• Dan Kao

Nutrition and Surgery Series (Part 2)

Updated: Jun 19




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!


Miss Part 1 on what to eat before surgery? Check it out here!


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Have questions about your upcoming surgery? Sign up today for your free personalized pre-op consult with an Orthopedic/Spine Nurse Practitioner or Medical Device Specialist today!

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Post-Operative Nutrition Therapy


Congratulations, you made it through your surgery and are now in the recovery phase. As discussed in the previous blog post, the way you eat and drink prior to your surgery is very important, but the nutrition checklist has not ended just yet. Your diet after surgery is equally if not more important to improve rate of healing and surgical outcomes. Working as a registered dietitian (RD) at a primarily orthopedic surgical hospital, I dedicate the majority of my time to ensuring my patients are meeting their post-op estimated energy needs and recommending the ideal menu selections to alleviate any side effects of anesthesia, surgery, or pain medication. Utilize the following guidelines to be sure you are optimizing your healing and recovery through nutrition:

  1. Emphasis on protein. Protein remains number one from the pre-operative checking to the post-operative checklist because adequate protein intake continues to be extremely important during the recovery phase. Your body just went through some trauma and is in a catabolic state, so focus on high biological value protein sources to achieve optimal wound healing and maintain your lean body mass given the likelihood of muscle atrophy in a more sedentary state. 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. If patients are unable to meet their nutritional needs via diet alone, dietitians will sometimes recommend oral protein supplements such as powders or shakes.

  2. Fiber, fiber, fiber. One of the most common patient complaints post-surgery is constipation, whether it be opioid-induced or related to lack of oral intake or movement. Fiber is an indigestible carbohydrate that helps promote bowel regularity and comes in two forms – soluble which softens stools and insoluble which bulks stools – both imperative for regular bowel movements. I encourage patients to consume prunes, prune juice, and plenty of fruits, legumes, vegetables, nuts, seeds and whole grains as tolerated.

  3. Hydrate! Fiber and hydration go hand in hand in while combating constipation. If you are increasing your fiber intake, you definitely want to ensure you are adequately hydrated to help move the fiber along the gastrointestinal tract. Not only does water play a key factor in preventing constipation, it also is important to avoid post-surgical complications such as blood clots and infections.

  4. Eat small, frequent, balanced meals. Your appetite may not be the greatest post-surgery as you may be in pain, fatigued, or nauseous from the anesthesia; eating may become more of a chore than a pleasure. Try have small, frequent, balanced meals and consume your fluid between meals to avoid a heavy volume of food/fluid in your stomach at once, and slowly increase your intake as tolerated. If you can only tolerate small volumes of food, aim for items packed with calories and protein such as shakes/smoothies, avocado, nut butter, and Greek yogurt. This is not the time to skimp out on calories and experience drastic rapid weight loss – even if that is a long-term goal.

  5. Choose calcium and vitamin D rich foods. This one is especially important for bone fracture surgeries as calcium and vitamin D work together to promote bone health and formation. Calcium rich foods include all dairy products, but if you are lactose intolerant or avoid dairy for any reason, obtain calcium from dark leafy vegetables or fortified foods such as orange juice, tofu, oatmeal, or cereal. The best source of vitamin D is the sun, but it is also obtained from dietary sources such as fatty fish, eggs yolks, cheese, or fortified milk. Your dietitian and/or doctor may recommend a supplement if you are deficient or your diet lacks calcium or vitamin D.

  6. Keep your blood sugar stabilized. Just as it is recommend you avoid added sugar pre-surgery, avoid sugar post-operatively as well (and really always!) Soda, juice, candy, cake, cookies, baked goods, syrups, and condiments which can spike your blood glucose levels disrupting circulation and immune system function, and increase your chance of infection.

  7. Choose vitamin C rich foods. Not only does vitamin C support a healthy immune system to fight off post-surgical infections, it also helps with wound healing and bone formation. Choose foods such as citrus fruits, green and red bell peppers, collard greens, broccoli, spinach, strawberries and tomatoes.

  8. Choose zinc rich foods. Alongside its role in immune support, zinc has also been shown to support wound healing, unite bone fractures and prevent osteoporosis due to its role in collagen synthesis. Zinc is abundant in oysters, meat, dark poultry fortified cereals, dairy, beans, and nuts.

  9. Limit alcohol. Alcohol consumption impacts the body’s ability to absorb calcium and other nutrients and disrupts vitamin D metabolism. Alcohol intake of three or more alcoholic drinks per day can be detrimental to bone health and healing. Not saying you cannot drink again, but moderation is key and there is nothing wrong with a glass of wine daily paired with a nutritious, active lifestyle.

If you just had surgery, it may be in your best interest to meet with a registered dietitian to confirm you are eating for optimal healing, lean body mass retention, complication reduction, malnutrition prevention and to alleviate any uncomfortable nutrition-related side effects. Consult with an RD if your surgeon recommends weight loss after surgery, if you take steroids/experience elevated blood glucose levels, have multiple food allergies or preferences which eliminate food groups, or exhibit poor wound healing. As mentioned in part one of this blog series, insurance typically covers these outpatient dietitian visits and dietitians want to support and optimally fuel your body at all stages of recovery: immediately post-op, throughout the rehabilitation period, and beyond!


Check out Part 3 on nutritional supplements here!


References:

  1. Berg KM, Kunins HV, Jackson JL, et al. Association between alcohol consumption and both osteoporotic fracture and bone density. Am J Med. 2008;121(5):406‐418. doi:10.1016/j.amjmed.2007.12.012

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

  3. Jensen JE, Jensen TG, Smith TK, Johnston DA, Dudrick SJ. Nutrition in orthopaedic surgery. J Bone Joint Surg Am. 1982;64(9):1263‐1272.

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

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

  6. Smith TK. Nutrition: its relationship to orthopedic infections. Orthop Clin North Am. 1991;22(3):373‐377.

  7. Smith TK. Prevention of complications in orthopedic surgery secondary to nutritional depletion. Clin Orthop Relat Res. 1987;(222):91‐97.

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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/


San Diego, CA

858-444-6812

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