Nutrition to Speed Recovery

Question:

I have a 32 year old male client who has just had an arthroscopy to his left knee. The prognosis is he will need a partial knee replacement for the medial aspect. This means three months off of work for him. I want to really attack his nutrition during this time and create a strategy that will help speed up healing and keep him feeling positive while he's inactive. Are there specific foods/amounts he should include, and are there foods to avoid (i.e., sugar)? I would be grateful for any advice.

Answer:

I will assume from your email that your client is apparently healthy with no significant medical issues (like kidney or liver problems, to name a few) other than the arthroscopic surgery you told us about. Based on this, here are some things to consider:

• Calories: Calories are important because they supply the energy the body will need to help repair itself. Your email does not say how many calories your client is currently eating. His calorie needs may increase a little in the first few weeks after surgery as the body craves extra energy for the repair process. Increasing calories by 300 or so per day may in theory help him heal a little faster. Obviously, the calories should come from clean sources of carbs, protein and fat. The trick here is to give his body what it needs but not so much to produce significant gains in body weight. Bottom line: If the client is not working out (or not working out at the same intensity as prior to surgery), weigh him each week to see if his weight is increasing significantly. A few pounds are ok, especially if he is not working out. If you notice his weight going up substantially (10 pounds or more), cut back about 300 to 400 calories a day from what he is eating. Some preliminary research suggests that a 300 to 400 calorie deficit may be optimal for weight loss.
• Carbohydrates: Carbs are the body’s preferred energy source and are also important in the repair process, so they should not be skimped on. With carbs, keep it simple: 100 percent whole wheat bread (remember it has to say 100 percent whole wheat, otherwise it may be white bread), other grains, oats, veggies and fruits.
• Protein: Since he is post surgery, you may want to increase his protein intake a little bit. After surgery, his need for protein may increase since his body is repairing any damage it incurred during surgery. The RDA for protein, as you may know, is 0.8 grams per kilogram of body weight (which is about 0.36 grams per pound).  For example, suppose your client weighed 180 pounds. There are 2.2 pounds in one kilogram. Thus, 180 pounds divided by 2.2 pounds is 82 kilograms. According to the RDA, his protein requirement would be 82 kilograms multiplied by 0.8 grams equals 66 grams of protein per day. If he's been working out with you regularly, he may already be consuming more than this amount and rightly so, since research generally finds that people who exercise need a little more protein than sedentary individuals. After determining how much protein he is consuming at the moment, you may want to consider increasing this to 1.2 to 1.5 grams per kilogram of body weight. When possible, incorporate high quality protein containing foods (e.g., tuna, chicken, soy etc.). Depending on his eating habits and appetite, a protein supplement may be needed. Focus on food first since it contains not just protein but other nutrients that his body will need to recuperate.
• Supplements: The use of supplements after surgery is a touchy issue because of possible interactions with medications he is taking. If he is not on any medications, one supplement that in theory may help him recover a little faster is the amino acid, glutamine. While very popular in fitness circles, I usually don't recommend glutamine for most people because of the little known fact that most of the research on it stems from very sick people (e.g., cancer) and those recovering from surgery. Because he is post surgery, glutamine may help, although how much is debatable. Some research suggests that two to five grams a day may help some individuals speed recovery after surgery. Keep in mind that protein shakes tend to contain glutamine, so he may already be getting enough between his food and supplements.