Food Friday: Protein for Healing

Most of you have been following the saga of my son’s recovery from his fractured femur. He is coming along nicely and that is due in part to his fantastic physical therapy support. They have done physical work, cognitive, and have even talked about the nutritional end of things. In particular, they have emphasized the role of protein, along with Calcium and Vitamin D. 

Protein comes from meat, seafood, poultry, and certain combinations of legumes and grains. (Legumes are foods like peas, beans and lentils.) Under normal circumstances, people need about 0.36 grams per pound of body weight of protein. This is about 50 g per day for a women and 70 g per day for a man. However, during pregnancy, athletic training, and recovery from illness, even more is needed. 

Our son’s therapists have noted that his protein requirements have increased to nearly 100 grams per day as an injured young adult male weighing about 175 #, who is trying to rebuild a femur. This is about a 40 % increase. 

Protein is composed of a string of amnio acids. All animal food are complete proteins, in that the ratio and types of amnio acids present meet human dietary needs. Plant sources of protein need to be combined to fulfill this criteria. For more on this see THIS SECTION on the website. 

In practical terms,  I had to help Vale figure out how to meet this nutritional requirement at a time when his mobility was restricted and his time for cooking was nil. Additionally, we had to take into consideration that more protein intake requires excellent hydration, since metabolism of larger amounts of protein in a dehydrated state is hard on the kideys.  We had to make sure he consumed just the right amount, and not too much since metabolism of excessively high amounts of protein can also cause the bodies calcium to be depleted- not what we want. Finally, I had to take into consideration the following: that protein is best utilized when interspersed evenly throughout the day. 

Here is how we set him up. First I made a one page schedule of meals and activities. I posted it all over his house and set up a google doc for the friends and family who would be helping. Secondly, I made a menu. There would be some constants, and some variables. The constants would be as follows: 

• Morning:16 ounces of skim milk with a protein powder
• Midmorning would be a high protein, high fiber oat cereal, and hopefully a hardboiled egg.
• Lunch would be a can of salmon made like tuna fish salad, with olive oil mayonnaise, relish, and olives. He could also have whatever else he wanted.
• Mid afternoon would be another high protein snack like a mozzarella cheese stick
• Dinner would be a traditional cooked dinner with meat chicken or fish, and salad with veggies cooked by family or friends.
• Fruit could be eaten all through the day
• A hospital pitcher would be used to measure water intake which was to exceed three liters per day, titrating to nice clear appearing urine (sorry… i’m a doctor, not a food blogger. ) 
• I had him take a gummy prenatal vitamin and two tablets of Calcium Citrate with D. 
• The items are simple, edible, and met the criteria. Of importance, I created a routine schedule that would be the same every day to foster compliance. I created checklists in different convenient locations. In other words, I have tried to engineer his nutritional success.

So far so good, as he is already crutching around to class, grateful, and enjoying being back at school. 

Food Friday: Food for Healing

As most of you know, we spent the better part of the week nursing our 22 year old son after his ski accident. He sustained a badly fractured femur requiring a long surgery which entailed significant blood loss. He also had a mild concussion, pulmonary contusion, and a broken rib. He is stable and improving. But his course has illustrated several important things about nourishing those who are recovering from illness or injury. I thought we might take a moment and discuss them here, especially since it has been on my mind. 

When people come home from the hospital, most of time, their IV is removed. They will come home adequately hydrated. However, that can quickly change, since their capability to hold down food and drink is often limited. Your job as caregiver is to help minimize nausea which may be interfering with hydration, and to provide appropriate enticing liquids for them to sip. If your “ patient” did not come home with anti-nausea medication, and needs it, do not hesitate to call their doctor. Most of the time this can be prescribed over the phone, but sometimes, nausea heralds a concern, and the patient will be asked to come in for an evaluation. 

Another way to minimize nausea and maximize intake is to avoid overuse of narcotic pain pills. The most common are lortab and percocet, aka hydrocodone and oxycodone. These are necessary with early post ops, but they can cause nausea and constipation. Ask your doctor how they should be used if you are not sure. 

Sick or injured people do not always know what they need. It is up to the caregiver to encourage them in the right direction. In this regard, many patients will not want to drink as much as they ought. So you have to be clever. 

Hydration of the unwell is best accomplished gradually and continually. This way they are more apt to tolerate it. It is also best accomplished by fluids which contain some sugar and some electrolyte (like IV fluid!) . 

For starters, let’s do water. Some who cannot drink water can drink soda water, aka plain club soda. Even more can drink this with a splash of fruit juice or a wedge of lemon or lime. Some do well with dilute fruit juice. Decaf instant iced tea works well. Oftentimes having it quite cold will help, but this is suboptimal if your patient is chilled. Some do better with frozen cubes of the aforementioned drinks. 

On the other hand, many patients prefer hot drinks. Herbal tea is the go-to here. You can make it more appealing by adding honey or agave, and a little lemon. Decaf coffee is not a bad choice, but lots of caffeinated coffee is dehydrating. 

Some patients prefer savory or salty drinks. This is an advantage since it will better expand their intravascular volume. Here broth is the best solution, unless they can take something like Bloody Mary mix, or salted tomato juice. The best of all is a brothy chicken soup, just like tradition teaches us. Nowadays organic broth mix is widely available commercially in chicken, beef, and vegetable flavors. 

You can also hydrate your patient with watermelon if they like it. Most fruits will help, and a smoothie of fruit, ice, water, juice, and even plain yogurt can be very agreeable, even to one who is sick. 

When patients are doing well enough to take solid food, there are a few key nutritional points to bear in mind. Healing from illness and injury takes more resources than ordinary life - lots more resources. A man needing 70 g of protein a day will come to need over a hundred. He will need more nutrients too, though he may not necessarily need more calories. Therefore, everything a recovering person eats should be nutrient rich. Leave the top ramen, Pepsi, and white bread for another day - like NEVER. Present choices such as chicken, salmon and red meat, but prepare them in a way that is easy to eat. For the meat and chicken, cook it well, ground or in small pieces. For salmon, consider getting canned salmon and making it up like tuna fish salad with mayonnaise, relish and olives. But beware, if your patients are picking at their food or dairy containing drinks, the dishes cannot stay out too long, or they will spoil. The last thing you need is a recovering patient with food poisoning. With the same goal in mind, don’t put too much on a serving plate. Start with a small serving and get seconds if you need to. And, for best results, offer small quantities of food quite often. 

Caregiving is hard work. With a little forethought and a few tricks of the trade, your well hydrated, well nourished patient will have the best chance at an optimal recovery.