Bone Repair (how to Repair with Nutrition)

Bone Repair

Stage 1: Reactive Phase Inflammation (up to ~2-3 weeks) Bleeding from the fractured bone and surrounding tissue causes the fractured area to swell.

Stage 2: Soft callus (from ~2-3 weeks post-injury to ~4-8 weeks post injury) At this point, the pain and swelling will decrease. The site of the fracture will stiffen, with new bone forming. The new bone is weaker and incomplete and therefore cannot be seen on x-rays.

Stage 3: Hard callus (from ~4-8 weeks post-injury to ~8-12 weeks post injury) During this phase, new bone begins to bridge the fracture, covering the soft callus. This bony bridge can be seen on x-rays.

Stage 4: Bone remodeling (from ~8-12 weeks post-injury to several years) The fracture site remodels itself, correcting any deformities that may remain as a result of the injury. This final stage of fracture healing can last up to several years.

Bone injuries go through an early inflammation phase. This attracts plasma and inflammatory cells to the site of injury. These cells help clear out the damaged tissue as well as help revascularize the area. After this occurs, other cells (in this case, periosteal cells) proliferate and differentiate into chondroblasts and osteoblasts to form new tissue (cartilage and woven bone). This ends up forming the callus.

This early tissue is eventually replaced again. This time, the cartilage and woven bone forums first lamellar bone and this occurs after a collagen matrix becomes mineralized.

One goal of your treatment plan for acute injury should be to support (but manage) the inflammatory process. As the inflammatory process is critical in stage 1 of injury repair, any modality designed to eliminate inflammation or blood flow to the injured area should be avoided. However, pro-inflammatory agents should also be avoided as excessive inflammation could increase total tissue damage, slowing down the repair process. Further, a secondary goal of managing inflammation is to reduce pain as pain can cause biomechanical

compensations/changes that can lead to secondary injury. However, again,

strategies that eliminate pain often target inflammation. And in this case, the elimination of inflammation (and pain) may also reduce healing.

Dietary Fat A diet high in trans-fats, omega 6 rich vegetable oils, and saturated fat will be proinflammatory while a diet high in monounsaturated fats and omega 3 fats will be antiinflammatory. So it's clear that the ratio of omega 6 to omega 3 in the diet is important for overall inflammation in the body - especially during normal periods of healthy living when we definitely want to keep inflammation under control. In these circumstances, the omega 6 to 3 ratio should be anywhere from 3:1 to 1:1 and this should lead to a balanced inflammatory profile. Of course, beyond 3s and 6s, overall fat balance is also important here. With a good balance of saturated, monounsaturated, and polyunsaturated fats (about 1/3 of total fat intake each), the body's inflammatory profile should also achieve a healthy balance. However, during acute injury, an intentional decrease in omega 6 that goes along with a similar increase in omega 3 (specifically fish oil) is recommended High omega 6:3 ratios reduce collagen production while a low 3:6 ratio is supportive of healing. It appears that even though this scenario leads to an anti-inflammatory response in the body, this response isn't enough to reduce healing - rather, it only helps with injury healing and collagen deposition. 3-9g of fish oil per day is recomended.

1) To balance your fats:

Increase intake of olive oil, mixed nuts, avocados, flax oil, ground flax and other seeds, etc - getting some of each fat source each day. By eating these foods, you'll likely balance out the saturated fats naturally present in your protein sources.

2) To balance your 6:3 ratio:

Add 3-9g of fish oil each day while reducing omega 6 fats like vegetable oils such as corn oil, sunflower oil, safflower oil, cottonseed oil, and soybean oil, etc.

strategy should take care of your omega 6:3 ratio.

Dietary Herbs and Phytochemicals Beyond healthy fat balance, certain dietary herbs can be very beneficial in the management of inflammation.

Turmeric 800mg a day. Garlic 1200mg garlic extract a day.

Bromelain is another anti-inflammatory plant extract, coming from pineapple. While best known for its digestive properties, Bromelain is an excellent anti-inflammatory and analgesic compound although it's mechanism of action is poorly understood. Typically

Bromelain 1000mg/day for the management of 300mg doses 3x per day. (last dosage 400mg) Grapeseed Extract 500mg a day. The idea here is to control inflammation from getting out of control, not stop it from happening.

Protein Each meal/snack should contain complete protein including lean meats, lean dairy, eggs, or protein supplements (if whole food is unavailable).

3) Vegetables and Fruit Each meal/snack should contain 1-2 servings veggies and/or fruit (1/2 - 1 1/2 cups or 1-2 pieces) with a greater focus on veggies.

Starches Additional carbohydrates should come from whole grain, minimally processed sources like whole oats, yams, beans, whole grain rice, quinoa, etc. should eat fewer starches when not training (such as during injury recovery),

Although a no carbohydrate or no starch diet is unwarranted.

Fats You should eat each of the following good fats each day - avocadoes, olive oil, mixed nuts, flax seeds, and flax oil. In addition 3-9g of fish oil should be added to the diet. Increase intake of olive oil, mixed nuts, avocados, flax oil, ground flax and other seeds, etc -Add 3-9g of fish oil each day while reducing omega 6 fats like vegetable oils such as corn oil, sunflower oil, safflower oil, cottonseed oil, and soybean oil, etc. This strategy should take care of your omega 6:3 ratio. You also should include 2-3 cups of bone broth a day.

macronutrients: Vitamin A – 10,000IU/day for 2-4 weeks post-injury Vitamin C – 1000-2000mg/day for 2-4 weeks post-injury Copper – 2-4mg/day for 2-4 weeks post-injury Zinc – 15-30mg/day for 2-4 weeks post-injury

Arginine 7g morning 7g at night. This amino acid may act in a number of ways to speed up injury repair. First, it may stimulate insulin release and IGF action. These powerful anabolic hormones may stimulate protein synthesis and collagen deposition. Further, its role in stimulating nitric oxide production may increase blood flow to the injured area as well as activate macrophages for tissue clean-up. These macrophages also help produce and activate growth factors, cytokines, bioactive lipids, and proteolytic enzymes necessary for healing.

Glutamine 7g morning/7g night

HMB 1g morning/1.5g at night

**** This is a general idea, you always should consult a certified sports dietitian for your specific case and conditions.

Fernanda Aguiar RDN

619 2009674

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