• Dan Kao

Nutrition and Surgery Series (Part 1)

Updated: Jun 16




An often overlooked part of surgery is the nutrition factor. Eating correctly will help your body recover faster and fuel it for the increased metabolic demand. This series we have Kylie Gearhart MS, RD-AP, CDN, CNSC to give expert advice on what to eat before and after surgery!


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Pre-Operative Nutrition Therapy


Gearing up for a surgical procedure means you have likely put in your fair share of time, research, and doctor appointments - but have you thought about your nutritional status? The way you eat and drink prior to your surgery may have a significant impact on your outcomes and rate of healing, making pre-operative nutrition therapy a vital (but sometimes overlooked) component of surgical care. Working as a registered dietitian (RD) at a primarily orthopedic surgical hospital, I have witnessed first-hand the importance of adequate nutrition prior to surgery. In fact, rare situations have occurred in which surgeons/physicians delay or refuse to perform surgery on patients who are deemed inadequately nourished. I recommend to focus on the following nutrition checklist for the months, weeks, or even days leading up to your surgery to set your body up for success:

  1. Emphasis on protein. Surgery puts your body into a catabolic state, therefore it is important to focus on maintaining or building lean body mass with adequate protein intake and exercise (if able) to increase ease of recovery. Ensure each meal contains a protein-rich source such as eggs/egg whites, chicken, fish/seafood, turkey, lean beef, pork, Greek yogurt, cottage cheese, low fat milk or cheese, tofu, soy, farro, quinoa, beans, nuts, and seeds.

  2. Consume a well-balanced diet. Aim to consume three meals per day (with the addition of snacks as needed) incorporating all the food groups and macronutrients. Each meal should consist of a carbohydrate (especially whole grain sources which are rich in B vitamins to combat stress), a lean protein, a healthy fat, and a variety of colorful vegetables. Fruit and dairy can be incorporated into meals or as snacks between meals.

  3. Prevent/correct possible malnutrition. Have you experience recent weight loss, decreased appetite, or are you underweight? Unless recommended by your physician or surgeon, weight loss prior to surgery is not ideal as it increases your risk of malnutrition. Avoiding pre-operative malnutrition is of utmost importance as malnutrition is associated with negative outcomes including increased infection rates, poor wound healing and increased risk of decubitus ulcers, overgrowth of harmful bacteria in the gastrointestinal tract, abnormal nutrient losses, even mortality. Aim to incorporate healthy high calorie/high protein foods to maintain your weight and lean body mass. These foods may include: meat, dairy, beans, nuts/nut butter, seeds, avocado, fish, milkshakes or smoothies, oats, brown rice, sweet potatoes, whole grain/lentil/chickpea pasta. Protein powder and oral nutritional supplements may be recommended if you are unable to meet your calorie and protein needs via food alone.

  4. Avoid added sugar. I am not talking about the natural sugar found in fruit, dairy, grains, or certain vegetables. I am talking about the added sugar in soda, juice, candy, cake, cookies, baked goods, syrups, and condiments which can spike your blood glucose levels. Controlling blood sugar is important for circulation, immune system function, and preventing post-op infections, especially if you are diabetic or prediabetic.

  5. Hydrate! Studies have shown that patients who are well hydrated report less pain and nausea post-surgery. As a general rule of thumb, divide your weight in pounds in half to calculate the amount of fluid you should be ingesting daily. You may want to consider eliminating caffeine and alcohol from the diet as these act as diuretics and can remove essential nutrients from the body. Follow your surgeon’s recommendations regarding when to discontinue oral water intake prior to surgery.

  6. Support your immune system. I suggest consuming foods rich in vitamin C and zinc to support a healthy immune system and prevent post-surgical infections. Vitamin C is found in citrus fruit, broccoli, cauliflower, kale, bell peppers, sweet potatoes, and strawberries. Zinc-rich foods include meat, shellfish, legumes, seeds, nuts, dairy, eggs, and whole grains.

  7. Run a vitamin panel. If you have time prior to surgery, I recommend having your vitamin levels checked to correct any deficiencies. Supplements may be recommended by your physician if necessary, but I try to promote a “food first” approach.

If you are anticipating an upcoming surgery, it may be in your best interest to meet with a registered dietitian to be sure your nutritional status is optimized, shorten post-op hospital stays, and reduce complications. Not all patients fit under the same medical picture, proving individualized nutrition support to be paramount.


Final Tips


Consider setting up an appointment with an RD prior to your surgery, especially if you have experienced signs of protein calorie malnutrition including: significant weight loss, decreased appetite, a body mass index of less than 18.5 kg/m2, decreased strength, muscle wasting, and subcutaneous fat loss.


It would also be a good idea to consult with an RD if your surgeon recommends you lose weight prior to your surgery in a healthy manner, or if you take steroids/experience elevated blood glucose levels, have multiple food allergies or preferences which eliminate food groups, or exhibit poor wound healing.


Bonus: insurance typically covers these outpatient dietitian visits! We prepare for all types of major life events: races, exams, weddings, and presentations – why not prepare and nourish our bodies for surgery?


Ready to see how to eat for after surgery? Check out Part 2 here!


References:

  1. Elwyn DH, Bryan-Brown CW, Shoemaker WC. Nutritional aspects of body water dislocations in postoperative and depleted patients. Ann Surg 1975; 182:76.

  2. Kinney JM, Weissman C. Forms of malnutrition in stressed and unstressed patients. Clin Chest Med 1986; 7:19.

  3. Santos JI. Nutrition, infection, and immunocompetence. Infect Dis Clin North Am 1994; 8:243.

  4. Mainous MR, Deitch EA. Nutrition and infection. Surg Clin North Am 1994; 74:659.

  5. Hayhurst C, Durieux ME. Enteral hydration prior to surgery: the benefits are clear. Anesth Analg. 2014; 118(6):1163-1164.

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Kylie Gearhart MS, RD-AP, CDN, CNSC is a registered dietitian nutritionist based in New York City.


Associate Dietitian – New York Nutrition Group (accepting most insurance coverage and available for in person or virtual nutrition consultations): https://www.nynutritiongroup.com/


Contact Kylie for a nutrition evaluation: kyliegearhart@gmail.com


Follow Kylie on social media @kylie.nutrition


Check out her personal website: https://kylierd.com/


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