Pre-operative nutrition

I frequently support clients who have either had or are going to have operations.

It is common knowledge that your nutritional status and health prior to an operation has a big impact on the outcome of surgery and your recovery post operation. It is estimated that between 24% and 65% of patients are malnourished and unfortunately this tends to increase during hospital stays. Nutritional supplementation has been shown to reduce hospitalisation costs being associated with fewer complications and shorter stays.

I have recently been researching this area for a client with impending surgery This blog is focused on protein and carbohydrate requirements pre-operation. I will consider micronutrient status in a future blog.

There some easy strategies you can implement though to help with muscle preservation and to support and accelerate healing. Carbohydrate consumption pre-operation helps to:

Support increased energy demand during the initial period and to cope with the initial inflammatory state.
Reduce muscle wastage and preserve lean body mass.
Manage the insulin resistance which is common post-surgery. Remember insulin resistance will prevent glucose entering your cells. This is important because the body will generate its own glucose (gluconeogenesis) due to the stress and it is important that the cells can absorb this.

General guidelines for nutrition before surgery

The goal is to prepare the body for the stress of surgery, support increased metabolic demand, whilst offsetting the consequences of the breakdown of body protein. The goal of pre-operative nutrition is to ensure adequate energy stores to meet the demands of the stress state. The guidelines given here are aimed at minimising some of the metabolic consequences of surgery, using nutritional supplementation to overcome some of the issues that whole foods would otherwise present.

7-10 days prior to surgery - emphasise high-quality carbohydrate and protein intake to ensure optimal nourishment. To maximise glycogen stores, the sports nutrition model suggests consuming ~60% of total energy (8 g per kg body mass) per day of carbohydrate for a minimum of 3–4 days. Protein intakes of 1.2–2.0 g/kg/day, from high-quality protein sources distributed throughout the day (20–40 g of protein per meal) is recommended to help ensure protein needs are met.

6-12 hours before surgery – consume a well-rounded meal emphasising complex carbohydrates and high-quality protein.

6 hours before - begin abstaining from whole foods, but continue to consume protein and carbohydrate containing beverages, such as a protein shake, a sports drink, or chocolate milk. Since modified carbohydrate supplements rapidly empty from the stomach, consumption may sustain glucose levels for the duration of surgery.

2-4 hours before – It is suggested to ingest free form essential amino acids (EAA’s) to promote a positive protein balance. EAA’s contain all nine essential amino acids and do not require digestion.

Conclusion

In conclusion carbohydrate intake supports the increased post-surgical metabolic (energy) demand and wound healing. Protein intake supplies the amino acids needed for wound healing, immune function and preservation of muscle mass. Combined amino acid and glucose intake can help to mitigate muscle loss and strength, especially prior to surgery. Depending on proximity to surgery different sources of carbohydrate and protein can be used to maximise nutritional intake. Supplemental sources can be useful to support intake during periods when whole foods are not tolerated.

This blog is written to help inform about nutritional needs pre-surgery and is based on scientific rationale. However much of this research is relatively new and further research and trials are needed to elaborate. Therefore this information does not override any medical guidelines given directly to prepare for planned surgery. These will supersede this information unless your medical team are happy to sanction otherwise.

References

https://pmc.ncbi.nlm.nih.gov/articles/PMC8156786/figure/nutrients-13-01675-f003

Having surgery? Here are your nutrition guidelines.

I frequently support clients who have either had or are going to have surgery of various kinds.

The biggest issues are muscle loss due to tissue breakdown and metabolic demand exceeding supply due to the increase in stress and energetic demand. Micronutrient status is also important but will be covered in a separate blog. This article is focused on protein and carbohydrate requirements both pre and post operation.

There some easy strategies you can implement to help with muscle preservation and to support and accelerate healing. Carbohydrate consumption pre-operation helps to:

Support increased energy demand during the initial period and to cope with the initial inflammatory state.
Reduce muscle wastage and preserve lean body mass.
Manage the insulin resistance which is common post-surgery. Remember insulin resistance will prevent glucose entering your cells. This is important because the body will generate its own glucose (gluconeogenesis) due to the stress and it is important that the cells can absorb this.

Post-surgical amino acid supplementation has been shown to effectively reduce the turnover of whole-body protein and muscle breakdown, and to stimulate an increase in protein generation.

General guidelines for nutrition before and after

Pre-Operative Nutrition

The goal is to prepare the body for the stress of surgery, support increased metabolic demand, whilst offsetting the consequences of the breakdown of body protein. The goal of pre-operative nutrition is to ensure adequate energy stores to meet the demands of the stress state. The goal of post-operative nutrition, on the other hand, is to promote nitrogen balance, reduce the loss of lean muscle mass, and facilitate rapid healing and recovery. The guidelines given here are aimed at minimising some of the metabolic consequences of surgery, using nutritional supplementation to overcome some of the issues that whole foods would otherwise present.

6-12 hours before surgery – consume a well-rounded meal emphasising complex carbohydrates and high-quality protein.

Post-Operative Nutrition

The post operative nutrition model is basically the reverse of the preoperative model.

In the early post-surgery period, patient appetite is often suppressed making consumption of solid foods difficult. During this time, free form EAA’s may help to support the immune system. Patients can transition to protein shakes and sports drinks until they are able to consume whole food sources or meals.

During the rehabilitation period, protein intakes of at least 1.6 g/kg/day and up to 2.0–3.0 g/kg/day is generally recommended. If appetite is reduced and this goal is difficult to meet then consumption of EAA’s and/or protein shakes between meals can help to optimise protein and nutrient intake.

Conclusion

In conclusion carbohydrate intake supports the increased post-surgical energy demand and wound healing. Protein intake supplies the amino acids needed for wound healing, immune function and preservation of muscle mass. Combined amino acid and glucose intake can help to mitigate muscle loss and strength, especially prior to surgery. Following surgery, free form amino acids plus supplementary dietary protein can help to support protein generation and an increase in whole-body protein. Depending on the proximity to surgery different sources of carbohydrate and protein can be used to maximise nutritional intake. Supplemental sources can be useful to support intake during periods when whole foods are not tolerated.

This blog is written to help inform about nutritional needs both pre and post-surgery and is based on scientific rationale. However much of this research is relatively new and further research and trials are needed to elaborate. Therefore this information does not override any medical guidelines given directly to prepare for planned surgery. These will supersede this information unless your medical team are happy to sanction otherwise.

References

https://pmc.ncbi.nlm.nih.gov/articles/PMC8156786/figure/nutrients-13-01675-f003

Preparing for surgery with nutritional support

I frequently support clients who have either had or are going to have operations.

I have recently been researching this area for a client with impending surgery This blog is focused on protein and carbohydrate requirements both pre and post operation. I will consider micronutrient status in a future blog.

Surgery is stressful and our energy demands increase. To cope with this our sugar stores (glycogen) are rapidly burnt from the liver and muscle. This can lead to significant skeletal muscles loss and some degree of this post-surgery is inevitable. Skeletal muscle serves as the primary source of essential amino acids. If protein intake is below the requirement to sustain daily functions the body will breakdown muscle for protein. Despite this however, the hormonal stress response prevents normal protein generation. All of this is often compounded by the forced rest and immobility due to the surgery itself.

It is important to try to minimise the muscle loss and if exercise is not feasible nutritional strategies can help to mitigate this. In healthy individuals, loss of muscle tissue begins to occur in as little as 48 h of inactivity, with significant loss within five days. This is followed by loss of strength and functionality.

There some easy strategies you can implement though to help with muscle preservation and to support and accelerate healing. Carbohydrate consumption pre-operation helps to:

Support increased energy demand during the initial period and to cope with the initial inflammatory state.
Reduce muscle wastage and preserve lean body mass.
Manage the insulin resistance which is common post-surgery. Remember insulin resistance will prevent glucose entering your cells. This is important because the body will generate its own glucose (gluconeogenesis) due to the stress and it is important that the cells can absorb this.

Post-surgical amino acid supplementation has been shown to effectively reduce the turnover of whole-body protein and muscle breakdown, and to stimulate an increase in protein generation.

General guidelines for nutrition before and after surgery

Pre-Operative Nutrition

The goal is to prepare the body for the stress of surgery, support increased metabolic demand, whilst offsetting the consequences of the breakdown of body protein. The goal of pre-operative nutrition is to ensure adequate energy stores to meet the demands of the stress state. The goal of post-operative nutrition, on the other hand, is to promote nitrogen balance, reduce the loss of lean muscle mass, and facilitate rapid healing and recovery. The guidelines given here are aimed at minimising some of the metabolic consequences of surgery, using nutritional supplementation to overcome some of the issues that whole foods would otherwise present.

6-12 hours before surgery – consume a well-rounded meal emphasising complex carbohydrates and high-quality protein.

Post-Operative Nutrition

The post operative nutrition model is basically the reverse of the preoperative model.

Conclusion

In conclusion carbohydrate intake supports the increased post-surgical metabolic (energy) demand and wound healing. Protein intake supplies the amino acids needed for wound healing, immune function and preservation of muscle mass. Combined amino acid and glucose intake can help to mitigate muscle loss and strength, especially prior to surgery. Following surgery, free form amino acids plus supplementary dietary protein can help to support protein generation and an increase in whole-body protein. Depending on proximity to surgery different sources of CHO and protein can be used to maximise nutritional intake. Supplemental sources can be useful to support intake during periods when whole foods are not tolerated.

References

https://pmc.ncbi.nlm.nih.gov/articles/PMC8156786/figure/nutrients-13-01675-f003

Heart burn, acid reflux, GERD – what is the difference?

All of these conditions occur when acid from the stomach escapes into your oesophagus, via the sphincter at the top of the stomach, creating a burning sensation.

All of these painful digestive conditions are related and tend to cause similar symptoms, however, they usually develop in stages.

In the case of acid reflux, stomach acid leaks out of the stomach and into the oesophagus. When this progresses, it can be diagnosed as gastroesophageal reflux disease (GERD) which is considered to be more severe. Heartburn is also commonly called GERD.

The most common symptom of GERD is frequent pains in the chest and burning sensations hence the name “heartburn”. Other signs of GERD are difficulty swallowing or keeping down food and liquids, coughing, wheezing and chest pain. Often these symptoms occur or are much worse at night.

An alarming finding from one study conducted in Norway found that the incidence of acid reflux rose from around 11 percent of the population to over 17 percent over a period of 11 years. A similar rise is happening in other industrialised countries too.

It might not be the biggest deal to have acid reflux symptoms on occasion but research shows that people with long-standing, chronic heartburn are at greater risk for serious complications. These include stricture (narrowing) of the oesophagus and inflammation of the oesophagus or oesophagitis. Other developments can include chronic infections and there are concerns re fracture risk and pneumonia (linked to PPI medication).

If we have low stomach acid our food isn’t broken down as quickly or completely so proteins stay in the stomach longer than is normal. This means the acid also stays longer and this can cause digestive issues, especially when we start moving around following a meal. Slowing our digestion down is also a problem as it gives food time to ferment and putrification can occur. This means bacterial balance can become problematic as certain undesirable species thrive (pathogenic) and yeast and fungus can also start to proliferate. This in turn can lead to more serious problems from an unhealthy microbiome balance and conditions such as IBS and multiple digestive issues.

So we need our stomach acid but we need it in the right place.

What do Nutritional Therapists help with and how to find one?

You might be someone who gets bloated after every meal. Or someone who feels exhausted by mid-morning despite a full night’s sleep. Maybe your skin flares up regularly, or you’re dealing with unpredictable mood or energy changes.

These are just a few of the reasons people turn to nutritional therapists.

Common concerns supported by nutritional therapists include:

Digestive issues (IBS, bloating, reflux, gall bladder issues, gout etc.)
Fatigue or low energy
Pre diabetes and heart health especially cholesterol
Osteoporosis and issues with bone density
Skin conditions
Female hormonal health (PMS, perimenopause, PCOS)
Stress and mental wellbeing
Autoimmune conditions such as arthritis
Healthy ageing and preventive healthcare
Optimising athletic performance

You don’t need to be diagnosed with a condition to work with a nutritional therapist. Many clients seek support for prevention, performance, or simply to understand their bodies better.

Why People Seek Nutritional Therapy

Many people turn to nutritional therapists after trying multiple solutions—diets, supplements, or private testing—without clarity or consistent results. Others feel dismissed by standard medical care or overwhelmed by conflicting online advice.

Nutritional therapy offers a structured, evidence-informed approach to identifying patterns and making progress that lasts.

It’s ideal for anyone who:

Has symptoms that don’t have a clear medical diagnosis
Feels like they’ve tried everything but still don’t feel well
Wants to optimise health before issues become problems
Prefers natural, lifestyle-based strategies alongside medical care

How to Find a Qualified Nutritional Therapist

To ensure you’re working with a properly trained practitioner:

Look for CNHC registration – this confirms they are qualified and regulated
Check for BANT membership – this indicates high standards of ethics, education, and science-led practice
Use BANT’s Find a Practitioner tool
Visit the CNHC public register to verify credentials

Discover the Value of Working with a BANT-Registered Nutritional Therapist

Nutritional therapists play a vital role in bridging the gap between general wellness advice and personalised healthcare. They take time to understand how your diet, genetics, environment, and lifestyle interact and use that insight to guide tailored, evidence-based recommendations that help you feel better, for longer.

Generic nutrition tips and one-size-fits-all plans can fall short. Working with a Registered Nutritional Therapist puts your individual needs at the centre. For many clients, it’s the first time their symptoms, history, and goals have been fully explored and connected into a clear plan.

This approach supports symptom improvement while also helping you reconnect with your body, increase daily energy, and take charge of your long-term wellbeing.

If you’re ready to stop guessing and start understanding what your body really needs, a Registered Nutritional Therapist could make all the difference. Please feel free to get in touch or book a call via my website.

What qualification dose a Nutritional Therapist have? Are they different from a "nutrionist"?

In the UK anyone can call themselves a “nutritionist”. The title is not legally protected so regardless of training anyone can call themselves a “nutritionist”.

However, Registered Nutritional Therapists including me are:

Fully trained in nutrition science and functional medicine
Required to register with the Complementary and Natural Healthcare Council (CNHC), a PSA-accredited regulatory body
Members of professional organisations like BANT (British Association for Nutrition and Lifestyle Medicine)
Required to follow a strict code of ethics and maintain Continuing Professional Development (CPD)

This level of regulation ensures clients are receiving safe, evidence-based advice from a qualified professional.It’s important to remember that only those registered with CNHC are recognised to deliver one-to-one clinical care.

In my case I trained with the Institute of Optimum Nutrition (ION) in London and gained a diploma (DipION, Distinction). I also did some preliminary training at the University of Westminster.

What does a 'Nutritional therapist' do?

What Does a Nutritional Therapist Do?

Have you been dealing with ongoing symptoms and feel like no one’s joining the dots? Maybe you’ve tried diets, supplements, or read endless articles online, yet nothing seems to stick. If this sounds familiar, you might be wondering if a nutritional therapist what could help.

With growing public interest in functional medicine and personalised, preventative care, nutritional therapy is gaining interest. There’s still confusion about the role, who is qualified, and how it differs from general nutrition advice. This blog explains it all.

Nutritional Therapists Offer Personalised, Evidence-Based Health Support

A nutritional therapist applies the science of nutrition and lifestyle medicine to support individuals with a wide range of health concerns. This can include digestive problems, fatigue, hormonal imbalances, immune issues, and more.

They work in a one-to-one setting, assessing each client’s health history, symptoms, diet, lifestyle, and environment to identify potential imbalances. Then they create a tailored plan that supports the body’s ability to heal and function at its best.

Nutritional therapy is:

Personalised – considering your unique biology, history, and lifestyle
Science-informed – based on the latest research in nutrition, epigenetics, and systems biology
Holistic – looking at the whole person, not isolated symptoms

The aim is not to diagnose or replace medical care, but to complement it with targeted nutritional and lifestyle recommendations.

What a Nutritional Therapy Consultation Looks Like

A consultation with a Registered Nutritional Therapist typically involves:

Detailed case history – exploring symptoms, medical history, family history, diet, lifestyle, and environment
Analysis of diet and nutrition status – sometimes supported by laboratory testing
Individualised plan – including food, supplementation, lifestyle changes, and referrals if needed
Follow-up support – adjusting the plan over time based on response and progress

This process helps the therapist and client build a picture of how different factors may be contributing to the client’s health status and how to support improvement in a structured, measurable way.

Know your numbers

This blog was inspired by an article written by a lady who had a heart attack at the super young age of 42. She did have high cholesterol and some significant family history but it really highlighted to me that ‘knowing your numbers’ is a good thing. I am generally a cautious tester for various reasons. It can make clients anxious and there is often a lot of work you can do just based on a client’s diet and lifestyle questionnaire. However knowing certain key health numbers can also save a life, help with motivation and direct a client’s protocol for maximum support.

HDL cholesterol

Here are the top line numbers we should be aware of and why.

Known as the good cholesterol, low levels of HDL are linked to an increased risk of heart disease. Cholesterol has a metabolic cycle in the body and if this is functioning well your LDL (known as ‘bad’ cholesterol) will be converted to HDL (known as ‘good’ cholesterol) and returned to the liver with any excess being excreted. It’s the overall pattern and clinical picture that matters so if you are unsure what your numbers mean it’s best to talk to your GP or health professional.

OPTIMAL LEVELS ARE:

Total cholesterol - below 5 mmol/L
HDL cholesterol – 1 mmol/L or above

Triglycerides

High triglyceride levels can indicate elevated levels of fat (lipids) in the blood. This figure is measured with a blood test. Remember that fat in the body is not just from fat in the diet. Any sugar that we eat in the diet that the body can’t immediately utilise for energy will be converted to fat. Sugar in the diet is not just from fruit or added sugars such as honey, syrup, sugar etc. We also convert starch from grains and vegetables to sugar during the digestive process and subsequently to fat if your cells and sugar stores (glycogen) are already full. The more processed and refined the food, the quicker this conversion happens.

OPTIMAL LEVELS ARE: below 1.7mmol/L

Blood pressure

High blood pressure stresses your heart and blood vessels, which increases the risk of cardiovascular disease. Healthy blood pressure is a marker of overall metabolic health. We need to manage stress, exercise regularly and maintain a healthy body fat percentage to regulate our blood pressure.

OPTIMAL PRESSURE IS: 120 /80 mm/Hg systolic/diastolic.

Waist to hip (WHR) ratio

Divide your waist circumference by your hip circumference to obtain your WHR.

WHR measures the ratio of your waist to your hip circumference. It determines how much fat is stored around the waist, hips, and buttocks. It is an easy, inexpensive, and generally accurate way to assess the body’s proportion of fat. This is important as not all excess weight carries the same health risks. It can help predict your risk of heart disease and diabetes when reviewed alongside other health markers.

OPTIMAL ratio is:

Men should be more than 1.0
Women should be more than 0.8

Waist circumference

This is another marker for assessing abdominal obesity which is associated with increased health risks and metabolic conditions such as diabetes and heart problems.

OPTIMAL ratio is:

Men should be less than 102 cm.
Women should be less than 90 cm.

I hope you have found this guide to your top-level health markers useful. Remember no test is perfect and no test can fully convey the complexity of your health. To understand your full health picture there are many factors to take into account including information about your diet and lifestyle.

My next blog will summarise how to improve the body’s blood fat picture.

You can read the full article that prompted this blog here: https://www.womenshealthmag.com/uk/health/conditions/a64363807/young-heart-attack/

Silent reflux - what is this?

Over 112 million people in Europe, about 20% of the population, are estimated to suffer with acid reflux. Acid reflux occurs when acid from the stomach flows back up into the tube running from the throat to the stomach (the oesophagus). This causes a burning sensation known as acid reflux or heart burn.

Silent reflux occurs during the night and is so named as people often don’t know it is happening. One of the most common symptoms is an unexplained need to cough frequently or clear your throat a lot. This is due to the erosion of the protective mucus which lines the oesophagus or irritation and damage to the cell membrane itself.

Both acid reflux and silent reflux are often treated with medication to reduce the level of acid in the stomach. Too much stomach acid is rarely the issue however, it’s more about stomach acid escaping from the stomach, where it belongs. In fact, both conditions often arise initially due to low levels of stomach acid and digestive enzymes, which frequently decline with age. As digestive function declines the bacteria in the gut (microbiome) can become imbalanced leading to dysbiosis, bloating and gas, or conditions such as small intestine bacterial overgrowth (SIBO). These issues increase the risk of bacterial fermentation, instead of digestion of food. Fermentation causes gas which can lead to a buildup of pressure in the gastrointestinal (GI) tract. If this causes the sphincter at the top of the stomach to open and the acid will reflux, causing burning.

My approach

I am always looking for the root cause of health problems and acid reflux is no exception. There are many steps which can be taken to improve digestion and acid reflux symptoms.

Acid suppression medication from your GP can help with immediate symptom relief and may be needed initially to protect the lining of the oesophagus. It is best not to rely on this long-term however, so we would look to investigate root causes. Is it poor digestive function, bacterial overgrowth or imbalance or are there any structural issues such as weak diaphragm muscles, weak sphincters, hernias, ulcers? Parasites or fungal and yeast infections also need to be ruled out.

Sometimes simple diet and lifestyle changes are all that is required. We will often work to take the pressure off your digestive system whilst starting to improve digestive capacity. There are also some key practical steps that can help such as losing weight, avoiding eating just before bed or avoiding key food triggers such as alcohol, caffeine, spices and chocolate.

Acid reflux symptoms

Common	Less common
Heartburn	Voice changes
Chest pain	Hoarseness
Dry cough	Sore throat
Nausea	Difficulty breathing – asthma symptoms
Thick and bubbly saliva	Teeth damage
Pain in the upper part of the abdomen	Damage to mucous membranes in the mouth

Get in touch

If you would like to get to the bottom of your acid reflux, please get in touch for a free initial chat on 07740 876233. I would love to help you.

References

Holzer, P. (2007) Acid sensing in the gastrointestinal tract; American Journal of Physiology Gastrointestinal and Liver Physiology 292(3): G699-G705 doi: 10.1152/ajpgi.00517.2006

Eom, C-S. et al. (2011) Use of acid-suppressive drugs and risk of pneumonia: a systematic review and meta-anlaysis. Canadian Medical Association Journal; 183(3) pp.310-319. doi: 10.1503/cmaj.092129

What fats can I cook with?

This blog is a reminder of which fats to use for cooking and which ones are best used cold in salad dressings. It also covers which ones to avoid.

Fatty acids are classified according to the presence and number of double bonds in their carbon chain. Saturated fatty acids (SAFA) contain no double bonds, monounsaturated fatty acids (MUFA) contain one, and polyunsaturated fatty acids (PUFA) contain more than one double bond.

This table above shows the fatty acid composition of various culinary oils.

You can see from the table above that oils tend to be classified according to their largest constituent. We need to cook with oils which are stable when heated and therefore have a high smoke point. The more double bonds a fatty acid has, the more unsaturated and unstable it will be, especially when heated.

The most stable fats are solid at room temperature, so lard etc. Olive oil (virgin/extra virgin) is pressed straight from the seed or fruit without further refining. There is research to show that the phenols in unrefined olive oil protect it from degradation during cooking (Ramirez-Anaya, 2015).

Oils such as rapeseed, sunflower and vegetable are obtained by washing and crushing the seeds, and then using processes such as heating, hexane, solvents, extraction, processing, bleaching, deodorization and peroxide to maximise production volume. As these oils are highly unsaturated (many double bonds) the risk of oxidation from processing is high, either during processing or if used to cook with. Most of these oils are also much higher in omega-6 than omega-3. As our diets tend to be more deficient in omega-3, I focus on hemp and flax (small amount) which have a 4:1 and a 0.3:1 ratio respectively (o-6:o-3) to try to redress this. I also advocate cold pressed and organic versions to preserve quality and nutrient content.

The following table is a guide Whether you wish to cook with animal fats will depend on various criteria including your health and dietary preferences as well as your ability to digest and absorb fat.

Which fat to cook with and which to use for dressings and drizzles

REFS: Del Pilar Ramírez-Anaya, J. et al (2015) Phenols and the antioxidant capacity of Mediterranean vegetables prepared with extra virgin olive oil using different domestic cooking techniques. Food Chemistry Vol 188; pp. 430-438.