Episode 72 | Nutrition + ACL Rehab with Emily Barnhart, Sports RD – Part 2

Ravi Patel: Welcome back to this two-part episode series where we are talking with Emily Barnhart, a registered sports dietician, and someone who specializes in injuries, like ACL injury and surgery. And today, we are diving into part two of this episode series where we talk about nutrition in ACL rehab. We answer all of your questions, we answer some from Instagram, and we talk about mindset. There are a lot of different pieces in this episode. If you have not listened to part one, go back and listen to part one and then build into this episode. Now, sit back, enjoy the episode, and get all you can from Emily’s conversation. That’s great. It’s one of those, and it’s funny you bring that up because that was actually one of the common questions I got from the Instagram poll that I did. How useful is collagen? Is it worth it? How to use it, and things like that. 

Emily Barnhart: Again, I would say it’s only useful if that baseline is in place. If you’re skipping breakfast and lunch every day, but you’re taking your collagen and your coffee, it’s not really doing much for you. You also need vitamin C to be able to make that collagen useful to you. A couple common supplements, like Vital Protein has vitamin C with their collagen. But if you are pouring that into your hot coffee, it’s denaturing that vitamin C. I like to try to tell people to mix it with orange juice or you can take it with your multivitamin because there’s vitamin C in your multivitamin. There’s just a lot of nuance to make sure you’re doing it right. Collagen is temperamental. 

Ravi Patel: It’s one of those things where you could take all the collagen you want, but if you’re not tackling the bigger buckets of proteins, carbs, and fats, or you’re not exercising, then you’re not really making it available. You’re just taking it in and it’s not necessarily benefiting you nearly as much, as compared to maximizing the bottom of the pyramid, if you will. And then at the top of it is where these supplements sit. 

Emily Barnhart: Perfectly said. 

Ravi Patel: In terms of moving in a little bit of a different direction, one of the things that I wanted to talk about is mindset around nutrition, specifically around the ACL surgery. You’re working with a lot of athletes who have these injuries, what do you typically see and how do you approach mindset with nutrition?

Emily Barnhart: The mindset piece is probably the main reason that I love working with these athletes. Because obviously, mental health is important for healthy athletes too, but it really plays a role in an injury. People really struggle and obviously I am not a mental health professional. But, nutrition for a lot of people plays a role in their coping mechanisms. Especially if how they typically cope with stress is to go get a workout in and now that’s suddenly taken away from them. A lot of people revert to food. And it also obviously plays a big role in body image. A lot of what I’m talking to athletes about is how to have a healthy relationship with food and a healthy relationship with your body image. And it’s tough, it’s a really tough time to do that. 

Ravi Patel: It is very difficult. And I’ve talked about this before. But your background will play into this. And for me, I grew up and I was incredibly overweight. When I was younger, and so that has always stayed on me in terms of- or you think back to it. But luckily, it’s one of those things that motivated me to move and to get healthy and that played a big role. But I will be honest with this, is that when I had my ACL injuries, this crept back in. The thought of like gaining weight and all this hard work that I had done to get towards a body composition, I appreciated. But whenever I had these ACL injuries, I knew my energy expenditure, or I know I wouldn’t be moving nearly as much so that factored into my recoveries. I tried to be as methodical as I could with this. The mindset piece, and I know for a lot of you out there listening is a big part of this. One of the things I want you to talk about is weight gain or the fear of weight gain, especially during this immobilization period where you’re not moving nearly as much.

Emily Barnhart: I think also an important piece to include here is, yes, for a lot of athletes there’s a fear of weight gain. For a lot of athletes, there’s also a fear of weight loss. Especially if they’ve worked really hard to put on muscle in the last year or two. I can tell you, I have seen grown men cry with this fear of having to redo all of that really hard work. It goes both ways. There’s just fear of change that’s coming that you don’t know is coming. Something that can be helpful is getting some education on what change maybe to expect and what is coming. And also, if you are seeing changes on the scale, what those potentially could be coming from, and what that means?

If you are magically gaining five pounds in a day, I promise you that is from water, that is not fat. If you have lost weight in the past or you have gained weight in the past, it doesn’t happen overnight. It happens slowly over time. You’re not just magically going to wake up and things are going to be different. Keeping that in mind too, that things happen over time and you won’t be stuck in this immobile state forever. 

And then the other piece that we can address here is, where is that fear coming from or where is that feeling of insecurity coming from? Is it coming from social media and comparing yourself to other athletes? There’s all sorts of stuff on social media. If your scroll is making you feel bad about yourself for the love of God, please unfollow those people. Either find a feed that is making you feel good about your body image or just doesn’t talk about food, or any of that at all. You have control over that. Sometimes that fear is also coming from maybe a comment that a coach said or a parent said, or maybe even something that someone said in the past that has stuck with you and is in the back of your mind, that’s a little bit harder to address. It really depends on your situation of, can you have a conversation of, hey, this isn’t helpful. Or if it’s a coach, for example, and their words are like, hey, don’t come back fat, or be careful. They mean well, but it’s not helpful. Try to remind them of all the other things that go into your performance.

You can say things like, yep, I’m going to watch my weight, but I’m also going to make sure that I come back strong. I also am going to make sure that I work on my agility and my sport-specific skills, and I come back with those in check. I am taking those seriously and don’t worry about it. I’m working with other professionals that are going to make sure that when I’m back, I am back and I’m good to go. And that’s much easier said than done.

And then I guess my last piece of advice on body image is again, those first couple of weeks after surgery, people just don’t know what to do with themselves. Their world has turned upside down. There is a quiz and again, I’m not a mental health professional. But there is a quiz that I really like. It’s on the VIA institute. And it’s about connecting with your values and finding some purpose during that time. And I like it because it gives you kind of some buckets that match your personality and that you get energy from. And it also gives you activities of what you can do to fill those buckets. This sounds kind of woowoo and whatever. But, for example, my top bucket is love of learning, which tells you how nerdy I am. And some of the recommendations are like, can you read a Wikipedia article every day, can you learn a new language, all that stuff which doesn’t sound exciting for a lot of people. But for me, it’s fun and it brings me joy.

Finding those other things that are going to make you feel like yourself that are going to make you feel confident, that are gonna give you purpose, that are going to help take your mind off of the suffering that you’re going through, can really be helpful. 

Ravi Patel: There’s so much value in all the things that you just said. Some of the things I want to touch on. One is the identity piece that you had just mentioned. And we’ll make sure we, tag that quiz in the show notes, that way you guys can do that. But identity is such a big piece and the mindset piece in general with this process, any injury, navigating nutrition, navigating the rehab, is difficult, it’s tough. And making sure that you have pieces in place in order to make the most of it. Those first two weeks, like you said, I’ve had athletes, whether they can’t work their job because it’s more physical, where they had to just take time off. Teachers who are doing that, where they just can’t necessarily do anything. They’re literally just laying at home for a little while because they can’t move around. There’s a lot of time to think, a lot of time to think a lot. 

Emily Barnhart: Too much time to think. 

Ravi Patel: Too much. And no human beings are that great with too much time to think. You have to be very filtered and very judicial about the things that you let in during that time. And to your point of social media, circling around to comparison. If you’re comparing yourself to a teammate, to someone else at the physical therapy clinic, whoever you see, baby body appearance on social media, you just need to be very careful about how you let that stuff in. Because it could really trickle into your mindset and then put you down this spiral, if you will. And it’s easy to get there without even thinking about it. Making sure that that filter is there, that you’re letting in, as Emily had mentioned, the positive stuff and things that are going to empower you and motivate you in this process rather than sitting in your misery.

And the other piece too is that this is an opportunity for you to figure out more about yourself, especially if you identify with a specific activity or sport. This is an opportunity to find more about your identity and your purpose outside of what that is. And there is something there for you. Those are big pieces here. And the last thing that I want to touch on, if you feel like you’re prone to this, then finding a professional that will help you with this. If you know that you have had, maybe it’s eating-related issues in the past or body image, or maybe it’s the rehab side of things, you kind of suck at accountability and doing the things at home. There is nothing wrong with finding someone to help you in this process, whether that’s working with Emily on the nutrition side, finding a physical therapist that’s going to support you, or even a someone who is focused on psychology or mindset. If you know that that’s going to be something that plays into this. In a perfect world, we have an entire team for people to approach nutrition and physical therapy and mindset. It’s a team approach which is ideal. In this world, that’s not always going to be the case. These are things that are important to keep in mind as Emily had just touched on.

Emily Barnhart: I’ll say my DMs are always open. I’ve had plenty of athletes pop in and ask a question or vent, and I am so happy to have that conversation with you. And I’ve had a couple where financially it comes down to, do they want to work with me or do they want to talk to a therapist? And if I’m losing out to a therapist, I promise you I am not offended. I support that wholeheartedly. But at the end of the day, if you are struggling, I don’t care who you talk to, if it’s a friend, if it’s a parent, if it’s a stranger in their DMs. Hopefully, a helpful stranger like me or Ravi. Don’t shove that fear of body change or that stuff away. It’s so helpful to talk about it because there are so many other people that experience the same thing that are happy to share their experience with you. 

Ravi Patel: This comes down to building your team, especially the support system in place. Because I know not everyone is going to run and go get a professional for each bucket. But at the same time, if you can, that’s great. But outside of that, even your support system of your friends or family, teammates, anyone along with that. Whether it’s accountability or just someone that you can literally just talk to being a safe space is so key through this whole process. Whether it is the nutrition or the rehab or mentally, like there’s some tough stuff going on. That’s going to be a very important part of this process. 

Emily Barnhart: If I can, while we’re on this too, I want to touch on some other resources. I mentioned earlier that some education can be helpful. And there’s a few accounts, again, I’m not related to them in any way, shape or form. I just love them, so I’m happy to promote them to people. There’s a woman called Food Science Babe. She’s on Instagram. She addresses a lot of ingredient fears that people have. It’s very trendy now to hate on ingredients for whatever reason. She, in a very logical way, will explain what it’s doing in that food and you can decide whether that’s for you or not. She is awesome. There’s another woman named Lauren Link that is director at Purdue. She has linked to nutrition. She’ll do like Marketing Madness Mondays and just kind of explain what you’re getting shown that’s just trying to sell something to you versus what is valid. And she has a lot of really good information on there. 

And then there’s another podcast called RDS versus BS, and they just go into different, like diets or different things that are popular, and explain whether it’s worth your time or not. And they’re pretty good too. And then obviously, like I said, my DMs are always open for questions.

Ravi Patel: That’s awesome. Make sure you guys check that out. We’ll link those in the show notes as well, that way you have access to those. But that’s where it’s going to be incredibly important, especially, and even before Emily and I got on to record. We were talking about the world of performance and health and fitness, and especially nutrition. It can be very difficult to navigate. Because you would think in a world where we have so much information available that we would have more accuracy and ability to filter through that. But it actually makes it more difficult because we don’t know what’s right from wrong. And that’s where learning from professionals like Emily in this space is so critical because they have the education and then they’ve done the research. And so that way you can find resources that can help to solidify some of your thinking in this area. 

Emily Barnhart: The internet is a crazy world out there. Try to find information that’s trustworthy, sometimes easier said than done. Oh, it’s crazy. I’ll get DMs all the time of, people are like, hey, what’s the best exercise for this? Or, someone’s like, here’s how you accelerate your ACL rehab recovery. And it’s like, you can’t accelerate it. If you have a paper cut, you’re not going to do anything to speed up that paper cut healing. Your body has to do its thing to some degree, you could create a great environment. But at the end of the day, the body is biological as well as other pieces. So those all have to play into it.

I’ve never heard the paper cut analogy before. I like that one a lot. And I think your profession also sees this as much as mine, where people will be like, what’s the one simple thing I can do that makes the big difference? And again, I’m a broken record here, but It’s big picture. It’s getting those three meals and snacks in and doing it consistently every day. Unfortunately, there’s not one supplement, there’s not one food, and that goes both ways. There’s not one food that’s going to ruin all of the progress that you’ve made, or one thing that you can do that’s going to turn everything around. It’s all going to fit in one way. It’s the big picture, which is frustrating to hear for a lot of people. 

Ravi Patel: I think everyone always is looking for the magic bullet. And that’s the thing that’s really tough with this. And it’s the same thing with ACL. I mean, you could list this for any profession or any situation for the most part. But when you boil it down and you talk to the professionals in the field, it comes back to mastering the basics as well as you can. And if you’re talking about, hey, what supplement is this? Or what exercise is this as well? Are you moving well? Are you eating well? And are hitting these bigger buckets. Are you managing your stress? Also, something we haven’t talked about at all is sleep. Hello. If you are doing everything well in nutrition and movement, but you’re only sleeping three hours a night, guess what? You’re working against yourself and you’re likely doing more harm than good. Sleep is a big piece. Stress is a big piece. And community, your support system plays into those things. Those are, what we call the big buckets of health and performance to make sure we are maximizing each of those buckets to be able to make the best athlete that you are in this process.

Emily Barnhart: And the basics are sometimes easier said than done. Especially with nutrition. You’ve had these habits for 20, 30 years maybe. And if you expect yourself to magically turn around and be able to change perfectly, you are setting yourself up for disappointment, and you’re setting yourself up to be harsh on yourself. Like I said, those basics in the bottom of the pyramid is what I’m working on with most of those people. And there’s a lot that goes into that. What is your food budget? What is your ability to cook and grocery shop? What is your time like? What obstacles are you going tp face to actually be able to execute this? A lot of us are super busy and food is very much on the go now. We eat in our cars and we don’t like sit down and have family meals anymore. My mindset is always going to be: how can we fit this into your routine in a way that’s as easy and as stress-free as possible? The Internet doesn’t tell you that kind of stuff. They just throw a meal plan at you and they’re like, you should be able to do this. And if you can’t do this, you’re lazy. And I hate that, I hate that because it’s not true.

Ravi Patel: I think the thing is, especially for something that might be a bit more templated. To the points that you had just mentioned is that each person has a very unique situation, whether they’re in school, whether they’re working, whether they’re professional athletes, whether they’re just a stay at home mom. All of these things are going to be so different, and that’s why you need professionals to help meet you where you are, as opposed to fitting you to this perfect program which doesn’t exist. It needs to be adaptable, it needs to be flexible along the process. And I think that that’s really big here is like, don’t make yourself feel like you need to fit into this perfect program. More like find a professional who you trust and feel comfortable with and see if they can meet you where you’re at in this process. 

Emily Barnhart: Again, operate in that gray area. Everything doesn’t have to be so black and white. That’s also why I’ve talked a lot about things that you can add, instead of everything you need to cut out. I don’t want you to feel like you have to cut everything out. We don’t need to do that. But we can add things in that will be helpful to you. And for most people, that’s a much easier mindset to operate off. 

Ravi Patel: As we wrap up here, I got a couple questions. One is, what is something that athletes in this ACL process, people you’ve worked with, what are some of the common things that you see that would be the lowest-hanging fruits? I know we talked about protein and a few things. Are there any other things that you would mention or advice for these athletes as they’re getting ready for surgery and even later in the process? We want to make sure we don’t leave that as well, making sure that they’re optimizing the whole process.

Emily Barnhart: I think the lowest-hanging fruit would be, you can add that multivitamin in, that’s pretty easy. Put it by your toothbrush at night so you remember to take it. Hopefully, you brush your teeth at night, I guess. And then again, whatever the easiest thing that you can come up with to get three meals in a day. If you are not a breakfast eater and you start out with just a frozen protein waffle and some peanut butter… and sometimes for some people that’s too long and that takes too much time. If it’s just half a banana and that’s where we’re starting, I will take that over nothing. Lunch is easiest for you to get Chick-fil-A through the drive-through. And 50% of the time, you choose the baked over the crispy sandwich. I’m absolutely taking that as a win. It doesn’t have to be these huge life-changing shifts. Take it slow. You’ve got a long rehab ahead of you. We’ve got plenty of time to work with. If you’re making 1% change every week and you’re trying to set small goals and hit those goals, it’s going to absolutely add up over time.

Ravi Patel: That’s really a great advice. Instead of feeling like you need to make these massive changes, or you have to hit these big milestones, if you will, it’s just focus on the day to day and the 1% changes. And also building your environment to make sure it facilitates that. If you’re trying to cut out a bad habit and you got a bunch of cookies and sweets in the fridge and you’re also trying to take your protein, but you’d rather eat that stuff, make sure you build your environment to help facilitate that as best as possible.

Emily Barnhart: Ravi, you got caught up almost saying to cut something out though. If you love those cookies, let’s pair it with something that’s helpful to you. Do you have a chocolate protein shake and you want to dip those cookies and some milk? Typically, that also helps you eat three cookies instead of 10. Or, if we want to make some kind of Greek yogurt dip or something, just pair it with something or portion it in a mindful way. You don’t have to cut it out. 

Ravi Patel: Yeah, exactly. And that’s one of the things as I was thinking about, I was like, not cut it out, because even during my process there were things you got to keep those little things in there in order to enjoy it and not just feel so miserable. There’s a way to balance this so well. And it always comes back to kind of like a sliding scale as opposed to an all or nothing; operate in the gray as opposed to black and white. You got to cut something out versus not.

Emily Barnhart: I think one other really great tool, if I can go on a tangent for a little bit that’s kind of related to this, and can also help with that fear of weight gain or weight loss, too. There’s something called the Hunger Fullness Scale. And it’s a scale that operates from 1 to 10 and one is like, I’m so hungry, I could eat my own arm right now. And 10 is, I’m so full, I’m going to throw up. And in a perfect world, we kind of waiver throughout the day between a four and a seven. You can recognize when you’re starting to feel hungry and you’re like, I should probably eat something now so that I’m not hungry later. And a seven is, you feel satisfied. And part of that satisfaction is you enjoyed the food that you just ate and you actually were mindful, in the fact that you enjoyed it. But also, you’re feeling full but not uncomfortable. And if you check in on that scale, a couple times a day and you start to notice that, hey, I’m a two all morning and then I’m starving at night, so I’m a 10 at 9 o’clock at night because I’ve just eaten everything in sight. That’s a pattern that’s potentially unhelpful. Or if you’re fluctuating throughout the day between a six and a nine, that might be an indication that you’re eating too much because you’re never really feeling hungry. And we’ve talked about how post-surgery sometimes you’re not hungry and that affects the scale a little bit. But using that tool and checking in with that tool of, yeah, how are you managing food and your hunger is really helpful. And it’s free and it’s easy to do. 

Ravi Patel: That’s really helpful. I know sometimes I could be that way too, where I can hit the 10 pretty quick because maybe there’s less in the day. And then all of a sudden, it’s all right, we’re going to go into dinner and eat more. Being able to be aware of this scale is really great. The last question I have for you is, and this could be a little bit loaded. But should there be any distinctions between men and women? I think an interesting question that I got from an ACL athlete on Instagram that I wanted to ask you. We always talk about gender differences and obviously body image can play into things like that. But just in general, as you’re approaching this process, is there anything, any distinctions between men and women for you? 

Emily Barnhart: That’s a really good question. I do want to say that I think men struggle with body image issues just as much as women. I’ve worked in a lot of male sports and it shows up a little bit differently. We don’t notice it as much. Men tend to maybe binge eat a little bit more. They eat perfectly in front of all their friends, but then at night they go somewhere secret and they eat a lot of food that maybe they’re feeling uncomfortable afterwards. And men also struggle more with like bigorexia or orthorexia where they’re obsessed with exercise and eating perfectly, as that pure food is fuel and nothing else mindset. That can definitely cross an unhealthy line. I do just want to make it clear that I think men struggle with body image issues just as much as women and talk about it less, which is really unfortunate.

In forms of straight-up nutrition, some of what I talk to my female ACLs about is we can talk about period stuff. There’s some fluctuations that can happen in your nutrition based on your period and where you are on your cycle. I’ve also had a couple people that lose their cycle right after surgery and it takes a little bit for it to get back to normal. And again, that’s not my area of expertise. Ideally, we always want a regulated cycle. So that might play a role in it. But for the most part, yeah, I don’t really think there’s a ton of differences. There’s differences in numbers. Men need 11 milligrams of zinc and women need nine. But most things are based on body weight anyways. And I know plenty of men that are maybe shorter and smaller than some of their female counter parts and vice versa. I don’t think there’s a huge difference. That’s a really good question. 

Ravi Patel: And I think that’s such an important point you bring up is that, it’s not like it’s a massive difference between the two, it’s so specific to your situation. And at the end of the day, what we do is you take the principles of what we know in this process and you apply it specifically to their situation, their body weight, their lifestyle, their day-to-day, all of those things. No different nutrition, no different in your ACL rehab. It’s always going to be individualized. And I think that’s an important thing to take away from this rather than two different genders sitting on different ends of the spectrum.

Emily Barnhart: That’s a great point.

Ravi Patel: All right, gang. Emily, it’s been such a pleasure to have you on the show today. Where can people find out more about you online and how can they keep up with you on social media? 

Emily Barnhart: I have a website www.injuryrd.com. You can find me on socials as injury_rd. I’m on Instagram and TikTok. I’m a cringey TikToker though. I’m not going to lie. But Instagram is the place to be. Like I said, my DMs are always open. And I have some links in there with some resources or how to apply to work with me. And then if I can just plug really quick. Working with me, I run a four-month ready-to-return program. Within that program, you have unlimited access to one-on-ones with me, we do tech support, we do we weekly check-ins. Again, my whole mindset and the whole goal is: you feel confident about the choices that you’re making and you feel confident about what is maybe to come and you feel continuous support from a professional. So that we can make those small changes over time. And nutrition doesn’t feel overwhelming. You have enough stress going on in your life. I don’t want food and nutrition to be adding to that. And that’s always my goal. . 

Ravi Patel: Make sure that you check all that out. If you are someone who is potentially struggling with nutrition, don’t know where to start, if you need some help with this, then please reach out to Emily. She’s a great resource. Even if it’s a question or if you end up working with her, that is something, just think of it as a part of your team and being able to make sure that you look at this as the big picture rather than just your rehab or just your nutrition or any of the other pieces. Make sure you’re trying to maximize those as best as possible. 

We will have all of Emily’s information in the show notes below. Emily, thank you so much for coming on the show today. 

Emily Barnhart: Yeah, thanks so much for having me. This was fun. 

Ravi Patel: I think a lot of people will take away a lot from this episode. Nutrition is such a big bucket and such a big question. And it’s good to have you on here to be able to talk about some of these myths or things that is hard to grasp. And you put in a very simple way, so thank you for that. 

Emily Barnhart: Yeah, it’s confusing. I studied it, I spent way too long in school and it’s still confusing to me sometimes. If you’re overwhelmed or confused, I think that’s totally understandable.

Ravi Patel: Even professionals, we get new research or information all the time, so we’re trying to sift through it. It could be tough, but that’s what we’re trying to do, to put out to everyone who’s listening as well. I think that wraps things up for this episode, folks. As always, thank you all so much for listening to the ACL Athlete Podcast. This is your host, Ravi Patel, signing off.