HOW TO NOURISH YOURSELF BEFORE AND AFTER SURGERY

Surgery is a common intervention in the U.S. that ranges from minor surgery to major surgical procedures. Surgery can be minor, like removing a mole, cataract removal, dental surgery, biopsies, and require less recovery time. Major surgical procedures, like cesarean sections, joint replacements, bariatric procedures, hysterectomy, mastectomy, and heart procedures all have a higher risk for infection and longer recovery time. 

Significant planning, preparation, and recovery support goes into a major surgical procedure. It is important to have an at home care plan, to stop eating at least six hours prior to surgery, and to follow the doctor recommended after care protocol. However, there are also a few nutritional steps you can take before and after your procedure to improve your overall healing time and experience.

*Please note that these recommendations are for educational purposes only and are not meant to treat any condition. Please, contact your doctor prior to surgery for individualized recommendations and questions.

PRIOR TO SURGERY

About one to two weeks prior to surgery the doctor will likely recommend that certain, if not all, supplements and medications be discontinued. This is to avoid complications during the surgery. 

One week prior to surgery slowly increase your complex carbohydrate intake. Your last meal should have a high carbohydrate content, such as pasta. Studies have shown that increased carbohydrate intake, or carb loading, prior to major surgery resulted in improved glucose regulation during the procedure and better overall outcomes.1 Sometimes this is also done in the hospital, with an oral glucose suspension, but you can certainly begin this process at home.

Why carb-load? 

**If you are diabetic, please check with your healthcare provider to get specific recommendations.

Trauma, such as major surgery, causes immense stress on the body. When our body endures an injury it becomes hypermetabolic releasing epinephrine, increasing glucose, and increasing insulin levels/resistance.2,3 The glucose found in carbohydrates is our cells preferred source of energy and this is why carb loading prior to surgery may be helpful, it provides a quick energy, and prevents surgically induced insulin resistance, thus sparing lean muscle mass. You want to be well nourished, with a variety of whole foods, prior to surgery for the best results.

Lastly, you will want to stay adequately hydrated the week prior to surgery but not drink too much the day of the procedure. Bodily fluid is lost during the course of a major surgical procedure so making sure your tissues are properly hydrated beforehand will help. However, drinking too much too close to surgery can increase the risk of aspiration, so it is recommended to stop drinking liquids 2 hours prior to surgery.

POST SURGERY

Postoperative metabolic changes are more pronounced than perioperative metabolic responses. This means that meeting your nutrition goals post surgery will be that much more important and influence your recovery. It is believed that reducing catabolic and metabolic responses is the driving factor to a quick and healthy recovery.2 

Inititially, the doctor will determine when it is safe to reinstate your supplement and medication regimen. Some things you can do in the meantime are:

Increase your protein intake

The recommended intake for sedentary individuals is .8 g/kg of body weight. To prevent muscle catabolism (breaking down for energy) and help rebuild the damaged tissue the recommended protein intake after major surgery increases to 1.5-2.0 g/kg of body weight. 

That means that for a 150 lb person their protein intake goal would be between 113-150 g of protein per day.

PROTEIN CONTENT OF FOODS

Meats

3.5 oz chicken breast = 28 g 

3 oz lean beef = 25 g

3 oz turkey breast = 26 g

Fish

3 oz salmon: 19 g 

3 oz shrimp: 20 g 

1 can tuna = 27 g 

3 oz cod = 16 g

Eggs

1 large egg = 6 g

1 cup egg whites = 27 g

Tofu/Tempe

I/2 cup tofu = 10.1 g 

1 cup soy milk = 6.3 g 

3 oz tempe = 15 g

Grains/ Pseudograins

1 cup quinoa = 8 g 

1 cup oats= 11 g

1 slice whole wheat bread = 3-5 g

Dairy

6 oz greek yogurt = 17 g 

1 cup whole milk = 8 g 

1 cup low-fat cottage cheese= 28 g

Legumes

1 cup lentils = 18 g

1 cup kidney beans = 15.3 g

1 cup peas = 8.6 g

1 cup pinto beans= 15.4 g 

1 cup black beans = 15.2 g

Nuts/Seeds

1 oz almonds = 6 g

1 oz peanuts = 7 g

1 oz pumpkin seeds = 9 g

1 oz pistachios = 6 g

Increase your caloric intake

Second to protein intake, increasing caloric intake is important post surgery since the postoperative metabolic response can increase by 15-30%.2 Trauma increases the metabolic rate of the body and therefore also increases its caloric needs. This may seem counterintuitive, since our usual physical activity is less after surgery. 

However, if the body is not getting enough energy from food intake, it will seek out other energy sources from the body tissues, such as muscle. This poses a problem because protein requirements increase after surgery to support the healing process and the building of new tissue. Caloric needs are specific to the individual, so reach out to Jade or Shawna and they can help determine what is right for you.

In general, the recommendation is to increase caloric intake to:

Non-obese:  25-30 kcal/kg/day

Obese:  14-18 kcal/kg/day

Maintain your carbohydrate intake at the RDI

Although your intake of carbohydrates remains at the recommended 45-65% of your daily caloric intake, the amount of carbohydrate in grams you are taking in will increase because your daily calories are increasing. Carbohydrates still remain the preferred energy source for the cells so it is important to keep feeding them as they work hard to repair the body after surgery. 

Carbohydrates are found in fruits and vegetables that are also high in antioxidants, polyphenols, vitamins, and minerals. Eating whole food complex carbohydrates will provide the body with the energy it needs to heal, as well as the micronutrients and phytochemicals needed to support the healing process and regulate inflammation. Foods that are high in vitamin C, vitamin A, and Zinc are especially helpful.

Less Fat More Quality

As protein and carbohydrate intakes increase, fat intake should decrease since it is not the primarily utilized macronutrient after surgical trauma. Although fats are not the primary energy source they still play an important role in regulating inflammation after surgery. This is especially true for omega-3 fatty acids. Be sure to include healthy fats such as fatty fish (salmon, herring, mackerel, sardines, trout), avocado, and olive oil.

Recovering from major surgery is challenging but fueling the body with whole foods that meet intake requirements will go a long way in improving the healing process and speed. 

Have questions? Reach out to Jade or Shawna at Wellness-speaks.com and find out what supplement and nutrition recommendations may be right for you.

References

1. Kotfis K, Jamioł-Milc D, Skonieczna-Żydecka K, Folwarski M, Stachowska E. The Effect of Preoperative Carbohydrate Loading on Clinical and Biochemical Outcomes after Cardiac Surgery: A Systematic Review and Meta-Analysis of Randomized Trials. Nutrients. 2020;12(10):3105. Published 2020 Oct 12. doi:10.3390/nu12103105

2. Şimşek T, Şimşek HU, Cantürk NZ. Response to trauma and metabolic changes: posttraumatic metabolism. Ulus Cerrahi Derg. 2014;30(3):153-159. Published 2014 Sep 1. doi:10.5152/UCD.2014.2653

3. Bessey PQ, Brooks DC, Black PR, Aoki TT, Wilmore DW. Epinephrine acutely mediates skeletal muscle insulin resistance. Surgery. 1983 Aug;94(2):172-9. PMID: 6348987.