I decided to talk about protein today because because of its importance to healing post surgery and because, well, it’s Thanksgiving. Remember not to rely on my information alone but to discuss your diet with your Doctors, medical providers, and Registered Dietitians that make up your nutritional support team.
The purpose of protein:
The purpose of protein is to make/repair tissues and to perform many other body functions. Proteins can also serve as a source of calories. While healing in the hospital post major GI surgery, like HIPEC, most PMP patients will require twice the amount of protein as usual. Albumin is a circulatory (serum) protein found in blood that is important because it is vital in maintaining the correct osmotic gradient pressure in blood. Blood albumin is also important as it is used to transport various substances in the blood to where they need to go (like drugs, fats, hormones, and more). If you do not obtain the appropriate amount of protein while healing then blood albumin will drop (called hypoalbuminemia- or low blood albumin). Hypoalbuminemia has been shown in literature to correlate with an increase in morbidity and mortality. Chronic protein-energy malnutrition (Kwashiorkor) can cause apathy, diarrhea, inactivity, flaky skin, fatty liver, and edema (swelling from fluid buildup) of the belly and legs, and in children can cause growth failure.
The exceptions (those who should be cautious with protein) are those with kidney failure or certain rare inherited genetic disorders ( ex PKU and maple syrup urine disease- both of which are usually diagnosed when people are very young).
Proteins are made from smaller building blocks called amino acids. There are three categories of amino acids:
- Essential amino acids. There are 9 essential amino acids that humans must obtain by eating food. Foods that contain all 9 essential amino acids are called complete proteins. These foods include dairy, eggs, meat, poultry, fish, soy, and some other plant based proteins (wiki “complete protein”). A lot has changed since I practiced as an RD (Registered Dietitian). On
researching online I see that now proteins are “graded” on how digestible they are as well. Complete proteins are highly digestible. They actually use this fancy score called the “ProteinDigestibility Corrected Amino Acid Score” or PDCAAS. What a mouth full! The scores range from zero (lowest digestibility) to one (highest digestibility). When people talk of proteins with “high biologic value” they are talking of proteins that are complete proteins with high digestibility. These are the types of proteins encouraged post major GI surgery to maintain optimal serum (blood) protein levels. Because we can have problems with seeds, husks, shell casings, and grains because of fiber, this means the “safe” high biologic value proteins post surgery are basically meats, fish, dairy, eggs, poultry, and soy. However, see the post I put up labeled “Your Post PMP Surgery Diet” because even some of these “safe” proteins should be regarded with caution (depends on your remaining bowel anatomy and any post surgery GI issues). While in the hospital I always ask to speak to the hospital Dietitian because there are some liquid protein supplements that can be added to your diet to boost your oral protein intake.
- Non essential amino acids. These are amino acids that your body can produce on its own, even if you don’t get them in the food you eat.
- Conditional amino acids. These are amino acids that are usually not essential, except in times of illness or stress. These include arginine, cysteine, glutamine, tyrosine, glycine, ornithine, proline, and serine. The reason I bring these up is because there is debate about adding these to your diet while healing. These are found in a lot of supplemental protein powders like you see athletes use. Talk to the Dietitian to see if any of these would be beneficial to you. The most common one I see supplemented for GI surgery patients is with Glutamine.
Hopefully, this helps you understand the importance of getting adequate amounts of the right protein after HIPEC surgery. As always, be sure to work with your healthcare professionals to develop a dietary plan that makes sense for your particular case. If you ever have other questions for me, send me an email at firstname.lastname@example.org, and I’ll be happy to get back to you right away.
PMP Pals has hope for you!