Obesity has become such a pervasive problem in the United States that few people think about gaining weight on purpose. That is, until they lose a drastic amount of weight due to serious illness, surgery, or injury. The weight lost in these circumstances includes a significant amount of muscle. Recovery almost inevitably involves regaining the weight that was lost. It is important that the regained weight is largely muscle, and that you don’t replace the muscle you lost with new fat. The key to gaining good weight is optimal amino acid nutrition.
The Catabolic State
The catabolic state refers to the rapid loss of weight, especially muscle, accompanying physiological stress. Examples of catabolic states include major surgery or trauma, serious chronic diseases like cancer and heart failure, or acute illnesses such as pneumonia. Even a serious case of the flu creates a catabolic state. There are two components of the catabolic state:
- Changes in muscle metabolism that are part of the stress response
- A decreased appetite
Many catabolic states involve hospitalization during the most severe stage, perhaps even in the intensive care unit. Nutrition in a severe catabolic state is problematic because the normal anabolic (muscle building) response to protein intake is diminished (anabolic resistance), glucose metabolism is altered significantly (insulin resistance kicks in and fat accumulates in the liver), and fatty acid levels in the blood are elevated. The debilitative effects of bedrest are often superimposed on the stress response during the acutely severe stage.
Consumption of essential amino acids (EAAs) is the primary nutritional goal in the catabolic state. When your body is in anabolic resistance, EAAs can effectively slow down the loss of muscle. Even EAAs have a limited effectiveness in the catabolic state, however, and muscle loss is inevitable.
Recovery from a Catabolic State
After recovery, you may actually be happy to have lost some weight. The problem with this perspective is that the stress response specifically targets muscle loss. Although some fat is lost as well, a significant portion of weight loss in the catabolic state is muscle. Further, you are very likely to regain the weight that you lost in one way or another. The key is to restore your lost muscle mass and not unfavorably affect body composition by regaining your body weight as fat.
The Basic Diet
Consuming 25-30% of your daily calories as high-quality protein will favor muscle gain over fat gain. Initially, anabolic resistance lingers after recovery, which will limit the efficacy of the protein you consume, but as your physical condition improves the dietary protein will become more effective in promoting muscle growth. You will benefit by consuming a rather high percentage of your calories as high-quality protein food sources. This will entail eating a variety of animal-based proteins, including dairy, that not only contain all the EAAs you need, but also have a high proportion of their total calories as protein. On average, about 50% of the calories in animal protein food sources are protein. In contrast, many plant-based protein food sources may be 70% or more non-protein calories.
A further advantage of animal protein in the recovery phase is that the non-protein calories are fat. While many of us have been conditioned to think eating fat is harmful, that is certainly not the case when you are recovering from a catabolic state. Carbohydrate consumption is much more worrisome. The metabolism of dietary carbohydrate requires effective action of insulin. The catabolic state induces a resistance to the normal action of insulin that may persist for months. Insulin resistance makes carbohydrate less effective as an energy substrate. It is more likely that the carbohydrate you consume will be converted to fat and stored in the liver. It is therefore reasonable to limit carbohydrate to 20-30% of your caloric intake.
As you regain your muscle mass and approach complete recovery, your basic diet should evolve towards one of the diet options that suits your individual needs and preferences. Maintaining a high protein intake (about 25% of calories) will help to maintain the muscle you have regained during recovery.
Exercise is always important in relation to muscle mass and function, and never more so than when you are recovering from a catabolic state. Exercise is the best way to reverse muscle loss and regain normal function. However, depending on your particular situation, it may be difficult to follow the general guidelines of the American College of Sports Medicine for the amount and intensity of exercise. It may be necessary to go to a physical therapist initially, followed by an experienced trainer, to formulate the best plan for recovery exercises. The general guideline of resistance exercise twice per week and aerobic exercise five times per week is appropriate, with the understanding that the level of intensity can be quite limited at first. The key to successful recovery is understanding that your exercise capacity will eventually return if you stick with it. This may be easier said than done in the depleted state after recovery from a catabolic state, but there is no substitute for persistence.
EAA supplements play a key role in recovering from catabolic stress. The formulation of your EAA supplements should target an increase in muscle mass and function. Ideally, you will want to take your EAA supplement between meals to avoid the muscle loss that normally occurs in the absence of the absorption of dietary protein. As you regain strength, you will want to start coordinating the timing of your supplement intake with your exercise routine. It is optimal to take EAAs about 30 minutes before exercise and then again after exercise. Regardless of how light the exercise is, it is in fact activating the muscle to begin the process of restoration to full strength. EAAs should be taken in conjunction with whatever physical activity you perform.
You’ll want to choose an amino acid supplement formulated with EAAs in a relatively pure form that includes minimal non-protein/amino acid calories. The dosage of EAAs that gives the greatest stimulation of muscle protein synthesis is 15 grams—more than 15 grams at one time won’t provide much additional benefit. On a gram/gram basis, smaller doses may be more effective. A dose as low as 3.6 grams has been shown to be a potent stimulator of muscle protein synthesis. Therefore, there is quite a bit of flexibility in dosing. Nonetheless, the larger the dose (up to 15 grams), the greater the muscle gain with each dosage, so for optimal restoration of lost muscle 15 grams twice per day between meals will give you the fastest results.