A little prior planning with specific attention to the dietary intake and supplementation and specific micronutrients can ensure that an athlete is able to recover from training and improve their performance as quickly as possible. Whether this means that they will be functioning closer to their full potential on game day or just able to make all their lifts in practice, it is imperative that the coach and athlete make ensure that the body has everything it needs to recover. Manganese, Zinc, and B Vitamins all play essential parts in the repair of tissue within the body. Keeping a consistently clean and high quality diet will keep all of the tools of recovery and repair at a state of high preparedness for the body and help expedite the process of recovery and enhance the effects of training.

Manganese and Zinc

Manganese and Zinc perform critical roles in several essential functions of the human body. These minerals may have an underappreciated role in the synthesis and repair or muscle tissues. The majority of research done on these minerals focuses on their effects on wound closing, and while the correlation between their role in healing wounds and repair muscles is not fully understood, the implication is that may be essential for the first stages of muscular repair. An athlete’s ability to maximize their immediate muscle repair will be able to endure greater stress and therefore perform better during multiple event competitions or train harder on days that involve multiple training sessions. The faster an athlete can recover from an imposed training stress, the more capable they will be of performing near their maximal potential on subsequent efforts or training sessions.

Manganese

Manganese is known to have diverse physiologic effects, many of which remain incompletely understood. Known functions include those related to its anti-oxidative effect, cellular metabolism, bone and cartilage growth and health, and wound healing. Manganese is responsible for prolidase activation, which in turns produces proline, an amino acid that plays a pivotal role in collagen formation and stability. Both topical (manganese mineral salts) and oral applications have been described with respect to wound healing in particular.

Chebassier presented insights in 2004 in looking at the stimulatory effect of both boron and manganese on keritinocyte migration as related to wound healing. Their work documented a 20% acceleration of wound closure as compared to the matched control. Further analysis prompted their conclusion that the documented acceleration in wound healing was prompted by an increased keritinocyte migration response (as opposed to proliferation).
It is reasonable to believe that this same effect will be seen in the healing and repair of muscles, tendons, and ligaments that are damaged during training as the two processes haves many of the same requirements.

Recommendation for manganese in the athlete: 1.5 mg/day

A single case report for supplement-related oral manganese toxicity describes a person taking high-dose mineral supplements for a period of years. It is a singular isolated report (without correlate), and there are certainly no know instances of toxicity for those taking elevated mineral supplement levels for shorter durations (months).

RDA: not established, but AI levels range from 1.6-2.3mg/day depending upon age and gender. The tolerable upper limit is 11mg/day for adults.

This means that it is a relatively worry-free mineral to take as an oral supplement. Manganese is abundantly available in whole foods sources. Green leafy vegetables and mollusks are the most bountiful source. A cup of cooked kale contains .5mg and an ounce of mussels contain .2mg.

Zinc

Zinc is an essential trace mineral, and over 300 enzymes require zinc for their activities. These numerous cellular zinc-dependent processes include catalytic, structural, and regulatory roles in DNA synthesis, cell division, protein synthesis, cell signaling, anti-oxidant function and beyond.

Zinc has been widely researched for its effects on wound healing, and zinc deficiency is well associated with poor wound healing and decreased biomechanical integrity of healing wounds and soft tissue. These effects have been attributed to decreased collagen and protein synthesis, affecting a broad range of healing tissues to include skin, muscle, tendon, ligament and bone. In skin, zinc has been shown to enhance healing by facilitating keritinocyte migration through several mechanisms, to include integrin modulation. Zinc demands are believed to be highest during phase I of wound healing (immediately following injury/training), emphasizing the importance of preemptively optimized zinc levels.

The wound healing properties may extend to include vascular tissue repair as well, which would be of particular importance to athletes training for muscular endurance or hypertrophy. Kaji et al reported their in vitro work investigating the role for zinc in promoting the repair of wounded monolayers of cultured vascular endothelial cells. Both the appearance and number of cells was markedly improved in the zinc-treated group, with other results suggesting that zinc promotes the visualized repair process of damaged vascular endothelium (the thin layer of cells that lines the interior surface of blood vessels) through the lipoxegenase pathway (that modulates the cellular response to endogenous bFGF).

Recommendation for zinc in the surgical patient: 25-40 mg/day.

This is an elevated dose versus the RDA, and is targeted to meet the expected increased demands imposed by training. This is of additional importance, appreciating present sentiment that zinc deficiency in humans is common and under-recognized. These doses, while elevated from the RDA, are far below the levels associated with mild GI side effects that are reported in isolated individuals taking 50-150mg/day of supplemental zinc. Prolonged excessive zinc intake can interfere with copper and iron absorption and metabolism.

RDA: 8mg/day for women and 11mg/day for men.

Most athletes, especially those with an affinity for red meat, will have no problems achieving or exceeding these levels of zinc through whole food sources. While we do not recommend taking supplemental zinc in excess of 40mg/day, consuming high levels of zinc from whole food should not pose any issue. An athlete that eats high quantities of red meat and eggs each day may want to be more conservative with their supplementation. However, optimizing the intake of zinc in conjunction with the protein and amino acids found in real food sources is the optimal way to facilitate muscle and tissue recovery and growth.
B6, B12, and Biotin

Much like the micronutrients previously profiled, these three B Vitamins support a diverse array of biological functions, ranging from immune system functioning to metabolism to red blood cell functioning. For the athlete and the coach, it is important to focus on the role that these vitamins play in the proper and effective functioning of several energy substrates and in central nervous system functioning. No matter how it is defined, a hallmark of functional training is that it taxes several metabolic pathways and that there is a high demand on the central nervous system for task accomplishment. An athlete attempting to train while deficient in these B complex vitamins will suffer from a decreased performance potential.

Vitamin B6

Vitamin B6 has an essential role in over 100 enzyme reactions, catalyzing a wide range of reactions throughout the body. It has a primary role in mobilizing glycogen energy stores to meet increased metabolic demands, as when healing, and is fundamental in converting protein to usable energy forms through gluconeogenesis. It is important for immune function, red blood cell formation and function, nervous system function, nucleic acid synthesis (as during post-operative reparative cell division), and hormone function (through the alteration of gene transcription). B6 also has an important role in human bone metabolism, with support of proper cancellous bone structure and biomechanics.

Low vitamin B intake has been shown to measurably impair immune function. The interaction between the immune system and recovery from training stimulus is not very well known. The immune system accomplishes many critical tasks during the first phase of tissue healing. Restoration of vitamin B6 levels has been shown to result in normalization of lymphocyte proliferation and interleukin-2 production, further confirming that adequate vitamin B6 intake is important for optimal immune system function, as during the normal early phases of wound and other tissue healing.

Badner and colleagues investigated a role for B6 in mitigating myocardial ischemia with nitrous oxide anesthesia, studying 53 patients undergoing elective total knee or total hip replacement. They found that pre-emptive utilization of vitamin B6 and B12 (in elevated doses) was significantly preventive, and concluded that a one-week course of oral B vitamins can prevent increase in homocysteine from nitrous oxide, and by implication myocardial ischemia as well--which translates into faster and more complete muscular recovery for the athlete.

Vitamin B6 levels measurably increased from typical daily intake, and as optimized for the orthopaedic surgery patient will foster:

Optimized immune function in the medically-stressed surgical patient
Mitigation of myocardial ischemia with nitrous-oxide anesthesia regimens
Support of peri-operative red blood cell function and production
Support of nucleic acid synthesis during restorative tissue healing
Support of proper cancellous bone structure and biomechanical function (as particularly related to bone & joint or spinal reconstructive procedures).

Recommended vitamin B6 intake for the surgical patient: 100mg/day

Long-term intake of B6 at levels of 500mg/day has been shown to be related to rare instances of sensory neuropathy. The Food and Nutrition board recommends an upper tolerable limit of B6 of 100mg/day, and there are no reports of beneficial reports in levels beyond.

RDA: 1.2-1.7mg/day.

Vitamin B12

Vitamin B12 is unique in containing a metal ion (cobalt), and also has the largest and most complex molecular structure of all the vitamins. B12 has a number of actions, including those on the peripheral and central nervous systems, bone marrow and osseous tissue, skin, mucous membranes, and blood vessels. Of these, the affects related to nervous system function and maintenance are those most relevant to the athlete. The importance of supplement support in the athlete is further compounded, as B12 deficiency is estimated to affect 10-15% of people over the age of 60.

A number of studies have investigated the role for B12 for neurologic support before and after nerve tissue injury. Okada and colleagues reported the use of high dose vitamin B12 in rat sciatic nerve injury model, demonstrating improved histological nerve regeneration as well as functional recovery. In sum, this body of literature provides support for the utilization of high-dose B12 for both neuroprotective and other effects in the peri-operative patient. This would reasonably be of particular merit for patients undergoing procedures for neurologic compromise, such as carpal tunnel release, or cervical spine or lumbar spine decompression.

No toxic or adverse effects have been associated with large intakes of vitamin B12 from food or supplements, and no tolerable upper intake level is set by the Food and Nutrition Board in the most recent revision of the RDA.

Recommended vitamin B12 intake for the surgical patient (without known B12 deficiency): 100mcg/day

RDA: 2.4 micrograms/day for vitamin B12.

Biotin

Biotin is a water-soluble vitamin, and it took nearly four decades of research after its discovery for it to be recognized as a vitamin. It is often regarded as a B-complex vitamin. It is known to be important co-factor of enzymes required for fatty acid oxidation and synthesis, gluconeogenesis, and metabolism of certain amino acids. Biotin deficiency is uncommon, although high doses of pantothenic acid are knows to compete with intestinal and cellular uptake for biotin (given their similar molecular structures). As higher dose pantothenic acid is important in facilitating rapid wound healing and tissue strength in the surgical patient, biotin should be supplemented as well to prevent potential for competitive biotin deficiency in this setting.
Biotin recommended for the orthopaedic surgery patient: 300 mcg/day

When taken along with a regular diet, this dose will meet the above requisites (and is in keeping with RDA recommendations and safety).

RDA: 25-30 mcg/day, and the tolerable upper limit has not been established.