Stress Fractures and the Nutrition Connection
Chances are if you’re an athlete, you may have already experienced a stress fracture – possibly in your shin or lower leg. Some research suggests 40 percent of athletes have experienced at least one in their life. So what causes them, and more importantly what can be done to help prevent them in the future?
“A stress fracture is an injury caused by overuse and most commonly occurs in the lower leg and foot – which bear the weight of the body,” explains Alicia Bosscher, UW Health registered dietitian. “When there is overuse, it causes muscle fatigue. The stress is then transferred from the muscle to the bone, which can eventually lead to a crack in the cortex.”
She notes that the cracks can be so small, an MRI would be needed to diagnose. But common symptoms include minor pain where the break is located and that occurs during or after normal activity. There may even be some tenderness and swelling at the site – such as on top of the foot or in the ankle.
Bosscher says hormones, genetics and diet all can play a role in causing stress fractures, which may be one reason women experience them more often than men. Other risk factors include low body weight, low bone mineral density, menstrual irregularities, low dietary calcium intake and even a history of stress fractures.
“It is thought that 75 percent of our bone mass is determined by genetics, and only 25 percent is environmental – which includes our diet,” she says.
The Importance of Whole Foods
Some may wonder what role a dietitian plays in treating or preventing stress fractures. Bosscher explains it’s because of that 25 percent. “We can’t control our genetics, but we can control our diet. And one of the best things an athlete can do is to ensure she is eating an adequate amount of calories from whole foods.”
High school age through young adult female athletes are most at risk for nutrient deficiencies – and therefore stress fractures. And because they are still in their bone-building years, proper nutrition is critical for their future bone health.
“Without adequate calories, reproductive hormones are suppressed and a loss of bone can result,” she says, noting, “While calcium and vitamin D are important for bone health, there are overlooked nutrients that are equally important – potassium, vitamin K, boron, silicon and magnesium.”
When an athlete experiences recurrent stress fractures, they may be referred for a nutritional consult to take a look at eating habits and see if any changes might be recommended. Bosscher says that she doesn’t typically recommend supplements unless it’s clear a person is not getting enough nutrition from food.
“If you don’t consume dairy due to plant-based eating or lactose intolerance, for example, I might recommend looking for a nut-milk with added pea protein,” she says, explaining that without the pea protein, nut milk on its own has very little total protein. On the other hand, nut or plant-based milks are usually supplemented with calcium to match the amount found in cow’s milk. But it’s also important to know how the body actually uses the nutrients and minerals.
“One example is that calcium citrate is better absorbed if taken on an empty stomach,” says Bosscher.
When looking to food as a source for nutrients, Bosscher notes that there is a variety of options available.
Sources of Nutrients
Protein, which is a key nutrient in bone building, can be found in chicken, turkey, egg whites, low-fat dairy and soy milk.
When people think of bone health, they often think of vitamin D (which is actually a hormone). While some estimates suggest as much as 70 percent of the U.S. population is low in vitamin D, it’s best to have levels checked before taking a supplement. Some good sources include wild salmon, egg yolks, fortified milk and cereal.
Bananas, low-fat milk, white and lima beans, spinach and lentils are all good sources of potassium, while cooked greens such as kale and collards, broccoli and asparagus are good sources of vitamin K.
Magnesium is found in whole grains, almonds, cashews, spinach, legumes and even Raisin Bran. Peanut butter (and peanuts), legumes, avocado are all sources of boron, while grains and vegetables offer silicon.
Healthy Snack Ideas
Choosing nutrient-rich meals and snacks will not only give athletes the fuel they need to perform, but it will help ensure their bones stay strong. A few snack suggestions include:
- Strawberries and almonds with vitamin D fortified low-fat yogurt
- Yogurt parfait with mixed fruit and granola
- Eggs scrambled with spinach and cheese on a whole wheat tortilla
- Raisin bran with fat-free milk and a banana
- Peanut butter sandwich on whole grain sandwich thin
While stress fractures may not be entirely preventable, eating a diet that supports your lifestyle can help make a difference. To learn more or schedule an appointment with a UW Health registered dietitian, visit uwhealth.org/nutrition
UW Health Services
Date Published: 04/24/2018