Don said:Hi, my dad is 57. He just few days ago had to have double
bypass surgery. He is also diabetic. He is overweight but
has been on medicine for many years which keeps his
chloresterol lower than mine. (Around 130)
I've read a lot of recommendations lately that say that
people with=20 existing cardiac problems should try to get
their serum cholesterol=20 under 100 with a favorable
HDL/LDL ratio.
Quoted message said:My question is: What type of diet does he need to follow
after surgery? I figure a low chloresterol, low sodium
diet. I am not trying to start any wars about whcih diet
is best.=20
He needs a reasonably balanced diet relatively high in
protein to help=20 his body repair the trauma of the
surgery. Here's the body of a note I=20 posted on a mailing
list in 1999, after my bypass.
<<< begin quote >>>
Speaking of food...
After my recent surgery, I felt lethargic. A friend
(medical writer) went out on the net and found some very
interesting stuff about post-traumatic (open-heart surgery
is VERY traumatic) nutrition and found info for the amount
of protein desirable and caloric requirements in the
circumstances. Cells are being repaired and for that
reason, the major nutritive requirement is protein. Beyond
that, to my surprise, even though activity is reduced, MORE
calories than usual are necessary, for the same reason. The
suggested protein level is 1.5 grams of protein per kilo of
body weight per day. Not meat, protein. I weigh 83 kilos
with all this inactivity. That translates into lots of
meat, eggs and cheese.
Very interesting stuff and, for me, smack on. I was trying
to do a more broadly balanced diet and was feeling weak.
Switched to this approach and immediately - the same day -
felt better. Mood improved, energy came up and general sense
of well-being improved. Hardly statistically important - one
man's experience - but confirmatory.
According to the formula for caloric needs, I should be
taking in almost 3,000 calories per day, tapering off as I
get closer to pre-surgical condition. It's been almost 5
weeks now and I'm very close to baseline now so I've cut
back on the food.
I've also had the unfortunate task of disposing of the
candies I bought for Halloween. I'm doing very well with
that project, thank you. Whew.
Pastorio
-------------------------------------------------------
----------
[source: "Surgical Nutrition," a lecture by Michael L.
Cheatham, Assistant Director, Surgical/Trauma ICU, Orlando
Regional Healthcare System, Orlando, Florida; can be found
at <mdacco.comsurgOpen ↗
med/Lectures/surgnutr.html>]
The Harris-Benedict equation is perhaps the most commonly
used method of estimating a patient=92s metabolic energy
requirements. It calculates the estimated basal energy
expenditure=20 (BEE) in kcal/day for a patient using the
following equations:
Male: BEE =3D 66 + (13.7)(weight in kg) + (5)(height in
cm) - (6.8)(age) Female: BEE =3D 665 + (9.6)(weight in kg) +
(1.8)(height in cm) - (4.7)(age)
The resting energy expenditure (REE) is considered to
estimate a patient=92s true metabolic energy requirements
after accounting for activity and the stress of injury and
can be calculated using the BEE as:
REE =3D BEE * activity factor * injury factor
Activity factor: bedrest 1.2 ambulatory 1.3
Injury factor: minor surgery 1.2 trauma 1.35 sepsis
1.6 burns 2.1
The Harris-Benedict equation was derived from the energy
requirements of healthy volunteers and is therefore
not=20 directly applicable to critically ill patients.
While the BEE tends to underestimate the true metabolic
requirements of the surgical patient,=20 the REE commonly
overestimates energy requirements. Nutritional=20 therapy
based on these measurements alone will therefore likely
lead=20 to overfeeding. The Harris-Benedict equation is,
however, frequently=20 used as an initial estimate of a
patient=92s energy requirements in=20 order to begin
nutritional support.
Surgical patients are inherently catabolic due to the stress
imposed by their disease process, operative intervention,
and metabolic recovery. Thus, they require increased protein
administration to prevent further protein breakdown. These
patients=20 also have increased energy and protein
requirements to provide for=20 wound healing as well as the
need to replace protein which is lost=20 from wounds and
fistulae. Estimation of protein requirements must=20
therefore take these increased losses into account.
Because of the inaccuracy associated with determination of
protein requirements, the current recommendations are that
an estimate of 1.5 grams of protein/kg/day should be used in
calculating protein administration for surgical patients.
For comparison, a healthy person requires approximately 0.8
grams of protein/kg/day. Administration of more than 1.5
grams/kg/day exceeds the body=92s=20 ability to incorporate
protein and does little to restore nitrogen=20 balance.
Quoted message said:But I started myself eating less carbohydrates. (I am not
following an Atkins plan per say). I eat bacon for
breakfast, a piece of chicken for lunch with diet coke
and some cheese cubes, and a regular dinner of whatever
my wife fixes. During the day I drink 2 low carb shakes
and eat 2 Atkins low carb candy bars a day. I have lost
25 lbs since January and my total chloresterol has went
from 203 last August to 144 last month. My tryglicerides
went from 253 to 53 and my HDL went up from 40 to 47.
Would a low carb approach be dangerous for my dad after
bypass surgery?=20
It likely won't be dangerous, but check with his doctor.
Pastorio
This leads me to my second question:
Quoted message said:=20
If his chloresterol was so low before and he had no
blockages 5 years ago when he had a dye test how did he
get 2 cloged arteries since then?
