Foods To Heal After Knee Surgery

Transcript:

LEAH: Welcome to Dishing Up Nutrition, brought to you by Nutritional Weight & Wellness. We are a Minnesota company that specializes in real food nutrition education and counseling. Since we work with hundreds of clients every year, we frequently meet people who are experiencing pivotal moments in their lives.

It might be preparing for the birth of a new baby or a new grandbaby, graduating from high school or college or graduate school, changing jobs, mourning the loss of a loved one, preparing to run or bike a major race, or recovering from an accident or an illness. Another pivotal moment that may occur in someone's life is when they have surgery.

TERESA: A few months ago, we did a show on healing fast after surgery, and in that show, we shared a surprising statistic. We shared that the average person will have nine surgeries in their lifetime. Nine surgeries. And we have a population of people who are living longer and longer. That only increases the likelihood of hitting that number.

Some surgeries are planned and are scheduled a few weeks or a few months in advance, like a joint replacement surgery or cataract surgery. Some surgeries are unplanned, like an emergency appendectomy or an emergency C-section.

LEAH: Yeah. Some surgeries are very minor. You walk out the same day with some ice and some Tylenol. And some surgeries are major. They require time in the hospital afterwards to heal and recover. And you may be off your feet or maybe mostly on the couch or the recliner for several weeks. Many knee surgeries are in that latter category.

So we've seen people at all stages in their surgical preparation and recoveries. I actually love when I get a client coming in who is thinking about how to optimize their nutrition and their supplements before surgery and strategize their nutrition for after surgery. And so today's topic for the show is foods to heal after knee surgery.

Most common types of knee surgeries

TERESA: Yes, and it's great when we can help these clients be methodical with their food choices before and after surgery and knee surgery, it's no exception. Let's chat quick about the most common types of knee surgeries. Most people know about knee replacements. This is where the damaged part of the knee joint is removed, and replaced with new materials such as metal, ceramic, or plastic.

A knee replacement surgery could be a total replacement or a partial knee replacement. There are about 790,000 knee replacement surgeries done each year in the United States.

LEAH: Yeah. That was a lot of knees. And I know as I was doing some research for this show, and we're going to talk about this in just a minute: ACL repair. So ACL is one of the major ligaments in the knees that can get torn. That I believe was like the next highest or one of the other top highest knee repairs, but that was at like 400,000 something.

So compare that to almost 800,000 knee replacements. It's like, it's amazing. Just comparing those two numbers. My mom and many of her siblings have had that knee replacement surgery, whether it's total or partial knee replacement. So they've had these surgeries done. And from what I've witnessed, it can be a gnarly recovery process.

And I believe the recovery timeframe for knee replacements, it can be anywhere from usually like minimum three months up to a year.

TERESA: Wow. That's a lot.

LEAH: Yeah. You’re off your feet for a long time. I mean, they get you moving, get you walking and trying to like not let those muscles atrophy too much, but it is a long process to kind of feel like you're getting back to a somewhat of a normal state again.

So that's one of the reasons why I'm doing what I can now to preserve the tissues and structures in my knees. Unfortunately, my risk is a little higher as I, I've already had some knee surgeries. So I counted it up the other day. I think I'm at five surgeries already out of, yeah.

So it's like, oh, I'm already like over halfway to that nine point. I've had ACL reconstruction now in both of my knees. I did one when I was 17 and actually one just last summer. That ACL reconstruction is another major knee surgery that takes a long time to recover.

I know people get different opinions, but my surgeon said don't plan on trying to go back to the soccer field before a year. It is another long recovery process. And I just met with a new client of mine, maybe about two weeks ago who played soccer in college, and she's had four ACL repairs throughout her athletic career.

Unfortunately the research shows that knees that undergo an ACL reconstruction are five to seven times more likely to need a knee replacement later in life. It's just that trauma adds up.

TERESA: Right. That makes you very susceptible. And so we want to do everything we can in order to be on the prevention side. Meniscus repair or removal is another common knee surgery. This is where the cushioning between the bones and the knee gets torn or somehow damaged and needs to be repaired or removed.

Arthroscopic knee surgery is also common. Although, luckily, this kind of knee surgery is less invasive and recovery is a lot quicker. In summary, there's a lot of different things that can go wrong with our knees. Most of the time, knee surgeries are not emergency situations and are scheduled out at least a few weeks. So, if we know we need to have a procedure done on our knee what should we be thinking about before we even get to the surgery center?

Surgery prep tip: manage inflammation levels

LEAH: Yeah. I've got a couple thoughts and I know you do also, Teresa. In my mind, the first thing if I were sitting down with a client and this is the conversation we're having, you know, knee surgery a couple of weeks out. One of the first things I'm thinking about is getting this person into a lower level of inflammation, just a lower state of inflammation.

Any kind of surgery or procedure is going to invoke inflammation. That's normal. This is part of the healing process. If you have a knee surgery, that knee is going to be swollen. It's going to be stiff. It's going to be painful for a while. And while you're waiting for surgery, that knee is also probably going to be bothering you to some degree.

But if inflammation remains high or it lingers longer than expected, that's where things start to take a not so good turn. So I'm thinking about how we could make sure someone has less inflammation in their body going into surgery so we stand a better chance of resolving that inflammation better after surgery.

First & foremost: eat less processed foods

TERESA: Yeah, so let's run with that idea of less inflammation. To me, that means, first and foremost, fewer foods that cause inflammation. And no surprise to our listeners here, but that means less processed foods; less processed foods that get our immune system up in arms and ready to fight. A knee surgery is going to be a battle for the immune system . Do we really need to start a fight with our immune system before we go into surgery?

LEAH: I love how you frame that. I think that's a great way to think about it is like, how can we make sure our immune system is happy and that we're not picking fights with it before the immune system is going to actually get called to a bigger war, which again, it's planned, but it's still going to be kind of a war for that immune system.

So we pick a fight with our immune system every time we eat that muffin made with soybean or sunflower oil, and we drink a medium pumpkin, white mocha with 95 grams of added sugar, which is almost 24 teaspoons of sugar. We pick a fight with our immune system each time we grab a cookie or we grab the chewy granola bar for an afternoon snack from the vending machine at work or we raid the kid's stash of snacks in the pantry. And we pick a fight with our immune system when we're exhausted on a Friday night and we sit down to a bag of butter popcorn for dinner.

TERESA: Ah, popcorn. It often still gets the health halo in many nutrition circles because it's low fat and it usually doesn't have any added sugars. And it's whole grain, right?

LEAH: Yeah.

Control blood sugar to help control inflammation

TERESA: And who doesn't love the salty crunchy combo? But what often gets glossed over is that popcorn creates a big blood sugar spike for most people, followed by a quick blood sugar dip. This is the case, even if you're making it in the air popper and using real butter or coconut oil. So often people are, are you sure if I use butter and coconut oil, is it still…?

LEAH: Yeah. Can we make it better? Yes. Is it still going to create the blood sugar rollercoaster? Yes.

TERESA: High blood sugars create little micro nicks and tears in our blood vessels, which leads to some low level inflammation. Now you could probably buffer that blood sugar spike if you sat down and ate a pork chop and an avocado with your popcorn. But that's really not how most people do it.

LEAH: Yeah. It's hard to envision that. And I mean, what's the more common thing? It's too, it's way more typical to sit down and open like the hundred calorie bag of popcorn for an afternoon snack, or you're mindlessly kind of reaching into the bowl of popcorn while you're just sitting down, maybe on that Friday or Saturday night, sitting down for a movie.

So we sit down with that popcorn and there's no protein. There's minimal amount of fat to buffer those blood sugars. And that blood sugar piece that you mentioned, Teresa, is so key. It is well known in the research and with clinicians that people who struggle with their blood sugar, so we think about people who are running with type 2 diabetes or prediabetes, are at a higher risk of complications with any kind of surgery, let alone knee surgery.

So improving blood sugar balance and improving inflammation before surgery is one of the best things you can do just to lower that inflammation in general and keep peace with your immune system before surgery. And the nice thing I try to remind my clients about too is the wonderful thing about tackling blood sugar is that you can make a huge change in your blood sugars and your inflammation response after even just one meal.

It's not something that maybe in a month or two will, we might see some things happening. Like you can change your blood sugar response after just one meal. You will notice a difference how you feel if you eat a meal that slowly brings your glucose up to maybe 110 and it slowly goes back down versus a meal that spikes that blood sugar up to 190 and then it drops off a cliff an hour or two later.

If you knew that you could have less pain, better energy, and maybe even lose a little bit of weight before knee surgery, would you be willing to eat only meat and vegetables, fruit, and healthy fats for a few weeks?

TERESA: Let's take a turn here and talk about colonoscopy.

LEAH: Oh, a different procedure.

TERESA: Yeah. Just as an example, right? So everyone who's had this procedure, they know that it's just a part of the process that you have to alter your diet for three to five days before your procedure to get the best possible outcome. Why don't we get the same message when it comes to other procedures or major surgery?

Even three to five days is enough time to make impressive progress with blood sugar control and lowering inflammation. We can do this by getting the ultra processed foods out and introducing satiating anti inflammatory whole foods.

Ideally, we'd be working on this for weeks or months before the knee surgery, but it's never too late to take steps in the right direction. Could you see yourself eating eggs or turkey sausage and vegetables cooked in butter every day for breakfast for a week before surgery?

Could you have some plain flavored Greek yogurt with berries and chopped pecans for a snack every day? I'd argue that that's much more enjoyable prep than a colonoscopy prep.

LEAH: Yeah, absolutely. And if we can start with that lower baseline of inflammation going into surgery, again, we stand a better chance of a smoother recovery after surgery. So we talked about what we can do in those at least couple of days, if not a few weeks or a few months prior to surgery.

Let's talk about actually that post surgery experience now. So coming out of surgery, you likely have some kind of wrap or a brace on your leg. You're probably on crutches or using a walker. I just remember for most of my surgeries, but also my knee surgeries, like taking a shower and getting to and from your PT appointments are like the most rigorous things you're going to be doing for a couple of weeks.

And then you have to try to sleep on your back with your leg propped up on a pillow. You're probably setting lots of alarms or jotting down notes just to stay on top of the pain medications, whatever you have to take. So I mean, it's quite the scene for a while.

Adequate nutrition consumption is essential pre and post surgery

TERESA: I was reading through a research paper that was published in 2021 in the journal, Nutrients. It was all about nutritional considerations for pre and post orthopedic surgery patients. This paper said adequate nutritional consumption is essential for addressing the surgical stress response and mitigating the loss of muscle mass, strength, and functionality.

In other words, post knee replacement, or ACL surgery, is not the time to skip over some meals or try to purposely cut back on your calories because you're not moving around as much. In many cases, clinicians worry about patients eating too little to support their muscle mass and the recovery of those tissues.

Adequate protein intake is important for surgery recovery

That same study I just mentioned said protein intake is especially important for modulating surgical stress and supporting recovery. Yet, surgical patients significantly under consume protein, taking in about 22 to 36 percent of estimated requirements, or in other words, they're missing close to 75 to 80 percent of the protein that their body needs to recover properly.

LEAH: Yeah, we're not, we're missing out on potentially 75 to 80 percent of ideally what we should be having to repair those tissues from protein. So yeah, this is not the time to go on a crash diet in order to try to keep the scale at the same weight.

When many of us have kind of played that calories in calories out game in our head before, and then you go from having your normal level of activity to now you are kind of parked on the couch a lot of times, it is that first inclination to say like, oh, I'm not moving as much. So let's not eat as much, but this is the opposite thing that we would need to be doing at this point.

TERESA: But once you argue though, Leah, like when we are in those situations, the foods that we crave are often high calorie processed packaged foods many times. A lot of times people are concerned about weight gain, but it's, well, what are we actually eating? Are the foods that we're eating, are those the foods that would cause weight gain anyway, that processed, like, are we ordering ice cream? Are we door dashing fast food? What are we doing at that time? Versus eating nutrient dense protein sources, vegetables, and so on.

LEAH: Yeah, that is a great point. It is like, what are the quality of those foods that we are eating both before and after and what's, you know, what are we doing in those times? And I remember, gosh, so I'm dating myself, but back in my dietetic internship, so this is many moons ago now, part of when you go through the dietetic internship, you're usually doing a rotation in the hospital.

So you're learning a lot of the clinical skills. And one of the things that you learn when you are in the hospital as a dietitian is to calculate calorie and nutrient needs for critically ill patients, who are, on tube feedings or TPN. So like patients who are in the surgical ICU, again, they've likely had some kind of trauma, they've had a big surgery. Now they need to spend some time in the hospital to recover. And I remember always being shocked at how high their calorie needs were when they were just laying around all day in a hospital bed.

TERESA: Yeah, it is shocking.

LEAH: And the, and clinicians, they would still, we would still see weight loss in those patients, mostly because they are losing a good amount of muscle at that point. So we're just saying at this time in post surgery, this is the time to nourish. your tissues and to give your immune system the nutrients it needs, kind of like what we said before, to kind of go to war for you.

So we actually do need to take a quick break. You are listening to Dishing Up Nutrition, brought to you by Nutritional Weight & Wellness. I am Leah Kleinschrodt, along with Teresa Wagner, and we are your hosts for this episode all about nutrition and knee surgery. We'll be back in a moment.

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Welcome back. You are listening to our Dishing Up Nutrition weekly podcast. Let's get back to talking about healing from surgery with real food. And this week we are specifically talking about healing after knee surgery, and prior to break, Leah was talking about how this is the time to nourish your tissues, both pre and post surgery, and actually, regardless if it's knee surgery or any surgery, now is the time to nourish our tissues and give our immune system the nutrients it needs in order for it to heal well.

So before we went to break, we were talking about a 2021 Nutrients research paper and I have to say, I agree with that paper that eating protein has to be a central component for recovery. The paper had an interesting protocol for post op nutrition that I wanted to mention. They suggested that as soon as possible after surgery to consume 12 grams of essential amino acids plus 50 grams of carbohydrate mixed in some water.

Then, as the patient's appetite recovers, drink 30 grams of protein in the form of a protein shake and then hopefully within 24 hours the patient is back to regular solid food focusing on 30 grams of protein at meals and 20 grams of protein at snacks.

LEAH: Well, a lot of that sounds familiar. I know after my ACL surgery last year, I was starving after surgery. Cause usually in most surgeries, you have to go X number of hours without having food or not even water sometimes before your surgery. So I couldn't wait to get home and to dive into some real food. I know this is not everyone's scenario, but I was ready to eat.

My first meal was a chicken salad with avocado oil mayo. And man, it was good, but man, my mouth was so dry from some of the pre op medications they gave me. So in hindsight, I think a protein shake would have gone down a little easier as that first meal probably would have been a little bit better of a choice.

And in talking, Teresa kind of gave a protocol from the research study using 12 grams of essential amino acids and a few other things. You know, something that is actually maybe more accessible to people. If you've got a great whey protein powder, you're going to get all of those essential amino acids in that whey protein powder.

I think the idea is when you're able to get something down, try to get some of that good protein in right away. Try to get some of those carbohydrates in. Maybe you're blending that whey protein with some fruit and maybe a little bit of fat in there too, because as that paper said, there is a huge stress response after surgery. And so getting in that protein early, getting in some of those carbohydrates early starts to offset some of that stress from the surgery.

TERESA: Right. And if you think about that too, just sorry to interrupt you.

LEAH: You're good.

TERESA: We're trying to heal our tissues at that point. So after surgery, all those fibers have to come back together and heal. And what do we use to do that?

LEAH: Yeah. Nutrients, food, protein. Yep. Yeah. So really, I, I was looking through our, the web, really any of our protein shake recipes on our website would be great to make. And maybe you bring that to the surgery center with you and maybe they have a little fridge that they, you could store that in or you give it to your support person who's there with you.

Or maybe this is waiting in the fridge when you get home if you're having just a day surgery. I would just make sure that whatever protein source you're using in that shake, whether it is yogurt or whether it is protein powder, using some collagen powder, like that whey protein powder that we mentioned, you want to try to make sure that the amount of protein adds up to at least 30 grams of protein.

So if someone was using our Wellness Whey protein powders, I'd have them use two scoops of protein powder in one serving of smoothies. So that would bring the total up to at least 36 grams of protein.

TERESA: I'm so glad you mentioned collagen powder as well, because this is something I would definitely recommend to any client of mine undergoing any kind of surgery. Collagen is the most abundant protein in the human body and it makes up a lot of the protein in our skin, bones, tendons, and ligaments; the very tissues that are getting cut and repaired in knee surgery.

So adding collagen into your diet before and after surgery can be extremely helpful for healing those injured areas for that healing process. Our Key Collagen has very specific peptides to target the skin and joints. So I'd add a scoop of that collagen powder to the post op protein shake. Of course, you could also drink eight ounces of some homemade bone broth for a dose of Mother Nature's collagen.

LEAH: I know my knees always feel better when I've had a mug of hot bone broth, but I definitely utilize the key collagen powder as my easy button during my knee surgery recovery and even a couple of years ago also when I had my C section with my daughter.

The importance of hydration

And let's hit on hydration quickly also since we're talking about drinking bone broth, drinking liquids. Drinking enough water is an easy thing to fall behind after knee surgery. You might not feel very thirsty if you're just sitting around indoors all the time. Or realistically, you might try to avoid having to get up and get yourself to the bathroom every one to two hours if it's super painful and awkward to crutch your way around. Or you might feel bad asking your spouse or your caregiver to refill your water bottle. But hydration is important for hydrating those soft tissues and, and for also helping prevent post op constipation.

TERESA: Right, we certainly don't need to add an uncomfortable belly to an uncomfortable leg. During surgery, and while you're in the recovery room at the surgery center, you probably were getting IV fluids, but once you are home, you have to pick up the hydration baton and run with it. If you are able to, stash some bottles of water within arm's reach in all the areas you think you'll be resting: the couch, the recliner, your bed, your work from home space.

Drinking enough water not only keeps your tissues hydrated, but it also helps your liver and kidneys manage the influx of medications you're on, ranging from the anesthesia for the surgery to the pain and anti-inflammatory medications.

You might also want to keep a bottle of the Mixed Magnesium in your cabinet in case you do find yourself getting a little backed up after surgery. I know that oftentimes people say that after they wake up, that sometimes their colon has remained asleep.

LEAH: Oh, that's an interesting way to think about it.

TERESA: So when we're thinking about that while we're waiting for the anesthesia to you know, get its way out of the system and get things working again, I usually tell my clients to start with two to three capsules of Mixed Magnesium at night before bed and go up from there if they're not getting any relief.

LEAH: Yep. Yeah, I've had many clients do the same thing with that Mixed Magnesium. I have had clients, not necessarily after surgery, but just constipation in general need even five or six to just get that relaxation effect in the colon. So again, like there's, there's some wiggle room there.

The importance of vitamin C from fruits & vegetables for good immune function

And speaking of gut health and constipation, we can't forget about those lovely fruits and vegetables after a big surgery. The fiber from these foods can be hugely helpful for re-regulating bowel movements. But also they're our biggest source of vitamin C in the diet.

We talked about collagen protein earlier. We actually can't make those collagen fibers in our body without vitamin C. Vitamin C is a major antioxidant also. So again, thinking about the immune system, your immune system will be stronger for longer when we've got enough vitamin C coming in from those fruits and vegetables. I know someone who spent a lot of their post knee replacement munching on M&Ms and drinking Diet Coke.

So if I could rewind the hands of time, I'd, I'd have asked if we could replace those M&Ms with like blueberries and raspberries and that Diet Coke maybe with some sparkling water with root beer flavored stevia drops, or maybe even a little low sugar kombucha for a little bit of probiotics.

TERESA: Yeah. I love that. Thinking back to that mayo based chicken salad that you had mentioned earlier, Leah, that's a great opportunity to add up on the veggies. Someone could add some bell peppers and onions and celery in the salad, and then serve it over a bed of mixed greens or baby spinach. A great meat and veggie soup would check all the boxes that we just talked about.

Meat for protein, bone broth for collagen and hydration. And the vegetables for fiber. The hamburger soup recipe or the chicken pot pie soup recipes on our website are great and tasty examples of this formula. Like a protein shake, homemade soup may be easier to stomach. Or just maybe more appealing after a major surgery.

LEAH: Yeah. So sometimes those meals or a protein shake, that's a little bit more liquidy, just easier to go down might sound a little bit better. Just again, sometimes we are looking for the easy button when we're in that recovery mode.

TERESA: You don't want to be cutting things up as you are on the couch. You just want something that's very easy to eat and chew.

LEAH: Absolutely. So I think that's the perfect way to round out our show. There is a lot more we didn't really have a chance to cover in this show, but I do encourage listeners to go back to a few of our previous shows, if you want some different angles and thoughts about how to nutritionally prepare for surgery and how to foster a faster recovery.

Specifically, we mentioned this at the top of the show, Melanie and Kara did an amazing show on March 5th of this year, 2024, that I highly recommend listeners check out. And if anyone out there is looking at an upcoming knee surgery or any surgery for that matter, and you're wanting a personalized eating and supplement plan for your procedure and your health goals, get in contact with us. Any of our wonderful counselors would be more than happy to help. And our office number is 651-699-3438. And our website is www.weightandwellness.com.

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TERESA: Our goal at Nutritional Weight & Wellness is to provide each and every person with practical, real life solutions for everyday health through eating real food. It's a simple, yet powerful message. Eating real food is life changing. Thank you for listening, and if you enjoyed this show, please head over to iTunes or your favorite podcast app to leave a review and help others find our show.