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Diet

Hippocrates 'Let food by thy medicine'?

It is estimated that one in five deaths worldwide are potentially preventable with improved diet. There is a wealth of evidence to show that many diseases, such as heart disease and diabetes, can be controlled and indeed reversed with changes in diet. 

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There is irrefutable evidence that eating a healthy balanced diet, with adequate calories and rich in nutrient dense foods such as leafy vegetables while minimising consumption of processed foods (e.g. ready meals, pies and pasties) is very important for our health and wellbeing generally and not least when preparing or recovering from surgery.  Undergoing an operation or treatment puts your body under significant physiological stress and getting adequate nutrition and calorie intake is very important in helping you through that stress and recover as quickly as possible with the lowest chance of complications such as infections. The sections that follow are aimed at giving some general advice and pointers.

Vegetables

What does a healthy balanced diet look like?

There is a lot of conflicting information available and constantly advertised about what a healthy diet looks like, from juicing, to plant based diets, grain free diets, intermittent fasting and so on. Variations aside it is clear that minimising the amount of processed and high sugar content food we eat (e.g. ready meals, pies, pasties, shop bought cakes, sweets and biscuits) and instead eating a wide range of nutrient rich unprocessed foods such as vegetables and fruit is important to our health and wellbeing. A healthy balanced diet includes a variety of unrefined carbohydrates (e.g. wholegrain bread and pasta, brown rice and quinoa), proteins, and fats, with an emphasis on  wide range of vegetables, whole grains, and healthy oils.   In general the closer to nature your food is, i.e least processed, the better its nutritional value will be for you. I have discovered and learned myself that there is no one clear 'winning' formula and what works best for one person may not exactly be what works for another. It takes discipline, sometimes baby steps (for example start by changing one meal or snack a week to healthier options) and is important to learn to listen to your body - what helps you feel good and energised more of the time and what doesn't? Some people find keeping diaries of their energy levels, sleep and mood alongside what they are eating and exercising helps them to understand this. 

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At different times our body will need different caloric intakes and ratios of 'macro' (protein, carbohydrate and fat) and 'micro' nutrients. You will have your own journey and learning about what works best for you to help you achieve what you wish for. The following information is focussed on advice for diet before and after an operation, but is not exclusive to that so please do read on even if you are not undergoing an operation or healthcare treatment at this time.

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Changing your diet can seem very daunting and hard work to begin with - my advice is to persist, look to sources of inspiration and garner the support of your family and friends. Consider enlisting the support of a nutritionist. For some people the perceived increased costs of changing to healthier alternatives can seem a barrier. My advice on this is to consider bulk buying certain items such as brown rice, wholemeal pasta, nuts and seeds from retailers such as Buy Whole Foods Online (https://www.buywholefoodsonline.co.uk), stocking up on frozen vegetables such as spinach, broccoli, berries and fruit and eating seasonal vegetables as these tend to be lower in price. Preparing your own meals at home and minimising the number of take-aways and meals out you have. If you do, for example, buy lunches at work, take-aways/meals out, calculate the costs of these over a month. This may help to better see where your food spend money is going and build towards being able to buy healthier, less processed foods.

Healthy Food

Calories, Macros & Micros

This section is a brief overview of some terms you may encounter. 

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Calories = unit of energy, in relation to food or drink it refers to how much energy your body will gain from eating/drinking something. Recommended daily calorie intake varies with age, size, height, sex, lifestyle and general health. Below is a link that may give you a rough idea of what that looks like for you. In general the recommended daily calorie intake for moderately active men is 2500 calories and women is 2000 calories. 

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Macros = group of nutrients in food that give us energy, these are protein, carbohydrate and fat. Your daily diet should contain all of these macro-nutrients. You may read articles or books that recommend 'counting your macros'. This refers to how many grams of protein, carbohydrate and fat you are consuming. The recommended ratio's of these three vary according to what you are hoping to achieve and what makes you feel best. General guides suggest a daily intake of a third of each macro (1/3 carbohydrate, 1/3 protein, 1/3 healthy fats). If you are interested in understanding what yours are there are lots of online resources that can help. Many people find apps such as 'MyFitnessPal' and 'Senza' helpful. 

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Micros = nutrients your body needs in small amounts, for example vitamin D. These include vitamins, minerals and anti-oxidants and are essential to maintaining our health. They are found in natural food sources such as vegetables, fruit, nuts, dairy, fish and meats. Taking supplements is sometimes helpful if we aren't getting sufficient micronutrients from our diet and environment, for example Vitamin D. 

Before an operation

Pre-surgery nutrition can be considered as similar to getting ready for a sporting event where you are preparing your body to cope with additional stress. In the context of surgery, you are preparing your body to help cope and recover from the stress of a surgical procedure. This includes filling your bank with nutrients that support healing and boost your immune health.

We would advise considering your diet as soon as you know you are being planned for an operation and at the minimum trying to incorporate more calories and healthy choices as soon as the plan for surgery has been made, ideally in the four-six weeks before. As outlined in the section above on average, women should have around 2,000 calories a day and men should have around 2,500 calories a day. Keeping a diary of what you eat each day can be a helpful way of ensuring you are eating enough calories and having a balanced diet. A link to an example of this is included at the bottom of this page. 

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Your pre-surgery diet ideally should contain:

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  • At least 5 portions of fruit and vegetables a day such that they make up at least a third of what you eat each day. Variety of vegetables is important. Green vegetables in particular are rich in vitamins and minerals, including vitamins C, K and magnesium. Incorporating as many of these as possible in your diet in the lead up to surgery is beneficial for your post-operative recovery and healing. Examples include spinach, broccoli and salad. 

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  • Lean protein. Protein provides building blocks for our muscles, bones and immune system.  Protein needs are based on the amount of muscle that you have, but research has shown that 65 – 100 grams per day are proving to be optimal. This means lean protein should be approximately one third of your daily intake and ideally each meal should contain a source of lean protein. Consider adding sources of protein to any snacks you may have, for example almonds as a snack or adding almond butter to fruit snacks. 

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Examples of protein include:

-          Meat (e.g. chicken, turkey, beef, pork , lamb)

-          Fish (e.g. cod, haddock, salmon, mackerel, sardines)

-          Eggs

-          Dairy (e.g. milk, cheese, cottage cheese, yoghurt)

-          Nuts and seeds ( e.g. peanuts, cashews, almonds, walnuts, nut butters)

-          Meat alternatives ( e.g quorn products, soya products (e.g. tofu, tempeh)

-          Bean, lentils, pulses

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  • Starchy foods. Approximately one third of your daily intake should be these. Wholegrains are particularly good as they are rich in B-vitamins which are very good for your health and recovery. Examples include whole-wheat/granary bread, brown rice, oats, lentils and whole-wheat pasta. 

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  • Healthy fats - found in, for example, avocado, olive oil, nuts, oily fish such as salmon.

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  • Stay hydrated. Aim to drink 6-8 glasses of fluid a day, avoiding high sugar high caffeine drinks where possible. Again some people find it helpful to keep a record of what they drink in a day to really be able to understand what that looks like for them. As we get older our signals for thirst lessen while our requirements stay the same. Keeping a note of what you are drinking in a day can therefore be especially helpful.

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Try to avoid: 

  • Excess refined sugar, such as in high sugar drinks, many deserts and cakes and sweets. 

  • Highly processed foods such as ready meals, pasties and pies. 

  • Excess caffeine

  • Alcohol

These create more stress on the body and actually remove nutrients from the body to metabolise properly.

After an operation

Your body is exposed to a lot of stress when you undergo a surgical procedure and having adequate calories and nutrients in your diet is very important in helping it recover and to minimise complications that can occur after such as wound healing issues and infections.

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Eating and drinking well aids you to:

-          Have more energy as you begin to do more

-          Avoid any unintentional weight loss

-          Rebuild muscle strength

-          Fight infection and build/ maintain a strong immune system 

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Leaving hospital following surgery is a big step in your recovery.  There may be some things that you may find difficult, such as being able to eat and drink as you used to or having a reduced appetite. Even though you may not feel hungry it is still extremely important to give your body the nourishment it needs to maintain your weight and support your recovery. Your body actually needs more energy than it normally does even though you may not be as active.  If you saw a speech and language therapist during your stay in hospital and are need a modified texture diet please continue to follow the advice appropriate to the textures recommended. Keeping a diary of your intake, as in the pre-operative period, can be helpful, as well as regularly weighing yourself in the post-operative period to ensure that you are not losing weight in that time (we recommend once a week for the first 6 weeks after surgery). If you are having particular difficulties reach out to your surgical team or GP for help and support - its what we are here to do. 

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The dietary advice given in the ‘Before your operation’ section above applies for after your operation too. Your postsurgical diet shouldn't be all that different from your pre-surgery diet if you were following the general advice given in the pre-surgery section. However you will need to increase your calorie intake to help meet the additional calorie needs of your body in the post-operative period.  You need to continue to consume the foods rich in nutrients that help support healing, including fruits, vegetables and whole grains, and try to minimise highly processed foods which are often low in fibre, high in sugar and lacking good nutritional content. 

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To help meet the additional calorie needs of your body in the post-operative period, and help you maintain that intake even if your appetite is reduced, please read and consider the following advice: 

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  • Have small meals and snacks regularly across the day especially if you have a small appetite. If you are having a fruit snack, consider adding a nut butter too, for example. 

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  • Have high energy and high protein snacks in between meals (see below for ideas)

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  •  Choose nourishing fluids. For example instead of water, low sugar squash and black tea/coffee, try drinking full fat milk/milk alternatives, smoothies, hot chocolate (ideally low refined sugar version!), and fruit juice.

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Examples of high energy foods:

-          Bananas

-          Avocado

-          Nuts and seeds

-          Oats

-          Sweet potato

-         Oils such as olive, avocado and hemp seed

-          Full fat yoghurt

-          Lentils and brown rice

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 In addition consider including daily sources of vitamin C in your diet, as this helps the body heal wounds and boosts your immune system. Get vitamin C from sources such as citrus fruits (e.g. oranges and lemons), green and red peppers, broccoli, spinach, strawberries, tomatoes, and potatoes.

Grapefruit and Vitamins

Vitamins and supplements

Ideally we should get all our nutrients from the food we eat. However with intensive farming and industrialisation the nutritional content of our food, however healthy that diet may be, can mean that we do benefit from nutritional supplements from time to time. In the UK many people are vitamin D deficient and I would advise having your levels checked by your GP, consider supplementation particularly in the winter months and in the lead up to and recovery from surgery (among other things it is important for immunity). In the lead up to and recovery from surgery (especially two weeks before and after) there is some evidence supplemental high dose Vitamin C taken to gut tolerance can aid  wound healing and reduce the risk of infections. If you are vegan you should consider taking B-complex and iron supplements. If you do consider taking vitamins and supplements I would advise researching where you buy them from, as many can be bound to harmful artificial ingredients. Below is a link to two companies I use. If you are interested in exploring this more I would recommend consulting a nutritionist or specialist in ecological medicine (https://www.bsem.org.uk).

Where can I get help?

Help is there, be that to implement some healthier choices, with weight loss or weight gain, specific swallowing issues and so on. If you are struggling I would recommend contacting your GP, surgeon, specialist nurse or a nutritionist. Please just ask!

Resources

These are a some resources that you may find helpful and inspiring.

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Plant powered meal planner

Subscription based service that offers healthy eating focused personalised meal plans and options that aren't time consuming or complex to make. https://meals.richroll.com

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Madeline Shaw

Nutritionist and author. Lovely range of simple to make healthy recipes. https://madeleineshaw.com

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Dr Chatterjee

UK based Doctor focused on the importance benefits of healthy eating and living. Recipes and tips.  https://drchatterjee.com

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The Doctor's Kitchen

UK based Doctor focused on the importance benefits of healthy eating and living. Recipes and tips. https://thedoctorskitchen.com

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The Body Coach

Platform developed by Joe Wicks with both dietary and physical exercise programmes and support. https://www.thebodycoach.com

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Deliciously Ella

 Plant based lifestyle platform. Informative webpage, several excellent recipe books available to buy and also a subscription based app with a wide array of recipes, plant based. https://deliciouslyella.com

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Hello Fresh

Healthy menu boxes that can be delivered to your door. https://www.hellofresh.co.uk

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Melissa Hemsley

Chef and author. Healthy accessible recipes. https://melissahemsley.com

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Happy Pear

Plant based eating recipes, courses and inspiration. https://thehappypear.ie

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Buy whole foods online

Online 'grocery' store good for bulk buying items such as lentils and whole-wheat pasta. https://www.buywholefoodsonline.co.uk

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Sevenhills wholefoods

UK based company with a wide range of responsibly sourced superfoods for sale. https://sevenhillswholefoods.com

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Form Nutrition

Responsible company that makes high quality plant based protein supplements. These may be a helpful addition to your post-surgery nutrition as you recover. https://formnutrition.com

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Athletic Greens

Supplement powder with a high nutritional profile. Responsible company with high quality sourced ingredients. https://athleticgreens.com/en

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©2021 by the holistic neurosurgeon.

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