A balanced and nutritionally sound diet is essential to fuel our bodies for everyday life. Eating well is also integral in the pre-operative, peri-operative and post-operative periods to decrease the duration of convalescence and recovery time, decrease the likelihood of complication and improve overall wound healing.
It is well documented that poor nutrition leads to post-operative infection, delayed wound healing, wound break down (or dehiscence), increased inflammation and pain, and an overall prolonged recovery.
A balanced diet includes appropriate amounts of our basic macronutrients: protein, fat, and carbohydrates as well as water, electrolytes, and vitamins, aka the micronutrients. This vital combination is needed to help build, repair and maintain tissues.
Let’s break it down. The normal adult requires 30-40kcal/kg of body weight per day (of total calories) and 0.8g/kg of protein calories per day. In medicine and surgery, a 70kg human is considered a baseline normal healthy adult. For this healthy 70kg (150lb) adult, that equals approximately 2700kcal/day and 56g of protein.
These needs increase (typically by 5-10 kcal/kg) in sickness, injury, and of course, surgery. Even this healthy 70kg human requires more calories in these situations.
Protein – one of the most important nutrients in the body; proteins repair and rebuild the body’s tissues, facilitate metabolic reactions, maintain proper pH and fluid balance, promote and support a healthy immune system, transport and store nutrients, and provide an energy source
Fat – sources of the essential fatty acids (linoleic and lenolenic acids) which are essential for brain development, inflammation control and blood clotting, required for the absorption and use of Vitamins A, D, E, and K, and to maintain healthy skin and hair
Carbohydrates – your body’s most important energy source for cells, organs and tissues
Vitamin C (ascorbic acid) – necessary for synthesis of collagen; lack of Vit C can lead to delayed wound healing and decreased strength of the scar, leading to dehiscence
Vitamin A – important for prompt healing; deficiency can delay wound healing
Trace metals (zinc, copper, Mg) – promote scar formation; deficiency decreases rate of scar formation
Glucose – energy for the fibroplasia step (white cell formation) in wound healing
Minerals such as Na+, K+, Ca+, PO4–, Cl– must be present for normal cell function
Vitamin K – prevents bleeding disorders; when absent, they can lead to uncontrolled bleeding causing hematoma formation and subsequent infection and/or wound dehiscence
So what do I do?
Here are some easy guidelines to follow:
Fluids and fiber rich foods can help reduce and prevent constipation.
It can be hard to consume large meals in the acute post-operative periods. Therefore, instead of large meals, more frequent smaller meals and snacks are a better option.
As we have discussed, proteins help boost healing, energy and your immune system so it Is important to consume these daily while avoiding sugar, alcohol and processed foods.
Nutritional supplements (such as Boost or Ensure) are often necessary and recommended to provide the essentials that you need for a quick and uneventful recovery.
I recommend the following to my patients:
Consume at least 1-2L of water a day supplemented by a minimum of 1000 calories just to maintain (this is equivalent to approximately 3 bottles of Boost or Ensure a day) to a goal of 1500-2000 cal. This is the bear minimum. I often tell my patients, getting the proper nutrition in the first 1-2 weeks after surgery is your new job and it is hard work, no doubt about it. Expect to be tired from it; but the more compliant you are, the quicker you will recover and the faster you will heal.
Good sources of protein: fish, white meat poultry and pork, eggs, greek yogurt, lean beef, soy, beans, dairy, cheese
Good sources of carbs: fruits, vegetables, whole wheat bread, brown rice, milk
Good sources of fats: avocado, coconut oil, EVOO, nuts and seeds, eggs, dark chocolate (70% cacao or greater)
-Jaclyn A. Tomsic, MD, DMD, FACS