Nutritional Considerations When Preparing for Surgery

You’ve done it! You have made the leap and have scheduled your surgery. Now what? Hopefully, you’ve discussed with your surgeon and his staff regarding what tests and other preparations you need before showing up for that big day. Something that is often overlooked are your nutritional needs. Why is nutrition so important, especially now? One of your body’s responses to stress is to break down protein and fat for energy in a process called gluconeogenesis. The greater and prolonged the stress, the more protein and fat is needed for this process. Where does the protein and fat come from? In normal circumstances, you would rely on your diet, but during times of stress, your food intake may decrease due to loss of appetite or other issues such as nausea and vomiting. You may have problems with the digestion and absorption of nutrients. Your body would then take the protein and fat from your body stores. This would include subcutaneous fat and, more importantly, your muscles. Physically, your body considers surgery to be a type of stress that usually involves wound healing. Studies have shown that the more protein there is available, the better the response to stress. In other words, you’ll heal faster and with fewer complications If you have more protein available.

So how do you achieve this? The obvious answer would be, prior to your surgery, to eat more foods that are high in protein. However, increasing your protein intake is just part of the picture. You need to find a way to store it as muscle. Otherwise, the protein will be converted to energy (calories), and if not used up, it will then be stored as fat. How do we make muscle? Yes, exercise is key to storing our dietary protein as muscle. I think I just heard a collective groan. However, exercise does not have to be training for the Olympics; it can something as simple as going for a 30-minute walk, or as fun as jumping on a trampoline with (or without, depending on your energy level!) your kids.

Let’s talk about dietary protein. It’s important to not just increase your overall intake of protein, but to choose good sources of protein. Protein is made up of amino acids. There are nine essential amino acids which the body cannot make and so must get from food. Good sources of protein will have most if not all of these amino acids. Some examples of good sources of protein are:

1. Meat - beef, pork, bison, lamb, organ meats (liver, heart, kidney)
2. Poultry - chicken, turkey, duck
3. Fish and seafood - fish, shrimp, crab, scallops, lobster
4. Legumes - soybean, chickpeas, peanuts, navy beans. pinto beans, lentils, tofu
5. Nuts, grains and seeds – almonds, walnuts, pecans, sunflower seeds, chia, quinoa
6. Eggs and dairy – egg whites, milk, yogurt, cheese, cottage cheese
7. Insects (yes, insects) – silkworms, crickets, ants, ant eggs, mealworms

So how much protein is enough? Recommendations by the Academy of Nutrition and Dietetics is 0.8 grams of protein per kilogram of body weight to maintain your protein stores. However, this can go up to 1-2 grams/kg body weight when stress is factored in. The greater the stress, the greater the protein requirement. From a surgical standpoint, if it’s a minor surgery and you don’t have any underlying problems, then 1.0-1.2 grams protein/kg body weight may be sufficient to meet your needs after surgery. However, major surgeries such as body lifts can up that requirement to 1.2-1.5 grams protein/kg body weight after surgery. For example, if you weigh 150 lbs (68 kg), then for a relatively minor surgery such as liposuction, you would require about 68-82 grams of protein per day. However, after a body lift, your protein needs may increase to 102 grams per day. Keep in mind that these recommendations are for AFTER you’ve had your surgery.

To build up your protein stores prior to surgery, let’s assume a general requirement of 1.0 grams protein/kg body weight. Using the above example of a 150 lb (68 kg) person, the daily protein requirement would be 68 grams of protein. How do you work that out in a daily intake? Let’s assume the following general values for protein content (Please note that these are general values only. The content may vary depending on the amount of fat and water in the food):

Food Portion Size Grams Protein

Meat boneless, cooked 1 ounce 7

Poultry skinless/boneless, cooked 1 ounce 7

Fish skinless/boneless, cooked 1 ounce 7

Canned tuna, drained of fluid 1 ounce 5

Egg, large 1 6

Pinto beans, cooked ½ cup 11

Lentils, cooked ½ cup 9

Edamame, cooked ½ cup 9

Quinoa, cooked ½ cup 4

Nut butter 1 Tbsp 7

Almond, shelled 1 ounce 6

Walnuts, shelled 1 ounce 4

Sunflower seeds, shelled 1 ounce 6

Greek yogurt 6 ounces 18

Regular yogurt (nonfat) 1 cup 11

Cottage cheese (1% fat) 4 ounces 14

Milk, cow’s, skim 1 cup 11

Milk, soy 1 cup 8

Mozzarella (part skim) 1 ounce 7

String cheese (nonfat) 1 piece 6

So how does this help you in figuring out what to eat? In general, it’s better to consume frequent small meals throughout the day to help curb hunger, which prevents overeating, and to distribute your nutrient intake throughout the day. Try to incorporate a food high in protein with other foods at each meal to give you some energy (calories) in addition to the protein. For example, cheese and crackers or yogurt with fresh fruit. Below is a sample menu that incorporates approximately 68 grams of protein in a day (not included is the protein content of foods that are generally lower in protein):

Breakfast Protein (g)

1 egg 6

1 slice whole grain toast

2 tsp butter

4 oz orange juice

Mid-morning Snack

1 string cheese 6

1 banana

Lunch

Sandwich (2 oz sliced turkey/1oz Swiss cheese) 21

2 tsp mayo or butter

1 cup baby carrots

Mid-afternoon Snack

1 cup plain regular yogurt 11

½ cup fresh blueberries

Supper

3 ounces cooked steak 21

1 baked potato (plus toppings)

1 cup green beans

Evening Snack

1 Tbsp peanut butter 7

4 whole grain crackers

Total Protein (grams) 72

As you can see, it isn’t difficult to meet your protein requirements. If you find you can’t consume 6 small meals a day, then try to divide up the protein into 4-5 meals a day. For example, you can incorporate the mid-morning snack into your breakfast by adding one ounce of grated mozzarella cheese to your scrambled eggs instead of having the string cheese for a mid-morning snack. Remember to exercise for 20-30 minutes a day in order to build up your muscle and to keep your heart healthy. This may include walking, or better yet, walking with weights, water aerobics, Pilates, cycling (on a bike or stationary bike), rowing (on the water or on a machine), kayaking, spinning, or any other form of exercise that gets you moving. Please consult your physician before engaging in an exercise routine as there may be some underlying medical conditions that need to be addressed. Try to follow the diet and exercise routine for one month prior to your surgery. This will build up your protein stores, which can help you recover from your surgery more quickly and with fewer complications.