I saw this in a bariatric group on of all places, LinkedIn.
Hello. I am interested in your input regarding "carb loading" for a post-op gastric bypass patient who is running a 1/2 marathon. I do not agree this is necessary. Anyone with experience with this?!
XXXXX Registered Dietitian at University of YYYY Medical Center
Check out Clearfast from http://www.bevmd.com. It may be a good fit for what your patient is seeking.
The product is designed for pre-op carb-loading prior to surgery as part of an ERAS (Enhanced Recovery After Surgery) protocol, which eliminates NPO at midnight by instead providing hydration and nutrition to the patient. This has been clinically demonstrated to improve patient outcomes and increase patient satisfaction.
The product is a 200 calorie CLEAR LIQUID that provides 50g of carbs (44 complex carbs using maltodextrin), vitamins, and electrolytes to provide hydration and nutrition before a stressful/truamatic event (i.e. surgery, marathon, etc.). At 400 mL in volume, I expect that it would work well for a patient with volume restrictions and food intolerances (i.e. bariatrics).
I went to the website and found that they also have a post-op product:
I wonder if we should be asking our surgeons about this (although bariatric surgery ON the stomach might be an exception)?
Hello. I am interested in your input regarding "carb loading" for a post-op gastric bypass patient who is running a 1/2 marathon. I do not agree this is necessary. Anyone with experience with this?!
XXXXX Registered Dietitian at University of YYYY Medical Center
Check out Clearfast from http://www.bevmd.com. It may be a good fit for what your patient is seeking.
The product is designed for pre-op carb-loading prior to surgery as part of an ERAS (Enhanced Recovery After Surgery) protocol, which eliminates NPO at midnight by instead providing hydration and nutrition to the patient. This has been clinically demonstrated to improve patient outcomes and increase patient satisfaction.
The product is a 200 calorie CLEAR LIQUID that provides 50g of carbs (44 complex carbs using maltodextrin), vitamins, and electrolytes to provide hydration and nutrition before a stressful/truamatic event (i.e. surgery, marathon, etc.). At 400 mL in volume, I expect that it would work well for a patient with volume restrictions and food intolerances (i.e. bariatrics).
I went to the website and found that they also have a post-op product:
PostOpt® that completes our commitment to the huge need and demand for Perioperative Nutrition™. PostOpt is a “meal in a bottle”, a clear liquid drink that provides a delicious blend of carbohydrates, proteins and amino acids, fiber, vitamins, minerals and anti-oxidants for the post-operative patient whose nutritional needs are often neglected. This beverage embodies all the building blocks that are fundamental to the healing process. It is an excellent “option” or alternative to a solid meal or it can be consumed as a supplement.
And this is behind the philosophy of NOT being NPO before surgery (which makes a LOT of sense to me!):
Over 20 years ago, as the Medical Director of the largest freestanding outpatient surgery center (OPSC) in Southern CA, I analyzed the Center’s stats on costly case cancellations and postponements.
The majority related to our patients’ inability to maintain the pre-op fasting protocol of “NPO (nulle per os) or nothing by mouth after midnight”…no matter what their scheduled surgery time.
While this rigid rule made little sense to me, it had gone virtually unchallenged for nearly 50 years! Its purpose was to prevent dangerous intra-op regurgitation and aspiration of stomach contents. Those patients who managed to maintain the fast complained bitterly about all the expected symptoms of prolonged starvation and dehydration: thirst, hunger, nausea, headaches, anxiety, irritability, and generalized discomfort.
By 1996, I was actively seeking a scientific rationale for the practice, but found none in the anesthesia literature. I soon realized that physiology and nutrition publications held the key. Abstaining from solids for 6-8 hours prior to anesthesia was justified by good science. Prolonged deprivation of clear liquids was totally counter-intuitive as healthy subjects could completely clear large volumes of water and other clear liquids from their stomachs in less than an hour. However, I recognized that hydration was only part of the challenge; nourishment was the other. I learned that complex carbohydrates, not simple sugars, represented the best calorie sources, being more rapidly absorbed and more readily available to the body and, therefore, less likely to “pool” in the stomach.
While I was formulating and applying for a patent on Clearfast®, a tasty clear carbohydraterich beverage, anesthesia researchers around the world confirmed that healthy patients who drank such beverages actually reduced the volume and acidity of their residual gastric fluids, thus actually reducing their risk of regurgitation and aspiration. The American Society of Anesthesiologists (ASA) then issued new Pre-operative Fasting Guidelines for Healthy Patients that exactly reflected the Clearfast patent: healthy patients having elective surgery should have clear liquids about 2 hours prior to surgery! I immediately licensed the beverage to a major US pharma company. But, neither they nor the US market was truly ready for the concept at the time. Fast-forward a decade: the Medical World is now clamoring for it!
Enhanced Recovery After Surgery (ERAS), a new paradigm of surgery and anesthesia has emerged in and taken Europe and the UK by storm. Physiologists, nutritionists, surgeons and anesthesiologists there collaborated in an effort to reduce post-surgical hospital stays by reducing post-op complications. They identified 17-20 peri-operative patient care elements that are evidence-based (or best practices) and combined them into a protocol for managing colorectal surgical patients. The outcomes and findings have been remarkable: (1) post-op complications and hospital stays have been reduced and (2) pre-op oral carbohydrate loading (with beverages such as Clearfast) three times (not just once) in the 12 hours prior to surgery has been shown to reduce typical post-op insulin resistance (that occurs even in non-diabetics) that leads to hyperglycemia and wound infections (one of the major post-op complications).
The majority related to our patients’ inability to maintain the pre-op fasting protocol of “NPO (nulle per os) or nothing by mouth after midnight”…no matter what their scheduled surgery time.
While this rigid rule made little sense to me, it had gone virtually unchallenged for nearly 50 years! Its purpose was to prevent dangerous intra-op regurgitation and aspiration of stomach contents. Those patients who managed to maintain the fast complained bitterly about all the expected symptoms of prolonged starvation and dehydration: thirst, hunger, nausea, headaches, anxiety, irritability, and generalized discomfort.
By 1996, I was actively seeking a scientific rationale for the practice, but found none in the anesthesia literature. I soon realized that physiology and nutrition publications held the key. Abstaining from solids for 6-8 hours prior to anesthesia was justified by good science. Prolonged deprivation of clear liquids was totally counter-intuitive as healthy subjects could completely clear large volumes of water and other clear liquids from their stomachs in less than an hour. However, I recognized that hydration was only part of the challenge; nourishment was the other. I learned that complex carbohydrates, not simple sugars, represented the best calorie sources, being more rapidly absorbed and more readily available to the body and, therefore, less likely to “pool” in the stomach.
While I was formulating and applying for a patent on Clearfast®, a tasty clear carbohydraterich beverage, anesthesia researchers around the world confirmed that healthy patients who drank such beverages actually reduced the volume and acidity of their residual gastric fluids, thus actually reducing their risk of regurgitation and aspiration. The American Society of Anesthesiologists (ASA) then issued new Pre-operative Fasting Guidelines for Healthy Patients that exactly reflected the Clearfast patent: healthy patients having elective surgery should have clear liquids about 2 hours prior to surgery! I immediately licensed the beverage to a major US pharma company. But, neither they nor the US market was truly ready for the concept at the time. Fast-forward a decade: the Medical World is now clamoring for it!
Enhanced Recovery After Surgery (ERAS), a new paradigm of surgery and anesthesia has emerged in and taken Europe and the UK by storm. Physiologists, nutritionists, surgeons and anesthesiologists there collaborated in an effort to reduce post-surgical hospital stays by reducing post-op complications. They identified 17-20 peri-operative patient care elements that are evidence-based (or best practices) and combined them into a protocol for managing colorectal surgical patients. The outcomes and findings have been remarkable: (1) post-op complications and hospital stays have been reduced and (2) pre-op oral carbohydrate loading (with beverages such as Clearfast) three times (not just once) in the 12 hours prior to surgery has been shown to reduce typical post-op insulin resistance (that occurs even in non-diabetics) that leads to hyperglycemia and wound infections (one of the major post-op complications).
I wonder if we should be asking our surgeons about this (although bariatric surgery ON the stomach might be an exception)?
