If you are having surgery any time soon, you’ll want to read this. Perioperative nutrition is overlooked way too often.
As an athlete I have always been aware of the importance of nutrition and nutritional supplementation in improving performance. As a surgeon I have applied that same awareness to my surgical cases. The nutritional status of a patient is a huge factor in recovery from surgery. Many different tissue types need to heal after even the simplest of orthopaedic surgeries; the incision, bone, blood vessels, tendons, ligaments, cartilage, and more.
There are numerous scientific studies that support attention to nutrition around the time of surgery. This is especially important in those undergoing elective surgeries like an ACL Reconstruction or Rotator cuff repair, as you can proactively improve your diet to maximize your outcomes. Chances are that if you are reading this you are already trying to change your diet and life-style in away conducive to successful surgery.
Some surgeons are not as “in-tune” with nutrition and supplementation around surgery as I am. If your surgeon doesn’t seem to hold particular interest in these things you could certainly consult with a nutritionist.
In addition to a healthy balanced diet rich in low-fat proteins and veggies, I often make the following recommendations for perioperative nutrition:
1. Have a carbohydrate load the night before.
Most surgeries require at least a 6 hour fast prior to anesthesia. Usually, this is to avoid any aspiration of stomach contents during the anesthesia induction. In some cases you are told to have nothing to eat or drink after midnight the night before. Well, this can be pretty tolerable if you are the first case in the surgeon’s day starting at 7am. However, delays happen all the time in the operating room. If you are the 3rd or 4th case, chances are you may be waiting 12-16 hours from your last meal before having surgery. As a result you are essentially going into the surgery starved.
Research shows that a carbohydrate rich meal prior to surgery can help build up glycogen stores to resist such an overnight fast. I would highly recommend eating your last meal as close to your bed time the night before as possible. Have complex carbohydrates (75-100g, yams, rice, potatoes), a healthy protein (Fish, chicken breast, lean beef, etc), and veggies. Avoid high fat and fried foods the night before.
Saturated fat and omega-6 rich fats may increase the inflammation post-operatively. Consider having and omega-3 rich food like salmon to reduce your inflammation and pain post-operatively.
2. Take your Multivitamin
Although some surgeons say to stop your multivitamin prior to surgery for fear that you are taking a supplement that thins your blood, I believe that a regular strength multivitamin with minerals is safe to have up to the day of most surgeries. The essential vitamins and minerals are helpful for wound healing and are critical antioxidants in time of stress. I recommend paying particular attention to taking your multivitamin regularly up to 3 weeks before surgery and 6 weeks thereafter.
3. Take 500mg Vitamin C
Vitamin C has been shown to limit the incidence of a complication that can occur with all surgeries. Complex regional pain syndrome (CRPS) is a pain syndrome that can make even the best surgery go bad. We do not know what the exact cause of CRPS is but it is definitely complex. We do know that after sustaining a wrist fracture, taking 500mg of Vitamin C for the first 6 weeks helps prevent the formation of CRPS which is relatively common in this condition. It is believed that the antioxidant effect of the Vitamin C plays a role. Vitamin C is also an important nutrient in collagen formation and thus wound healing and bone healing.
4. Consider a protein supplement.
I always recommend whey protein shakes or at least any additional protein that one can take in the early post-operative period. Some patients may even be a little malnourished going into surgery and require a few weeks of supplemental protein for maximizing nutritional markers preoperatively. Vegetarians can use soy protein supplements. Going through surgery can be as stressful as running a marathon. You need to fuel recovery just as you would a tough workout.
5. Have a protein supplement/RTD available for first day.
It is always a good idea to have a meal replacement protein drink or “ready-to-drink” protein available for the day of surgery. Try something in the week before surgery so that you know you like the taste and that it is appealing to you. You may be nauseated after surgery either from the anesthesia or from the pain medicines you might take afterwards. The pain may even make sitting up for a full meal difficult or uncomfortable. If you have a protein shake that you can sip on you can be certain to get critical nutrients needed for healing. Also, by getting some nutrition you will help reduce your stress hormone levels. I recommend to my patients that they continue to use the shakes until they feel like they have gotten back into their normal healthy dietary habits.
6. Calcium and Vitamin D
Calcium and Vitamin D are important in healing of bone. If you are having surgery involving bone healing (fracture repair, osteotomy, fusion surgery) it is important that you have your vitamin D levels checked pre-operatively. If you are deficient your physician may recommend supplementation. I have had patients who presented to me with bones that just won’t heal only to discover vitamin D deficiency. After supplementation with vitamin D and use of a bone stimulator, many of these patients can avoid revision surgery and go on to solid bone healing. The typical dose of vitamin D is 400iu twice per day. I recommend 1000iu once or twice per day. Calcium is dosed 500mg twice per day. The dosing might be higher if needed.
7. Glucosamine Sulfate
Glucosamine is a critical component of your articular cartilage. This is the lining of your joints at the ends of your bones that provides smooth gliding surfaces for the joint. When damaged this causes mechanical clicking, catching, and locking in the joint along with swelling and pain. Badly damaged cartilage leads to degenerative arthritis. In randomized, placebo controlled studies; glucosamine sulfate (not glucosamine hydrochloride) has demonstrated beneficial effects for cartilage damage and joint pain. The articular cartilage has a relatively high amount of sulfate. I believe that the sulfate version of glucosamine is more beneficial because of the affinity for sulfate to the joint. Some surgeons may not want you to take glucosamine sulfate if you are on a blood thinner for its theoretical risk of increasing bleeding. I recommend any of my cartilage repair patients to use 500mg of glucosamine sulfate three times per day during their post-op rehabilitation. In addition, fish oil supplements help with reducing joint inflammation and pain and are thus good additions to the glucosamine.