Mackie: Weight-reduction plan earlier than and after surgical procedure may help with restoration

Until recently, preoperative nutrition requirements have centered on guidelines from fasting to hydration – starting at midnight before surgery.

NEW ORLEANS – The annual recreational or sports injury and rehabilitation cost is estimated to be approximately nine billion for young adults ages seventeen to forty-four. In many cases, for example an injury to the anterior cruciate ligament (ACL) with associated damage to the surrounding ligament – meniscus and medial collateral ligament – early osteoarthritis is in the future.

When I was a performance conditioning and nutrition consultant for the St. Louis Blues Hockey Organization from 1989 to 1999, hockey research reported that an injury can be expected every 1,000 man hours on the ice.

If you put 50 players on the ice (during training camp) with a 3 hour practice limit, you will have burned 150 man hours in one practice hour. 30 percent of the injuries were contactless and caused by fatigue.

A major focus of injury management, treatment, and possibly pre / post surgery is managing inflammation, which is a normal, important aspect of the body’s repair process – until it gets out of hand or becomes protracted.

Treatment modalities like cryotherapy, anti-inflammatory prescriptions, and even nutritional interventions like omega-3 supplements may be contraindicated in the initial therapy intervention.

It requires guidance from the attending physician, physical therapist, chiropractor, or certified sports trainer to determine the type and timing of inflammation management.

According to Dietary Considerations and Strategies for Facilitating Injury Recovery and Rehabilitation published in the September 2020 issue of the Journal of Athletic Training, “After an injury, a cascade of inflammatory, immune, and metabolic responses is activated, resulting in a hypermetabolic state . To support this hypermetabolic state and the healing process of injuries, significant macro and micronutrient support is required. “

Until recently, preoperative nutrition requirements have centered on guidelines from fasting to hydration – starting at midnight prior to surgery to minimize the risk of anesthetic lung aspiration.

The study’s authors – from the Department of Exercise and Sports Science, the Human Movement Science Curriculum, the Department of Nutrition at the University of North Carolina’s Gillings School of Public Health at Chapel Hill – note that “more recently, collecting Data has led to suggestions that less stringent fasting routines can be used without endangering patients. Feeding patients a high-carbohydrate drink immediately prior to surgery was safe, reduced catabolic surgical stress, and may have improved post-operative outcomes. “

Indeed, note the researchers: “Recent guidelines recommend that patients fast 6 hours before and 2 hours before surgery after a light meal and from clear liquids. With these guidelines in mind, this preoperative time can potentially be used to maximize recovery potential. “

The researchers add further evidence that preoperative consumption of 100 g of an oral glucose solution on the evening before surgery in conjunction with 50 g 2 hours before surgery was effective in reducing postoperative insulin resistance.

After surgery and during the rehabilitation period, it is common for the immune system to respond to the stress – the trauma of the surgery and the repair process of rehabilitation – by creating a catabolic state (degradation environment) during the healing process. The potential loss of lean body mass (LBM) is a target for dietary interventions – calorie needs, increased protein needs, and micronutrient needs.

An assessment of the patient’s overall energy needs – resting metabolic rate, activity level, and stress response – is of the utmost importance to the healing process. For example, protein requirements can be in the range of 1.6 to 2.0 to 3.0 grams of protein per kilogram of body weight daily – every 3 to 4 hours throughout the day and before bed, as the body also repairs during the sleep cycle.

The amino acid leucine – the anabolic (anabolic) amino acid – may have an additional 3 grams per day daily requirement during the tissue repair process, either in a whey protein isolate powder or drink (a high source of leucine) or as a supplement.

From the point of view of carbohydrates after surgery, the need can be in the range of 3 to 5 grams per kilogram of body weight in the form of complex carbohydrates.

The essential fatty acids, especially EPA, DHA and ALA, contribute to the healing process by helping to bring the inflammatory process under control after the initial stage of inflammation.

The Chapel Hill researchers say, “The recommended daily intake is 2 grams of omega-3 fatty acids per day and 10 grams of omega-6 fatty acids per day. Common food sources for omega-3 fatty acids are avocado, olive oil, fish, flax, nuts, and seeds. “

During the recovery process, “Omega-6 fatty acids found in processed meat, fried and fatty foods, and vegetable oils should be limited because of their anti-inflammatory properties.”

Based on decades of work, the researchers state: “Creatine monohydrate (CrM), consisting of the amino acids arginine, methionine and glycine, is one of the most effective ergogenic aids for improving intensive training performance and improving LBM in combination with exercise. Other benefits of creatine included preventing traumatic brain injuries and improving bone health and neuromuscular function. “

The patient’s vitamin D status in serum 25 (OH) should also be checked. “Vitamin D is usually known for its importance in calcium and bone regulation, but it also plays a role in innate and adaptive immune regulation and in skeletal muscle function, and thus has potential effects on improving regeneration,” the research study said.

It has been shown that HMB, a metabolite of the essential amino acid leucine, prevents protein breakdown and at the same time upregulates protein synthesis, especially in stressful physiological situations such as injuries or surgery.

In particular, “HMB can regulate the enzymes that are responsible for breaking down muscle tissue. During the immobilization periods, HMB can stimulate protein synthesis by activating the mTOR pathway, upregulating the rate of repair of muscle and tendon tissue, and mitigating the breakdown of myofibrils, thereby reducing muscle loss. “

From a micronutrient point of view, “Vitamin A had positive effects on wound healing even in a non-deficient condition, while vitamin C supplementation was mostly beneficial only in patients with severe stress or injuries. The supplement with vitamin E led to a reduction in oxidative stress and thus to a shortening of the wound healing time. “

The researchers point this out, and I recommend that you consult a licensed dietitian who specializes in surgical recovery or wound healing in terms of the type, composition, and calorie intake of food – along with certain micro- and macronutrients Support under the guidance of your treating doctor.

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