Postoperative Nutrition Considerations & Importance of Protein for Optimizing Healing

Surgery is something that we hope to avoid throughout our careers in both competitive athletic pursuits and in our recreational exercise years. However, as the saying goes, stuff happens. 

So, if we’re faced with a situation where surgical intervention is the necessary approach to resolving an injury we have sustained, then our goal shifts towards the most effective and efficient rehabilitation from that surgery. Just as there is ‘optimal’ when it comes to performing in our sport or activity, there is also ‘optimal’ when it comes to post-surgical recovery. And ultimately, optimizing our post-surgical rehab gets us back to the activity or sport we want to be participating in as quickly as possible. 

There are certainly other considerations when optimizing post-surgical rehab, such as optimizing sleep, hydration, and consistently performing your physical therapy exercises. But, in this article, we want to provide some insight on a sometimes under-appreciated aspect of recovery, which is nutrition. 

Surgery is stressful to the body

Undergoing surgery means there will be a significant stress response in the body. Metabolic, inflammatory, and immune responses within the body will be sent into overdrive to attempt to heal. In addition to this, and especially important after orthopedic surgery, muscle protein synthesis becomes reduced and protein breakdown increases. This, in addition to immobilization that is often required following surgery, can lead to significant loss of muscle (atrophy) and strength. 

Think optimize and minimize

Having realistic goals is vital. Avoiding the above altogether is impossible. The body is going to have to go through a natural healing process. However, what we can do is minimize the amount of atrophy and strength loss that occurs and ensure that we are providing our bodies with the appropriate building blocks to aid in the repair and recovery process to make it as efficient as possible. 

A crucial building block to the repair process after surgery is amino acids. Stores of amino acids in the skeletal muscle will be used by the body after surgery to aid in healing. So, we have to ensure that our protein intake is adequate to provide the body both a sufficient amount of amino acids to heal AND to maintain and restore our muscle mass and strength. Because of the healing process that is also occurring, post-surgical daily protein requirements will be even higher than normal. 

A 2016 paper in the Clinical Nutrition Journal showed that post-surgical amino acid supplementation effectively reduced whole-body and muscle catabolism (breakdown) by stimulating a 40% increase in muscle protein synthesis and caused a 20% reduction in whole-body protein/amino acid breakdown. Further, a 2021 paper in the Journals of Gerontology Series A, showed that essential amino acid supplementation following total knee replacement surgery led to less quadriceps and hamstrings muscle atrophy at 2 and 6 weeks following surgery compared to placebo. So, as we can see, protein and essential amino acids are vital for recovery and best outcomes after surgery. Now, the next question, how much?

Protein recommendations 

A general recommendation for daily protein consumption during post-operative rehab is 1.6 g/kg/day at a minimum and up to 2.0-3.0 g/kg/day. What this means is that an individual who weighs 160 lb, or 72.5 kg, should consume 116 to 217.5 grams of protein per day. 

Other post-surgical nutrition considerations 

Hopefully if you have made it to this point in the article you now are on board with the importance of nutrition in optimizing recovery following surgery. To conclude, here is a list of some other post-surgical nutrition considerations for most efficient and effective recovery:

• Reduce intake of inflammatory foods (i.e. sodas and other sweetened drinks, cookies, chips, fried foods, refined grains, foods with a lot of added sugars, etc.) 

• Eat sufficient fiber to avoid constipation 

• Appetite may be reduced, especially, in the first several days following surgery. This may be a time when amino acid supplementation or protein shakes in powder/drink form is advantageous.   

• Ensure adequate nutrition to fuel exercise sessions when you are performing your rehab/physical therapy exercise. Make sure you are eating around the window of your rehab sessions just like you would before and after your training sessions in the gym.

• Creatine monohydrate, omega-3 fatty acids, and probiotics are other supplements that have been shown to have an ability to aid in supporting muscle function and strength and may be worth researching further and adding to a post-surgical supplementation regimen. More on these supplements and their potential for aiding muscle building and strength can be found here and here. 

Chris Stires, PT, DPT