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How to work through appetite loss after surgery

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Post-surgery appetite loss can slow the body’s ability to mend, but there are easy ways to stay well nourished.

QUESTIONI had hip replacement surgery two weeks ago and it went well. However, I haven’t enjoyed my food since then. I have no appetite and am wondering if this will hinder my recovery?

ANSWER: Appetite loss is common after major surgery, including joint-replacement operations. It is inconvenient when you consider the role nutrition plays in the healing process.

Patients who are well nourished heal faster and actually shorten their hospital stay. Protein requirements can increase by up to 35% in the post-operative period. So, without an increased dietary intake, or even the same dietary intake as before surgery, the body will rob Peter to pay Paul. An example of this is taking protein from our skeletal muscles to help repair the area affected during surgery.

The role of nutrition and diet in orthopaedics was first reported in 1936. That study, published in the British Journal of Surgery, revealed that patients with long-bone injuries required about three times the normal amount of dietary energy during the healing process.

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Total joint arthroplasty (TJA), including hip and knee joint replacements, is a relatively common procedure, with more than 20,000 operations done in New Zealand in 2017. TJA patients commonly report appetite loss following surgery.

Given how important nutrition is to the recovery process, Australian researchers recently investigated the time frame of appetite loss among TJA patients, publishing their findings in 2016 in the Annals of the Royal College of Surgeons of England.

They found the median time for appetite to return was four weeks among patients who had either a knee or a hip replacement. All patients reported a return of appetite by the six-week mark. If loss of appetite persists after six weeks, the authors recommended investigations to see if there is an underlying problem.

Being well nourished before going into a surgery will definitely assist recovery and healing. However, there may be another two to four weeks of low appetite to work through. During this time, making the effort to eat will promote healing.

In this post-surgical state, the body won’t always provide reliable hunger signals. Instead, approach nutrition as a form of “self-care” and eat even though you may not want to.

It’s better to eat small and more frequent meals, and to select foods that  appeal to you, even if that means eating cornflakes for dinner. The goal is to keep energy intake up while adding protein and nutrients.

Easily digestible food such as soups, smoothies, jellies, yogurts, scrambled eggs and soft breads are often preferable to chewing through a T-bone steak. Dairy products are a great source of protein and calcium, which is exactly what the body needs after surgery. Other helpful options are protein-rich beans, nuts, fish and lean meats.

Smoothies packed with fresh fruit and vegetables are a great way to boost vitamin C, which helps to repair ligaments and tendons, and the fibre helps reduce the risk of post-surgery constipation, as does staying well hydrated.

This article was first published in the April 6, 2019 issue of the New Zealand Listener.