Catalyst Health, Wellness and Performance Coaching

Influence of Nutrition on Injury and Surgery Response - Dr. Abbie Smith-Ryan (Episode #143)

November 30, 2020 Dr. Abbie Smith-Ryan Season 3 Episode 78
Catalyst Health, Wellness and Performance Coaching
Influence of Nutrition on Injury and Surgery Response - Dr. Abbie Smith-Ryan (Episode #143)
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Catalyst Health, Wellness and Performance Coaching
Influence of Nutrition on Injury and Surgery Response - Dr. Abbie Smith-Ryan (Episode #143)
Nov 30, 2020 Season 3 Episode 78
Dr. Abbie Smith-Ryan

Are you curious about how nutrition affects your surgery recovery and or injury response?  Would you like details on what nutritional choices would improve your results to surgery or recovery from injury? In this episode, Dr. Abbie Smith-Ryan digs into the details of what you need to know and how you can apply it in your own life or that of family, friends or (for health care providers) patients.

You can access the published study with all the details referenced in the discussion here: https://meridian.allenpress.com/jat/article/55/9/918/444137/Nutritional-Considerations-and-Strategies-to

Show Notes Transcript

Are you curious about how nutrition affects your surgery recovery and or injury response?  Would you like details on what nutritional choices would improve your results to surgery or recovery from injury? In this episode, Dr. Abbie Smith-Ryan digs into the details of what you need to know and how you can apply it in your own life or that of family, friends or (for health care providers) patients.

You can access the published study with all the details referenced in the discussion here: https://meridian.allenpress.com/jat/article/55/9/918/444137/Nutritional-Considerations-and-Strategies-to

Speaker 1:

Welcome to the latest episode of the catalyst, health, wellness, and performance coaching podcast. I'm your host, Dr. Bradford Cooper of the catalyst coaching Institute. And we're not big about talking about secrets on this podcast, but from the looks of it, this one just might qualify. Our guest is Dr. Abby Smith, Ryan out of the university of North Carolina, her research summarizing the key nutritional choices that can enhance both our recovery from injury and from surgery. Those of you who've experienced either of those in the recent past. No , it must be a secret because almost nobody in healthcare talks about it. Well, today we hope to begin to change that. Please don't hesitate to share this episode with friends and family members, as well as physicians, physical therapists and others who might find it as an intriguing way to enhance their outcomes. It's a nice addition to the recent video we did over the YouTube coaching channel about what anyone can do before surgery to improve their surgery outcome. You can find that along with almost 90 other freely available videos at youtube.com/coaching channel, by the way, did you know you can earn continuing education credits for listening to this podcast? Uh , I'm not kidding. We we've received approval for this. It's super exciting. All the details are [email protected]esultsatcatalystcoachinginstitute.com. Now let's dig into how our mouth can facilitate faster healing with our body with Dr. Abby Smith, Ryan, on the latest episode of the catalyst, health, wellness, and performance coach channel today, a huge pleasure. We have Dr. Abby Smith Ryan out of UNC joining us today on a topic that is so critical. There's not a lot of attention on this, and we want to try to bring that to the forefront. So Dr. Smith, Ryan, we are thrilled to have you here. Thanks for joining us.

Speaker 2:

Yeah. Thanks so much for the opportunity. Glad to be here.

Speaker 1:

So your article for those of us, those watching on the video, we G they just had this article printed in the journal of athletic training. And it, it basically States the unfortunate, obvious is what I'm calling it here. And in the first sentence, nutritional interventions are not commonly a standard of care in rehabilitation interventions. And we could expand that to healthcare in general. What's up with that? Why , why do you think that's the case?

Speaker 2:

I think a lot of it is scope of practice or perception of scope of practice. And so you have, you know, you have medical doctors that don't get a lot of nutrition training, and then you see like a physical therapist and rehabilitation therapy that they don't get a lot of training or think that, that it's not their scope of practice. Um, and so who does that? Leave it to the nutritionist, but a lot of times, and in registered dieticians, they're not in the trenches, you know, as far as, so I think it's just part of why writing the article and my passion in this, this Avenue is to get it into hands that then changes perspective that we can have this conversation and then make it part of standard of care.

Speaker 1:

So everybody listening, it's our job. We got to get this thing out here, and we will a link in the, in the description on both the video and the podcast for this. So you can share it with folks. All right. So you covered both pre-audit preoperative nutrition during the rehab process. What differences between the pre-op and the rehab process, or are they essentially the same

Speaker 2:

Great question. So I think they're a little bit different. Um, one thing prehab , um, or pre, you know, whether it's surgery. One thing that I find pretty interesting is that typically when someone's scheduled for a surgery, the general recommendations that we're given is to fast the night before that's it ? And it doesn't matter if your surgery is at 6:00 AM or 2:00 PM. Um, and a lot of that, I think, you know, we have to recognize a lot of, that's more of a concern of , um , if you're using anesthesia and so the risk of aspiration or some of that, but when you look at physiology and digestion, we're doing ourselves a disservice. And so there's two things to take away. As I look at it, there's good data that suggests that leading up to a surgery, if you actually do somewhat of a carbohydrate load or a glycogen load. So basically increasing the amount of carbohydrates, particularly like our high quality , um , fibers and our complex carbs that can help with surgical outcomes. Cause anesthesia does something to our ability to break down carbohydrates. It just kind of our glucose control.

Speaker 1:

It's like a race and you're talking three days before, a week before, what is the general? And I know it hasn't been deeply studied here, but just generally

Speaker 2:

I would say about a week before. Yeah. So nothing crazy, but that's something that easily we can do increase our fruits and vegetables increase our kind of high quality carbohydrates. And then I think one thing that, you know, like , let's say you forget, or you , you know, who , who has time for that, if we can really take advantage of the night before and the morning of it can have in my mind , um, I mean, physiologically huge implications and the , the nitty-gritty of that is the night before a surgery. You want to think about having, like, how do I have , um , keep all of my nutrients readily available, especially if I need to be somewhat fasted or who, when am I going to eat again? And so what kind of the research suggesting that we recommend is that evening before meal, maybe plan it a little bit later and then make sure you have a high quality protein. So usually that's an animal protein, a complex carbohydrate , so it's slow releasing carbohydrate and then a high quality fat. So essential fatty acid. That again, kind of all those nutrients are readily available.

Speaker 1:

Okay, good. And is that something they should bring to their dock ? Because like you say, the advice is very straight forward , fast from midnight the night before, in almost all cases, they're starting to make some exceptions with afternoon surgeries now, but , um, is that something they should bring their doctor and say, Hey, you know, I was reading some stuff and what would you think?

Speaker 2:

Absolutely. So I think the night before is nothing. That's still the guidelines. I would just be real cognizant about that meal the night before the morning of is where I think it gets a little bit , um, less clear, one thing, like I never want to say, go against the law through your doctors in other countries, that law is not there. I think in the U S there's a lot of concern about malpractice and more concerned legally. Um , but when you look at the guidelines, it's usually fast or clear liquids only, is that what they told you ? Okay. So then when you take that step a little bit further, the clear liquid. So when you look at digestion, if you think about a clear liquid, it's going to absorb within a couple of hours even quicker than that. Right ? So then if we look at trying to take advantage of that clear liquid, can we get some glucose, some carbohydrate that's easily digested and some amino acids, again, that's easily digested. None of that's going to be in the stomach when you go on during the seizure. So it's not necessarily disregarding the doctor's advice. It's just taking advantage of that clear liquid

Speaker 1:

And saying , okay, okay. So that's pre AB or pre-surgical now surgery is done under the rehab process. What, what are we doing at this point? And we're going to go through the specific five areas in detail here in a minute, but just generally speaking.

Speaker 2:

Yeah. So post, post Hab , I mean, there's a few things to think about one. I think that to me is like a top priority is that often post-surgery, you have some sort of , um , pain reducer , um , you're not as active. And so appetite is not, you know , there , um , yet our caloric needs are elevated. And so one reminder is just making sure that you know, that you need to eat. And if you don't, then you're going to lose more muscle and, you know, hinder something so that can , can slow rehabilitation.

Speaker 1:

So let's jump on that for a second. So caloric needs increased . Let's, let's go back into that because a lot of people would probably sit in there thinking, well , you know, I'm used to working out two hours a day or an hour a day or whatever, or I'm used to walking around at work, or, and now I'm sitting on the couch or I'm in my bed or I'm , I'm restricted to a desk. So I've been cutting back because I'm , I don't want to gain 20 pounds while I'm in my post-surgical aspect. Talk us through this. Well, wait a minute. No, no, no, no. You need more in that post.

Speaker 2:

Yeah. So I think there's a couple of things to think about. It's definitely individual specific. And so yes, if you're going from training three hours a day and it's a minor surgery, you're probably not going to need the same amount of calories, but it's important to recognize that anytime you're healing a wound or a muscle or a ligament, it does increase your metabolic rate. And so we can calculate that you get your, your, your estimated based on metabolic rate and then kind of your activity coefficient. And then what we call a stress factor. What I like to think about, it's it usually a few hundred calories extra, and it very much depends. It's very different, a soul shoulder surgery versus like a hip replaced. And so you have to think, I always just think about it with an athlete, or if you're exercising, that's a , you know, you , you are burning calories, but when, when we think about a wound, it's your body's on overdrive trying to repair and recover, which takes a lot of calories.

Speaker 1:

That's a huge point. I didn't even think about that. All right . So let's dig in some of the details. What are some of the key strategies for improving our rate of recovery either post-surgical or just while the injuries going on, even if a surgery is not really involved in, and you talk about this in figure one is one of the very nice diagrams you've got there. Can you talk us through that piece a little bit?

Speaker 2:

Yeah. I probably should have printed my now

Speaker 1:

There you go.

Speaker 2:

Yeah. And I mean , I have , I mean, I think so when we talk about nutritionally, now there's a number of like therapy things that, that, that you hopefully have a, you know, a professional helping you with nutrition, as you mentioned, is not often part of it. And so beyond the calories, I think it's even recognizing, like, you may not have that hunger. You still need to eat. And then it's like basic things we should be doing, but here's the friendly reminder, right? Like increasing our colorful foods, making your plate very colorful. So fruits and vegetables, because that has anti-inflammatory properties, increasing protein , uh , cause that has key, you know, we need amino acids to help rebuild and prevent muscle loss , um, essential fatty acids. So like our Omega threes and our Omega sixes that goes in and rebuilds the cell wall. And so it can potentially help , um, kind of recover faster that the incision and the injury itself. Um, and then there's like a host of dietary supplements that have some good data in addition to this kind of improvement in diet. Okay.

Speaker 1:

All right . Well, let's dig into them. So w we've touched on a few of these, but let's, let's take a deeper dive first up and I'll just list them all out for the listeners. First, if you've got calories, you've got protein slash amino acids, you've got carbohydrates, you've got fatty acids and you've got supplements and she's got about one, two, three, four about six or seven supplements. So let's start with calories. What do people need to be keeping in mind in terms of calories? And , and you've touched on this, so you can say, well, you know, rewind three minutes, Brad, but in anything else in terms of the calories that maybe we haven't touched on yet,

Speaker 2:

I would just say , um, if maybe if like people know how many calories they need, then that's a good start. How do you identify that? Well , we've put some numbers in the article, but essentially do a quick estimate online. Like what's your basal metabolic rate and then kind of estimate , um, how, how severe the injury is, how , how much recovery and then it's, you know, a range as I would guess from anywhere from like 200 to 500 additional calories.

Speaker 1:

And when you say, how severe is it body size ? Like you talked about a hip replacement, like that's center of your body, there's all these things they're smashing and breaking . Whereas for example, I had my labor and repaired and my biceps tendon stapled. So not as much involvement on my part versus somebody who had a hip replacement. Are there other things besides size of the, you know, your finger versus your knee in anything else that people should take into account?

Speaker 2:

Yeah. So I think how much , um, like other accessory organ damage, like, like how much muscle mass with how much bone , um, the age of the individual. Okay . So if you think about , um, like the older we are, the more help we might need or the longer we maybe need to recover , um, and then even like how much mobility you have , uh, so, or how much activity you can do on top of , uh , you know , what you can do already.

Speaker 1:

And we're going to talk about the nutrient dense aspects of these things as we go through this list. But I think that's an, I'm not the expert here. I'm guessing that's the emphasis here. It's not just, you know, what you need that 300 extra calories. So three Snickers bars and you are golden. Is it, are all calories created equal?

Speaker 2:

Well, no, that's not a nice softball for you . I mean, I think, and I mean, realistically, you know, I think that the takeaway is that nutrition can play a huge role in how fast we recover, but we ultimately have the choice of what we want to do and not to do. Right . And if I had to rank it, like if we can improve , um , you mentioned the Snickers bar. If we can improve the carbohydrate quality that can help, you know, maintain blood glucose and help some things. The research really shows that protein as a driving factor in recovery and really minimizing muscle loss. And so, you know, I would, I would focus there and then our essential fats, like our , that can really help with healing. Some of this stuff, like you're going to get it in your diet anyways, but it's really kind of saying like, what can I feasibly focused on and really like put my mind to. Right.

Speaker 1:

Okay. All right . So let's jump into protein, amino acids. You touched on this, let's take a deeper dive. Let's help people understand what do we need to be doing here? Is there a certain recommendation of grants per , per pound or kilogram of body weight? We did have Stuart Phillips on six, eight months ago. He is the protein guy. Uh, he was a great interview, but I would love just to have you fill that in for people that maybe didn't catch that or going specifically with the surgery piece.

Speaker 2:

Yeah, I mean, I think so based on some of the data is higher , um, so we're talking like 2.2 to 2.4 grams per kilogram is a good place to start that that's obviously kind of dependent on how much you're consuming already and if it's more plant-based, but that's a good place to start elevated protein intake.

Speaker 1:

And , and just to repeat everybody 2.2 to 2.4 grams per kilogram.

Speaker 2:

Okay, perfect. And then the other key piece that I think is maybe even more important is the timing of the protein . And so you really want to prevent these big gaps throughout the day or fasting periods. Uh , and so generally speaking about 30 gram boluses kind of evenly spaced throughout the day is what's most optimal. And that 30 gram dose really depends on how much muscle someone has. I'm sure Stu talked about some of that. So yeah . You know, someone that's much larger could get away with having 50 grams at a time, but it's really trying to kind of evenly space out throughout the day.

Speaker 1:

Okay, good. Good, good. And any specific you mentioned plant-based tends to be a little bit lower content, any advice for folks just in a general nature in terms of that?

Speaker 2:

Yeah, so I really recommend the animal-based , um, because then it has all of our essential amino acids and it's got the , um, a necessary amount of leucine. And so usually we don't want a lot of meat products, especially, you know, so meaning like we might not have the hunger for them. And so ways to get around that , uh , things like dairy, a eggs fish, it doesn't necessarily mean like you have to non chicken breasts all day,

Speaker 1:

Got your big Turkey thing going, how's it going? I just got out of surgery.

Speaker 2:

Well, especially if you have a reduced appetite, that's where some of the, like a protein supplement or like a nice rich chocolate milk, like where it's not something that you necessarily have to eat, you know, eight times a day.

Speaker 1:

Okay, good timing. Not as timing of the day, but is this critical the first week, first two weeks until pain is back to a one out of 10. Are there any guidelines along that in terms of how long should that person, if they're normally taking in 1.5 to 1.8, how long should they stay with that 2.2 to 2.4 kind of regimen?

Speaker 2:

I mean, it really depends on the nature of the immobilization. So really the goal of the elevated protein intake is to help maximize protein synthesis or minimize protein loss. Right. And so, I mean, I would continue it until like even return or clear to return to activity. Um , and then it becomes more of like probably when you return to activity, you need more carbohydrates. So then you need to lower that. It's all about kind of shuffling your macronutrient needs.

Speaker 1:

Okay. Very good. We're back to carbs now. And again, you touched on this one, anything else you wanted to throw out there about carbs since we're going through the list of five?

Speaker 2:

I mean, just trying to maintain those complex carbohydrates and, you know, kind of killing two birds with one stone is if you can really increase your fruits and vegetables, you're getting both the complex carbs, but also , um , kind of the inflammatory properties of a lot of those foods.

Speaker 1:

Okay, good. Fatty acids. You mentioned Omega threes, Omega sixes, best forms to get those in. We're going to talk about supplements here in a second. Are you suggesting those to get that or you're looking more at fish and what do you suggest?

Speaker 2:

Yeah, I mean, if we can start with food first, that's the best. Um, it's harder to get omega-3 through the diet. Um, so our, like our high quality essential fats. So just as a reminder to the listeners of essential fats, you can't create our body can't create and we must get through the diet. So things, when you think about healthy , healthy fats, those are going to be like our nuts or seeds or our , you know, our high quality oils. And it's just in our fish or fatty fish. Um , it's hard to get enough of that. And so something like Omega three, particularly for an injury rehab, I would recommend a supplement. Okay .

Speaker 1:

Okay. Good. Anything else on the fatty acid side?

Speaker 2:

Yeah, I think one can kind of caveat is that our body, I think the body's pretty amazing, but immediately post injury or surgery, we have this kind of innate natural inflammatory response. If you have an injury, the site is a lot of times warm after that's like your inflammatory response. Um , and so we don't probably want to do high doses of omega-3 right after an injury or surgery, like 24, 48 hours. And then after that , um, there's some really good data that it can help, not only with inflammation, but also kind of Mo muscle protein synthesis, like the muscle fiber itself, which is pretty interesting.

Speaker 1:

Very good. So start those Omega threes about 48 hours after it would be a general.

Speaker 2:

Yeah. And then dosing, I think is an important , um, thing to consider , uh, depending on the severity of the injury, but like I kind of a general dose about 2000 milligrams per day of EPA is a good place to start. And on most fish oils , um, that's usually like double the dose or triple the dose, depending if it's higher or lower quality. So what I do is like, look at the label. It should list EPA DHA, and then let's say it's 500 milligrams of EPA per two capsules. Well then you'd want to take six capsules. Okay.

Speaker 1:

Very good. All right . Now we're down to the one that we're going to have some pushback on. I'm sure supplements. A lot of discussion about do supplements , even make a difference. So we've got, let's see, creatine, HMB fish oil, omega-3 vitamin D probiotics and a multivitamin. So why don't we go in reverse? Cause multivitamins seem to get the most pushback on, I don't know if you're like me, most of my life. I was like, yeah, it's a little insurance policy and the more I read it's like, it's , uh , it's costing you money, Brad, but it's not giving you much. So is this an exception to that general thought out there right now?

Speaker 2:

I mean, I think, I don't think the research has really changed. I think a multivitamin, there was a reason that it was the last on the list. Like it , it is an insurance policy, but in a time of rehab injury or in a time where you're not eating enough, whole foods are kind of throughout the day. Right . Then I think a multivitamin is a good way to try and get things like your vitamin C or vitamin E you know, the , that really will help with healing.

Speaker 1:

And that makes sense. It's such a short time period. Yeah. It's easy. It's inexpensive. You can get them anywhere. Yeah. So it's almost like a slam dunk. Why not?

Speaker 2:

Yeah. And I wouldn't pay a lot of money for it. Um , and just recognize it is kind of like an extra, I mean, you may not see a huge difference, but at least, you know, you're getting kind of those key fat-soluble water-soluble vitamins.

Speaker 1:

Okay. Good probiotics then where do we go with that?

Speaker 2:

Yeah. I also kind of lower on my list. Not something I would recommend to everyone. I think the key thing though, to me, that's somewhat interesting is depending on the anesthesia or the medication, a lot of times that can influence your gut health. And so it's one of those things. I think we have more and more research that's coming out. Another key thing with some of the probiotics is that there are certain strains that actually help absorption of meat of amino acids, which again is kind of the goal to support muscle. And so a lot of it depends on what your diet consists of already, but that's one of those things that could have some potential benefit , um , depending on the individual and the gut flora and kind of what the total diet looks like.

Speaker 1:

And it sounds if I'm reading between the lines here, that that's a great one going into surgery to add to your list.

Speaker 2:

Yeah. Especially like there's a lot of things that can happen with immunity. Um, even I know people that have had surgery that post-surgery due to the anesthesia or some things there's a lot of, I like to call them bubble guts. Um, you know, and depending on the medication, it's a good way to kind of keep your gut health kind of in a regular sense , especially like another thing we see with pain meds is constipation. Um , and so obviously eating fruits and vegetables helps with that, but , um, a probiotic can also just help keep making sure that bacteria is , is a good one.

Speaker 1:

Yeah, good. Yeah. We had professor Felicia's Jacka out of Australia just a couple of weeks ago. And that's her thing that , the whole thing about the, the gut health. Um, all right . So vitamin D getting a lot more research about vitamin D recently, it's it seems like it's a really important factor in general, but in this specific situation, walk us through that piece.

Speaker 2:

Yeah. So I think the thing with vitamin D, as you mentioned, it's, it's related to everything, but can be particularly related to bone, tendon ligament. Um, and the thing about it is 99% of us are vitamin D deficient. And so it's just one of those things that you can't get enough of it in the diet. And so any time your system is compromised or working on overdrive, you'll see those increase needs. And so, I mean, this is something that you can easily get your measures taken. So it's not like surgery is going to make you deficient. It's just one of those things that, to make sure that you are an a , you know, a sufficient range, is it going to be important? And then the other thing , um, physicians have gotten so good about recommending vitamin D, but they left out that it's a fat soluble vitamin. And so what that means is that vitamin D should always be taken with food, particularly with fat. Otherwise you can't absorb it. And so that's like an important factor, like vitamin D is not going to be helpful unless you are taking it with food.

Speaker 1:

Good. Thank you for clarifying that fish oil. You touched on that, but anything else on the, on the fish oil side,

Speaker 2:

The only other thing I would mention is , um, deep sea water , cold fish kind of fish oil is, is, is really where it's at. Um, there is some good data on, you know, some potential and like krill oil, but it's really looking at that EPA DHA breakdown. Okay .

Speaker 1:

Okay, good. And then a fun one. We just had a doc out of Harvard talking about CBD oil and that kind of thing. H M B makes the list here and it's up towards the top of the list. Talk us through that a little bit. My understanding coming in is it, it's not a miracle cure, but it allows you to decrease inflammation. It allows you to optimize your , your body's baseline if you will. Is that kind of what you're seeing out there as well?

Speaker 2:

Well, so maybe two different things. So CBD is different than HMB yeah .

Speaker 1:

Uh, uh, form of it. Doesn't H and B come out of CBD completely separate. Well, there we go. Folks. I learned something new today too.

Speaker 2:

Um, CBD is maybe another conversation, but we can, we can add that. Um, H H M B is beta hydroxy, beta methyl butyrate, which is a metabolite of leucine. And it's at the top of the list because it was originally kind of identified , um, in a cancer population or for use in a cancer population. So it's very good at preventing muscle wasting. And I actually did some work on this long time ago , um , in elderly individuals. And so , um, H and B is , uh , in a lot of formulations for rehab. It's kind of expensive. It is marketed in a sports scenario. Um , but also you can find it in , um , like insure re bigger. So insure has some of it in there. Um, but it essentially works like leucine, which is a protein stimulator, but it very much is an anti catabolic and works more in this sedentary , um , and mobilized kind of reduced activity scenario, opposed to kind of these highly active individuals. So basically we'll , we'll try and prevent muscle loss.

Speaker 1:

And are there certain dosages of the H and B you would recommend?

Speaker 2:

Yeah. So about three grams a day divided in about one and a half gram doses. And so , um, you could buy just H and B powder. It's also in some different products. Um , like I mentioned and ensure , um , it is, and I think muscle armor is one of those products as well. So yeah, just plain HMB , like I said, it's a bit expensive, but it's one of those that I would pay for during kind of a post , um , surgery or like a rehab phase. Okay . Okay.

Speaker 1:

Excellent. And then the last one creating , again, a lot of research coming out about that, not just for, you know , muscle heads and postsurgical , but even just for brain health and those kinds of things. So talk us through in this context, the value of creatine and how much to take.

Speaker 2:

Yeah. Great question. And so this is one of those that's definitely top on the list. Um, it's cheap. So you buy a whole town for like $10 , um, and has the research really shows so much benefit? So there is some data that I'm not as convinced that it may influence like the muscle cell itself, but really what we see and what there's some good data that shows that when we look at dosing, so post rehab, one benefit and even potentially going into surgery is to do a loading phase. And normally I never recommend loading except for like an injury scenario and what that means. It's 20 grams a day in four , five gram doses. So four times a day, take five grams and do that for five days from there, then go down to kind of a maintenance dose to those, which is about three to five grams a day. And that's over

Speaker 1:

A week, two weeks type of thing. I would

Speaker 2:

Never stop to be honest. Um , so the 20 gram dose I would , or the 20 gram dose, I w you know, only do that during a rehab or as you go into surgery. Um, and then that five gram dose kind of consistently, and you hit it , hit it a little bit. There's some benefit in surgery. Post-surgery, we've seen some good kind of maintenance of strength and muscle, but I think one thing that's hard not to address is the mental component of surgery. Like now you have someone, you know, that was exercising and now they're completely sedentary. There's some fascinating data on the benefit of kreatin . We have creeds and stored in our brain. So the potential influence it's sometimes is better than an SSRI or like an antidepressant. I'm not saying,

Speaker 1:

Woo aren't you tuned in today, everybody,

Speaker 2:

But it can't hurt the site . I always liked to re kind of the risk to benefit ratio. And so it has some potential to help with that mental, you know , uh , version of being somewhat immobilized.

Speaker 1:

So all these things that the athletes are listening to this, and they're like, Oh my gosh, this is so awesome. I needed, why didn't I hear this 10 years ago? What about everybody else? It's like, you know, I want to get back to work. I wanna get back to life, but you know, I'm doing okay. Is this just advice for the person that I got to hustle? I gotta get back to my thing, or is this something that really helps everyone ?

Speaker 2:

Yeah, I'll put it in perspective. Um, my grandmother at the time was 95 and she fell, you would believe I would send her some kreatin and some H1B , those were the two, because feasibility. Right , right. Um , even better for those people that maybe aren't as active because usually active people spend more time on their diet and they know. Yeah. Whereas again, I'm a food first person, but for people that, you know, maybe aren't doing that as much, like a basic whey protein supplement in between meals and a creatine supplement and official oil . Like some of these things can really fill the gaps of what they're not doing. Right . Um, and I mean, I don't care if you're not an, like, we still have important activities of daily living, you know, getting up out of our car and our stairs and caring for our children. So, yeah. I think it's more important for people even that aren't active. Okay,

Speaker 1:

Good . Good. All right . Um, so as I was reading through this, I'm like, this is just good advice for life. Like put the rehab aside, put the surgery aside. This is just like, we should just all be doing this period. What's the difference? I guess it's the level of protein, maybe the level of including the HMB more consistently, any other differentiators between the recommendations here specifically for surgery or post-injury and just what we need to be doing.

Speaker 2:

Yeah. I mean, I think it, it makes it it's more important. Um, like we taught him and I'm sure you talked about this with Stu we talk about protein synthesis and maintaining protein balance, but within surgery and rehab, it is crucial because otherwise you're losing muscle. I mean, I'm sure you can talk about anybody that I'm , I'll just dance around here. Um , anybody that has had surgery, they see a loss in size of muscle. Yeah . Um, and when you think about it , uh, w you , you really want to prevent that we see athletes and even non athletes for several years after having that muscle imbalance, which then cause risk for re-injured. Right. Um, and so under this rehab, your body has , um, kind of excess needs. And so it is more important to really follow these things, whether you're an athlete or not kind of, you know, really paying more attention to nutrition essentially. And the timing. So one of the figures in there talks about even when you go to physical therapy, what you have before and after the timing is one of the key pieces that I don't think we often do , um, especially around physical therapy.

Speaker 1:

Okay, good. I did not catch that. Thank you for pointing that out.

Speaker 2:

Yeah. So before and after therapy, I consider that somewhat. I mean, it's all relative, but that's the exercise stimulus. And so we really want to make sure we have nutrients before and after available. Those are, that's one of those things. If you have physical therapists or someone working, like, I wish that we could put like a basic ready to drink protein supplement in a physical therapy clinic. Cause then you could just say, Hey, make sure you have one of these on your way in or

Speaker 1:

Right . And in terms of timing, is it 30 minutes before an hour before? Is it just at this point? The research just says before is better than not.

Speaker 2:

Um, I mean, it depends on the person. It really depends on when your last meal was, if you had lunch and then go to therapy, then I would say after, if you've been at work all day and haven't eaten anything well then before. And so it's really thinking about, are those nutrients in your system at all? Okay,

Speaker 1:

Good. All right . So we talked about this earlier, the loved your article and the timing just on a personal level is really important to , again, everyone, we will link to her article so you can access it in the description, both the video and the podcast. Do we have any hope that this is going to become part of healthcare [inaudible] as you've had this out there, as you know , it was published in journal of athletic training. So you've got , you've got it there on the front lines. Are you getting feedback from people saying, Oh my gosh, we're , we're going to start using this, or I don't know . I just look at this and think so much potential and we're not doing this

Speaker 2:

Well. Yeah. I mean, I don't think the article is going to change lives , but

Speaker 1:

Well, not until your interview at least. Right?

Speaker 2:

Yeah. Um, but I think, you know, I , I'm fortunate. I teach a lot of , um, most physical therapy programs have like a nutrition requirement. It's one lecture, but I know like I get to do it here at UNC and I do it at Duke. And so to me, it's kind of starting on the ground up and teaching them during their curriculum. Like, these are the questions that you should be asking, like, this is how you can do it. And so I think there's hope. And I think there's more awareness. And I know like, depending on in athletics specifically, a lot of this is already being done. Cause it's a team of sports, medicine, physicians, and nutritionists , to me, it's more important to get it to like the general population, because most people don't think like I'm not exercising. I shouldn't be eating or I have an injury, like I'm sedentary. I don't want to get fat. And it's like really changing that messaging or eating becomes more important and you know, trying to maintain the longevity of your body. Yeah. So yeah, I don't , I, my hope is that it will have some impact or, you know, even start conversation .

Speaker 1:

Well, at least you're getting out there for the PTs. We do have a lot of PTs listening to this. So hopefully we'll, we'll build on what you're doing too . Can you and see , all right, so final, wide open question. Any final words of wisdom you want to share? I haven't asked the right question or we missed an angle here that you're like, Brad, there was this really important thing in the article. You missed anything else you want to throw out to us for people that are wanting to either make the most of their own lives or they're trying to help other people do the same as PTs, as coaches, as health and wellness coaches, whatever it might be.

Speaker 2:

I mean, one thing I would say normally, I wouldn't say go read a research article. Um , but we tried to make this practical and like pictures and it's like how you might actually implement it. So in this case, I would say like, go check it out. It's free. It has some like good strategies. And the other thing I would say is like ask questions. I feel like sometimes we don't take enough ownership in our own personal journey or the people around us, you know, like your parents or the people that are having surgery and push the envelope a little bit. Like, can I do this? Can my clear liquid be this? Or what do you think about this? How do I accelerate rehab? And that doesn't mean everyone will have the answers, but I think those questions then can, can help kind of make that rehab process go smoother, faster.

Speaker 1:

When I think a lot of people don't realize that your physical therapist, your physician, your surgeon, they're learning too. And so when you ask those questions, it, it just gets them off autopilot. Or as somebody who practices a physical therapist for 25 years, it got me off. So I'm going to ask and I be like, that's a good question. Let's check it out. Let's look at the research. And so even if it's just moderately helpful for you, it might help that next person that goes to surgery. That next person that goes see their family practice doc and their PT or whatever. So a really good, really good, what's the best way for people to follow you. This is such important information. I want to make sure we get out there as at Twitter. Is there a website? What's your preference?

Speaker 2:

Um, I'm on Twitter, a Smith Ryan and on Instagram, same handle asmithryan and then I have a website that's not updated enough, but they're a Smith Ryan phd.com. Um , an email.

Speaker 1:

Okay, beautiful. Beautiful. Thank you so much. This is great stuff. And I really appreciate you joining us today.

Speaker 3:

[inaudible] makes perfect sense. Doesn't it?

Speaker 1:

Yep . When was the last time a health care professional said, okay. In addition to the things we're working with you here specifically, one of the best other ways to enhance your healing rate is to do the following with the nutrition. It doesn't happen very often, does it. And for those healthcare providers who have integrated this into the guidance you're providing, congratulations, keep it up. Thank you for tuning into the number one podcast for health and wellness coaching. Next week's guest is Dr. Trina Mulhall out of Norway whose research on physical activity has been featured worldwide. I think you'll find it fascinating and you'll be encouraged by what you hear a quick favor to ask of our listeners. If you enjoy video tools and resources, we've now produced over 80 videos over at the YouTube coaching channel, which you can find at youtube.com/coaching channel covers topics, everything from nutrition and exercise to positive behavior, change, mental toughness, and even the business of coaching. We'd love to have you pop over there. Sometime check out a couple of them and, and subscribe. If you'd find it beneficial, everything's free as always feel free to reach out to us with any questions about your current or future coaching career and [email protected] Now it's time to be a catalyst helping those around us move toward better than yesterday in meaningful ways. This is Dr. Bradford Cooper of the catalyst coaching Institute. I'll speak with you soon on another episode of the catalyst, health, wellness, and performance coaching

Speaker 3:

Guest , or maybe over on the YouTube coaching channel.