Episode 71 | Nutrition + ACL Rehab with Emily Barnhart, Sports RD – Part 1

Ravi Patel: Welcome back everyone to the ACL Athlete Podcast. This is your host, Ravi Patel. And today, I’m so pumped and excited. We have Emily Barnhart on the podcast today. Emily, how are you? 

Emily Barnhart: I’m good. Thanks for having me, Ravi.

Ravi Patel: Emily is a registered dietician who runs her own practice, specializing in nutrition for injuries and rehab called The Injury RD. Prior to that, she worked in collegiate and professional athletics, most recently with the Texas Rangers, and is currently a consultant with USA Volleyball. Emily, thank you so much for being here and welcome to the show. 

Emily Barnhart: Again, I’m excited to be on here and have this chat. 

Ravi Patel: Give us a little bit about your background. We talked a little bit about you, you’re a registered dietician, and some of your history. But talk about your background, what got you to this point you’re at right now? 

Emily Barnhart: Actually, my undergrad and master’s degree are both in exercise physiology. I originally wanted to be a strength coach, then did an internship with a football team and learned very quickly that I am not the right personality to be a strength coach. But long story short, during my master’s, I learned that sports nutrition existed and felt very strongly that my athletic career would’ve looked a little bit different if I had known some of this information, then swerved, and now I’m a registered dietician and I love it every day. 

Ravi Patel: I think it’s very unique. You have a special background, especially when you come into performance as a strength and conditioning coach. And it’s always cool, you get to dive into these different realms of performance, whether it’s weight training or especially nutrition, and they go hand in hand. It’s cool that you pivoted towards that. And I think it’s a very much needed area, especially when it comes to injuries, which is your specialty.

Emily Barnhart: When I was working in pro ball, obviously we had a lot of Tommy John injuries, which is an elbow injury that pitchers will get. And if you know anything about it, it’s a very long rehab process. Getting to see intimately what their rehab looks like and the group that they put together to support that athlete. Some of the struggles they were going through, I was just like, wow, we need to do a better job of supporting these guys. I took that and ran with it. 

Ravi Patel: It’s one of those things that, especially during rehab, and obviously we’re focused mostly on ACL injuries. But it’s not like nutrition isolates and focuses just on one injury in terms of what you take into your body. Tommy John is actually a good parallel to ACL injuries because of the length of the recovery. The only other one I can really think of is maybe an Achilles tendon where someone recovers from that. They’re so unique, they’re such a long process. What can easily get missed is the nutrition piece. There’s so many athletes I talk to where they are crushing it on the rehab side. But then they might be making not as good progress as they hope to be.

And when we ask about the nutrition side, they’re not really checking the boxes on the things they need to be working on. That’s one of the things today that I want to talk about is essentially when we talk about, so let’s take a step back and let’s talk about the macronutrients, nutrition, the big umbrella. Give us a very simple breakdown of those macronutrients or macros that we say. 

Emily Barnhart: Obviously, there are three macronutrients, technically four, but we don’t talk about alcohol. you can do that on your own time, but carbs, protein, and fat. Carbs are hopefully being used for energy. And when it comes to rehab athletes, they tend to give us a lot of the nutrients that we’re looking for. I see a lot of rehabbers try to automatically cut out carbs and I will fight that till my dying day. You still need some carbs. Fat is our other form of energy, so we’re getting energy from carbs and fat. Fat is also helpful for hormones. And then protein, of course, hopefully, is not being used as an energy source. It’s metabolically difficult to use protein, and it’s hopefully only being used as a building block. Your tissues are always breaking down. Protein is what we need to continue to repair that. And obviously, during rehab that is super important. 

Ravi Patel: And then what about, you’ll hear the term called micronutrients thrown around as well. What are those in a nutshell? 

Emily Barnhart: Micronutrients are your vitamins and minerals. And there’s some specific micronutrients that I pay attention to with all the rehabbers that I work with, which we can get into if you want. 

Ravi Patel: That leads perfectly to preparing for ACL surgery. I get this question all the time. How is nutrition different for someone who is going through this process? What I’d like to do is focus on the before, during, and after ACL surgery. If you want to walk us through that, what is your approach to that?

Emily Barnhart: The way that I think about before, during, after, in general, is you can break rehab down into parts. And then I always think of nutrition as, how can we support what PT is trying to work on or what you’re trying to work on in the weight room. You’re putting the external work there. How can we support that from the inside out? Obviously, Ravi, correct me if I’m wrong, but prior to surgery, our main goal is the range of motion, which nutrition can’t really affect. But also we’re working on building integrity within that muscle and getting as strong as possible heading into surgery. 

Ravi Patel: One of the biggest things is making sure we minimize atrophy to make sure the muscle doesn’t get small, but also can we still maximize the hypertrophy? Can we get it bigger and get it ready for surgery? 

Emily Barnhart: Correct. Obviously, nutrition can play a role in that one. And there’s really two things that it comes down to. One, are you eating enough? Because anytime you’re not getting enough calories, things are breaking down including that muscle. And two, are you getting enough protein? And protein is a huge topic that we’re going to talk about. And I’m probably going to start sounding like I’m repeating myself, but it’s easier said than done. 

Ideally, in a perfect world, we’re getting 20 to 30 grams of protein every three to four hours, and that is the best that we know to continuously signal to that muscle, like, hey, we still need you, we want you to continuously build up versus we actually know that 20 to 30 grams every three to four hours is better at that signal than 10 grams every two hours or 60 grams every six hours. So the biggest thing that I’m working on at all times with my athletes is that pattern. Are you eating breakfast? Are you eating lunch? Are you eating dinner? Are you eating snacks? And nine times out of 10, that is the first place we’re starting. Because we all know plenty of people that skip breakfast or just have a coffee for breakfast, they skip lunch, and then they’re starving at night and they have a huge dinner. That’s kind of one of the worst things you can do from a muscle standpoint and a protein standpoint. 

Ravi Patel: What you’re saying here is making sure that there’s a consistent pattern of getting protein into your system in order to make sure we’re facilitating that. That way there’s not too many highs and lows. And obviously, there’s a big piece to this of the amount that you’re getting as well.

Emily Barnhart: And if we want to talk numbers on the amount of protein before, during, after surgery, it’s all going to be the same. We are aiming for your body weight and protein basically. If I’m 150 pounds, I’m looking for 150 grams of protein a day. It can get a little bit higher if you’re a vegetarian and getting mostly plant-based sources of protein for availability reasons. For the most part, we’re looking for body weight and protein. Again, that’s for most people, 20 to 40 grams at every meal trying to include at least 10 grams in every snack. Or, an even easier way to think about it is at every meal do you have a hand-sized portion of protein on your plate? So that’s palm plus fingers laying flat in front of you. That’s what your piece of chicken should look like. 

Ravi Patel: That’s great. And so essentially what you’re saying is one gram per pound body weight is roughly a good roll of thumb in terms of trying to get the amount of protein per day in.

Emily Barnhart: That’s usually the starting point. And then obviously, like I said before, carbs and fats and other things are important too, when I usually build those around the protein.

Ravi Patel: How does that differ? And I know a lot of this comes back to activity and people’s daily lifestyles. I know that has to be factored in in order to give a good breakdown of what people need. But how do the other pieces, so let’s talk about carbs and fats. How does that play into the before, during, or after? Do you change anything up with those? 

Emily Barnhart: I think a lot of athletes like to think in extremes and we don’t have to do that here. We can operate in a gray area, just including those regularly throughout your day too. If we want to talk about portions, most people need a spoon or two of fat at every meal, or you can use your thumb if you want to go with our hand measurements again, and about a fist or two of carbs at every meal. Again, if you’re spooning rice onto your plate, does that pile of rice look about the size of your fist? Or actually, for most athletes it’s two, sometimes even three fists. 

Ravi Patel: And so what about protein shakes? I’m sure you get a lot of questions about this, but how do you fit this in, in terms of, you’ll hear some people say, oh, well it’s not a natural source, versus if we’re trying to get 150 grams of protein, you’re not going to eat seven chicken breasts in a day. The question is, with protein shakes, how do you incorporate those? 

Emily Barnhart: I mean, there’s definitely a way to do it through food, especially if you’re eating meat and dairy. But a protein shake can be very helpful. And I’m totally fine with that. Especially in the morning, a lot of people find a protein shake or smoothie easier to get down if they’re not big breakfast eaters, but we’re working on being better. But notice that I said a protein shake. I think sometimes the issue comes when, at the end of the day, you’ve done six scoops of protein powder. One, you’re missing out on other things if you’re going for that much. And two, that normally doesn’t sit well in people’s stomachs. They come to me and they’re like, yeah, and we don’t have to get into the visuals of all the stomach problems that I hear about day after day. But one scoop, maybe two, to help you hit that goal. But you don’t need a protein shake at every meal, or you shouldn’t. And if you’re struggling, then talk to a dietician and we’ll help you figure out something that’s going to work for you. 

Ravi Patel: With protein and those values, I know you mentioned if you’re plant-based, you might increase the number. Is there any other time during, or around an injury or a surgery that you will potentially increase the values of the protein that you’re looking for the athlete? 

Emily Barnhart: Not really. Protein is pretty stable. A lot of people think of protein as we need it as a post-workout. One, your workouts, especially in the beginning stages of rehab, aren’t super intense. And two, again, that pattern is more important than our pre and post-workout timing right now. Again, really focusing on getting high-quality, even distributions of protein throughout the day. 

Ravi Patel: When we’re talking about protein sources, what are your go-to that you typically tell your athletes? Maybe some easy strategies or just go-to’s that you give to your athletes. 

Emily Barnhart: Yes. Anytime we’re talking about sources, it’s hard to give general recommendations because I always want to consider what are people’s budgets, what people like, what people feel comfortable cooking. That kind of stuff. But there are a lot of easy hacks out there. You can always find protein waffles and there’s higher protein cereal options. Like Kashi is a good one or Special K has one that’s more than 10 grams. There’s higher protein milk options. The dairy itself is a great way to get some protein in. I feel like we have a big fear of dairy in this country right now. So even if you’re not drinking milk, a lot of the milk alternatives make sure they have at least eight grams of protein per cup. 

And then there’s some tricks, like if you’re someone that loves to eat chips. If we can find a way to pair that snack with a protein, so chips and salsa, you can listen, the sounds weird, I learned about this like two months ago. Don’t knock it till you tried it. Mix your salsa with some cottage cheese and dip your chips in it and you are getting a more balanced snack and you’re sneaking in some extra protein in there. Same thing if you love ruffles. They sell ranch dressing in packets. You can mix that in some plain Greek yogurt. And again, you’re making a snack that a lot of us would classify as unhealthy into a more balanced option. And that’s always the way that I operate. I’m never going to take away the things that you love. I’ve had athletes that love Doritos and we do the ranch and Greek yogurt option and I let them eat their Doritos, and they love that. We just make it more balanced. 

Ravi Patel: That’s brilliant. I love finding ways that you can take the athlete or their lifestyle and be able to implement different strategies to make sure you guys are kind of getting both of what you want. They’re hitting the protein numbers and they’re also getting their Doritos. That’s a really cool way to look at it. And then being able to sneak it in. And I think one thing that’s easy for people to sometimes look at nutrition, especially protein is like, I got to either have a shake or a protein or a chicken breast or something kind of like black and white when there’s different ways you had mentioned, whether it’s the cereal or protein waffles. Think about maybe what you’re eating now and what is it that you can sneak in to be able to try and hit those numbers that you had mentioned every few hours, but also total in the day. 

Emily Barnhart: And I think you touched on this, too. People assume if I’m trying to eat 150 grams of protein, I need eight chicken breasts every day. Keep in mind that most of your carbohydrate sources also have a few grams of protein in them. And again, if you’re including that at every meal, you’re including some whole grains at breakfast, you’re including some beans at lunch and things like that. That kind of adds up too. It hopefully doesn’t feel as daunting to see those numbers when you actually do the math and see, oh, you are sneaking some in some places. 

Ravi Patel: One thing I want to make sure we address before we move forward is eating too much protein. This is the classic question I will get. I know any of my dietician friends, and we talk about this. But what happens to your kidneys, the myth of too much protein is bad. So let’s talk about this.

Emily Barnhart: This is a very nuanced question. If you have kidney problems, there is such a thing as too much protein. If you don’t have kidney problems, there’s really not. However, if you remember what we talked about in the beginning with macros, we don’t really want our energy to come from protein. We want it to come from carbs and fat. If you’re looking at your macro breakdown and your protein intake is 40%, sometimes even 30% or higher, you’re going to run into that metabolism issue where you’re making your body work harder for its energy. And there are certain cases where that’s helpful, like weight loss, but right now we’re focused on healing. And we can still achieve weight loss without, if that’s the goal, without going super high on protein. 

The other thing is when your protein is that high, again, we’re typically looking at some stomach issues. Constipation is a big one if you are getting too much protein in. Are you potentially missing out on the other nutrients that we’re getting from carbs and fat? If you’re focusing too much on protein.

Ravi Patel: Got it. This is actually a funny segue way, but a lot of people post-surgery, especially after ACL, will deal with constipation. Talk to me a little bit about how we can help our ACL athletes out with feeling better. And I know that has to do with the medication they’re taking, as well as the mobilization and things like that. But talk to us about a better route to tackle constipation. 

Emily Barnhart: The big three that I see post-surgery are constipation, diarrhea, nausea or just like no appetite. If we’re talking about constipation, one, if it’s been more than three or four days, it’s time to call your doctor. Food can only do so much. But if you are struggling with it, try to slowly increase your fiber every day, like an extra five grams a day. If you add too much too quickly, you can actually contribute to the problem. An extra five grams would be, eat your normal diet, but add in a piece of fruit or swap out your white bread for whole grain bread on your lunch sandwich that day. Just slowly add five grams for three to four days and see if that makes a difference. Hydration also plays a big role in this, so make sure you’re drinking plenty of water and getting electrolytes, too. And then the other one is magnesium. Magnesium is a main ingredient for a lot of laxatives. And magnesium in high amounts, so roughly like 400 milligrams for most people is going to send things right through. You can either try a magnesium supplement by itself, or there’s magnesium in most multivitamins. And I would recommend a multi to most people post-surgery anyway. You can pop a couple of multivitamins. There’s magnesium and a lot of things that have fiber, those whole grains, beans, nuts and seeds, and all of that kind of stuff, trying to increase some of that intake can be helpful for constipation.

Ravi Patel: That’s really helpful and hopefully yes, can take away some information from that. But slowly increasing the fiber and then magnesium seems to be very helpful. And then, whenever you are potentially in pain or like struggling, like there’s no harm and reaching out to your doctor to make sure that you can get things taken care of.

Emily Barnhart: Take the medicine, it will help you. It’s so funny that you bring this up. This week, I had an athlete that was five days post-op and hadn’t pooped yet. And she was crying to me on the phone and I was like, you need to call your doctor. 

Ravi Patel: It’s one of those where you can be as prepared as possible. You can’t control your body in the way it reacts sometimes. You’re here thinking like, oh, that was me. It’s way more common than we think. These are some good strategies to implement regarding this. 

Emily Barnhart: And if I can while we’re on this topic, the other really common thing is just feeling nauseous and having no appetite. And again, we’ve talked about how right after surgery your muscle wants to waste away and it’s getting bombarded with signals. Those first couple of days, it’s actually so important that you eat. But unfortunately, most people feel really nauseous. If you are struggling with that, try to focus on small meals throughout the day, and try to focus on bland, plain room temperature flavors. And go slowly, a couple of bites is better than nothing. And a lot of times, I’ll also say a lot of us kind of revert back to our childhood favorites. And if you’re feeling that, I don’t care how unhealthy you perceive that to be, eating it is better than nothing. If you got to reach for, I don’t know, the Bagel Bites or whatever you had that you loved when you were eight years old, and that’s going to help you get something in, go for it, please. Guilt-free, go for it. 

Ravi Patel: I love that recommendation. Also, Bagel Bites are the bomb. 

Emily Barnhart: Bagel Bites are always my example because I lived on Bagel Bites and chicken nuggets from age 5 to 10.

Ravi Patel: They’re amazing. Yeah, I remember it is interesting you bring this up and when I reflect back on my two ACLs, like the surgeries around that time, especially my first one, it wasn’t that I was so dialed into nutrition as a high school athlete. But I do remember the appetite was not very much there for the first few days. And as you had mentioned, when we see muscle atrophy, it’s the biggest in those first few days.

Emily Barnhart: There’s a crazy stat and I can try to find this paper to cite it for you. It’s something like, 60% of total muscle atrophy happens in the first five or six days. And really the only fight we have against that in those first couple days is nutrition. Because it’s not like you’re going to be doing a lift, obviously. Nutrition getting enough calories and getting protein in. 

Ravi Patel: That’s one thing to make sure you guys focus on is being able to get your protein in immediately after surgery. That way you have your body is equipped to maximize your protein, as well as the muscle-building process and to minimize what we call catabolism, where it starts to break things down and make sure that we are able to yeah, minimize the muscle atrophy.

Emily Barnhart: There’s also an interesting theory that we can try to look at surgery, like an athletic event. Some people think we could potentially carb load heading into surgery. I wouldn’t go that far, but I do think there’s some metabolic value there without getting into too much of the science. Make sure that the night before your dinner has carbs in it. And then the morning of, even if you’re on a liquid diet, usually you can do juice without pulp or you can do, like real Gatorade that includes sugar. And then afterward, yeah, getting your protein in, but getting your carbs into. And I actually have a free handout on my website. It’s linked from my Instagram that goes into a schedule of what should you be doing leading up to surgery right before, and right after. And then some of those foods that you can focus on.

Ravi Patel: That’s perfect. We’ll make sure we’ll link that in the show notes. That way people can download that if they want to gain access to it. In terms of healing, I want to make sure that we tackle this subject. I know we’ve been talking about it, setting up the environment, setting up the knee and the body to facilitate the best healing process. We talked about the macronutrients, we talked about the protein and the carbs, and the fats, and how protein is super vital in this process. Are there any other things that you recommend as we’re approaching surgery, but especially the days after that stick out in your mind? 

Emily Barnhart: Approaching surgery a little bit, yeah; after surgery, for sure. There is nothing that can make healing faster. And if people are telling you that run. But nutritionally, there is one specific micronutrient that can slow you down if you are deficient. Before I even say this, keep in mind if you are deficient, that doesn’t mean that you need to mega dose with this. That’s actually not helpful. It just means that you need to get enough. And that micronutrient is zinc. So that’s a big reason that I recommend a multivitamin for most athletes. It’s just a really easy safety net to get it in. Depending on if you’re a man or woman, we’re looking for 9 to 11 milligrams a day. And that’s what pretty much every multivitamin that I’ve seen will have those. 

I am not connected to this label in any shape or form, but Nature Made is a good one, that I like that you can find at most grocery stores and Target’s… So that’s a solid multivitamin. You can also get zinc from most cereals are fortified with zinc. Again, another argument for why you should be including carbs. Oysters, surprisingly are really good. I don’t know if people are out there eating oysters every day. But if you have access to that. But red meat, chicken, and nuts are also really good sources of zinc. 

And then the other one is magnesium. Again, remember when we were talking about constipation, keep in mind if you are mega-dosing on magnesium, you’re going to have some diarrhea issues. But if you are getting enough, which is usually around that 300-milligram point. Magnesium is involved in like 300 reactions in your body. One of which is protein synthesis. And it’s a micronutrient that most people are not getting enough in their average diet. Again, magnesium is in most multivitamins. . It’s also in things like peanuts, pumpkin seeds, beans, lentils, and then there’s a little bit in milk and yogurt and stuff like that. Again, those are all carbs. I mean, peanuts are a fat. Again, that’s why we can’t just focus on protein, you have to have a balance of all three macronutrients to make sure you’re getting those micronutrients.

Ravi Patel: And it’s so important and we look at the big pictures of the macros, you talk about the proteins, carbs, and fats, and make sure that protein is important and we have emphasized that. But it’s also a part of the pie, if you will, and carbs and fats will be such an important piece of that. And all of these macronutrients play off each other. It’s not like they operate in silos. And when you think about your human body, sure, you have your immune system, you have your reproductive, your muscular. But at the end of the day, these all work together, and these macronutrients are the ones that help to facilitate energy, healing, building, and breaking down of all these different areas. And so that’s going to be super key to make sure as you’re approaching this process, that it’s not just protein or fat, it’s looking at the whole picture of what this is. 

Emily Barnhart: You also led me into a perfect segueway of something I want to make sure we definitely hit on, and that’s just total calories. Ninety-nine people out of a hundred will feel like they don’t need that much food because they’re not doing anything. And people equate exercise to needing calories. But you just listed off a bunch of things that require calories. Your immune system and your brain take a ton, and your heart has to continuously beat, obviously. And then that big giant gaping knee that you have after surgery is taking a ton of your calories. People think that there’s a huge difference between pre-surgery or pre-injury calorie needs and post-injury calorie needs, and it’s not as big as you think. Again, athletes are usually super dedicated and they operate in extremes, and we are operating in a gray area here. You do not have to. For most people, obviously, every person is different, depending on your sport and all that kind of stuff. But for the most part, you don’t have to drop your calories as low as you think you do. 

Ravi Patel: That’s really good to know because I think naturally most people will want to start not eating as much. And it depends on your background, who you are as a person, maybe the sport or activity. But naturally, we want to be like, okay, well we’re not going to be moving as much, so we should eat less. That logically it makes sense. But in reality, when you’re thinking about what your body still needs, as well as the things that are playing against it, you need to make sure- essentially the way that I view nutrition is essentially fuel. How’s it going to fuel your body for that day and for what you’re working towards? And you’re trying to fuel your body to be able to rebuild and to heal and to make sure that you are not in this caloric deficit during this time. 

Emily Barnhart: And most people don’t necessarily love to hear this, but I would much rather see you accidentally gain 5 to 10 pounds in this process than lose it. Again, for that muscle integrity. Because if you’re losing 10 pounds right after your surgery, the majority of it is coming from your quad muscle. 

Ravi Patel: We do not want that. One thing that I want to make sure we talk about is the lovely topic of supplements. And I know you have touched on this some. But, we know that some supplements can be beneficial, and some are not worth our time. Obviously, there’s a financial investment into these. Curious as you are in this process, let’s talk about, especially around the injury and surgery, what is worth spending your money and potentially your time on to help use it for your recovery and healing. 

Emily Barnhart: I think really the only one, and I’m going to talk about three others that you can decide if you want to use or not. But the only one that I pretty much automatically recommend to everybody is a multivitamin, an actual pill, not a gummy multivitamin. Because the gummies tend to not have as much of what we’re looking for. It’s just hard to pack that into a gummy form, so a pill multivitamin. And then we can also look at supplements in supporting stages of recovery. Omega-3 is an anti-inflammatory that could be beneficial. However, I say that with a big, huge, giant asterisk because – please refer to your surgeon on their opinion on omega-3s. I think it’s an old-school way of thinking. But there are some surgeons that will say absolutely no omega-3s before or after surgery because they’re potentially a blood thinner and we don’t want to go into any problems. There are other surgeons that don’t care about it. That obviously is not my area, so I’m always going to refer to what the surgeon tells you to do about your omega-3s. That being said, typically six weeks after surgery, around that mark is when they stop caring about it. So then I can recommend an omega-3. Just in general, it’s an anti-inflammatory, it’s good for your brain, it’s good for your heart, it’s good for your muscles. Most people aren’t getting enough. 

The other ones that you can think about are potentially creatine. If you are already taking creatine when your injury happens, I would encourage you to continue taking it, again, focusing on that muscle integrity prior to surgery. Picking it post can also help too, if you want to add it in, that’s totally up to you. If your protein and that meal pattern that we’ve talked about are already in check. And if you just want to add one more thing to top off that pyramid that’s potentially okay.

And the last one that you hear a lot about is collagen. And collagen can potentially be helpful. But we’re not a hundred percent sure yet. It’s definitely not going to hurt you. If you want to invest in it, go for it. However, I would say most people take it incorrectly. I don’t really think you need to invest or start in collagen until you are really getting into your physical therapy phase. Because tendons and ligaments are so difficult to heal because they don’t get a lot of blood flow to them. And all the nutrients they need for healing are in blood flow. I like to think of it as like, remember that show from a decade ago, Ice Road Truckers? And when the ice, oh, you don’t know that one?

Ravi Patel: I haven’t seen it. 

Emily Barnhart: Basically, there’s an ice road and when it exists, truckers can transport stuff and when it melts, it melts and it doesn’t exist anymore. Blood flow to your ACL is kind of like that. And that ice road exists when you are exercising. We want the collagen to be available when the blood is flowing to that ACL. Take your 15 to 20 grams about an hour before physical therapy or if you’re in the lifting phase. An hour before your lift is the only time that it’s going to be useful for you. Otherwise, we don’t have the ice road available or the blood flow available to send that collagen to where we want it to be, so you’re just wasting your money.

Ravi Patel: All right, team, this is part one of part two of this series with Emily where we were talking about all things related to nutrition in ACL rehab. Stay tuned for next week as we release part two and make sure that we are answering all of your questions, as well as a lot of different pieces that we did not touch on today. Stay tuned for that. As always, thank you so much for listening. This is your host, Ravi Patel, signing off.