How to Eat Before and After Surgery for Better Healing

In this episode of We Got Your Number, Dr. Alexandra Filingeri and Dr. Thomas Romo break down how nutrition can directly impact surgical recovery, healing, inflammation, and long-term health.

From preparing your body before surgery to knowing what to eat after, this conversation covers protein, hydration, supplements, GLP-1 medications, body composition, and why real food matters more than quick fixes.

Key Topics:
• Pre- and post-operative nutrition
• Why protein is critical for healing
• Supplements to avoid before surgery
• Hydration after anesthesia 
•GLP-1 medications and surgical risks
• Body composition vs. weight loss
• Nutrition for kids, adults, and aging patients

Healing starts before surgery. The better you fuel your body, the better you set yourself up for recovery.

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Transcript

SPEAKER_01 0:00

Welcome back to the We Got Your Number Podcast. Today we have a special episode where we get to dive into both of our specialty areas. I am Dr. Alexandra Filangeri, registered dietitian, doctor of clinical nutrition. I'm here with my co-host, Dr. Thomas Rovo, facial plastic surgeon. And today we are going to give you guys the recipes for success. So let's get right into it.

SPEAKER_00 0:22

Well, we're going to jump right into both of our expertise. I've been doing surgery for 30 plus years. And when you're dealing with surgery, you're dealing with healing. And it's all about healing and getting it to heal correctly. And there are so many influences that can improve healing and/or on the corollary, there are things that can make healing worse.

SPEAKER_01 0:48

Yeah.

SPEAKER_00 0:48

And we and we need to optimize that. So you want to get into uh start the questions and Yeah.

SPEAKER_01 0:54

So I think when we think just in general about post-operative healing, it's like you don't train for the marathon during the marathon. You don't eat to train, you don't eat or you don't teach yourself how to carbohydrate load during the marathon. You do it all beforehand. So I think especially if you're going into an elective surgery and it's something that you can plan for, then understanding what is your pre and post-operative roadmap when it comes to fueling yourself is the best way because as we know, we feel so what happens in general? We go into surgery, let's say it's elective surgery, and we're like, post-surgery, I'm gonna eat so healthy. I'm gonna take all my supplements, I'm gonna hydrate, I'm gonna start doing X, Y, and Z things. Um, but then we wake up from surgery and we're maybe not as feeling as great as we can. Day one, two, three, and all of those things go out the window. So we need to set ourselves up for success. So Dr. Ramon, a patient is coming into your office, um, they want to have elective surgery. What are things that are important that they're thinking of before the surgery?

SPEAKER_00 2:02

Okay, so I think that's that's a good question and a good place to start. Um my practice is skewed a little bit because I do elective cosmetic surgery, but all surgery um it it's a process where as a uh a surgeon, yeah, you you hopefully you're there's the altruism that comes out about taking care of your patients. So you're not doing this, and so you you bring this to all surgery, orthopedic surgery, general surgery, abdominal surgery, uh, and elective cosmetic surgery. Um they're all interventional processes. Um the patient needs to be educated about the procedure. They need to be educated about um what what it's gonna take to uh do go through the procedure, uh what's gonna happen after the procedure. Um some of the things that you and I, one of the reasons we've kind of gotten together as uh professional friends and colleagues is um your our interest in nutritional uh supplementation and improving outcomes uh in healing and in life and in all kinds of subs uh situations. So when after I see a patient like I did yesterday, I saw four, five, seven new patients yesterday, um the consultation is for me to educate the patient about what we're thinking about, giving them options, letting them think over uh because it's not uh mandatory, something that they have to do, uh but like a knee surgery, uh knee replacement. But be that as it may, they're all surgical interventions. So it means you're attacking the body. Now, once the the surgeon, if if the surgeon is only interested in let's get them into surgery, right? Um you're there are better ways to improve the outcomes. And you have to be, which I've always been, very much uh interested in improving surgical outcomes, and that comes from uh the data has shown, particularly the data from Europe, uh, that improved preoperative nutritional supplementation decreases post-operative uh uh surgical infections, and it also decreases hospital stay. So I'm very much into uh you know, if someone doesn't feel well in their gastrointestinal tract, they're probably not eating well anyway prior to surgery. But even if you're coming in for elective cosmetic surgery, a facelift or something, they may be working out and dieting and doing this, that, and the other, and they're going into surgery. So there are important uh processes, intakes that those patients need to do, which you're gonna help me discuss uh preoperatively and post-operatively, but preoperatively, is getting them ready for surgery nutritionally because the body is going to be assaulted. Uh they're not gonna be feel like eating afterwards, they're not gonna feel like drinking afterwards, and they need so they need that hydration, they need that uh uh supplementation and supplements more than just uh micro nucle nucleants, uh nutrients, but macros as well. So that's kind of where you're an expert, you're an expert on it.

SPEAKER_01 5:06

I think a good way to think about it, especially if it is a surgery that you can plan for, um is then it's such a beautiful time while you're planning for the surgery to not go on a crash diet and actually learn how to fuel yourself, right? Just from baseline, right? So what is what does that mean? Um consuming a well-balanced, nutrient dense, which means that we're taking in real food. We're not eating ultra-processed food that has a lot of calories and doesn't have a lot of nutrients in it. We're eating appropriate amounts of protein and we're also doing things, and it sounds I don't want to say it sounds silly, but it's something that we don't think about. You know, when you're not going to the bar every single weekend and getting drunk. Um, you know, you're not smoking cigarettes, you're not skipping meals, you're not um, you know, filling your body with these foods that are essentially nutrient voids. So I think that even before we talk about the micronutrient piece of preparing for surgery, it's just thinking about, I always say like removing the clutter, removing the addition the additives and the garbage and feeding your body real food, right? Absolutely. Especially if you have something on the schedule for three months from now. Maybe you don't, you don't need to lose weight. You're maybe that's not the goal. We still can focus on feeding our body real foods and giving our body the nutrients that it needs. Yes. For for just not even healing, just for general health.

SPEAKER_00 6:28

Well, of course that's for general health, but if you're planning on uh you you need a hip replacement and you're gonna do that uh and and you gotta the kids are home from college, you're not gonna do it right now, you're gonna do it in two months or something. I mean, you need to prep for that. And you're like a facelift like I do, you need to prep for that. You there's a preparation uh that you need to do. You need to optimize your body's capability of healing.

SPEAKER_01 6:53

Right. And I think that like the easiest way to think about it is if we look at each domain, we could talk about the macronutrients, right? Um very important protein, we understand, and and Dr. Rommel always says this that when we're healing, we need protein, we're not making our collagen and so on from fats and carbohydrates. But I think even just understanding, well, how do I get enough protein into my diet? I'll tell you what I tell my patients. You want to even evenly disperse it throughout the day. You want to take in around 20 to 30 grams. It could be a little bit more if you have higher protein needs, uh, every four to five hours, right? So understanding that you're building your day with an even distribution, 20, 30, maybe even 40 grams of protein evenly spaced out throughout the day, right? What where do we get protein from? It's our, you know, we start with our animal protein, chicken, turkey, fish, beef, and so on. We have our plant-based protein, which is like our tofu and our beans and so on. And then on top of that, we have our supplemental protein, right? So first we think how can we get protein from the foods that we eat from there, then we can look into getting supplemental protein. So I always hear it's hard to get protein. It's not hard to get protein when you have a knowledge gap and you don't understand that you can get a good amount of protein from pretty simple, you know, if we're talking like the surface of my hand, maybe a little bit smaller than the surface of my hand, is all the protein I have to eat at the meal, then we can evenly balance our day. That's, as you say, macro. Eat protein and eat it at each meal.

SPEAKER_00 8:20

Exactly. It's important. Uh uh, and we'll get into that, I guess, post-operatively, uh, but pre-operatively is just as important. Uh and the other thing is, as uh as you as well you know, um uh I I remember Katy Perry standing up one time at a concert and she had a bag and it must have had f a hundred different supplements in it. Right. And she's going, I take all these supplements. And you're going like, for what? Most of that supplement uh nutritional additive gets put in your food anyway. So if you eat a good diet, you don't need that supplementation.

SPEAKER_01 8:52

I think that you know the first thing is what before surgery is just correct deficiency. That's baseline, right? So of course you don't want to be iron deficient. Um you want to make sure that you have adequate vitamin D levels, you want to make sure that you have adequate iron storage, which is ferritin. Um oftentimes they'll do with typical blood work, they'll look at B12 and and folate and they'll make sure that you're not starting with the baseline deficiency. Correct. Right. So that we like to I consider is just the the bare minimum, not having a deficiency. Then we look at, okay, well, what could serve additional benefit on top of preventing deficiency? Yeah. Right. So that's where the word nutraceutical comes in, and what it nutraceutical means is it's not to prevent deficiency, it's to have additional extra benefit. Um, and I think the safest one until, right, you tell your patients, don't take any additional supplements. I want to talk about that. But in the months coming up to surgery, I mean, I think it's really safe to just start with the simple, you could start with a simple protein, right? If you're if you cannot get it through food, you can start with a simple whey protein. Um the data's good. It shows that post-consumption, there's an amino acid called leucine and isoleucine. They're branch chain amino acids. Um, the data shows that they do stimulate muscle protein synthesis. So we take them in, the levels of the amino acid leucine rises in our blood. We see the direct correlation between the rise of leucine and the activation of pathways that stimulate muscles to grow. Yeah. Right? Safe, evidence-based. Most people can tolerate protein. I think when you start to look at it's when you they start to add those additional things that get a little weird, right? The herbals, and this is where it's important before surgery. They start putting in higher doses of vitamin E or they start to put in different herbal blends, things that could potentially interact or influence how blood coagulates or how anesthesia responds in your body. What do you tell your patients? So they're how long are they should they sustain from um supplementation before surgery?

SPEAKER_00 11:00

Uh we ideally, because it depends on when you catch them when they're available and when they're gonna do this, but two weeks, uh I like to have them off two weeks. The I tell them high dose vitamin E, the G herbs, ginseng, ginkgo, garlic, sink, John's wart, uh you don't have to take those because we know that they what they do is they stop you from clotting. And you would if you're gonna have a uh a knee arthroscopy, you don't want to have surgery where you're not gonna stop bleeding. So you it's it's it's a real common sense kind of thing. And since people t are taking um uh a compilation of and and this is where I we're gonna have to get into uh the influence of social media. Social media, and and particularly once we get into amino acids and break it down so that everyone can understand uh what a protein is, uh where peptides come in, where amino acids come in, and you're an expert in that. Um but that's being sold and pushed. And and you can watch, I've watched reels where people that you think are, I know I'm watching their lips move and it's AI generated. Right. And they're the guy saying, Well, I take this, and it really makes me do well. And all I'm saying to you is if you eat a great diet and you don't take supplements that are that are going to be bad for you uh prior to surgery two weeks, uh the other one of course is GLP1. A lot of people are on GLP1. Anesthesia is always worried about that because the way it works, it stops you from gastric uh from emptying. Uh and if you are that means when you take in food and you go into anesthesia, uh you may have residual food in your stomach, and so you have to be a little more careful with your GLP1s.

SPEAKER_01 12:36

And what I see is the patient that is at most risk for that is the patient that not the patient that's fine with the physician that wrote the order, um, is the patient that's getting it off label or they're getting it from telehealth company. So no no physician is monitoring them. They're probably not going to self-disclose to the surgeon that they're on it, and I'll tell you why, because they're it's not medically indicated. They're probably on it for cosmetic weight loss. That's the person that I actually worry about the most because they may not understand, even if told stop all medications, they may think, oh, well, I injected myself with that a week ago. Um that is the person that I think it would is likely to be at the most risk.

SPEAKER_00 13:14

So, you know, that's there's two sides of the coin of telemedicine. If you're you're you're in uh uh way out in the country and there's no medical doctors and you can use telemedicine to do that, but if you're using telemedicine to promote products uh that uh uh I like the ones that they they say, call us and within an hour uh you'll get your it'll be coming to your door. Uh I mean what kind of history and physical have they done? Work up in-depth, they know the patient, they're there's gonna be side effects from the medication. Right. How are they gonna follow that? I mean, if somebody gets pancreatitis from a GLP one, what are they gonna do? Call the guy in uh, you know, five states over to say, Oh, I have a pain in my stomach? No. It's it's so there's really there's no you can't believe everything on social media. And at this point, there are no backstops. So there's gotta be a lot more common sense and people like you and me speaking out about it, right? Letting people know, use your brain. Okay, and and get the data, the true data from people that are experts. Yeah.

SPEAKER_01 14:17

Even in the supplement, you know, the someone that's gonna get something, they're gonna order it off Amazon, and it says healing and recovery, right? And they're like, oh, I need to heal and recover. Maybe I should take this, maybe I should take it before surgery, right? So I've seen a lot of trends where I'm always telling my patients, and this is something that anybody can do from home, is the first thing that they should do when they're looking at these supplements in general, is they should look and see if it has been like third-party tested, right? Is what's in it actually in it really important. Secondarily, is they can go, they can flip the bottle over and they can look at the percentages. So if something is a thousand percent of the DRI, the dietary reference intake, let's say, okay, so the DRI for calcium, which is the reference intake um for an adult, is a thousand milligrams, right? Now, we typically wouldn't recommend calcium supplementation, I'm just using it as an example.

SPEAKER_00 15:10

Exactly.

SPEAKER_01 15:10

So if I'm looking at a pill bottle and I see 3,000% of the DRI, you have to understand that you are taking thousands percent or um hundreds of milligrams more than what we know to be safe inside of our body. So I always think that that is the first red flag. The second red flag is when you're reading the supplements and you're seeing things that you don't know what they do, right? So especially in this pre-operative phase, you don't know what it does in your body. Um so it's taking a risk that you don't necessarily have to. And I think that that's the the best thing. I always tell the patient, like, if you're taking something, at least bring it with you to the doctor and show it to them. Bring it to me, bring and and show me so that I can make sure it's safe for you, right? So in this pre-op phase, it really is, which is great. It's it's no gimmicks, it's general wellness. Eat a well-balanced diet, right? Eat an energy appropriate diet, eat a diet that is, you know, maintaining of your weight if you don't have weight to lose. If you're on a weight loss journey, make sure that you have a hypocaloric, which means low calorie, high protein, protein balanced diet where you're getting in enough fiber and you're not restricting carbohydrates so that your body is strong so you can go into the surgery. So now, you go into the surgery, Dr. Roman gets to work his magic, right? You come out of the surgery. This is when the healing game starts. When you get, when you call your patient the day after they have surgery, typically what do you how are they? I'm sure they're doing fabulous, but how are they feeling?

SPEAKER_00 16:46

Well, you you wanna it again, like you've said, we we we prep our patients prior to that. So we, you know, it it you you but you it's like anything else. It's not their job to think about that. They're business people or they're working people and they're thinking about what they do, and they're gonna have surgery, and they're just gonna heal from it. We're surgeons and uh but we're also physicians. We care about our patients, and we want to have the best outcomes. And part of that comes from having a patient that uh takes in proper nutritional supplementation uh following surgery. And it's a little common sense. Patient comes in, hopefully they're optimized to surgery. Then now they've had surgery. They've been under anesthesia for two, three, four hours. Uh they're gonna wake up uh groggy, uh, they're gonna go, you want to be hydrated. You don't want to be dehydrated. The anesthesia has already had you be NPO past midnight. I always tell the patients that's okay. You'll come in and they'll start a little IV and they're gonna give you a bottle of Gatorade, which is the IV fluids, and you'll be hydrated again. But once you go home, um, you need to make sure at your bedside or people who can help you to continue your hydration. Hydration's important. You gotta keep your body, your body's burning up uh uh you know, three liters a day of fluid, and so you gotta get that fluid in. That's three bottles of Gatorade that you're losing. So you gotta breathe replace that fluid. And then on top of that, you've just had surgery. You're 12, 24, 36 hours after. I really don't feel like eating. And what I'm what I have told you, and I've and I tell the patients, is you know, patients talk about uh scars. Am I gonna scar? Um, and I'm talking about an incision line that I'm making for a facelift, real delicate here, and I'm going, that's not a scar, that's an incision line. Scarring is the process of healing. If you don't, when you lift a flap or you do surgery on a bone, if you don't lay down scar tissue, you don't heal. And that scar tissue is mostly made of protein and collagen. And so you're gonna get into that because I mean, it's I always say to you, it's not made up of fat, lipid, and it's not made up of carbohydrate, which are all important. But what's key, what your body is going to do is the body wants to heal. The body's gonna make itself heal. And if you can you're not taking in protein orally, then what it's gonna do is it's gonna take it from your muscles. And you're gonna you're gonna get muscle wasting on top of your healing. So it's critical to uh have that protein or or some type of, and you get into uh breaking it down to peptides and amino acids, yeah, uh, and what are essential and not essential, but the that's that first day three, day four, day five, day six, that week, that week after. It it's important to have a schedule of supplementation, nutritional supplementation to improve your healing.

SPEAKER_01 19:44

Yeah. So the hydration piece is so important. I I find that just from an action item step, people need items. So what I tell them to do, I always say I can have the most brilliant patient in the world. It doesn't mean that they're gonna make the smart choice when it comes to nutrition, because they typically won't. Um, so I say get a two-liter or three-liter bottle of water and make it as simple as you would tell your kid. Drink this today. That's it. I don't want to be wild, I want you to drink this today. And that's what I find that especially in times when we're not feeling 100%. So that covers hydration, right? Then we look into the protein piece. And if we break down a protein, right, we're in the peptide world where everyone's like peptide, peptide, peptide. Um, I know that this podcast has the stance of we believe in science and we follow science until it's you know safely approved, and we're not going to recommend them. But let's talk about diet. Like, what is a dietary peptide? So proteins are made up of strings of amino acids. Um, an amino acid is a single molecule. Um, and when the proteins come together, so you can imagine stacking the proteins together, they have peptide and dipeptide bonds, so they interact with each other. So if we have a string of amino acids, so you can think about it, amino acid one, two, three, four, five, when they start lining up, they start lining up evenly, but through the um the forces between the way the amino acids interact, they don't stay a straight line. They can't become these twisty type of molecules. And that's what a complex protein is. Exactly. Now, structures function. I'll just use an egg white, for example. You have protein and egg white. When you change the structure by heating it up, it changes into a different form, right? So that's how proteins interact internally and externally. So we need proteins. Our body, our cells are always making proteins, and what they're doing is they're using these little amino acid blocks to go and build new proteins. So I'll give you some example. The message is I need to make a collagen strand. I'm gonna use X, Y, and Z amino acids to help go make that collagen strand. Or um my pancreas needs to make insulin. Now I'm going. To use X, Y, and Z amino acids to go and make insulin. So anytime something is protein derived, we're going to use amino acids. Now, we had such an amazing podcast that we're releasing this month on hearing. Um, what our guest said is, well, what's more important? Do you need your heart to beat or do you need to hear? Right. And our body does the same things with protein. It prioritizes. What is more important? Do I need to heal or do I need m skeletal muscle mass? Of course, if we can think about them, they are both important. But the process that is going to be more critical to life is the process that is going to take priority in our body. Exactly right.

SPEAKER_00 22:43

Supersede that. Yeah. The body's going to look at that. Trevor Burrus, Jr.

SPEAKER_01 22:45

Right. So when it comes to protein post-surgery, um in times of stress, and it's so our body is so brilliant, but in times of stress, even we could think about like non-elective surgeries, hospitals, when there is inflammation, which surgery is, you know, you're you're provoking that inflammatory response if it's positive inflammation and healing. Sure. Um, our body will favor every single time taking proteins versus taking fat. It does. It's crazy. And it's like, come on, like, why can't you selectively take my body fat? Why do you have to take my amino acid reservoir? Right. But that's that is the physiology of how our body works. Exactly.

SPEAKER_00 23:22

Once you understand that, then you know what to play how to play the game.

SPEAKER_01 23:26

Right. So now you're in this, you're post-operative, you wake up and you're like, all right, well, you know what? I don't really have a big appetite. That's fine. I already told you big water bottle, drink it. Here's the next one I'm telling you. Protein shake, blend it and sip it, right? That's simple, right? Um, you know, don't make it too thick that now you're struggling with the cup. Um, blend it thin if you want. You can mix it with coconut water to get a little bit more electrolytes. If you need a little fiber, you can mix in some berries or maybe a little psyllium husk. You're not gonna rush. You're going to sip that, you're gonna try and drink it within the hour. So now we already know that you're working on your hydration and you're working on getting in some protein. Okay, step one, breakfast. This is how I'm teaching my patients that are post-stop. It's it's really that simple. Now we're looking at, okay, well, what are other critical things that we need to provide into our body in this healing phase, right? So we talk about anti-inflammatory nutrients. Um I've been talking about surgery as positive inflammation. In the physician lens, can you describe what that means for our audience?

SPEAKER_00 24:34

Well, um, inflammation uh is a natural process of the body. Uh when the body uh is irritated uh by trauma, uh be it someone hits you with a bat or ac or cuts you with a scalpel, uh the body responds by that by the inflammatory chemicals that are released, as well as the white blood cells. And they go to that area and they're and you have an inflammatory reaction. So all inflammatory reactions are not bad. In some ways, if you don't have an inflammatory reaction, you're not gonna heal. The thing is, you don't want it to continue once it's not necessary anymore for the healing process. So we know you're gonna have inflammation. Um it but again, it's it the body will with when you supply the body with the nutritions and what all those uh white blood cells need and what those inflammatory components are. Once you supply the body with that and it does its job, it'll cessate.

SPEAKER_01 25:37

Yeah. Yeah. So something that um I just thought about is so, for example, like how we can for micronutrients, we can measure them on basically based off of like their biological activity. So we can measure vitamin C stores by looking at white blood cells. We can look look at leukocyte um vitamin C. Why is that relevant? Because vitamin C in general, which you can get, like for example, you don't have to take vitamin C powder, you can eat it orange or you can have strawberries. Exactly. Um, and so on. But what vitamin C does is it is um it serves as an anti-inflammatory by have be having the ability to donate an electron. So for example, um you have an inflammatory process and you have something called a free radical, which essentially what a free radical does is it runs around and it it bothers membranes and it will pick off, it will pick off um a certain group from a cell membrane or um from a body process. And what the electron or what the um vitamin can do is it can donate an electron so it can terminate this free radical that's going and causing damage in our bodies. Correct. Right? So we need inflammation, but they're we don't need excess inflammation. So we're thinking in this post-operative phase, nothing crazy. You're definitely not. No one's ever gonna say, go take, you know, 10,000 milligrams of vitamin C. But what we are gonna say is, okay, if we're gonna use our food to hijack our healing, then what we want to do is we want to focus on both water and fat soluble antioxidants. A simple one is the relationship between vitamin C and E. Eat your greens. You can't eat them, make a minestrone soup and drink and drink it. Blend it and drink it. Now you're getting fiber. It doesn't take a lot of energy for you to eat this and add in your green, your green leafy so you're getting your C and E. Use a little oil in the soup and eat that. So, what we're doing in this postoperative um period is I'm thinking, okay, so what's important? Protein's important, how do you get the protein? Okay, then we're looking into the micronutrients and we're thinking, okay, how do I get in my anti-inflammatory vitamins that are proven by science to help with inflammation?

SPEAKER_00 27:49

Exactly.

SPEAKER_01 27:49

Then how it's translated to the patient is like I just told you, I just said, okay, well, you know you need vitamin C and E, so why don't you make a soup, a tomato-based soup which has um the anti-inflammatory property of lycopene, which is studied in tomatoes to be anti-inflammatory. Right, absolutely. Why don't you mix that with other vegetables that are rich in vitamin C and then use a little bit of an oil that's rich in vitamin E. And because you're not feeling well, all I'm requiring of you is that you consume a bowl of soup that's around this big, and maybe you'd throw a ground turkey which has all essential nine amino acids into it. That's a perfect recipe for healing. It doesn't have a lot of sodium, right? So it's the translating of the nutritional science into how to feed the patient. So if you're watching this and you are going in for surgery, I just gave you a fabulous idea of what to have for breakfast and what to have for lunch. Why don't you meal prep a little before surgery and potentially eat a little bit of it for dinner? Right? Absolutely.

SPEAKER_00 28:49

So it's all critical for uh again, it's it's it's just the thinking person's game. And you can't let uh it's I was somebody told me the other day I heard a good thing about AI. It can't be in your peripheral brain.

SPEAKER_01 29:02

Yeah.

SPEAKER_00 29:02

Uh it's it's a lobotomy with a monthly subscription. So I mean, what you need to think this through and and and and and it it's not impossible. It's really is really straightforward. But you win you improve outcomes for your body, and and in the healing milieu, that's even more critical. And then and just with life, as you're aging, you you know, there are changes that occur, uh uh particularly uh perimenopausal women uh going through menopause have very particular uh problems that occur uh and nutritional needs uh that need to be uh uh supplemented.

SPEAKER_01 29:37

Right. So especially like now where and you you know this was I've learned so much from Dr. Romo, but something that he said to me, which was so common sense that it I didn't think about, he's like, Allie, most of my patients are in menopause. Like, I do baselifts. And and um why do I bring that up? Because then now I'm thinking, okay, for in this post-operative peel um healing phase, you know, we're thinking about those critical nutrients. Like, is does this woman have osteoporosis? Like, is she meeting her baseline micronutrient needs? Does she know how to have enough protein? We understand how the you know the critical benefit of fiber in this like perimenopause menopause period. Um, can I teach this woman how to meet her 28 to 30 grams of fiber? Um, so it's different. Um, you know, if I have a patient that is 17 that just had a rhinoplasty, I'm giving her very different nutrition recommendations than the woman that is 60 that had the same surgery because their body is just in different positions.

SPEAKER_00 30:34

And and you know, GLP1s and uh the weight loss uh medicines uh are having an incredible positive effect. I I sent you some things yesterday about uh improving ADHD and maybe improving dementia and then all the cardiovascular and sleep apnea. It's it's really incredible uh and and it's it's they're they're making the equivalency of it being like AI, it's not going anywhere, it's only gonna get more perverse. But the other thing that patients have to understand, and that you are an expert on, is body composition. Because losing weight, and particularly losing weight prior to surgery, and and and you don't want to do it after surgery, but losing weight, um, you don't want to lose muscle mass.

SPEAKER_01 31:20

Right.

SPEAKER_00 31:20

You would you want to lose fat. And so stepping on a scale, uh regular scale that you're gonna get from a store, uh, it doesn't tell you that, it just tells you about your weight. But it's you know how critically important and you may want to talk about body composition because you actually measure that every time the patients come in.

SPEAKER_01 31:38

So I think it's it's so important nowadays, and I think that um you know the field is evolving where we're understanding the importance of body composition. But I have a simple example that will show you that I don't think that we're yet there. Um I have a patient that I've been working with for some time, and she's on weight loss medications prescribed independently from a different doctor outside of um our you know sphere, and she had done body composition, and if she stepped on the scale, she would have been her weight was her weight was fine for her height, but composition let me know that she needed to gain a whopping 12 pounds of muscle and lose I I don't know if it was an equivalent 12 to 13 pounds of fat. So she was muscle deficient, right? So we had done our session and you know, she left and she had the composition and she comes back and she goes, Good news. I'm like, what's the good news? My my doctor told me that my composition is perfect. I'm like, that's great, but did your doctor read the scan? Um and it just shows that there still is, and it's not even just like a physician, dietitian, there just still is like a um a worldwide need for really understanding what those metrics are. Because you're right, if you look at her and she stepped on the scale, it's fine. But now I'm thinking, if we think of muscle as our metabolic engine, so now we a woman that starts at 40, now she's 60 and 70. I worked in a nursing home um with the patients that I I went home, I think, after my first day, and I said, like, I think at the time I was still living at home, I'm like, mom, they don't walk. No one walks, everyone's in a wheelchair. I was like, I was blown away, which I shouldn't have been. It was really just lack of of understanding. But understanding that that could potentially be in the future where these patients are not strong enough to walk, why would we lose 10 pounds of muscle at 50 electively?

SPEAKER_00 33:29

Yes.

SPEAKER_01 33:30

I think that that is just so important to understand. We don't always connect because we live for now. We all do. We live for right now. And of course, weight loss is GLP ones have changed the game as they should, but we have to be thinking, we can't think about now. We have to think about later. Well both.

SPEAKER_00 33:48

Yeah, exactly. And and I think you're uh the the term that I learned from you was skinny fat.

SPEAKER_01 33:55

Yeah.

SPEAKER_00 33:55

So they're uh they're uh they've lost all this muscle uh and they're skinny, uh but what residual they have is fat.

SPEAKER_01 34:03

Yeah. And I think because our podcast specifically, I I always think that we're spoil I'm I'm spoiled because I work everyone that I work with is brilliant and cares about their patients. Um but I think that it's so the patients are really well covered. They're well covered going into surgery, post-surgery, they know how to eat, they're well covered when they're taking their medications or getting their body composition tested. But you know, the reason that we started the podcast is it's fabulous. I hope our patients are listening. Um but I think it's also for okay, so we're saying, okay, we're seeing really nice data that just came out on triple agonist weight loss medications. We're seeing it these numbers rival bariatric surgery. That's beautiful. It's so fantastic to see the covering of fat that was surrounding the heart gone. We understand that that's going to extend someone's life. Um, but we have to also just think about the fact that um we don't have composition data because they didn't publish it from the triple agonist medications. Um, so we don't know that the weight that they're losing, that it isn't coming from muscle. So it we should be optimistic about these medications and and what they can do. But ultimately it all comes down to you must eat properly. And I say that very harshly.

SPEAKER_00 35:19

You are an expert in that. I and I the the the other thing that I found so cute about you was what a nerd you are. So when you start talking about the citric acid cycle and the current cycle, and I'm going, every person I know is a physician, is they don't they learn that in medical school and they don't even understand it anymore, much less John Q Public. Uh getting back to what you were saying about the triple agonists, um, it's a new medication uh that's coming out, supposedly uh the new weight loss medication uh coming out uh supposedly in January 27, which has uh GLP1, which also has GIP and has glucagon. So it has three agonists, which are going to really uh cause you to lose even as much weight as going and having surgery, bariatric surgery, where they're making your stomach smaller, and you're really gonna and the point you were making there is that the the data hasn't isn't out yet, which it will be hopefully, particularly with people like you uh eyeballing it uh and lecturing about it, um, will be is it are you losing muscle or are you losing fat? Um and and and and again, taking these medications are important, but changing the way you eat. If you take uh GLP1 and you're you're getting Ozempic or whatever and you're still eating French fries and hot dogs, uh you've got to change the way you eat as well to uh um optimize the the effect of the medication and also r maintain the fat, I mean the muscle that you need and working out as you can. Um I heard an interesting uh anthropology uh lecture the other day, TED Talk, uh somebody talking about us being bipeds. We have two legs, and we're actually designed to walk. And the only time we were really designed to run was when we were running after game and trying to stab it with the spear or something. But the majority of time you're not running, it's walking.

SPEAKER_01 37:12

Right.

SPEAKER_00 37:12

And so walking is a great way of exercising and keeping your muscle mass up. So I I think that's uh that's gonna be critical. Uh doing all those supplemental processes to keep yourself safe and uh and and longevity. And that's the key today. Everybody wants to be into wellness, anti-aging. I was just reading about a conference in Austin uh about that uh whole thing, 5,000 people coming there for anti-aging and wellness and this, that, and the other, when some of it could be really simplistic, but you need to hear the facts and not hear it from social media.

SPEAKER_01 37:45

Right. And that's why, like when I give education, I like to keep it as simple. Like I said, what did I say before? Take this water bottle, drink it, here's the smoothie recipe, make it. And and I would never want to um simplify nutrition down to that because you know, I mean, there are social determinants of health and government policy and so many reasons that nutrition is not quite accessible to everyone. Um, but I think that uh we still have to focus on laying down a foundation and and eating um, you know, real food if if possible.

SPEAKER_00 38:17

So uh what um people don't know about you, is which is very skewed and how unique you are, and this way I get back to pin you down. Um you're actually a college professor and you teach college students about nutrition uh and you get into the very aerodite and very incredible detail. Uh how does John Q public not get it off of social media and how do they interface with someone at your level or s individuals like you? How do you because social media is selling things? Okay, people forget that there's a the the the nidus, the impetus behind social media is to sell you a product. Right. It doesn't matter who they've got AI speaking. Uh Sylvester Stallone, I saw one the other day speaking, and he was his I was looking at his lips, weren't moving to what he was saying, and he was selling a product. Yeah. He's a beefy guy and this, that, and the other. How how do people not use AI or use social media and get uh the an honest word on this?

SPEAKER_01 39:24

Yeah, so I think like uh a few things. So first look for the RD credential. Registered dietitian is somebody that's you know studied the coursework and and understands nutrition, but also start with your general hometown physician, right? Explain to them what you're struggling with and ask them if they have a connection. And you know, hopefully nowadays they do, but if they don't, they may have someone in their network that can connect you with somebody. Um so I think that like what we're looking online when we shouldn't be, we should actually be looking within our own individual networks because that's how we're gonna find somebody that is is most best equipped to help us.

SPEAKER_00 40:03

Motivated.

SPEAKER_01 40:04

Yeah.

SPEAKER_00 40:04

Correct.

SPEAKER_01 40:05

Um yeah. So I think like just start with your general physician. Um if it's school, so if it's parents, go to the school and ask what the school like nutrition resources are. Um if it's um, you know, adults, if they're looking on social media, just look for cred look for the right credentials. Um and I think that that is at least a good like starting place for somebody.

SPEAKER_00 40:28

So getting off of healing and getting into um what you just kind of introduced to the topic is um uh if you're eating bad as a child or as an adolescent, you're probably gonna carry that on uh into your adulthood. Um and you you mentioned something which was interesting, which is having parents be interventional at the school about what their children are being fed.

SPEAKER_01 40:52

Yeah.

SPEAKER_00 40:53

Um you you you have all this knowledge as a parent and you're gonna make them a great dinner, uh, but for years people have been critici you know critical of what their what their children have been getting fed at the uh at school. And and if the these kids are being given nutritionally weak uh food for lunch and or breakfast, um it's it's gonna affect them, they're gonna be obese uh and uh overweight, and uh that's gonna follow them and bring disease.

SPEAKER_01 41:20

I love pediatrics and even adolescents because it's so different than adults, um, just even in like the communication style with the child. So of course there's like policy and like national school lunch programs and so on, um, which do meet certain criteria um per FDA and USDA, which is not the worst. I think it it's the snacks that are being brought into the school that are even worse than the like the school lunch programs. But what I've learned with working with kids and working with adolescents is if we want to change, like rewrite the child's life starting in in um when they're in growth and development, is we have to understand that a child's brain doesn't work like an adult's brain. Um so when I have children in my office, it's not the kid is not motivated because they want to look good in a swimsuit. I mean, soci the world teaches them that that's what they need to be. Um, but especially before they've learned that, they don't care about that. So I think it's first understanding that a child is not motivated by aesthetics. Now it's getting younger and younger that they do care about how they look. But what a child is more motivated by is, you know, in these pediatric sessions, like is we're focusing on diversity of getting different colors in, and I'm challenging them them with textures and colors, and I'm building up autonomy and confidence that when they make a healthy food choice, they feel good about it, or they're understanding that like when I eat french fries until I'm physically sick, my belly hurts and I'm slow. So I think that oftentimes trying to treat pediatric and adolescent obesity like they're adults is the reason that we haven't gotten anywhere. Correct. Um, but ultimately if you get on the floor with the kid and you're coloring with them and you're meeting them where they're at and you're able to teach them um and allow them to trust their body and learn how eating good feels at a young age, then you can develop better habits starting at a young age.

SPEAKER_00 43:23

It requires patient uh parents being involved. Uh the kids are are not gonna do that on their own. Right. Hopefully the teachers, if we could uh uh uh involve the teachers, which are if they're overwhelmed with a whole bunch of kids, right? You know, that's difficult to do. Uh again, it's having uh getting that information. Um I think the pendulum is swinging back the other way about uh uh introducing uh these iPhones and social media to young children. Yeah, it's bad. Yeah. Um it's it's interesting when they talk about the guys who created these uh uh social media platforms. They talk about they don't let their own children get them until they're 12 or 16. Right. And yet they want them in the hands of every 12-year-old that's out there. So uh there has to be something about that. And hopefully that common sense uh process is coming, uh is going to come out, and it's gonna be come out with uh We Got Your Number Podcast. Uh you and I have been able to uh really try to emphasize common sense, but also you need to take care of yourself. Do your due diligence. Um it's is the the whole thing is you are what you eat.

SPEAKER_01 44:30

Yeah. So common sense and science is what we're doing.

SPEAKER_00 44:33

Yeah, that's common sense and we always make science because we're both scientists. So we're both working with that. So uh it's great talking to you today. Um we're uh we always both uh encourage each other and we learn from each other. Uh and uh this is uh We Got Your Number podcast, and please follow us because you're gonna learn a whole lot.