PURPOSE
Nutrition therapy is a critical aspect of perioperative management.  The surgical literature clearly shows that patients with optimized nutritional parameters have improved outcomes, specifically better healing and fewer complications. Proper nutritional preparation is an essential, though under-appreciated, responsibility.

The American College of Surgeons and the American Association of Hip and Knee Surgeons both highlight the importance of additional protein-based supplementation.  Accordingly, a team of surgeons and nutritionists created Nourish Rx not only for patient safety and efficacy, but also specifically for these 4 reasons.

WOUND HEALING
Studies find that a typical diet is too often not enough for surgery.  The physiological stress of an operation increases the demand for acute phase protein synthesis, lymphocyte proliferation, and tissue repair. (Wischmeyer, 2018)  Each Nourish Rx serving holds the recommended minimum daily protein intake of 20g. Protein supplementation reduces the risk of surgical infection.  Arginine and other amino acids provide potent immunonutrition support.  Cytokines are proteins and peptides secreted by white cells to regulate and coordinate the immune response.  Interleukins are specific glycoproteins that play an immunomodulatory role in T-cell activity.  In testing, lymphocytopenia with a count below 1500 is a direct marker of protein malnutrition. Several large studies correlate low protein health with an increase in postoperative infection.

MUSCLE REGENERATION
Additional branch chain amino acids (BCAA) are especially important in skeletal muscle metabolism.  HMB (beta-hydroxy beta-methylbutarate)  up-regulates protein synthesis pathways to increase muscle gain and functional strength in healthy older adults. (Wu) More importantly, a large randomized study of 652 elderly hospitalized patients demonstrated that a high protein supplement with HMB reduced mortality by almost 50% relative to placebo. (deutz, nourish study group 2016)

TISSUE REPAIR
For the surgical patient, it is well established that insufficient nutritional preparation is a significant risk factor.  During this period of acute physiologic stress and anabolic demand, patients require increased macronutrient and micronutrient support.  Hypoalbuminemia is a modifiable risk factor that is associated with a statistically significant greater risk of delayed healing, readmission, and complications.  Strong bones are needed to improve recovery.  Older adults are especially at risk for osteopenia and osteoporosis.  Supplementation with Calcium and Vitamin D can enhance bone metabolism. Protein provides structural bone support and accounts for one third of bone mass and volume. Low levels of these can increase the risk of fragility and pathologic fractures.

MICROBIOME HEALTH
Surgery and antibiotics are known to disrupt microbiome health. The normal gut flora regulates digestive health and bowel movements.  Nourish Rx contains Lactospore probiotics to repopulate healthy gut flora after antibiotic prophylaxis. The gut flora defends against pathogens by fully colonizing the space, making use of all available nutrients, and by secreting compounds that kill or inhibit unwelcome organisms that would compete for nutrients with it. (Yoon, 2014) Disruption of the gut flora allows competing organisms like Clostridium difficile to become established that otherwise are kept in abeyance.

While the blend of nutrients was specifically chosen to optimize surgically recovery, certain supplements were deliberately omitted to minimize the risk of complications.  Although  popular nutrients, omega 3 fatty acids and Vitamin E are associated with an increased bleeding risk and therefore excluded.

As a nutrient focused surgical supplement, Nourish Rx taken twice daily is a proven and simple step to reduce the risk of adverse events.  Tissue repair, wound healing, and muscle regeneration are necessary for a successful surgical outcome.   Among protein options, a pure whey isolate protein is especially bioavailable in an older and elderly population. It is not intended for body-building or as a sport supplement.