EP.308/ protein for surgery recovery - how much and which types?
Today I want to continue on with the theme of foods for surgery recovery.
And today, we’re talking about protein.
In my training on endometriosis surgery recovery, the importance of protein intake, and good quality protein intake, was really emphasised - and with good reason.
Protein is essential for tissue repair, and whilst we need lots of nutrients to recovery after surgery, protein is the key component to rebuilding tissue and in short, knitting us back together!
Whilst there is debate around protein intake requirements, the calculation to work out your basic protein needs (that I’m trained in, based on a Functional Medicine Model) is 1 to 1.5 grams of protein per kilogram of body weight. So for example, I’m about 117 lbs, which is 53 kilograms, so I need about 53 to 79.5 grams of protein per day.
The minimum amount we need, according to the RDA, and again, I want to emphasise that this is the minimum we should be getting to prevent decificiences, is 0.8g of protein per kilogram of body weight, which is 42g of protein per day. This wouldn’t be enough for me if I was recovering from surgery and is suitable for someone with a sedentary lifestyle and very little activity.
If you’re very active, you lift weights or you’re heading into menopause or are already in menopause, you’d want to lean towards the upper end of your intake, with some research and experts advising to go even higher, especially in the aging population or in those who are focused on building muscle mass (which by the way, we should be doing as we age, to prevent the risk of bone loss).
One recent 2021 paper, noted that most surgery patients are consuming significantly less protein than required for good surgery outcomes. The Enhanced Recovery After Surgery (ERAS) guidance recommends 1.2–2.0 grams per kilogram of body weight per day, which works out to be between 20 to 40g of protein per meal, prior to surgery, beginning 7-10 days before the operation. Other papers also state the requirements at at least 20g per meal/60g per day, with more required if the surgeries are extensive, the patients are older or the patients are at risk of malnutrition.
Following surgery, the ERAS recommend a minimum of 1.6g of protein per kilogram of bodyweight, going as high as 3g protein if necessary, for 4 weeks or longer if the surgery was particularly invasive. Additionally, it was stressed that the first 24 hours after surgery were particularly important, and simpler forms of protein, such as branch chain amino acids or protein shakes may be beneficial, especially for those who are struggling to eat (which can certainly be the case when you’re bloated and sore from surgery).
In our training, we recommend clients to have at least 20g of protein per meal on a daily basis, which supports hormonal health, blood sugar balance, energy, muscle and tissue repair, brain function, mood and much more - all issues that endo clients tend to face. Additionally, research has indicated that proper muscle recovery and repair occurs at around 20g-35g protein per sitting, though this seems to be a constant area of debate! So, if we’re thinking about surgery recovery, we really want to aim more to the upper end of that serving size with each meal.
Now, the ERAS also emphasis spreading protein out across meals. This is because research indicates that protein is better absorbed over the day, rather than in one large sitting.
In the research, an emphasis is given to proteins which are easier to digest, which is animal proteins, including lean meats, fatty fish and eggs. Now, don’t worry, that doesn’t mean you can’t eat plant based proteins or if you’re vegan, you’re missing it out - but the recommendation is that you would focus on a higher intake of protein, as you’ll likely absorb less.
For those of you who do eat meat, before you go full carnivore for your surgery, from an inflammation perspective, plant foods have been shown to be the key, with better health outcomes and lower inflammation levels when we have a higher plant to meat ratio.
So, that takes us back to the blood sugar balancing plate model I always talk about, with 50%-75% of your plant being veggies, 25% of your plate being protein, and another 25% being complex carbs, plus two heaped tablespoons of fat.
In reality, that looks like half or just over half of your plate being veg, a quarter being say, meat, and the other quarter being maybe lentils, and then we have perhaps half an avocado as our fat source. You can clearly see here how the plants outweigh the animal-based protein, and yet you still benefit from the bioavailable protein with some of your meals.
One of the ways that eating a higher ratio of plants to animal products supports inflammation levels, is because when we have too much animal protein in one sitting, it makes its way to the large intestine, because the small intestine cannot absorb it all, and there it is fermented by gut bacteria, and this promotes a pro-inflammatory environment and has been linked with inflammatory diseases. However, when we eat lots of fibre from veg, this gives the bacteria better food to munch on, and they opt for that instead, which promotes an anti-inflammatory gut environment.
Now, for those of you who are wondering - what about red meat and endo, myself and Katie Edmond discuss this in depth in my interview with her, so I’ve linked to the podcast episode. However, to give you a brief overview, the two studies that found red meat to be associated with endo looked at very high levels of red meat consumption. One study found that those who ate red meat seven or more times on a weekly basis were 100% percent more likely to have endo than those who ate red meat three times (or less) a week. The other study found that women who ate two or more servings of red meat per day had a 56% higher risk of endometriosis in comparison to those who consumed one serving or less per week.
That’s a lot of red meat. Additionally, there are other considerations to be made with these studies which we explore in the podcast, and my masterclasses and courses.
So, there’s lots of debate on this, but based on these studies and the studies on meat and inflammation, I lean towards recommending conservative amounts of meat, if clients or students want to eat it, that provide bioavailable protein and nutrients that are better absorbed from meat, but are not in levels associated with inflammation, endo, cancer, etc.
So that looks like about 1-3 servings of red meat, 1-3 servings of poultry, two servings of fatty fish and about two servings of shellfish or white fish per week (to minimise mercury exposure), with of course, an emphasis on eating lots of plant foods and plant proteins too. And serving size wise, I am typically referring to about 70g cooked/100g meat/fish of per serving. This also leaves plenty of room for having some meals being solely plant-based, which has been shown to have numerous benefits.
As an FYI - the NHS recommend eating no more than 70g of cooked red meat per day (about 100g raw), but if you eat say closer to 100g cooked on one day, to cut down the next day, so it averages out. And the World Cancer Research Fund, advise between 350g - 500g cooked red meat per week, which is about 500g to 700g raw. However, many health experts advise somewhere between 200g - 300g (again cooked) per week, which is closer to the cautious approach I take, but I wanted to give you a range of recommendations so you could judge for yourself and make your own decision.
If you want to go lower because you’re still unsure or you want to eat less meat and fish for environmental reasons or ethical reasons, you absolutely can, but you do need to focus on increasing your protein intake from plant foods, and ensuring you’re getting in good amounts of iron, B12, zinc, etc. from other sources.
Now remember, I’m a coach - I cannot prescribe you a certain diet or protocol, I’m not a doctor or dietician. What I can do is offer you information and education, and help you to make an informed decision, so ultimately, the amount of protein you consume and whether you eat meat or plant protein, is up to you. But I hope this helps you to understand where to put your focus.
The basics are:
Aim for a minimum of 20g protein with each meal, before and after surgery, but try for a bit higher if you can.
Aim for easier to digest protein if possible, even if that means you also supplement with a good quality protein shake if you’re vegan.
And finally, whatever the proteins source (but especially with meat) make veggies the stars of the show.
If you have a surgery coming up, I really hope that this episode was helpful!
Show notes
https://www.health.harvard.edu/blog/how-much-protein-do-you-need-every-day-201506188096
https://www.dietaryguidelines.gov/sites/default/files/2020-12/Dietary_Guidelines_for_Americans_2020-2025.pdf
https://www.aana.com/practice/clinical-practice/clinical-practice-resources/enhanced-recovery-after-surgery
https://www.espen.org/files/ESPEN-Guidelines/ESPEN_practical_guideline_Clinical_nutrition_in_surgery.pdf
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7997257/
https://www.sciencedirect.com/science/article/pii/S0002916522025175
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8156786/#B20-nutrients-13-01675
https://journals.lww.com/anesthesia-analgesia/fulltext/2018/06000/american_society_for_enhanced_recovery_and.19.aspx
https://pubmed.ncbi.nlm.nih.gov/28468890/
https://www.sciencedirect.com/science/article/pii/S2666337623000501
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7534941/
https://www.mdpi.com/2072-6643/11/5/1088
https://www.sciencedirect.com/science/article/pii/S2666379123005402
https://www.sciencedirect.com/science/article/pii/S0002916523049213
https://www.theguthealthdoctor.com/protein-the-gut
https://academic.oup.com/humrep/article/19/8/1755/2356458
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6066416/
https://www.wcrf.org/diet-activity-and-cancer/cancer-prevention-recommendations/limit-red-and-processed-meat
https://www.cambridge.org/core/journals/british-journal-of-nutrition/article/modelling-the-replacement-of-red-and-processed-meat-with-plantbased-alternatives-and-the-estimated-effect-on-insulin-sensitivity-in-a-cohort-of-australian-adults
https://www.nhs.uk/live-well/eat-well/food-types/meat-nutrition
Free resources:
This podcast!
Ways to work with me:
This EndoLife, It Starts with Breakfast digital cookbook
Masterclasses in endo nutrition, surgery prep and recovery and pain relief
Live and Thrive with Endo: The Foundations DIY course
One to one coaching info and application
This episode is sponsored by BeYou Cramp Relief Patches. Soothe period cramps the natural way with these 100% natural and discreet menthol and eucalyptus oil stick on patches. Click here to find out more and to shop: https://beyouonline.co.uk/pages/how-it-works
Produced by Chris Robson