NSAIDs Can Help Decrease Inflammation and Pain but Impact Muscle Gains

NSAIDs (non-steroidal anti-inflammatory drugs) including ibuprofen, naproxen, diclofenac, celecoxib and indomethacin can decrease pain. Take them for the shortest possible time as they can be harmful.

Should you use NSAIDs? If you must get back to work ASAP then consider the risks vs. benefits. Talk to your pharmacist and physician (MD).

NSAIDs can help decrease inflammation and pain

NSAIDs can Help Decrease Pain from:

  • Acute ligament sprain – use for < 5 days. NSAIDs reduce pain and swelling so you can return to activity faster.
  • Osteoarthritis (cartilage wear and tear)
  • Delayed onset muscle soreness. When taken for several days before muscle damaging exercise, NSAIDs may reduce soreness. Take with caution as they can wreck your strength gains (see below).
  • Muscle bruise (contusion). Short term use can decrease inflammation with no adverse effects on healing.
  • Tendonitis – reduces inflammation and helps recovery. NSAIDs may do more harm than good for chronic tendon issues.

How NSAIDs Impact your Strength Gains

  • Short-term low dose (400 mg ibuprofen) use may have no real impact on muscle strength or size.
  • Longer term, higher doses (1,200 mg ibuprofen) may compromise muscle growth and, when training was preformed with all-out max reps, strength gains were also compromised.
  • The elderly may benefit due to a decrease in inflammation from taking NSAIDs. Chronic inflammation, which is not uncommon in the elderly, impairs strength gains. NSAIDs help tame inflammation.
  • After muscle injuries, NSAIDs can help reduce strength loss, soreness and muscle markers of inflammation, particularly when lower body muscles are injured.

Why do NSAIDs Impact Training (Strength) Gains?

NSAIDs work by blocking COX enzymes. COX enzymes alter prostaglandin synthesis, mediators of inflammation and pain. Prostaglandins have other actions in the body including regulation of muscle protein metabolism. Decreases in the prostaglandin PGFare associated with decreased protein synthesis and reduced muscle fiber size. In one study, 1200 mg ibuprofen blocked protein synthesis after resistance training. Other studies show signaling responses in muscle are decreased for hours or days after resistance training when NSAIDs are used.

Arthritis Res Ther 2013;15(Suppl 3):S2.
Annals of Phys and Rehab Med 2010;278-288.
Am J Sports Med 2004;32(8):1856-9.
Am J Physiol Endocrinol Metab 2002;282(3):E551-6.
Acta Physiol (Oxf) 2018;222(2).
J Physiol 2009;587(Pt 24): 5799-5800.
Am J Sports Med 2018;46(1):224-233.


Pre-Workout and Post-Workout Meal Ideas

You’ve seen them. The people who faithfully go to the gym day after day and spend quality time on the cardio equipment and in the weight room. Yet their bodies never seem to make any visible changes. They are training. But they aren’t training smart with a plan that is specifically designed to meet their goals, lifestyle and current state of conditioning. A plan that helps them progress and not just maintain. But, even with the best training program, a person’s progress will be limited if they don’t eat a diet that provides the energy they need while also facilitating training adaptations and helping improve recovery. And though eating well means choosing nutrient-dense foods 90 – 95% of the time, the most important meals for an athlete are pre- and post-workout:


In order to sustain your energy levels through your workouts, your body needs food. If you have just 2 hours before you hit the gym, track or field, opt for a lighter snack. Four hours beforehand, opt for meal that is higher in carbohydrate, contains some protein for staying power and is low in fiber and fat (both slow digestion and who wants their stomach busy digesting food when they are about to run sprints?). Lastly, don’t try something new before workouts that may make you a little queasy. For example, spicy food can give you heartburn and greasy food may make you sick to your stomach. Think familiar and easy-to-digest.

Half a cantaloupe with cottage cheese

Snack examples:

  • Cottage cheese and fruit
  • Banana spread lightly with almond butter or peanut butter
  • Yogurt
  • Granola bar
  • Pancakes or waffles


The main purpose of eating after you workout is to turn a catabolic environment into an anabolic one. In other words – your post-workout meal will facilitate the processes underlying muscle growth, re-hydrate, help curb excess inflammation and restore muscle glycogen. In addition to improving recovery, your post workout meal will help you make training gains.

Post-workout meal ideas:

  • Protein pancakes (Simply pancake mix with added protein powder.)
  • Protein shake
  • Low fat chocolate milk (you’ll need more protein than this if you are lifting weights)
  • Bagel, bread or pita with melted cheese
  • Tunafish or turkey sandwich

Eat so you can train well, don’t hit the gym or run a few extra miles as an excuse to eat more food that doesn’t fit in your training program.

Written by: Rachel Rosenthal & Marie Spano

Gatorade’s Product Line – Confusing but Forging Forward

Written by: Sara Shipley, RD student, runner, nutrition writer and more

Gatorade fruit bites and pro chews? Yes, you read that right. PepsiCo’s brand is embarking on a major product expansion into a new market.

Recently, an article about Gatorade caught my eye, and here’s why. I find their product line a bit confusing. I know they offer an electrolyte-rich sports beverage to mass markets and serious athletes alike, but keeping up with the right drink to consume pre or post workout honestly gives me a headache. This article will shed light on the direction the brand is heading and how they are getting there.

At the IMG Academies in Bradenton, Florida, Gatorade has a lab and, well known sports figures including NBA star Dwayne Wade and Iman Shumpert are involved in the studies, which drive the scientist’s knowledge of an athlete’s needs for performance. The brand has set out to develop products that rival competition in other markets. ‘“One beverage can’t serve all your needs as an elite athlete,” says the brand’s chief, Sarah Robb O’Hagan. (Her official title is Gatorade president, North America, and global chief marketing officer, sports nutrition, for PepsiCo.) Gatorade’s goal is to go from a big fish in a $7 billion U.S. sports-drink industry to an even bigger fish in a $20 billion sports nutrition market.’

As the sports drink took a hit during the 2008 economy bust, Gatorade’s market share decreased from 80 to 74%. Compounded by competition in the performance fuel market (Jelly sport beans, energy bars and Honey Stinger waffles), professional and serious athletes were looking elsewhere for energy sources. Gatorade marketing strategists’ knew that in order to revive their brand, they would need to expand product offerings.

Examining athlete’s performance and nutrient absorption has been a major focus as Gatorade goes into the lab and tries to develop effective products. Lawrence Armstrong, professor of environmental and exercise physiology at the University of Connecticut’s human performance laboratory explained in the article: “Research says protein helps repair muscles after exercise. But simply chocking a bar full of protein won’t work. The body can handle only so much at a time. And even when the optimal level of a carbohydrate is determined, making large amounts of the supplement palatable in a drink requires further expertise. There are many, many factors that influence performance, including psychology, sleep, and environmental conditions.’’

As I mentioned, their product line seems convoluted. Gatorade executives agree. “I think it’s a very confusing brand,” says Tim Hoyle, director of research for PepsiCo.  Although the sports drink giant now offers a wider assortment of products, ‘Gatorade has its work cut out for it. It will need to persuade everyone from high school jocks to weekend tennis warriors that they should trade bananas for packaged carbohydrate chews, and peanut butter sandwiches for processed protein bites.’ Currently, three core product lines for G Series include ‘G’, ‘G Fit’, and ’G Pro’ and each offers pre, during and post workout products.  The ‘G’ line is targeted to ‘performance athletes such as high school teams or recreational adult league players- which according to the article make up nearly a quarter of the United States population.  The ‘G Fit’ is intended for the more moderately active population who exercises to stay healthy, but do not participate in competition. Finally, the ‘G Pro’ line is the list of products formally only available to pro athletes. Consumers are now able to purchase the bars and chews with precisely engineered ratios of carbohydrates, protein, vitamins and mineral for performance and recovery.

Armed with an assortment of new products, the brand faces another challenge. Executive Sarah Robb O’Hagan noticed the brand really wasn’t marketing to athletes. “The huge aha! for me was, ‘We’re an athletic performance brand, we’re selling in convenience and grocery stores, but we don’t even show up in a sporting goods store, in a cycling store, or in a place where an athlete actually goes to equip themselves to play sports.” Distribution will be instrumental in their success. Vice-President Brand Marketing Andrea Fairchild explains: “We are setting a different bar for how we are looking at retail’…instead of just stacking beverages high and selling them cheaply in grocery and convenience stores, the new strategy requires the company to rethink everything from advertising to in-store displays. Gatorade now is selling to GNC vitamin shops, Dick’s Sporting Goods, Whole Foods Market, and specialty sports stores. It’s about being where athletes shop and sweat.”

As an amateur runner, I have personally had great success with homemade pre- and post workout snacks, including peanut butter toast and Greek yogurt with oatmeal. However, I’m intrigued with the bite-sized fruit nut bars for long runs. Have you tried any of Gatorade’s new products? Do you think they can sustain their dominance in the market and grow as a sports nutrition resource? Share your comments!

Source: http://www.businessweek.com/magazine/gatorade-goes-back-to-the-lab-11232011_page_3.html

Nutrient Timing: Important for Sprinting & Short Bursts of Activity

Every endurance and strength athlete knows what they fuel their body with, especially their nutrient timing tactics, will affect their performance and recovery. And, many team sport athletes get this concept as well – even if you make it far on raw talent at some point poor nutrition catches up with you.

Add sprint athletes and those who engage in repeated bouts of short activity (hello hockey players) to the group who can benefit from nutrient timing tactics. Scientists from the Nestle Research Center took healthy, well-trained athletes and had them perform two bouts of sprint cycling with either a protein-carbohydrate supplement (24 grams whey protein, 4.8 grams leucine, 50 grams maltodextrin) or a non-caloric placebo prior to each exercise session. At rest and 15 and 240 minutes post-exercise they took muscle biopsies to evaluate protein synthesis and muscle cell signaling.

Though power output was similar between the groups, post-exercise myofibrillar protein synthetic rate was greater with the supplement than with a placebo. In addition, consuming the protein-carbohydrate drink was beneficial for cell signaling proteins that play a role in protein synthesis. In addition, force-generating, myofibrillar proteins were also greater in the supplemented group indicating that a protein-carbohydrate beverage within proximity to exercise may, over time, translate to increased power and speed.

PS – check out the incredible muscle on Jamaica’s Usain “Lightening” Bolt.

Muscle Injuries in NFL Players Related to Low Vitamin D?

A new study presented at this month’s American Orthopaedic Society for Sports Medicine conference suggests that low vitamin D levels may increase the likelihood of muscle injuries in athletes, specifically NFL players.

Vitamin D deficiency is rampant. Few foods contain this vitamin (fortified milk and other fortified products, fish – but you must eat the bones) and many of us aren’t getting the sunlight required to make vitamin D (not the best route anyway if you want to protect your skin). And, football players – even though they practice outside, are covered up in so much gear that little to no skin is exposed to UV rays from the sun.

In this study, 80% of the NFL football team studied had vitamin D insufficiency (they weren’t deficient per se, but their levels certainly weren’t optimal). Of the 89 NFL athletes on this team:

  • 27 were vitamin D deficient (< 20 ng/ml)
  • 45 had low levels (but not true deficiency; 20 – 31.9 ng/ml)
  • 17 players had normal vitamin D levels (> 32 ng/ml)
Among the players who were deficient in vitamin D, 16 suffered from a muscle injury. Though this study doesn’t show cause and effect but instead a relationship between vitamin D and muscle injuries, there are some clues from other studies about the role vitamin D plays in athletes:
  • skeletal muscle has a receptor for vitamin D (which in the body acts like a steroid hormone)
  • vitamin D deficiency has been tied to pain, specifically low back pain
  • vitamin D deficiency is tied to fat infiltration in muscle tissue (fatty muscle = less effective functioning of muscle tissue)
Athletes have a greater risk of developing a vitamin D deficiency if they:
  • live in the Northern half of the country (above Atlanta, GA)
  • play indoor sports or are covered in clothing outside
  • have darker skin
  • those who take in little to no vitamin D in their diet (fortified milk, fish with bones)
Signs & Symptoms of deficiency:
  • fatigue
  • muscle weakness or cramps
  • joint pain, lower back pain
  • constipation

If you are an athlete and want to perform at your best, it makes sense to get tested. Go to your primary care physician, campus health center or a local testing facility (Lapcorp, Quest, directlabs.com). Ask for a 25(OH)D test and, get the results (don’t settle for them telling you that your levels are normal, low etc.). Ideally, for good health, your vitamin D should be 50 – 70 nmol/L or > 20 ng/ml (depending on the measure used).


Get Rid of Muscle Knots and Tendonitis with Dry Needling

I’ve spent my fair share of time at PT offices, in training rooms during my college years and at various orthopedic offices. And there’s one common thread I’ve noticed through the years – many practitioners want to put a Band-Aid on the issue and send you out the door. Foot pain? We’ll just assume it is plantar facititis, give you some exercises and send you out the door. Oh, and stay off your feet so you can get better. If you’re competing, we’ll just shoot you up with cortizone to mask the pain, tape the area and send you on your way.

Frustrated, but with no other real options, I went with the Band-Aid approach. So I’ve intermittently given up running countless times while faithfully doing PT exercises only to end up with knee pain, plantar facititis for the millionth time or something else.

But, through a twist of pure luck (thanks to CBS Better Mornings Atlanta), I found a PT practice that operates differently. One that spends time going through the biomechanical issues that actually cause the problem in the first place and then uses a systematic approach to treating areas that are tight, muscles that aren’t firing and more. And, they also incorporate a technique called dry needling. A technique that alone has made an immediate difference!

With dry needling, small needles are placed within within those muscle knots that are so tender. The needles hit the specific area within muscle tissue that is locked, causes it to twitch, cramp and release. For 2 seconds of pain you get amazing results! Sure, deep tissue massage feels great and it works but in my experience, dry needling is an instant relief – especially if you have painful tendonitis – you’ll feel better right away.

So what’s my take home message here? There are practices out there that take the time you need to thoroughly evaluate and then treat the actual cause of your joint and muscle pain. You may pay more, or pay out of pocket but, in the long run you’ll pay a lot less if you fix the problem on the first try instead of paying a bunch of copays and money on ineffective treatment modalities (remember, spending $20 to “try something” that has no validity, is likely a waste of $20).

In Atlanta, GA or the surrounding areas, my choice is One Therapy.
In Bethesda, MD or surrounding areas, go with Bethesda Physiocare.

Disclosure: because my treatment philosophies line up with One Therapy’s, I have aligned my business with theirs but, I’m also a patient. And, for the first time, my biomechanical issues (poor running gait, muscles not firing when they need to so I’m overcompensating with other muscles and overloading my knees) are being addressed.

Why Athletes Should Shake the Salt Shaker (on their food)

Yesterday morning I was telling a young, inactive man how to lower his blood pressure. By afternoon I was pleading with a pro athlete to use the salt shaker. The response I received was expected, “but I thought salt was bad for me? Both of my parents have high blood pressure.” Ah, but do YOU have high blood pressure? If the answer is no (and I’d be shocked if it’s yes if you are an athlete, especially a young athlete), then you absolutely need sodium.

The collective “skip the salt shaker” and “lower your sodium” advice is geared to the general population. The masses of inactive, overweight and obese inactive adults that populate the U.S. and many Westernized nations. But for athletes, salt is critical for a few reasons:

  • Sodium is the electrolyte you lose the most of through sweat
  • Low sodium levels = more fluid lost through sweat = dehydration, increased likelihood of overheating, heat illness
  • Low sodium + fluid loss can lead to low blood pressure. And, low blood pressure sucks since it can leave you feeling dizzy, lethargic and with orthostatic hypotension (get up too quickly and the room spins and everything goes blurry for a few seconds). And, you can even faint from low blood pressure (again, no fun). Oh and by the way, athletes tend to have lower heart rates and blood pressure then non-athletes anyway.
  • Very low blood sodium is called hyponatremia, a very dangerous condition (read more about hyponatremia here)
  • And finally, your body can get rid of excess sodium.

So, as an athlete, please don’t listen to the general advice for the masses. If you have specific questions, go to a sports dietitian.


My Anti-Inflammatory Stack

Lately I’ve got bad tendonitis. Too much typing, not enough stretching or massage, not following the RICE protocol, whatever the contributing factors are, all I know is that it hurts and popping NSAIDS is beyond useless. If you’ve spent your fair share of quality time in training rooms, in ice baths (I’m sold on these after my experience with them at Athlete’s Performance Institute), with a stem machine and more, you know how frustrating it is to be injured. And while there’s typically no one modality that works perfectly to fight pain and inflammation, a variety of things can help get you back to practice. And, nutrition plays an important role so, I developed my own concoction or “stack” (partly because I love mixing stuff together).

So here it is and below this a little why on the ingredients I chose:

  • Milk
  • Protein powder that’s rich in BCAAs (I used Isatori’s Eat Smart because it blends well and Muscle Milk Light Chocolate Mint)
  • Fresh cut pineapple
  • Frozen mango
  • Fresh ginger (peeled of course; I put in a nice 1 inch x 1/2 inch chunk)
  • Blueberries or frozen acai

There are 2 things missing that I could have added: caffeine and fish oil (though you can down this by pill form with any meal).

Now the rationnale:

  • Milk is loaded with high quality protein, calcium, vitamin D, magnesium and it tastes good so that’s my base.
  • I added protein (and high quality protein rich in branched chain amino acids)because it is key for building and repairing muscle.
  • Next I threw in an anti-inflammatory cocktail starting with fresh pineapple which is loaded with bromelain which fights inflammation;
  • Mango – may help with inflammation and makes my shake nice and thick!
  • Ginger – two studies at my alma mater UGA shows that 2 grams of ginger per day helps reduce exercise-induced muscle pain.
  • Red, purple, and blue fruits and vegetables contain antioxidant flavonoids that may limit inflammation, limit tissue breakdown, improve circulation and promote a nice strong collagen matrix.
  • Caffeine post exercise (granted, you may need a nice strong dose since studies have used 5 mg/kg body weight) can decrease delayed onset muscle soreness and pain after hard core exercise. If you want it in shake form, use a protein powder that contains caffeine or use cold coffee as your base.

And there you have it! My research-based, tastes great shake. Now if only I could incorporate the RICE technique somewhere on a beach overlooking blue ocean water, I’d be pain free!

Don’t Waste Your Workout

The past few days I’ve been at Bowdoin College working with the outstanding US Women’s World Cup Rugby team. And, today a college student (apparently a nutrition major) looked at me in the cafeteria and said “so do you all rugby people have a nutritionist or something? Because everyone eats the right foods.” After telling him he was talking to the dietitian, something occured to me (well, after Coach Kathy Flores pointed it out that is), many of the high school camp kids as well as the younger kids weren’t taking advantage of the variety and healthy foods that Bowdoin’s cafeteria offered at every meal (I can’t say enough about this cafeteria!). Instead, they’d load their plates with pasta, eat a little, then run over and get a bowl of frozen yogurt. Where’s the protein for recovery? Fruits? Vegetables? Fiber? Vitamins & minerals? Yep, there’s a lot missing on a diet comprised of pasta and frozen yogurt.

Many athletes miss this opportunity to fuel their bodies for their workouts and fuel them for recovery and muscle growth. And, to get better, pack on strength and gain speed, you have to eat and you have to eat the right foods. As my good friend and sports dietitian Amanda Carlson tells her pro athletes “nutrition can make a good athlete great or, a great athlete good.” And, as I told an athlete last night, why go to the gym for over an hour, power lift and do plyometrics if you aren’t going to fuel your body to actually benefit (maximally benefit that is) from your hard work? It isn’t a waste of time but it certainly isn’t the best use of time. And, if there’s one thing I’ve noticed when it comes to career longevity and performance, the best athletes have everything down pat – their eating, supplementation, rest, taking days off, rehabing and of course, training. They notice when one facet of their strength and conditioning program is out of balance and they fix it right away. So, I leave you with this thought – clearly identify your goal and train for it. But, make sure your eating program and supplements (what, when and how you take them) support your goals. After all, time is a commodity and, you might as well make the best use of your time in/on the gym, pool, court, and field.

Sorting Through Nutrition Information to Develop an Individualized Approach

FAU's Sue Graves and her studentsAt the ISSN conference a few weeks back, I had the opportunity to connect with good friends, pick the brains of some of the foremost sports nutrition scientists, talk sports nutrition strategies that work in the real world with the best sports dietitians in the country and learn about sports nutrition for Italy’s World Cup soccer players from Dr. Fabrizio Angelini (physician for Juventus) and Massimo Negro of Societa’ Italiana Nutrizione Sport e Benessere. And I soaked up every minute of it (and some sun, after all, Pensacola Beach is beautiful!). I’ll be blogging about what I learned over the next few days, but, I wanted to start with a conversation I had in the hall with Layne Norton, PhD.

I love talking to Layne because he is bursting with enthusiasm  for the many subject areas within sports nutrition. During his PhD he managed to speak throughout the country, write for bodybuilding.com and compete in bodybuilding (his wife, Isabel Norton-Lago is a personal trainer and competitor as well). His knowledge and experience make for a unique perspective on muscle, preventing loss of muscle mass and developing a person’s physique (which I’ll delve into tomorrow). But, the most profound thing we discussed that day, was the fact that there is so much nutrition misinformation out there and in reality, as Layne put it: many of them are right and many are wrong at the very same time. There are two main reasons for this:

1) Nutrition recommendations are made for the majority of people and that majority, here in the U.S., is overweight or obese and either has chronic disease or risk factors for chronic disease; and

2) Nutrition recommendations are made based on the current body of science at the time and what scientists interpret from this body of science (and Food Politics and Food Policy). And sometimes, the interpretation of the science is swayed because we don’t have the full picture (think of the changing recommendations between fat and cholesterol over the past 6 decades) or food policy influences the recommendations made (I’ll cover this tomorrow based on Layne’s presentation at ISSN).

Because of these two factors, the recommendations you hear in the news may not be right for you (think about the lower sodium recommendations – if you are an athlete, lowering your sodium intake could be dangerous). How do you know if they are or if they aren’t? Well, you can read about the subject matter you are interested in and decide for yourself or, seek the help of a dietitian who specializes in that particular area (sports, GI health, diabetes, CVD and more). The bottom line is this: nothing about nutrition is the exact same for every person.