Carb loading before surgery?

(Robin) #1

Hey guys. This Thursday I have surgery to remove a portion of my colon.
My instructions to prepare for the the surgery are about what you would expect… like prepping for a colonoscopy but to the max.

They had me buy a drink called Breeze to drink the night before and that morning… the reason is to load up on carbs. I am told extra carbs increase the ability to do well with surgery and stress.

I don’t have stress about the surgery. I am very excited for it.
But over the course of a few hours, I’ll be drinking about 250 grams of carbs (sugar).
I’m curious how my body will react to a sudden sugar intake like that.
And curious if you’ve heard of carb loading before surgery.

(Megan) #2

Hey Robin,

I googled it and found this:

“An optimal nutritional state is an important consideration in providing successful operative outcomes. Unfortunately, many aspects of surgery are not constructive to providing this. In addition, the metabolic and immune response to injury induces a catabolic state and insulin resistance, a known risk factor of post-operative complications. Aggressive insulin therapy post-operatively has been shown to reduce morbidity and mortality but similar results can be achieved when insulin resistance is lessened by the use of pre-operative carbohydrate loading. Consuming carbohydrate-containing drinks up to 2 h before surgery has been found to be an effective way to attenuate insulin resistance, minimise protein losses, reduce hospital stays and improve patient comfort without adversely affecting gastric emptying. Enhanced recovery programmes have employed carbohydrate loading as one of several strategies aimed at reducing post-operative stress and improving the recovery process. Studies examining the benefits of these programmes have demonstrated significantly shorter post-operative hospital stays, faster return to normal functions and lower occurrences of surgical complications. As a consequence of the favourable evidence they are now being implemented in many surgical units.”

Pre-operative nutrition and carbohydrate loading | Proceedings of the Nutrition Society | Cambridge Core

I have no idea how relevant it is to someone in ketosis pre-op. Protein is important post-op for tissue repair tho. Be interesting to see if my surgeon suggests something similar when I have my big surgery in 4 weeks.

(Geoffrey) #3

That’s interesting. I’ve had at least 15 surgeries in my life so far, some minor some major, but I’ve never been told to carb load before or been given anything beforehand to consume.
Is it because it’s bowel surgery or is this just starting to become common practice I wonder. As strict as I am with my diet I’m not so sure I could do it but if it will help you through the surgery that’s all that matters.
Good luck on your upcoming surgery and I’ll be praying for a successful outcome and a speedy recovery.

(KM) #4

I found something similar to Megan’s post and, as she says, it’s definitely not clear what effect this will have on a carnivore. I am assuming your doctor is well aware of your diet?

And yes, good luck! When is the surgery?

(Edith) #5

I read a while back that our body gets used to having little to no carbs, so that if we have a sudden influx of sugar, we can appear insulin resistant at first because the pancreas needs to ramp up the insulin secretion. Maybe introduce some carbs before you have to ingest that huge amount of sugar? Give your body a chance to start ramping up the insulin, before you shock it with 250 grams of sugar.

(Cathy) #6

I have never heard of carb loading before surgery. I had a major surgery 4 years ago and was and had been keto for a number of years. My recovery was good.

If I had been instructed to consume high carb solutions, I would have resisted. In fact, I questioned what was in the I.V. just to be sure they weren’t pushing glucose. They don’t typically do that, I learned.

Best wishes for a successful outcome!

(Bob M) #7

They made my mother drink something similar. I think they ran a study where people who drank that (what should we call it? crap?) stuff did better than those who didn’t. But I would think you’d be fine without drinking it. (Oh yeah, take a look at what else is in it – probably a lot of oils.)

Yeah, according to Ben Bikman, there are two phases of insulin response, (1) a learned one (like a memory) and (2) a response due to the carbs you’re taking in. The first one is based on what’s happened in the past. If you’re a high carb person, you’ll have a lot of insulin waiting to be released. If you’re a low carb person, you won’t. So, the first (or maybe few) time you eat carbs, your blood sugar will go higher than it would if you were a high carb person, because you lack that initial response of insulin. I’m not sure how this would affect surgery though.

(KM) #8

TLDR: if you are going to be doing pre-op carb loading and post-op dextrose IV or liquid shakes, just embrace SAD eating for a little while (starting a few days before the carb loading) til you’re back on your feet. This sounds like a pretty big operation, without much protocol for carnivores, and it’s probably safer for you not to be an outlier right now. :heart:

I seriously don’t understand what this is about … the implication, I think, is that giving insulin post op decreases blood sugar, which is apparently useful for healing. Sooo … giving sugar pre-op pushes the available insulin in the blood, aiding in post-op glucose reduction? I wonder how much of the need for / benefit of insulin therapy afterward is due to mitigating the dextrose IV drip used to feed while the body can’t ingest solid food after surgery.

If that’s the logic, then I agree with @VirginiaEdie, if you’re going to swallow 250 g of glucose at once, dose yourself with some carbs ahead of time so your body’s ready to create that big insulin surge. I’d be concerned that a big sugar push out of nowhere might have the opposite effect on a carnivore, depleting the small amount of available insulin at just the wrong moment.

Edited to add that I’m sorry you’re going to have to guess about this; I think we are all guessing but again, if you’re following the logic that applies to SAD eaters, perhaps it’s best to be one for a few days.

Not to add to your plate, but how long do you expect to be in hospital or on IV / liquid food, and is it possible to request an IV of something other than sugar? (I was amused to see that dextrose IV fluid is commonly referred to as D5W. Sounds like getting an oil change!)

(Robin) #9

It’s too late to slowly add carbs and adjust…I should have read the label sooner. All clear liquids yesterday and today. So, I’m planning to split the difference and just have 50g at night, 50 in the morning. I’m sure I can handle a jolt of 50 g.

Ready to get this show on the road!
Thanks for your input and well wishes.

(Bob M) #10

50g shouldn’t hurt.

But here are some studies pushing this:

https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/full/10.1111/anae.12921

This one is for colorectal surgery:

(KM) #11

The problem is that they’re all based on SAD eaters. Totally different insulin storage situation and glucose response. But I agree, 50g is probably manageable even for someone with no insulin stored. Whether it’s of benefit is a different question.

(Bob M) #12

I totally agree. The one study was using carb-loading for marathons as an example. Not a great example for us.

If I had to guess, I’d say nothing beforehand or meat would be good, and meat afterward would be good. I’d love to see a comparison of meat versus carbs. That’ll never happen.

(KM) #13

Post Op, may I suggest …

https://www.kroger.com/p/beech-nut-stage-1-beef-beef-broth-baby-food-jar/0005220000797?fulfillment=PICKUP&storecode=02100086&&cid=shp_adw_shopl_.FY24.01_search_ent_sales.nh_allent.lia_corelia_kroger.t1_g_lia_shop_acq_evgn_verylowperformers_all_rev_roas_sf&gad_source=1&gclid=CjwKCAjwzIK1BhAuEiwAHQmU3vf_eBcUX9yw8QLE4LBFXzvK25PAGC3dpugUO71zLlp7wHvTcWTa2hoCpW4QAvD_BwE&gclsrc=aw.ds

(Robin) #14

Wow, never would have thought of that. Thanks for the tip.
In theory I should be able to resume my usual diet the very next day.

(Robin) #15

@ctviggen @kib1 @VirginiaEdie
I’ve read all the studies, and if I was on a SAD diet, I wouldn’t think twice about this carb loading.

But since I have been at zero carbs (occasionally a 10g day maybe), I don’t like to imagine a spike in my glucose. I plan to go semi-rogue. 50g two times. I’ll see how the first one affects me.

Catch you all on the flip side.

#16

Best of luck with your surgery Robin, I hope it all goes smoothly and the carb spike does as advertised and moves you faster towards recovery. Good plan to break the dosage up a bit though. Happy Healing and I hope you have some good books on hand for the recuperation period!

(Bob M) #17

Yes, good luck on the surgery and recovery.

(Megan) #18

I looked at one of the studies @ctviggen Bob linked and found this:

" Fasting depletes glycogen stores, increasing the demand for amino acids. The endocrine response of insulin resistance to fasting is central to the catabolic surgical response, resulting in reduced insulin stimulated glucose uptake in skeletal muscle and adipose tissue, increased glucose release and hyperglycaemia. Hyperglycaemia is associated with more post-operative complications. Pre-operative carbohydrate (CHO) drinks may reduce insulin resistance by maintaining and improving whole-body protein balance and muscle function."

The fasting being referred to is the usual very short pre-op fasting. This makes the section I’ve copied and pasted sound off to me. Many people “fast” that long. It’s called sleeping then not eating breakfast the moment you wake. Surely doing this doesn’t create such a strong physiologic response?

Also, for someone eating extremely low carb or carnivore, aren’t our glycogen stores already somewhat depleted?

Anyone able to throw some light on this?

(Bob M) #19

I don’t have any idea what they’re saying.

#20

Good luck on the surgery!!!

I have no idea what would be best but using smaller doses sounds a fine idea to me. I wouldn’t want to load up on sugar right before a surgery (or any other time but especially not before a surgery) as it probably would upset my body. Surely if not followed by a lot of fat… But it’s me, I only know my own body to some extent, even it is subject to change, I seem to handle carbs better than before carnivore - but I still wouldn’t want to think about consuming a ton of sugar almost at once.
50g is never a problem though it’s never just some sugar in my case.

Hopefully all will be very well! Have the most successful, least burdensome surgery and quick recovery!!!