Nutrition and Delayed Onset Muscle Soreness (DOMS)

 Most of us have experienced delayed onset muscle soreness (DOMS). Whether from an intense workout or heavy yardwork, DOMS is that achy, stiff, and painful feeling in our muscles that develops 12-36 hours after activity. DOMS is uncomfortable and inconvenient for anyone. For competitive athletes, though, it can be a serious problem that interferes with training and performance.

 Contrary to widespread belief, DOMS is not related to lactic acid buildup in the muscle. DOMS occurs because of microscopic damage in the exercising muscle, which leads to inflammation (1,2). Although it seems strange, for exercise to be effective it’s important for some muscle damage to occur. Provided the damage is not too great, this micro-damage to muscle fibers and the resulting mild inflammation is what causes the muscle to strengthen over time – a process referred to as “adaptive remodeling” (3).

 Despite this, pain and mobility limitations from DOMS lead many to seek nutritional approaches to prevent DOMS or mitigate its effects. Since the main causes of DOMS are inflammation and oxidative stress resulting from muscle fiber damage, most of the evidence-based nutritional strategies for DOMS target these two processes.

 Two recent comprehensive scientific reviews have examined the evidence for various nutritional strategies to prevent DOMS or reduce its duration or severity (4, 5), providing answers to many common questions that people have about DOMS:

- The effect of protein and carbohydrates on DOMS is minimal, although balanced intake of these nutrients is very important overall for training and recovery. For example, many studies have looked to see if consuming protein shakes is helpful for preventing or treating DOMS and have not found any effect. However, certain amino acid supplements, including branch-chain amino acids and taurine, appear to reduce DOMS when taken prior to exercise.

- Strong evidence has been found for reduction of DOMS by the anti-inflammatory omega-3 fatty acids, EPA and DHA. Omega-3s are usually given as high-dose supplements (0.5-3 grams/day) given weeks or month prior to an intense athletic event.

- Several small studies have looked to see if Vitamins D and B12 can prevent DOMS. Both nutrients are important for muscle function but supplementing them only seems to have an effect if blood levels of the nutrient are low. Since Vitamin D deficiency is common even in sunnier climates and Vitamin B12 can be deficient in vegans or vegetarians, it’s worth getting your blood levels checked to determine if these supplements might be beneficial for you for preventing DOMS.

- While there are lots of claims about magnesium supplements and DOMS, there is limited research evidence. Magnesium does help muscles relax, however, and two very small studies in athletes found that magnesium supplements (350-500 mg/day) for 7-10 days prior to intense exercise reduced muscle soreness compared to placebo. If you choose to supplement with magnesium, be aware that doses above 350 mg/day can cause diarrhea, so start with a smaller dose and work your way up. As a bonus, if you take magnesium before bedtime, it may improve your sleep, which is also important for exercise recovery!

 Other nutritional supplements with convincing evidence for preventing DOMS include tart cherry juice, beetroot juice, and curcumin (a compound found in the spice turmeric) (5). These supplements all contain powerful anti-inflammatory and antioxidant compounds. Multiple clinical studies have shown that consuming tart cherry juice or beetroot juice prior to intense exercise reduces DOMS. Similarly, some (but not all) studies have observed decreased post-exercise soreness when curcumin (200-400 mg/day) is consumed regularly before intense exercise. Curcumin is not readily available to the body when taken by mouth, so invest in a high-quality supplement that has a bioavailable form.

 As mentioned above, inflammation plays a big role in causing DOMS. Inflammation has been associated with a fall in serum pH (6), so interventions that shift pH – such as NION - may be effective for managing DOMS. In one study comparing NION’s electrolyte beverage to placebo, researchers found that serum pH was higher post-exercise in the subjects taking NION, and heart rate, blood lactic acid, and perceived exertion were lower compared to placebo (7). NION also has an antioxidant effect, which may add to its potential benefits for preventing DOMS.

 Prevention is essential when it comes to DOMS. Proper exercise training, including warmups, cool downs, stretching, and avoiding over-exercise is key. And regular use of evidence-based nutritional approaches can also play a role. Unfortunately, once you have DOMS, there is little that nutritional interventions can do. At that point, ice packs, massage and, if necessary, non-steroidal anti-inflammatory drugs (NSAIDS) are your best bets until the muscle soreness eases. Of course, if you have chronic issues with DOMS, consult with a sports medicine physician or sports dietitian for personalized evaluation and recommendations.

Author

 Jennifer Lovejoy, PhD, spent the first part of her career in academia doing clinical research on obesity, diabetes, and women's health.  More recently, she served as Dean of the Nutrition and Exercise Science department at Bastyr University and held executive leadership positions at several lifestyle medicine and scientific wellness startups. She currently does research, speaking, and writing through her consulting
company, Integral Science, LLC (integralscience.net).  

References

1. American College of Sports Medicine. Delayed Onset Muscle Soreness (DOMS) https://www.acsm.org/docs/default-source/files-for-resource-library/delayed-onset-muscle-soreness-(doms).pdf [Accessed November, 2023].

2. Connelly DA, et al. Treatment and prevention of delayed onset muscle soreness. J Strength Cond Res 2003;17(1):197-208. https://pubmed.ncbi.nlm.nih.gov/12580677/

3. Peake JM, et al. Muscle damage and inflammation during recovery from exercise. J Appl Physiol 2017; 122(3): 559-570. https://journals.physiology.org/doi/full/10.1152/japplphysiol.00971.2016

4. Tanabe Y, et al. Dietary Supplementation for Attenuating Exercise-Induced Muscle Damage and Delayed-Onset Muscle Soreness in Humans. Nutrients. 2022; 14(1): 70. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8746365/

5. Harty PS, et al. Nutritional and Supplementation Strategies to Prevent and Attenuate Exercise-Induced Muscle Damage: A Brief Review. Sports Med Open. 2019; 5: 1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6323061/

6. Rajamaki K, et al. Extracellular acidosis is a novel danger signal alerting innate immunity via the inflammasome. J Biol Chem 2013; 288(19): 13410-419. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3650379/

7. Heil DP, et al. An alkalizing nutrition supplement that positively influences measures of health and aerobic performance. Int J Applied Exer Physiol 2021; 10(2): 21-37. https://drive.google.com/file/d/160hgpGG5FPj3Twa5Hza_0yWUdbR2hfK_/view