Nutritional Optimization for Surgery

A: Yes, significantly. Nutritional status is one of the most important modifiable risk factors for surgical site infection. Malnutrition impairs immune function, slows wound healing, and reduces the body’s ability to fight bacterial contamination. Vitamin C, zinc, and protein are all directly involved in immune defense and wound closure. Studies on orthopedic surgery consistently show that malnourished patients have higher rates of infection, longer hospital stays, and worse functional outcomes. Getting your nutrition right before surgery is one of the most concrete things you can do to reduce that risk.

A: Even for arthroscopic procedures — meniscus surgery, cartilage work, ligament reconstructions — the body still goes through a meaningful catabolic response. Muscle inhibition after knee surgery, particularly quadriceps shutdown, is well documented and can persist for months. Protein and creatine help maintain the muscle baseline you need to respond to physical therapy. The more significant the surgery and the longer the recovery, the greater the nutritional impact — but even for shorter recovery procedures, going in well-nourished consistently leads to better outcomes.

A: Yes, but it takes more planning. Plant proteins — pea, rice, hemp, soy — have lower leucine content and incomplete amino acid profiles compared to animal proteins. A label that says 25 grams of pea protein does not deliver the same muscle-building effect as 25 grams of whey. To get an equivalent response, increase your plant protein intake by approximately 50% per serving and consider combining protein sources (rice plus pea, for example) to create a more complete amino acid profile. Tracking your intake for at least a week before surgery is a useful exercise to see where you actually stand.

A: This is one of the most common challenges in post-operative recovery, and it is exactly why I recommend establishing good habits before surgery rather than starting from scratch afterward. When appetite is poor, small and frequent high-protein options work better than trying to eat large meals. Greek yogurt, protein shakes, eggs, cottage cheese, and protein-fortified drinks are easy to tolerate. Aim for 30 to 40 grams of protein per sitting, spread across four to five small meals or snacks throughout the day rather than three large ones.

A: Your pre-operative instructions will typically address this. Common recommendations include stopping high-dose vitamin E (which has antiplatelet effects) and any herbal supplements (garlic, ginkgo, ginseng, St. John’s Wort) that can affect bleeding or anesthesia. Standard doses of vitamin D, vitamin C, zinc, and a regular multivitamin are generally not a concern. When in doubt, bring a list of everything you are taking to your pre-op appointment and go through it with your care team.

A: Yes, we make you stop for 5 days prior to surgery. Fish oil has theoretical antiplatelet effects — meaning it may affect blood clotting — though the clinical evidence for significant surgical bleeding risk is limited and somewhat conflicting.  After surgery, resuming fish oil is beneficial and I generally encourage it.

A: Not without guidance from your primary physician. If you have been told you have chronic kidney disease, reduced kidney function, or protein restriction by any of your doctors, follow their guidance — do not increase protein on your own. With that being said, physicians who study protein and the effect on the body generally say that increased protein is very well tolerated in the body even with kidney disease, but I will never overrule your PCP or nephrologist.  For patients with normal kidney function, safety studies show no adverse effects at intakes up to 3 grams per kilogram per day.

A: Absolutely, and if anything it applies more urgently. Older adults face a physiological challenge called anabolic resistance — the body becomes progressively less efficient at converting dietary protein into muscle tissue. A 70-year-old needs roughly twice the protein stimulus to trigger the same muscle-building response as a younger adult. This is not optional biology; it is one of the primary reasons older patients struggle to regain strength after surgery. If you are over 60 and preparing for a major orthopedic procedure, protein and creatine optimization is one of the most impactful things you can do.

A: Yes — creatine supplementation raises creatinine levels in blood work, which is a marker routinely used to assess kidney function. This does not mean creatine is harming your kidneys, but it can produce a falsely elevated reading that may cause concern if your care team is not aware. Always let your surgeon and primary care physician know that you are taking creatine before any bloodwork is ordered.

A: Creatine monohydrate is one of the most studied sports supplements in existence, with decades of safety data and consistent evidence for supporting muscle energy metabolism and reducing post-exercise inflammation. It is not a steroid, not a stimulant, and not a controlled substance. I recommend 10 grams per day for most surgical and injury patients, including older adults. There is a growing body of evidence for cognitive benefits as well — relevant for patients navigating anesthesia recovery.

A: Whey protein is my first recommendation. It is a complete protein with an excellent leucine profile — roughly 2.5 to 3 grams of leucine per serving. Leucine is the specific amino acid that triggers muscle protein synthesis, and you need approximately 3 grams per sitting to meaningfully activate that process. If you prefer a plant-based option, you will need about 50% more powder per serving to achieve the same effect, as plant proteins have lower leucine content and incomplete amino acid profiles.

A: Food first — chicken, fish, eggs, Greek yogurt, and cottage cheese are excellent high-quality protein sources. But most patients find it genuinely difficult to hit 130 to 165 grams through food alone, especially when appetite is suppressed after surgery. A daily protein shake adds 25 to 40 grams with minimal effort and is a reliable way to bridge the gap. Think of it as a tool, not a replacement for real food.

A: Use your ideal body weight — the weight you were at when you were most fit and healthy — not necessarily your current weight. Multiply that number by 1.6 to 2.0 to get your daily gram target. For a person whose ideal weight is 180 pounds (about 82 kg), that works out to roughly 130 to 165 grams of protein per day. That is a meaningful amount, and most people are nowhere near it without intentional effort.

A: Start as early as possible — ideally two to four weeks before surgery. Going into the procedure with your protein stores loaded, your vitamin D corrected, and your muscles primed with creatine gives you a meaningful head start. The catabolic hit from surgery is coming regardless; your job is to show up as prepared as possible. Continue the protocol for at least four to six weeks after surgery, through the active healing and early rehabilitation phase.