Post-Surgical Nutrition: The Ultimate Guide

To make the most out of surgical rehabilitation programs and to maximize recovery patients should also prioritize their post-surgical nutrition.  Nutritional choices can have a drastic impact on both recovery and the risk of a retear.  This article will explore what surgical patients can do nutritionally following major orthopedic surgery to help ensure a full recovery and return to function. 

Surgery is Stressful!

Surgery is a major stress to the body which leads to muscle loss independent from the muscle loss that occurs from the disuse of the surgical joint. The less muscle loss you have, the faster the recovery and return to function. Nutritionally we can combat this stress and help preserve muscle a few different ways. First up is carbohydrate intake. Following an operation carbohydrate should be consumed at 3.63 grams per pound of body weight per day for at least 3 days following surgery. This is to maximize glycogen (energy) stores following the big stressful event, which depletes glycogen (Hirsch et al., 2021).

Protein is King

Protein is king following all surgeries.  The recommended range for daily protein intake following surgery is 0.73 – 0.91 grams of protein per pound of body weight per day (Wischmeyer et al., 2018).  Good thing that’s grams, not ounces!  Reaching this protein goal day after day can get difficult, and expensive.  Protein powders can make this goal easier to accomplish and look at cheaper meat options like turkey and chuck roast to save money.  

Post-Surgical Nutrition Study Highlight:

One study by Dreyer et al. showed that supplementing with protein for 6 days leading up to surgery and then for 6 weeks following surgery decreased muscle atrophy by an average of 5% (Dreyer et al., 2018)!  When protein, essential amino acids, and leucine are increased in the diet muscle disuse atrophy can decrease, and muscle function preserved (Howard et al., 2020).  Eat your protein!

Supplements Post-Surgery

The supplements studied in surgical cases look to assist the healing process by decreasing harmful inflammation, decreasing oxidative stress, increasing blood flow, and increasing collagen synthesis and quality (Oryan et al., 2011; Vitali et al., 2019; Yazar et al., 2022).  The beneficial results (when seen) typically include improved joint pain, stiffness, range of motion, function, and repair (Fusini et al., 2016; Lugo et al., 2016; McGlory et al., 2019; Schön et al., 2022; Yu et al., 2020).  Many studies even demonstrate that supplements can have an equal or greater benefit than non-steroidal anti-inflammatories (NSAIDs), but without the harmful side effects (Fusini et al., 2016; Henrotin et al., 2022; Vitali et al., 2019).  Well-studied compounds in supplements that would likely benefit a shoulder surgery patient include: Glucosamine and chondroitin sulphate, methylsulfonlymethane (MSM), curcumin, Boswellia, vitamin C, and omega-3’s.  

Keep Supplements Supplemental

Proper healing and recovery begin with the proper fuel, Consistent protein intake.  Further, supplements are never miracle pills and can take weeks to have an effect.  Those claiming otherwise are likely embellishing the benefits. 

Conclusion

In conclusion, the opportunities patients have from a nutritional perspective are wide-reaching and impactful.  From protein to supplements post-surgical nutrition has a direct impact on how the shoulder will recover, and how soon the patient can return to full function.  If these recommendations seem complex or confusing don’t hesitate to find a nutrition expert to help you on your journey!

Post-Surgical Nutrition Recommendations

• 3.63 grams of carbohydrate per pound per day for 3 days following surgery – focusing on complex carbohydrates (not super sugary stuff)
• 0.73 – 0.91 grams of protein per pound of body weight per day for the entire time the body repairing and strengthening
• Have 1 serving of fruit and vegetable each day for antioxidants

Post-Surgical Supplemental Product Recommendations:

• Whey Protein Isolate of any kind – oral protein supplement to reach protein goal
• OmegAvail Hi-Po from Designs for Health – fish oil for anti-inflammatory effects
• Joint Support Nutrients from Thorne
• Arthrosoothe from Designs for Health

Sources:

• Dreyer, H. C., Owen, E. C., Strycker, L. A., Smolkowski, K., Muyskens, J. B., Kirkpatrick, T. K., Christie, A. D., Kuehl, K. S., Lantz, B. A., Shah, S. N., Mohler, C. G., & Jewett, B. A. (2018). Essential Amino Acid Supplementation Mitigates Muscle Atrophy After Total Knee Arthroplasty: A Randomized, Double-Blind, Placebo-Controlled Trial. JB & JS Open Access, 3(2), e0006. https://doi.org/10.2106/JBJS.OA.18.00006
• Fusini, F., Bisicchia, S., Bottegoni, C., Gigante, A., Zanchini, F., & Busilacchi, A. (2016). Nutraceutical supplement in the management of tendinopathies: a systematic review. Muscles, Ligaments and Tendons Journal, 6(1), 48–57. https://doi.org/10.11138/mltj/2016.6.1.048
• Gumina, S., Candela, V., Passaretti, D., Latino, G., Venditto, T., Mariani, L., & Santilli, V. (2014). The association between body fat and rotator cuff tear: the influence on rotator cuff tear sizes. Journal of Shoulder and Elbow Surgery, 23(11), 1669–1674. https://doi.org/10.1016/j.jse.2014.03.016
• Henrotin, Y. E., Michlmayr, C., Rau, S. M., Quirke, A.-M., Bigoni, M., & Ueberall, M. A. (2022). Combination of Enzymes and Rutin to Manage Osteoarthritis Symptoms: Lessons from a Narrative Review of the Literature. Rheumatology and Therapy, 9(5), 1305–1327. https://doi.org/10.1007/s40744-022-00472-7
• Hirsch, K. R., Wolfe, R. R., & Ferrando, A. A. (2021). Pre- and Post-Surgical Nutrition for Preservation of Muscle Mass, Strength, and Functionality Following Orthopedic Surgery. Nutrients, 13(5). https://doi.org/10.3390/nu13051675
• Hong, C.-K., Chang, C.-J., Kuan, F.-C., Hsu, K.-L., Chen, Y., Chiang, C.-H., & Su, W.-R. (2020). Patients With Diabetes Mellitus Have a Higher Risk of Tendon Retear After Arthroscopic Rotator Cuff Repair: A Meta-analysis. Orthopaedic Journal of Sports Medicine, 8(11), 2325967120961406. https://doi.org/10.1177/2325967120961406
• Howard, E. E., Pasiakos, S. M., Fussell, M. A., & Rodriguez, N. R. (2020). Skeletal Muscle Disuse Atrophy and the Rehabilitative Role of Protein in Recovery from Musculoskeletal Injury. Advances in Nutrition (Bethesda, Md.), 11(4), 989–1001. https://doi.org/10.1093/advances/nmaa015
• Liu, J., Wang, W., Wang, Z., Wu, Q., Zhu, Y., Wu, W., & Zhou, Q. (2023). The Association between Dietary Habits and Rapid Postoperative Recovery of Rotator Cuff Repair. Nutrients, 15(21). https://doi.org/10.3390/nu15214587
• Lugo, J. P., Saiyed, Z. M., & Lane, N. E. (2016). Efficacy and tolerability of an undenatured type II collagen supplement in modulating knee osteoarthritis symptoms: a multicenter randomized, double-blind, placebo-controlled study. Nutrition Journal, 15, 14. https://doi.org/10.1186/s12937-016-0130-8
• McGlory, C., Calder, P. C., & Nunes, E. A. (2019). The Influence of Omega-3 Fatty Acids on Skeletal Muscle Protein Turnover in Health, Disuse, and Disease. Frontiers in Nutrition, 6, 144. https://doi.org/10.3389/fnut.2019.00144
• Oryan, A., Moshiri, A., & Meimandiparizi, A.-H. (2011). Effects of sodium-hyaluronate and glucosamine-chondroitin sulfate on remodeling stage of tenotomized superficial digital flexor tendon in rabbits: a clinical, histopathological, ultrastructural, and biomechanical study. Connective Tissue Research, 52(4), 329–339. https://doi.org/10.3109/03008207.2010.531332
• Schön, C., Knaub, K., Alt, W., Durkee, S., Saiyed, Z., & Juturu, V. (2022). UC-II Undenatured Type II Collagen for Knee Joint Flexibility: A Multicenter, Randomized, Double-Blind, Placebo-Controlled Clinical Study. Journal of Integrative and Complementary Medicine, 28(6), 540–548. https://doi.org/10.1089/jicm.2021.0365
• Vitali, M., Naim Rodriguez, N., Pironti, P., Drossinos, A., Di Carlo, G., Chawla, A., & Gianfranco, F. (2019). ESWT and nutraceutical supplementation (Tendisulfur Forte) vs ESWT-only in the treatment of lateral epicondylitis, Achilles tendinopathy, and rotator cuff tendinopathy: a comparative study. Journal of Drug Assessment, 8(1), 77–86. https://doi.org/10.1080/21556660.2019.1605370
• Wischmeyer, P. E., Carli, F., Evans, D. C., Guilbert, S., Kozar, R., Pryor, A., Thiele, R. H., Everett, S., Grocott, M., Gan, T. J., Shaw, A. D., Thacker, J. K. M., & Miller, T. E. (2018). American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Nutrition Screening and Therapy Within a Surgical Enhanced Recovery Pathway. Anesthesia & Analgesia, 126(6), 1883–1895. https://doi.org/10.1213/ANE.0000000000002743
• Yazar, İ., Sarıkaya, B., Koyuncu, İ., Gönel, A., Bozkurt, C., Sipahioğlu, S., Çetin, B. V., & Altay, M. A. (2022). Evaluation of oxidative stress in degenerative rotator cuff tears. Journal of Shoulder and Elbow Surgery, 31(10), e490–e497. https://doi.org/10.1016/j.jse.2022.03.011
• Yu, G., Xiang, W., Zhang, T., Zeng, L., Yang, K., & Li, J. (2020). Effectiveness of Boswellia and Boswellia extract for osteoarthritis patients: a systematic review and meta-analysis. BMC Complementary Medicine and Therapies, 20(1), 225. https://doi.org/10.1186/s12906-020-02985-6

Disclaimer

DISCLAIMER: If you are pre-diabetic or have type I or type II diabetes not all of these recommendations will be suitable for you. Every patient requires different recommendations, even in nutrition. If you have any questions about your individual situation reach out to me at zzenner@zion-performance.com or book a free consult to check out our coaching packages. What is discussed in this article are broad general guidelines, not specific to certain situations, thus it should not be considered medical advice or official recommendations from ZION Performance. As always consult your doctor before making any significant change to your diet