Until recently, the pre-operative nutrition requirements have focused on guidelines from fasting to hydration – beginning at midnight before the surgery.
NEW ORLEANS — It’s estimated that the annual cost of recreational or sports-related injury and rehabilitation is roughly nine billion for young adults seventeen to forty-four years of age. In many cases, such as in an injury to the anterior cruciate ligament (ACL), with associated surrounding ligament damage – meniscus and medial collateral ligament – early osteoarthritis is in the future.
When I was affiliated with the St. Louis Blues Hockey Organization, as their Performance Conditioning & Nutrition consultant, from 1989 to 1999, hockey research reported that you could anticipate an injury for every 1000 man-hours on the ice.
With a 3-hour practice limitation, when you place 50 players (during training camp) on the ice, you’ve burned up 150 man-hours in one practice session. Thirty percent of the injuries were non-contact, fatigue related.
A primary focus of injury management, treatment, and if applicable, pre/post-surgical, is the management of inflammation, which is a normal, important aspect of the body’s repair process – until it gets out of control or protracted.
Modes of treatment, such as cryotherapy, anti-inflammatory prescriptions, and even nutritional interventions, like omega-3 supplementations, may be contraindicated in the initial therapy intervention.
It requires the guidance of the attending physician, physical therapist, chiropractor, or certified athletic trainer to determine the mode and timing of inflammation management.
According to Nutritional Considerations and Strategies to Facilitate Injury Recovery and Rehabilitation, which appeared in the September 2020 issue of the Journal of Athletic Training, “once an injury is sustained, a cascade of inflammatory, immune, and metabolic responses is activated, resulting in a hypermetabolic state. To support this hypermetabolic state and the injury-healing process, significant macro- and micronutrient support is required.”
Until recently, the pre-operative nutrition requirements have focused on guidelines from fasting to hydration – beginning at midnight before the surgery to minimize the risk to any anesthesia-related pulmonary aspiration.
The study authors – from the Department of Exercise and Sports Science, Human Movement Science Curriculum, Department of Nutrition, Gillings School of Public Health, University of North Carolina, Chapel Hill – note that, “more recently, accumulating data have led to suggestions that less strict fasting routines can be adopted, without placing patients at risk. Feeding patients with a high-carbohydrate beverage immediately before surgery was safe, reduced catabolic surgical stress, and might have enhanced postoperative outcomes.”
In fact, note the researchers, “newer guidelines advise that patients fast after a light meal 6 hours before and from clear liquids 2 hours before surgery. With these guidelines in mind, it may be possible to take advantage of this preoperative time to maximize recovery potential.”
The researchers cite further evidence that preoperative consumption of 100 grams of an oral glucose solution the evening prior to surgery, in conjunction with 50 grams 2 hours before surgery was effective in reducing postoperative insulin resistance.
It’s common, after surgery and during the rehabilitation period, to see the immune system respond to the stress – the trauma of surgery and the repair process of rehabilitation – by initiating a catabolic (breakdown environment) state during the healing process. The potential loss of lean body mass (LBM) is a target for nutritional intervention – caloric needs, enhanced protein requirement, and micronutrient needs.
An assessment of the patient’s total energy needs – resting metabolic rate, activity level, and the stress response – are paramount to the healing process. For instance, protein requirements can be in the range of 1.6 to 2.0-3.0 grams of protein per kilogram of body weight daily – spread throughout the day every 3 to 4 hours and before sleep, since the body also repairs during the sleep cycle.
The amino acid leucine – the anabolic (building) amino acid – during the tissue repair process – may have a daily supplemental need of 3 grams per day, either in a whey protein isolate powder or drink (a high source of leucine) or by direct supplementation.
From a carbohydrate perspective post-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, specifically EPA, DHA, and ALA, contribute to the healing process by helping to bring the inflammatory process under control, after the initial inflammatory stage.
The Chapel Hill researchers say the, “recommended daily intakes are 2 grams per day of omega-3 fatty acids and 10 grams per day of omega-6 fatty acids. Common food sources of omega-3 fatty acids are avocado, olive oil, fish, flax, nuts, and seeds.”
During the recovery process, “omega-6 fatty acids, which are found in processed meats, fried and greasy foods, and vegetable oils, should be limited due to their proinflammatory properties.”
Based on decades of work, note the researchers, “creatine monohydrate (CrM), composed of the amino acids arginine, methionine, and glycine, is one of the most effective ergogenic aids available for improving intense exercise performance and enhancing LBM, when combined with exercise. Additional benefits of creatine included preventing traumatic brain injuries, as well as, improving bone health and neuromuscular function.”
The patient’s serum 25(OH) vitamin D status should also be checked. “Vitamin D is typically recognized for its importance in calcium and bone regulation, but it also plays a role in innate and acquired immune regulation, as well as, skeletal muscle function, thereby having potential implications for improving recovery,” according to the research study.
HMB, a metabolite of the essential amino acid leucine, has been demonstrated to prevent protein breakdown, while upregulating of protein synthesis, especially in stressful physiological situations, such as injury or surgery.
Specifically, “HMB may regulate the enzymes responsible for muscle tissue breakdown. During periods of immobilization, HMB may stimulate protein synthesis by activating the mTOR pathway, upregulating the repair rate of muscle and tendon tissue and mitigating myofibrillar degradation, thereby reducing the amount of muscle loss.”
From a micronutrient standpoint, “vitamin A had positive effects on wound healing, even in a nondeficient state, whereas vitamin C supplementation was largely only beneficial in patients with severe stress or injury. Vitamin E supple- mentation resulted in decreases in oxidative stress, thereby decreasing wound healing time.”
The researchers point out, and I recommend, that you consult with a licensed dietetic nutritionist, who specializes in surgery recovery or wound healing, as to the type, composition, and caloric extent of the food intake – along with specific micro and macro-nutrient support, under the direction of your attending physician.
For more information on this topic and wellness research, go to maxwellnutrition.com.