The surgical cascade is a complex series of responses in the body after surgery that includes:

• Inflammatory response

• Immune system activation

• Metabolic changes including: • Gluconeogenesis (creating glucose from non-carbohydrate sources) • Decreased insulin secretion leading to higher blood glucose • Elevated cortisol causing increased protein breakdown • Potential muscle mass loss (up to 1% per day in older adults)

These responses can impact recovery if not properly supported through nutrition. Adequate protein intake is crucial to prevent excessive muscle breakdown, while proper carbohydrate timing can help reduce insulin resistance by up to 50%. The ERAS (Enhanced Recovery After Surgery) protocol provides evidence-based guidelines for optimizing these factors.

This section covers the importance of nutrient timing in relation to surgery. Key points: • Proper timing of nutrients helps support increased metabolic demands during surgery • Early post-surgical amino acid supplementation can reduce the catabolic response • The focus is on three main goals:

1. Promoting nitrogen balance

2. Minimizing lean body mass loss

3. Supporting faster healing and recovery • Starting nutrient timing protocols as soon as possible after surgery is crucial for optimal outcomes

Pre-Op Nutrition General Principles key points: • Start nutritional preparation 10-14 days before surgery • Focus on quality of food sources:

• Choose organic produce and whole unrefined grains

• Shop the store perimeter for fresh foods

• Select organic, free-range animal proteins

• Avoid animals treated with hormones and antibiotics

• When possible, source from local regenerative farms • Quality nutrition is crucial for optimal surgical outcomes • While cost and access can be challenging, prioritize the best quality possible within your means

In this section about carbohydrates, Dr. McCoy explains that proper carbohydrate intake before surgery is crucial. Key points: • Aim for 8 grams of carbohydrates per kilogram body weight (4g per pound) 3-5 days before surgery • This higher amount helps fully load glycogen stores specifically for the surgical period • Focus on quality carbohydrate sources:

• Organic vegetables

• Fresh fruits

• Complex whole grains While this level of carbohydrate intake isn't typical for daily life, it serves an important pre-surgical purpose in preparing the body's energy stores.

Summary of Protein Requirements:

• Aim for 2 grams of protein per kilogram of body weight daily • Distribute 30-40 grams of protein across 3 meals and 1-2 snacks • Focus on high-quality sources:

• Organic, grass-fed/finished meats

• Wild-caught or line-caught seafood

• Free-range animal proteins • Plant-based options require more planning due to:

• Lower leucine content

• Reduced bioavailability

• Incomplete amino acid profiles • Supplement options:

• Whey isolate (preferred): 50% essential amino acids

• Casein: good for slow digestion

• Soy: 38% essential amino acids

• Other plant-based proteins may need combining • Timing is crucial - start early in day and distribute evenly

Key Points About Micronutrients: • Essential vitamins, minerals, omega-3 fatty acids, fiber, antioxidants and phytonutrients support recovery • Many Americans are deficient due to poor quality food choices • Important micronutrients include:

• B12

• Zinc

• Selenium

• Copper

• Vitamin D

• Iron

• Phosphorus

• Calcium • Best sources:

• High-quality animal proteins contain many essential micronutrients

• Organic produce provides antioxidants and phytonutrients

• Plant-based diets may require supplementation • Focus on whole food sources when possible for optimal absorption

Pre-Op Nutrition Plan Summary: • Begin nutrition preparation 7-10 days before surgery • Focus on whole foods and quality sourcing • Carbohydrate goals:

• Work up to 8g/kg body weight

• Emphasize organic fruits, vegetables, whole grains

• Reach full 8g/kg mark 3-5 days pre-surgery • Protein requirements:

• Aim for 2g/kg body weight daily

• Distribute 30-40g over 3 meals plus snacks

• May require protein supplements

• Experiment with supplement combinations for best tolerance • Quality sourcing essential:

• Choose organic produce

• Select grass-fed/free-range meats

• Use wild-caught seafood • Timing considerations:

• No food within 6 hours of surgery

• Clear liquids stop 2-3 hours before

• Special carbohydrate loading 2-3 hours pre-surgery

• Follow ERAS protocol guidelines

Please be sure to be consistent with your supplements as outlined in your Op Ready Action Plan. If you are working with us one on one, you will have a more specific outline on what to take on a week by week basis leading up to and after your operation.

T-Minus 24 Hours Summary: • Follow ERAS protocol timing:

• No food within 6 hours of surgery

• Clear liquids stop 2-3 hours before • For morning surgery:

• Quality dinner meeting protein/carb needs

• Carb loading 2-3 hours pre-surgery • For afternoon/evening surgery:

• Quality dinner night before

• Light breakfast if timing allows

• Use supplements as needed • Key carbohydrate loading:

• 50g carbs 2-3 hours pre-surgery

• Helps maintain insulin sensitivity

• Combined with amino acids

• Use natural products vs artificial options • Discuss timing with surgical team in advance

Post-Op Refueling Summary: • Resume oral feeding as soon as possible after surgery • Initial post-surgery nutrition sequence:

• Immediate: 12g EAA + 50g carbohydrate supplements in water

• 4-6 hours: Whey protein supplement as tolerated

• 24 hours: Return to high-quality whole foods

• Maintain target protein intake post-surgery • Focus on quality carbohydrates from vegetables, fruits, and whole grains • Aim for slight caloric surplus to support healing • Work with medical team for specific needs with GI surgeries

If physical therapy is part of your recovery program, you can use the timing of when you eat to optimize healing outcomes. 3-4 hours before training, consume a small meal with 100g of carbohydrate and 30-50 grams of protein. Then, 15-45 min before training, try to consume a 1:1  combo of carbohydrates and protein to support the healing process. Our powdered supplements work well here and should not make you feel bloated

If you chose to work with us individually, we have constructed a personalized supplement plan for you base on your blood work and other needs. If not, there are still some general supplement recommendations that may be a good choice which you can discuss with your team

In this comprehensive program, we've covered the essential components of the Op Ready clinical protocol designed to optimize your surgical outcomes. We discussed proper nutrition timing, including pre-surgery carbohydrate loading, post-operative refueling strategies, and the importance of maintaining adequate protein intake. We explored key supplements that may support your recovery, including creatine monohydrate, HMB, omega-3s, and various micronutrients. The program emphasized the significance of working closely with your surgical team, following ERAS protocols, and maintaining proper nutrition throughout your recovery journey. Remember, these evidence-based strategies have been successfully used with professional athletes and are now available to help you achieve the best possible surgical outcome. For personalized guidance and support, our team is here to help you create an individualized plan tailored to your specific needs.