WHY IT MATTERS
Nutritional needs increase significantly after surgery due to elevated levels of inflammation and stress in the body. Maximizing nutrition before surgery can decrease the stress response and the amount of muscle broken down to provide energy for wound healing.
WHAT HAPPENS IN THE BODY AFTER SURGERY?
Stored carbohydrate in the body is used up rapidly to provide energy for healing
Protein from muscle and the blood is converted into carbohydrate at an increased rate for energy use
Increased muscle breakdown and decreased muscle growth
Insulin response is reduced, leading to higher blood sugar levels
Can lead to impaired immune function & increased infection risk
CONSIDERATIONS
In healthy young men, total thigh muscle volume decreased by 5.5% (0.66 Ib.) after 7 davs of disuse
Following a knee replacement, atrophy has been estimated to be about 1% per day in adults >65 years old, with decreases up to 18% in the quads and hamstrings after 6 weeks
Resistance training is the most effective way to prevent muscle atrophy, but in cases where exercise is not safe or feasible, such as post-op, good nutrition is pivotal for minimizing muscle loss
THE PROTOCOL
7-10 Days Before Surgery:
Carbohydrate Loading:
60% of calories coming from carbohydrates (about 8 grams of carbohydrates per kilogram bodyweight)
Increased intake of fruits, vegetables, & whole grains
Aim for most of carbohydrates to come from complex carbs like fruits, vegetables, & whole grains
This helps to improve vitamin, mineral, antioxidant, and fiber status leading up to surgery
Necessary for minimizing inflammation and improving efficiency of body processes
Consistent intake of high quality protein
Between 1.2-2.0 grams of protein per kilogram of bodyweight per day
Choose high quality protein sources
Animal products, dairy, & eggs are best
Have all essential amino acids
Lentils, quinoa, black beans, soy, peas, and rice are high quality plant sources if preferred
Night Before Surgery:
6-12 hours before surgery, consume a meal containing both complex carbohydrates and high-quality protein
Morning_of Surgery:
Morning Surgery: if having a morning surgery, dinner will be the last full meal, so skip to next section
Afternoon / Later Surgery: if having surgery later in the day. breakfast will be the last full meal
Get up early to eat if needed
Have a high quality, balanced dinner, and a light, well-balanced breakfast in the morning with high protein and complex carbohydrates
6 Hours Before Surgery:
You must discontinue eating whole foods at this time, but you can stilldrink fluids containing protein/carbohydrates such as protein shakes. sports drinks, chocolate milk, and meal replacement drinks
Protein powder made from casein is a good option at this time due to its slower digestion
Other good options: wheyisolate (has a higher concentration of protein), whey concentrate, soy protein (>40 g serving) if needing plant-based
Modified carbohydrate supplements may be very beneficial at this time
They are slowly digested, so they can sustain blood sugar levels for at least 3.5 hours
Can improve insulin resistance that develops after surgery as a result of high inflammation levels
Hydrothermally Modified Starch Examples:
Vitaflo Glycosade
UCAN Super Starch
Cornstarch
2 Hours Before Surgery: fasting from clear liquids begins
Have 50 grams of modified starch (see above) and 12-25 grams of an essential amino acid supplement dissolved in water at the 2 hour mark.
WHEN TO SEE A DIETICIAN:
BMI less than or equal to 18.5 (18-65 years old) or less than or equal to 22(>65 years old): these BMIs indicate an underweight status and chronic under-eating for baseline energy needs.
Weight loss greater than or equal to 10% in past 6 months: this includes intentional and unintentional weight loss; indicates rapid weight loss and chronic under-eating that has compromised muscle and bone.
Reduced food intake by greater than or equal to 50% in past week: this indicates short-term malnutrition and is often accompanied by other symptoms that benefit being addressed by a dietitian.
GENERAL Q & A:
How can I make sure 60% of my diet is from carbohydrates?
Aim for half of your plate to be starches and grains. Starches include bread, tortillas, pasta, cereals, crackers, biscuits, granola, and vegetables like potatoes, winter squash, corn, and peas. Grains include things like rice, quinoa, oats, millet, farro, barley, & bulgar. Include starches and grains with all snacks as well.
What is a complex carbohydrate and why do I need them?
Complex carbs include vegetables, beans, and whole grains. Whole grains are labeled as "whole" or "100% whole" on food packaging. Complex carbs have more nutrients than simple carbs, help to stabilize blood sugar, and improve digestive health.
How much protein should I have with meals and snacks?
In general, aim for 20-35 grams of protein per meal and 15-25 grams of protein per snack. For meat, a serving about the size of your palm will provide about 25-30 grams of protein. Check the food labels to find protein amounts in other foods.
How can I make sure I'm getting enough to eat before surgery?
Having 3 meals and 2-3 snacks per day should help to ensure you are getting close to what your body needs. Check with a dietitian for more specific recommendations.
What supplements should I use before surgery?
Essentail amino acids(EAAs, not BCAAs); protein drinks, powders, and/or bars as needed; modified starch(Glycosade, UCAN)
What is a modified starch and what are examples?
Modified starches are carbs that were developed to help maintain blood sugar levels. They are digested more slowly, and in this way can help maintain blood sugar levels during surgery while also reducing risk of insulin resistance. Examples include modified corn starch and potato starch, waxy maize starch, Glycosade, and UCAN.
