your body is in the middle of one of the most metabolically demanding processes it will go through.
• 8:53
  SPEAKER_00: And it needs the raw material to do the job.
• 8:57
  SPEAKER_00: The same review found that surgical patients are consuming only about 22 to 36% of their estimated protein requirements post-op.
• 9:08
  SPEAKER_00: And look, I get it.
• 9:09
  SPEAKER_00: It is hard to get in protein, especially the right amount of protein for what our body needs.
• 9:16
  SPEAKER_00: But that's a pretty low amount that is not getting enough protein.
• 9:20
  SPEAKER_00: So that's less than a third of what the body actually needs.
• 9:24
  SPEAKER_00: That gap has real consequences: more muscle atrophy, slower tissue healing, and longer time to hit the rehab benchmarks that actually move you forward.
• 9:34
  SPEAKER_00: Here's what's frustrating about this athletes who are under fueling don't usually connect it back to their food.
• 9:42
  SPEAKER_00: They just feel it.
• 9:43
  SPEAKER_00: The quad won't activate, energy and PT tanks halfway through, progress stalls and feels invisible, motivation drops.
• 9:52
  SPEAKER_00: They feel mentally flat.
• 9:54
  SPEAKER_00: And they blame the injury or the protocol, what they're doing, or the timeline.
• 10:00
  SPEAKER_00: When a significant part of what's happening is that their body is stuck in a catabolic state because it doesn't have the raw material to do what rehab is asking of it.
• 10:10
  SPEAKER_00: You cannot build or retain muscle without adequate protein.
• 10:14
  SPEAKER_00: You cannot sustain a healing and rebuilding process without adequate calories, adequate calories.
• 10:22
  SPEAKER_00: That was hard.
• 10:23
  SPEAKER_00: These are not optional extras.
• 10:26
  SPEAKER_00: They are part of the program, and that's really important.
• 10:30
  SPEAKER_00: And this is something that we notice a lot with certain athletes and even sub-athletes where they're doing all the right stuff.
• 10:38
  SPEAKER_00: You know, they're working hard even, and they're not seeing progress in the way that we should, whether it's the quad strength or just even the energy that they're feeling.
• 10:49
  SPEAKER_00: And a lot of times it's really muddy, especially early post-op, because you do have pain, you do have swelling, you are limited in the amount you can do.
• 10:59
  SPEAKER_00: So you might not necessarily register that.
• 11:09
  SPEAKER_00: But the thing is, is that it's hard to also really be able to connect that to nutrition and related to all the things that might be declining by not eating enough.
• 11:22
  SPEAKER_00: There could be other variables that are also influencing that.
• 11:25
  SPEAKER_00: But in reality, we do see this a lot where people do have an impact on whether they are eating enough and also the amount that they are recovering from this process, especially from a strength, especially from a muscle mass retention standpoint.
• 11:44
  SPEAKER_00: And so, as I shared, I'm not a dietitian, so I'm not here to give you a meal plan, but that's not the point of this episode.
• 11:51
  SPEAKER_00: What I want you to walk away with is simple and actionable.
• 11:54
  SPEAKER_00: First, don't restrict calories in the early post-op period or honestly, ever in this process, right?
• 12:01
  SPEAKER_00: Like there is a time and place, sure.
• 12:03
  SPEAKER_00: Like work with a dietitian to make sure that that is timely for you.
• 12:08
  SPEAKER_00: But in general, we don't want to necessarily go into like a caloric restrictive state because that is going to really influence things.
• 12:15
  SPEAKER_00: Your metabolic rate does not drop off a cliff because you're not in the gym.
• 12:19
  SPEAKER_00: Just know that.
• 12:20
  SPEAKER_00: Do you need to adjust some things?
• 12:22
  SPEAKER_00: Because maybe, yes, you were, you know, running for two to three hours a day, you know, or on certain days based on, you know, endurance running or maybe certain sports you were playing.
• 12:32
  SPEAKER_00: You're playing pickup on the weekend for two to three hours on a Saturday.
• 12:36
  SPEAKER_00: Yeah, sure, you can adjust things, but we don't want to necessarily go the opposite direction, let the pendulum swing, and then really put you in a place where you really have to game back and it makes it really challenging.
• 12:49
  SPEAKER_00: Healing itself is energetically expensive, just know that.
• 12:52
  SPEAKER_00: And your body is running hard behind the scenes.
• 12:55
  SPEAKER_00: So give it the fuel it needs.
• 12:57
  SPEAKER_00: Second, make protein your priority at every meal.
• 13:01
  SPEAKER_00: I'm sure, as you guys know, protein seems to be in every single thing these days.
• 13:06
  SPEAKER_00: Protein this, protein that.
• 13:08
  SPEAKER_00: And so I just have to laugh because my wife and I literally laugh about this all the time.
• 13:15
  SPEAKER_00: I love it personally, um, as just like an internal meathead myself, but protein literally is in everything.
• 13:21
  SPEAKER_00: Like you got sweet drinks that are now protein, and you got like protein muffins and protein chocolates and protein gummies and all the different things that exist.
• 13:30
  SPEAKER_00: But it's real.
• 13:31
  SPEAKER_00: Protein's a very important building block and macro of our body.
• 13:34
  SPEAKER_00: And so this is something that's super important for us to make sure we get because it is such a component of the foundation of muscle building, right?
• 13:42
  SPEAKER_00: And the components of muscle themselves.
• 13:45
  SPEAKER_00: So after surgery, the protocols can recommend a variety of targets, if you will.
• 13:53
  SPEAKER_00: And so the thing is that I like to essentially aim for is one gram per pound of body weight.
• 14:00
  SPEAKER_00: Now, there can be ranges, like if you look at different research, 1.5 to 2 grams of protein per kilogram of body weight per day in the post-surgical period.
• 14:12
  SPEAKER_00: And that's what you'll see in um this paper that I'll reference that I was also referencing earlier.
• 14:19
  SPEAKER_00: But this simpler target rule of thumb of one gram per pound of body weight for protein is such a good rule of thumb.
• 14:27
  SPEAKER_00: Um, I know that many of the dietitian friends that I know and research experts in this space also tend to tout this.
• 14:36
  SPEAKER_00: And there's no necessarily downside of getting too much in.
• 14:40
  SPEAKER_00: It's rare that you will ever go so far beyond your body weight of protein.
• 14:46
  SPEAKER_00: It's just a lot to take in.
• 14:49
  SPEAKER_00: But that puts you at such a good spot and at the clinical threshold.
• 14:54
  SPEAKER_00: And for an active athlete in recovery, it is a solid, defensible number.
• 14:58
  SPEAKER_00: To make that concrete for a 150-pound athlete, that's 150 grams of protein a day.
• 15:05
  SPEAKER_00: For most people, that is still significantly more than they are currently eating.
• 15:09
  SPEAKER_00: I guarantee you.
• 15:10
  SPEAKER_00: It is way harder than you think, especially if you track it.
• 15:14
  SPEAKER_00: Lean meats, eggs, fish, Greek yogurt, cottage cheese.
• 15:18
  SPEAKER_00: Pick the sources, you'll actually eat consistently if you're falling short, add a quality, uh, protein supplement.
• 15:25
  SPEAKER_00: There's bars, obviously, protein powder.
• 15:27
  SPEAKER_00: All those are completely reasonable tools to close the gap to get there.
• 15:32
  SPEAKER_00: And I know most people do shakes.
• 15:34
  SPEAKER_00: I do shakes, and it's something that helps to fill in that gap because trying to eat, you know, 160 grams of chicken breast all day is just not doable.
• 15:44
  SPEAKER_00: Like we're just not going to do it.
• 15:46
  SPEAKER_00: Who wants to eat that much chicken breast?
• 15:47
  SPEAKER_00: So finding ways to get that in is super important.
• 15:51
  SPEAKER_00: And a lot of times you'll just find that your food around that will just fill in.
• 15:55
  SPEAKER_00: And guess what?
• 15:56
  SPEAKER_00: You eat more protein, you stay fuller longer, it helps with satiety.
• 16:00
  SPEAKER_00: There's a lot of benefits to eating protein.
• 16:03
  SPEAKER_00: Third, if you're genuinely unsure where you stand, work with someone.
• 16:08
  SPEAKER_00: A registered dietitian, as I had mentioned, you know, your coach or clinician can help with some guidance here as well.
• 16:15
  SPEAKER_00: Don't guess at this.
• 16:16
  SPEAKER_00: The difference between adequate and inadequate nutrition during this window is not small.
• 16:21
  SPEAKER_00: It shows up in your quad size, your strength numbers, and ultimately in how ready you actually are when return to sport outcomes are important and that time point comes around.
• 16:32
  SPEAKER_00: And I've seen this drastically improve people's numbers.
• 16:36
  SPEAKER_00: Y'all would be surprised.
• 16:38
  SPEAKER_00: I've had athletes who have been having a hard time gaining.
• 16:42
  SPEAKER_00: You know, they come in from somewhere else.
• 16:44
  SPEAKER_00: We talk through, you know, what they've been doing.
• 16:46
  SPEAKER_00: And sometimes they're doing stuff that should have been gaining them what they needed to in order to move the needle.
• 16:52
  SPEAKER_00: But then we also look at the other areas of just performance and health and wellness.
• 16:56
  SPEAKER_00: We look at not only movement and their exercise and what they're doing.
• 17:00
  SPEAKER_00: We look at nutrition, we ask about this, we check in with this every week.
• 17:04
  SPEAKER_00: We ask about sleep, their recovery.
• 17:06
  SPEAKER_00: That's going to be super important because that's where a lot of rebuilding happens.
• 17:10
  SPEAKER_00: We ask about stress, we ask about the management of this and making sure that we are mitigating this as best as we can.
• 17:18
  SPEAKER_00: And then the other thing, too, that I think is important is also continuously checking on uh their connection, their community.
• 17:25
  SPEAKER_00: Those are the kind of buckets of health that we look at that are super important in terms of health, wellness, performance that really anchor this whole process.
• 17:34
  SPEAKER_00: And so we don't want to just like zoom in on movement and ignore everything else.
• 17:37
  SPEAKER_00: And so I think that's really important.
• 17:40
  SPEAKER_00: So I want you to leave with this.
• 17:42
  SPEAKER_00: The goal in the weeks after surgery is not to stay lean.
• 17:45
  SPEAKER_00: That is not the mission right now.
• 17:47
  SPEAKER_00: The mission is to give your body everything it needs to heal, to rebuild, and to show up strong when it is called on.
• 17:54
  SPEAKER_00: You can address body composition later, and you'll be in a far better position to do that once you've actually built the foundation underneath you.
• 18:03
  SPEAKER_00: Underfueling during recovery doesn't save you anything.
• 18:07
  SPEAKER_00: It costs you muscle, it costs you progress, and it costs you time.
• 18:11
  SPEAKER_00: You can't get back in this process.
• 18:14
  SPEAKER_00: Feed the recovery.
• 18:16
  SPEAKER_00: That is the job right now.
• 18:18
  SPEAKER_00: So make sure you do that.
• 18:20
  SPEAKER_00: Thank you guys so much for listening.
• 18:22
  SPEAKER_00: If this hits home, share it.
• 18:24
  SPEAKER_00: It doesn't have to be an ACL athlete, anyone coming back from surgery or a serious injury that maybe needs to hear this.
• 18:32
  SPEAKER_00: And if you want to work directly with our team, please check out our website.
• 18:37
  SPEAKER_00: Please look at the show notes.
• 18:39
  SPEAKER_00: We have the information there.
• 18:41
  SPEAKER_00: Or if you just need some assistance and direction, please reach out to us because we are here to help.
• 18:47
  SPEAKER_00: We'll see you next week on the ACL Athlete Podcast.
• 18:50
  SPEAKER_00: This is your host, Robbie Patel, signing off.