Protein requirements for Surgery recovery

[MarkVI]

Hey guys,

I got some surgey two days ago --> I had a leg wound and it became infected with MRSA. They cut it out and drained (holy crap that hurt worse than anything I could imagine) the wound.

I now have a 1.5 x 4 inch wound -- (pic below). I spoke with the dietitian (PHD who knew his ****....)and we went over Calorie needs.

I'm not doing much moving around and no cardio/exercise so calorie needs were reduced from a 3200-3400 maintenance to 2600 maintenance. Protein needs he said are going to be in the 350-450 range for quickest healing and he said he wasn't too concerned about the fat and carbs because I eat a balanced diet.

Does that sound about right to anyone with medical knowledge or experience in dealing with this -- and NO, going on to google or wikipedia does not count.

http://i373.photobucket.com/albums/oo171/dmarkvi/Mobile%20Uploads/2011-03-09_165233.jpg




^^^ Dark spot is my muscle tissue.

Thanks guys, I figured this would be an interesting subject to discuss.

[Emma-Leigh]

Hey guys,

I got some surgey two days ago --> I had a leg wound and it became infected with MRSA. They cut it out and drained (holy crap that hurt worse than anything I could imagine) the wound.

I now have a 1.5 x 4 inch wound -- (pic below). I spoke with the dietitian (PHD who knew his ****....)and we went over Calorie needs.

I'm not doing much moving around and no cardio/exercise so calorie needs were reduced from a 3200-3400 maintenance to 2600 maintenance. Protein needs he said are going to be in the 350-450 range for quickest healing and he said he wasn't too concerned about the fat and carbs because I eat a balanced diet.

Does that sound about right to anyone with medical knowledge or experience in dealing with this -- and NO, going on to google or wikipedia does not count.

[IMG]http://i373.photobucket.com/albums/oo171/dmarkvi/Mobile%20Uploads/2011-03-09_165233.jpg/IMG]




^^^ Dark spot is my muscle tissue.

Thanks guys, I figured this would be an interesting subject to discuss.
Generally speaking - moderate injury or illness will increase calorie and protein requirement by about 1.25-1.33 from baseline. But I would probably consider a small wound not needing that much of an increase... So if I were going to work through your case =>

Calories
If you consider your baseline requirements during your sedentary period to be ~ 1.2 x basal metabolic rate, I would probably increase that that by only 1.1 (10% added). This would which means you need about 1.32 x basal metabolic rate for healing.

If I take your stats as 195# and, say, about 13% BF - then my best estimate as a basal for you would be about 2000 cals.... And 2000 x 1.32 = about 2650 cals (not too far off his guesstimate).

Protein
Personally, I don't think you need 450g... <-- that would be somewhat overkill to say the least. But I would do the full 1.35 x basal requirement in this case.

As I usually recommend 1.5 x lean mass, if your BF is ~ 13% (just guessing here), you'd be looking at ~ 1.5 x 195 x .87 = 255 as your base requirement and 255 x 1.35 = ~ 345g for your recovery.

The other way I will often do it is similar to VLCD protein suggestions. Which is ~ 2 x lean => which would be about 340g.

So 340g protein ~ 1350 cals....
Leaves you ~ 1300 cals from fats / carbs...
And I would probably split that to be ~ 100g fat and about 100g carb.


As for 'sources' of info - most will tell you ~ 1.5 x bodyweight in kg as a set standard requirement during significant illness or injury (range usually 1-2)... So you'll be looking LONG and HARD to find anything that supports 450g in you. :o You will not find anything to generally support my suggestions above, either....

If you want the 'evidence':
http://www.medscape.com/viewarticle/407543_9
http://pen.sagepub.com/content/3/6/452.abstract
http://www.nutritionmd.org/health_care_providers/general_nutrition/macro_protein.html
http://www.mayoclinicproceedings.com/content/81/6/809.abstract
http://www.ncbi.nlm.nih.gov/pubmed/16998142

Some stuff on keto here:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1355601/?page=6

note: there is also evidence for UNDERFEEDING in ill patients ->>
http://www.ncbi.nlm.nih.gov/pubmed/19005311
http://www.ncbi.nlm.nih.gov/pubmed/17119168
(please note - in no way or form do I suggest you are 'critically ill' ;) ).

[MarkVI]

That's awesome Emma Thanks! As a pre-med student the last two links I found really really interesting! It makes some sense.


I think the 450grams was a bit overkill too..I didn't really understand it. Thankfully I don't have to plow that much meat and eggs now. 345grams for me is a cinche, not even a problem with or without shakes.

Thanks again