Dr. Layne Norton

When injuries occur, we are told a wide variety of things by our doctors. Depending on the severity of the injury, we are either told to begin taking NSAIDs, go to physical therapy, rest for a prescribed period of time or even to get surgery. What we aren’t told, however, is how we should alter our diet. Given that nutrition is at the core of our health, this seems like a very large gap in the recovery process.

What might be the cause of this? When individuals become injured, the first person that they will go to is their doctor. While the aforementioned advice that the doctor gives is integral to the injury recovery process, medical school provides an insufficient education on matters concerning nutrition. According to a study done by NYU School of Medicine in 2008 called “What Do Resident Physicians Know about Nutrition? An Evaluation of Attitudes, Self-Perceived Proficiency, and Knowledge” (1), 94% of respondents — who were physicians — felt that it is their duty to inform their patients about nutrition, yet only 14% of them feel confident in doing so. This has been replicated by a 2015 study done by The Journal of Biomedical Education on “The State of Nutrition Education in US Medical Schools.” According to that study (2), the average amount of hours that are required to be allocated towards nutritional education in medical school is 25, which about 71% of medical schools fail to meet. Thus, it makes sense why few physicians feel confident talking about nutrition with their patients.

The state of affairs in medical schools when it comes to nutritional education, however, is making a slow shift towards improving for the better. In an article published in 2008 by The Wake Forest School of Medicine through the journal called “Global Advances in Health and Medicine” called “Nutrition Education for the Health-Care Provider Improves Patient Outcomes” (3) stated that “Educating health-care professionals on how to eat well provides an opportunity to improve physician and patient well-being.” This study concluded that physicians with such education were more capable of preventative care (4), were more competent in providing weight management advice (5), and did so in a manner that made both parties more comfortable (6). The organization Nutrition In Medicine is helping improve the medical field’s nutritional education, by providing an adequate nutritional curriculum to 90 out of 156 U.S. medical and osteopathic schools (7). “The NIM system has been well received by both medical student users and their instructors. Over 70% of students using the programs in 2009 agreed or strongly agreed with the statement: ‘I would recommend this module for future students to use.’” (8)

However, given the current lack of perspective from the medical field on the importance of nutrition when it comes to recovering from an injury, I asked Dr. Layne Norton his perspective on the matter. Layne holds a BS in Biochemistry from Eckerd College and a Ph.D. in Nutritional Science from The University of Illinois. Layne is also a professional world-record-holding IPF powerlifter, a natural pro bodybuilder and was one of the first-ever online fitness coaches, distinguishing himself from the rest with his foundation in evidence-based fitness.

A primary takeaway from this interview is that doctors are actually quite in the right to deemphasize nutrition in their advice to patients who going through the injury recovery process. There is not a lot of research done on this topic. However, Dr. Norton provided various interesting insights that still might help speed up the process of recovery through diet.

Daniel: Whether it is a major or a minor injury, or, an injury that might be a simple strain or one that might require surgery, those who are injured go to their medical doctor. The one thing that doctors rarely tell their patients when they get injured, is what alterations — if any — in their diet that they should be making. From your experience with injuries as an athlete, as a coach and as a nutritional scientist, what would you advise someone to do with their nutrition if they have gotten injured?

Layne: Good question. Typically what I advise is to make sure that you’re consuming enough protein. Right away, that is a big factor that will contribute to recovering, no matter what your body composition goals are [i.e. gaining muscle, maintaining your weight, or losing fat. This is determined by calorie intake]. Make sure you’re eating 2.0–2.5 grams of protein per kilogram of lean body mass. Usually, in terms of calories, I tell people to eat at maintenance [a calorie intake, where expenditure ideally equals intake]. [To calculate protein and calories, here is a link to a calculator so you can do it yourself!] My reasoning for that is because if you’re eating in a caloric surplus [a calorie intake, where expenditure is less than intake] it might be better for recovery, but a surplus will also lead to excess body fat gain, especially if you are unable to exercise due to the injury. By eating at maintenance, hopefully, you are going to stave off the extra body fat gain and still give yourself enough calories to recover and repair. A lot gets made out of, “oh if I eat in a big surplus I’ll recover faster.” I don’t think that is necessarily true. This is especially the case with torn tendons/ligaments/muscles, where these are injuries that are so significant that nutrition is not going to be the biggest driver of recovery. A calorie surplus in these greater instances might make a small difference. In fact, I was recently looking paper summarizing all of the research done on nutrition and injury recovery and what I got from it was that there hasn’t been a lot of research done on this topic. At most, there are very few studies that have been done looking at that link.

Getting optimal amounts of protein (0.8–1g per pound of bodyweight) is ideal when going through an injury

Daniel: Wow. Recently I strained my pectoralis major. I looked on your website (biolayne.com) for an article on what to do with my diet because of my injury and noticed that you didn’t have one. Knowing your affinity for research, it makes sense now that you didn’t have an article.

Layne: Yeah. We really don’t know. However, based on logical deduction, eating at maintenance makes sense for optimizing recovery without gaining excessive amounts of body fat. This is especially true if those calories are coming from high-quality protein sources, like whey or eggs.

Daniel: Do you have any supplement recommendations for someone who is going through the process of recovery?

Layne: With an injury where there is a lot of damage that needs to be repaired, there is some evidence that branch chained amino acids (BCAAs), HMB (beta-Hydroxy beta-methylbutyric acid) or fish oil can improve the process of remodeling. However, the research that has been done on these supplements, when it comes to injuries, is just ancillary data. There’s no research in terms of, “hey, we took people who had a muscle tear surgery and fed them x supplement and they had better recovery in comparison to baseline.” Much of the data is very speculative. Another supplement that I might recommend is creatine because of its ability to help build lean body mass, which is a necessary component to injury recovery.

Daniel: What about micronutrients [vitamins & minerals]? Should people just make sure that they are not deficient in any or should they also consider having a higher intake of certain vitamins and/or minerals?

Layne: If you’re taking a multivitamin and eating a generally balanced diet, you should be fine. Micronutrients are important for your overall health. Do they help with repair and recovery? Maybe a little bit. You do not need to be excessive with any of the micronutrients.

Daniel: Knowing how you dispel nutritional myths constantly, which I love, what are some nutritional myths that you have heard regarding injury recovery and can you please dispel them?

Layne: There’s a lot of nutritional quackery out there. There is also a lot of injury quackery out there. When people get injured, oftentimes they become desperate to recover and by into a lot of BS. When I tore my pec, I had people tell me that I should just go get electrical stimulation therapy or get a massage or get a chiropractic adjustment or do acupuncture. A massage was not going to reattach my pec to my humerus! So yes, there is a lot of quackery out there. Now, for a muscle strain or soreness, something like icing or getting a massage might help a little bit. When it comes to a major injury, however, there’s nothing out there that is really going to magically speed up the recovery process. There are some people who say that ice might help stave off some of the inflammation but there is also research indicating that inflammation is a necessary part of the process of recovery. This begs the question: do you really want to stave off that inflammation? We don’t really know that. There’s a lot of tenuous conclusions out there. Maybe they help, maybe they don’t. If you feel like something might help you, okay, but we should be careful in claiming that these things are “cures” or “hacks” because, scientifically, we simply do not know enough about this stuff yet. Rest assured, there are certainly no magic foods or diets that will quickly fix the problem.

I have personally taken a lot of Layne’s advice as a powerlifter and have found it greatly beneficial. I would highly recommend his youtube channel, “biolayne.” Layne has recently written two books which I would highly recommend. The first is called Fat Loss Forever: How to Lose Fat and Keep it Off and the second is called The Complete Contest Prep Guide. You can find these books on Layne’s website, biolayne.com, or on Amazon.

Fat Loss Forever

Citations:

(1) Marion L. Vetter, MD, RD, Sharon J. Herring, MD, Minisha Sood, MD, Nirav R. Shah, MD, MPH, and Adina L. Kalet, MD, MPH. “What Do Resident Physicians Know About Nutrition? An Evaluation of Attitudes, Self Perceived and Knowledge.” Division of General Internal Medicine, Section of Primary Care, Department of Medicine, New York University School of Medicine, 2009, Results. (PubMed)

(2) Kelly M. Adams, W. Scott Butsch, and Martin Kohlmeie. “The State of Nutrition Education at US Medical Schools.” Journal of Biomedical Education, 2015, 3.4 Changes in the Amount and Delivery of Nutrition Instruction. (PubMed)

(3) Vanessa Baute, MD, Revathy Sampath-Kumar, BS, Sarah Nelson, BS, and Barbara Basil, BA. “Nutrition Education for the Health-Care Provider Improves Patient Outcomes.” Global Advances in Health and Medicine, 2018, Abstract. (PubMed)

(4) Vanessa Baute, MD, Revathy Sampath-Kumar, BS, Sarah Nelson, BS, and Barbara Basil, BA. “Nutrition Education for the Health-Care Provider Improves Patient Outcomes.” Global Advances in Health and Medicine, 2018, Opportunities for Implementation. (PubMed)

(5) Vanessa Baute, MD, Revathy Sampath-Kumar, BS, Sarah Nelson, BS, and Barbara Basil, BA. “Nutrition Education for the Health-Care Provider Improves Patient Outcomes.” Global Advances in Health and Medicine, 2018, Provider Health and the Impact on Patient Outcomes. (PubMed)

(6) Zhu D, Norman IJ, While AE. “The relationship between health professionals weight status and attitudes towards weight management: a systematic review.” Second Military Medical University, School of Nursing Obes Rev. 2011; 12(5):e324–e337. (PubMed)

(7) Kelly M. Adams, MPH, RD, LDN, Martin Kohlmeier, MD, Margo Powell, MS, and Steven H. Zeisel, MD, Ph. “Nutrition in Medicine: Nutrition Education for Medical Students and Residents.” Nutrition in Clinical Practice, 2010, Nutrition In Medicine Medical School Curriculum Usage. (PubMed)

(8) Kelly M. Adams, MPH, RD, LDN, Martin Kohlmeier, MD, Margo Powell, MS, and Steven H. Zeisel, MD, Ph. “Nutrition in Medicine: Nutrition Education for Medical Students and Residents.” Nutrition in Clinical Practice, 2010, Nutrition In Medicine Medical School Curriculum Usage. (PubMed)