immune function, which increases the body's ability to fight infec-
tion and improve wound healing after surgery.
Patients with high blood pressure are instructed to monitor their
sodium intake and eat more fruits and vegetables to increase the
amount of potassium in their diets. Even a seemingly small reduction
in body fat (3% to 5%) leads to improvements in blood pressure val-
ues, says Ms. Yoder.
She provides busy professionals with home recipes and offers tips
for batch cooking, so they don't rely on the convenience of ordering
out. Her goal is to work with patients to create sustainable lifestyle
changes.
"We find the right amount of fuel for their bodies," says Ms. Yoder.
"They have to be able to perform daily tasks and maintain immune
function and health leading up to and after surgery."
New thinking in NPO
Dr. Goldenberg says research shows carbohydrate loading is an essen-
tial element of Enhanced Recovery After Surgery (ERAS) protocols.
Instead of asking patients to fast beginning at midnight the night
before surgery, permit them to drink clear liquids up to two hours
before their scheduled procedure time. Simple carbohydrate drinks
such as juices and sports drinks containing complex carbohydrates
are effective, but not ideal, options. Specialty carbohydrate pre-op
drinks, which contain immune-enhancing ingredients such as dextrin
or oligosaccharides instead of more simple sugars, lead to a steadier
release of carbohydrates instead of a more rapid spike, therefore pro-
viding a longer-lasting fuel reserve.
Dr. Goldenberg says consuming 110 g of carbohydrates the night
before surgery and 50 g up to two hours before anesthesia induction
releases insulin and shifts the body from a fasted to fed state. She
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