Performance Nutrition for the Intensive Care Unit

When we hear recommendations from sports nutrition about regenerative measures and race nutrition, we often think of high-performance athletes. However, there are others who can also benefit from these guidelines and protocols. Firefighters, for example, or musicians. Or hospital staff. They all go through intense shifts, whether it's a fire, a concert/rehearsal, or an emergency. During the COVID-19 crisis, we see many intensive care unit workers putting in hard work. It's good to recall the fundamentals of nutrition for them because it can make a difference for the personnel. How they enter a shift matters. They need to reduce and delay fatigue, recover between shifts, and, like athletes, they don't have much time to cook, meaning recipes should be quick and easy yet nutrient-rich.

Prepare - Supply - Recover - Hydrate

A good preparation involves having a good meal before the shift. It should include a generous amount of carbohydrates, preferably whole grains, and lean protein along with fruits/vegetables. The fat content should be low. Remember, it should be a preparation similar to how we approach a race (easily digestible).

‍Examples:

• Oatmeal with raisins, walnuts, cinnamon, and yogurt.
• Quinoa with zucchini, beets, olive oil, and ricotta.
• Chicken breast with potatoes and a serving of boiled vegetables, enhanced with olive oil.
• Whole-grain noodles with tofu, peas, and walnuts.

During intense physical exertion, we need quick energy. Walking back and forth between two rooms, going up and down stairs, pushing a bed down the hallway—all of these activities involve muscle work, and muscles function best with an adequate supply of carbohydrates. To keep the brain sharp, regular carbohydrate intake is even more important.

Examples:

• Banana
• Diluted fruit juice
• Banana bread
• Fruit bar
• Sports drink
• Water with syrup

OUR BRAIN NEEDS SUGAR
The preferred energy source for our brain is sugar. Do not underestimate the energy consumption of the brain. On a normal day, it requires up to 10g of sugar. However, when our brain has to do strenuous work, engage in complex thinking, or multitask, the energy demand is significantly higher.

After the shift, it's important to consider the three R's: rehydrate, rebuild, refuel. It's not always possible to drink enough during work, so rehydration is important to be well-hydrated again. Some protein for the muscles is crucial. Even though you're resting, the muscles remain active, recovering and needing the right building blocks. Additionally, it's not always easy to eat and drink. It's not uncommon to miss a meal because there's so much to do. Eating carbohydrates after the shift helps replenish the depleted stores.

‍Examples:

• Chocolate milk/cocoa,
• Tuna and kiwi risotto; tea or diluted fruit juice,
• Bread with cottage cheese and an apple; tea or diluted fruit juice,
• Oatmeal with raisins, walnuts, cinnamon, and yogurt; tea or diluted fruit juice,
• Smoothie with fresh fruit, oats, some nuts, and milk,
• Recovery shake.

HANDS OFF KETO!
‍Low-carb on days of high stress leads to depleted glycogen stores and will not adequately fuel the brain. A ketogenic diet will ultimately result in a faster decline in performance, even in the intensive care unit. Low-carb diets are still popular. A recently published study showed that a few days of a ketogenic diet leads to increased perceived exertion and faster fatigue during exercise. So, if you're working in the intensive care unit, remember that the keto diet is a bad idea, especially in these times of COVID.

And finally, a word on quality. More than ever, it is important that the diet is of high quality to absorb all the nutrients needed for a strong immune system. Whole grains and legumes (for carbohydrates), lean meat and fatty fish or plant-based protein, small amounts of healthy fats (fish, olive oil, canola oil, seeds, nuts), and a variety of colors with vegetables and salads. And if you need ideas for snacks, here are a few examples:

• Fresh fruit and some nuts,
• a sandwich with nut butter or cottage cheese,
• yogurt with fruit, cocoa powder,
• fruit salad with a glass of buttermilk,
• a smoothie with fresh fruit, oats, nuts, and milk,
• crackers with apple, buttermilk, and a piece of dark chocolate.