Surgeons know that a well-nourished patient is much more likely to have a short hospital stay, experience fewer complications and be a success story. So a few years ago a group of surgeons convened the North American Surgical Nutrition Summit to pull together the best knowledge about nutrition before and after surgery.

The result of the meeting was a set of recommendations focused on nutrition therapy for adults anticipating major elective surgery. Some of their recommendations are not really new, but other recommendations seem to contradict traditional pre-surgery recommendations. For this reason, always discuss your pre-surgery diet with your physician.

Question: Why does good nutrition affect surgery success and recovery?

Answer: Since surgery is an invasive process, the body responds accordingly. Tissues become inflamed, and the immune system goes into emergency mode. Even with very sterile surgery conditions, some bacterial exposure and risk of infection is inevitable. This increases the body’s calorie and nutrient needs to deal with the stress response and repair of tissues in the healing process.

Good nutrition before surgery is especially important for what the surgeons call high-risk patients. These include people with elevated blood sugar, very high or very low body weight, those who smoke and those with poor nutrition status.

Q: Are there any dietary factors that are associated with poor surgery outcomes?

A: Surgeons find that low blood levels of a protein called albumin (hypoalbuminemia) is one measure of nutrition status that is significantly associated with an increased length of hospital stay as well as an increased risk of infection and mortality. A common cause of low albumin is a diet inadequate in protein. When sick, it can be difficult to eat enough food to get adequate protein.

Q: What nutrition recommendations did the summit make regarding the day before surgery?

A: It helps to carbo-load — not to the same extent as a marathon runner, but the reason is similar. Storing up carbohydrate in the muscles and liver helps to maintain blood sugar during and after the surgery. The summit report provides specific guidance for consuming carbohydrate drinks the night before surgery and in the morning at least two hours prior to anesthesia.

Q: What other nutrients are considered to be important in the nutritional preparation for surgery?

A: Meeting all essential nutrient needs is always important. Also, the summit recommended the use of medical foods that contain the amino acid arginine, fish oil and compounds called nucleotides. Arginine boosts immune function to reduce the risk of infection. Omega-3 fatty acids in fish oils help to suppress inflammation. Nucleotides are used to synthesize DNA, which is necessary for cell replication and healing.

The summit recommended that high-risk patients consume these products for five to seven days prior to surgery. But, check with your physician, pharmacist or dietitian about the options.

Even if you are just scheduled for minor surgery like a root canal, being nutritionally prepared for the procedure is likely to make recovery go more smoothly and be less painful. But keep in mind that these are general recommendations that might not apply to all patients in all types of surgeries. Ask your surgeon for the best nutritional recommendations for you.

Alan Titchenal, Ph.D., C.N.S., and Joannie Dobbs, Ph.D., C.N.S., are nutritionists in the Department of Human Nutrition, Food and Animal Sciences, College of Tropical Agriculture and Human Resources, University of Hawaii-Manoa. Dobbs also works with University Health Services.